Urgencias hospitalarias y extrahospitalarias en Navarra: Razones que las motivan

Ciordia, Ignacio Pérez; Grimá, Francisco Guillén

doi:10.4321/s1137-66272009000500007

Cited by 8 publications

(12 citation statements)

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“…2011, Vol. 34, Nº 3, septiembre-diciembre ñalado con diferente intensidad en varias publicaciones como es el hecho de que las urgencias se utilizan por los usuarios de manera indebida, para patología banal [6][7][8][9]12 , condicionados en parte por un déficit de educación sanitaria [14][15][16][17] , además de por una ausencia de corresponsabilidad. Este uso inadecuado es señalado por los expertos como de máxima prioridad entre los problemas planteados.…”

Section: Discussionunclassified

“…Se han señalado los efectos negativos del exceso de demanda de atención urgente extrahospitalaria no justificada, como son la demora en la atención y prolongación del dolor y sufrimiento de pacientes que no pueden ser atendidos con prontitud [7][8][9] , insatisfacción de los pacientes y profesionales, descenso de la productividad, incremento de la frustración de los pacientes hacia los médicos, incremento de situaciones de queja y violencia 2,37 . Los problemas planteados con origen o responsabilidad pública son numerosos, manifestándose incluso a nivel muy básico como es el desconocimiento de las necesidades reales de atención a las urgencias.…”

Section: Discussionunclassified

“…Existe discrepancia sobre lo que se considera un uso adecuado de los servicios de urgencia, tanto desde la perspectiva del paciente como de los profesionales sanitarios 5,6 . Se ha constatado que el uso de las urgencias para patología banal tiene importantes repercusiones negativas en tiempos de espera, coste y disminución de la calidad [7][8][9] . Varios factores se han asociado al uso inadecuado de urgencias, tanto sanitarios como extrasanitarios, con importantes repercusiones en su gestión.…”

Section: Methodsunclassified

“…Varios factores se han asociado al uso inadecuado de urgencias, tanto sanitarios como extrasanitarios, con importantes repercusiones en su gestión. Se asocian a una mayor frecuentación el nivel socioeconómico bajo 10 , la mayor accesibilidad 7,11 , y la edad menor de un año 6,12 . La población inmigrante presenta una frecuentación similar a la española 13 .…”

Section: Methodsunclassified

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Identificación de problemas y propuestas para mejorar la atención de las urgencias extrahospitalarias en Navarra: un estudio Delphi

Pérez-Ciordia

Brugos

Guillén-Grima

et al. 2011

Anales Sis San Navarra

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Fundamento. Las urgencias extrahospitalarias de Navarra sufrieron modificaciones en la organización hace dos años, destacando la creación del servicio de urgencias rural (SUR) que coexiste geográficamente con el servicio normal de urgencias. El objetivo del estudio es conocer la opinión de expertos sobre los problemas y las recomendaciones de mejora que afectan a las urgencias extrahospitalarias.Metodología. Se realizó un estudio Delphi con la participación de 37 expertos (médicos y enfermeras). Por medio del correo electrónico se realizan 3 rondas de cuestionarios sucesivos. El último cuestionario identifica el grado de acuerdo con las ideas del grupo y se identifican los 15 problemas y recomendaciones más relevantes, seleccionando aquellas ideas que alcancen, al menos, el 50 % de acuerdo y una prioridad superior al percentil 25. Agrupamos las ideas mediante análisis de clúster jerárquico.resultados. Se identifican 4 clúster de problemas, destacando entre ellos que "la población utiliza las urgencias para patología banal, como una consulta más" con una puntuación de 297 puntos. De las recomendaciones, con 3 clúster identificados, destaca la "necesidad de diseñar un plan estratégico de atención a las urgencias con unos recursos acorde a las necesidades" (310 puntos de prioridad) y "enviar mensajes claros a la población sobre uso correcto de urgencias" (192 puntos de prioridad). conclusión. El método Delphi identifica problemas y áreas de mejora a través del consenso.Palabras clave. Delphi. Urgencias. Servicios de Salud. aBstract Background. Two years ago there were alterations to outpatient A and E departments in Navarre; in particular, a rural A and E service (Servicio de Urgencias Rural, SUR) was set up, which coexists geographically with the normal A and E service. The aim of this study is to determine the opinion of experts on problems and recommendations for improvements that affect outpatient A and E services. Methodology.A Delphi study was carried out with the participation of 37 experts (doctors and nurses). Three successive rounds of questionnaires were completed using email. The final questionnaire identified degree of agreement with the group's ideas, and the 15 most relevant problems and recommendations were identified; those ideas that were selected achieved at least 50% agreement and their priority was above 25%. We grouped the ideas using a hierarchic cluster analysis.results. Four cluster problems were identified; the most outstanding amongst them being "the population uses A and E for banal pathologies, just like any other consultation" with a score of 297 points. Outstanding amongst the recommendations, with 3 identified clusters, were the "need to design a strategic plan for A and E care with resources appropriate to the needs" (310 priority points) and "sending clear messages to the population on the correct use of A and E" (192 priority points).conclusion. The Delphi method identifies problems and improvement areas through consensus.

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Section: Discussionunclassified

Section: Methodsunclassified

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Identificación de problemas y propuestas para mejorar la atención de las urgencias extrahospitalarias en Navarra: un estudio Delphi

Pérez-Ciordia

Brugos

Guillén-Grima

et al. 2011

Anales Sis San Navarra

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“…Medical staff works under high pressure, because of the unpredictability of demand and the need to respond rapidly to situations. Moreover, their activity is conditioned with misuse of Medical staff by the general population and current budgetary constraints (14,15) . Therefore, medical staff is considered at risk of high levels of stress.…”

Section: Introductionmentioning

confidence: 99%

Psychosocial Stressors and Salivary Cortisol Levels in A Sample of Healthy Young Adults

Greish

2015

Suez Canal University Medical Journal

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Background: Stress has increasingly become a major concern for public health. It is known that psychological stress could produce physiological effects resembling physical challenges in a variety of physiological systems. Salivary cortisol reliably reflects the hypothalamus-pituitaryadrenocortical axis (HPA) activity. Aim: to describe the risks with constant exposure to stress and to determine its association with salivary cortisol. Patients and Methods: Cross-sectional study of 81 resident physicians working in Suez Canal University Hospital. Occupational psychosocial risk and perceived stress level were assessed with validated version of the Copenhagen Psychosocial Questionnaire (COPSOQ). Salivary cortisol was also measured as a biochemical marker of stress in the morning and evening. Results: The physicians reported psychosocial risk factors, particularly high demand on psychological resources and low job control. Cortisol levels were within the normal range. On bivariate analysis, no associations were found between COPSOQ findings and cortisol levels. Conclusions: Resident physicians are in a potentially harmful working situation, although we detected no effect on cortisol level as a biochemical marker of stress.

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State of emergency medicine in Spain

Miró

2010

Int J Emerg Med

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Spain has universal public health care coverage. Emergency care provisions are offered to patients in different modalities and levels according to the characteristics of the medical complaint: at primary care centers (PCC), in an extrahospital setting by emergency medical services (EMS) and at hospital emergency departments (ED). We have more than 3,000 PCCs, which are run by family doctors (general practitioners) and pediatricians. On average, there is 1 PCC for every 15,000 to 20,000 inhabitants, and every family doctor is in charge of 1,500 to 2,000 citizens, although less populated zones tend to have lower ratios. Doctors spend part of their duty time in providing emergency care to their own patients. While not fully devoted to emergency medicine (EM) practice, they do manage minor emergencies. However, Spanish EMSs contribute hugely to guarantee population coverage in all situations. These EMS are run by EM technicians (EMT), nurses and doctors, who usually work exclusively in the emergency arena. EDs dealt with more than 25 million consultations in 2008, which implies, on average, that one out of two Spaniards visited an ED during this time. They are usually equipped with a wide range of diagnostic tools, most including ultrasonography and computerized tomography scans. The academic and training background of doctors working in the ED varies: nearly half lack any structured specialty residence training, but many have done specific master or postgraduate studies within the EM field. The demand for emergency care has grown at an annual rate of over 4% during the last decade. This percentage, which was greater than the 2% population increase during the same period, has outpaced the growth in ED capacity. Therefore, Spanish EDs become overcrowded when the system exerts minimal stress. Despite the high EM caseload and the potential severity of the conditions, training in EM is still unregulated in Spain. However, in April 2009 the Spanish Minister of Health announced the imminent approval of an EM specialty, allowing the first EM resident to officially start in 2011. Spanish emergency physicians look forward to the final approval, which will complete the modernization of emergency health care provision in Spain.

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Urgencias hospitalarias y extrahospitalarias en Navarra: Razones que las motivan

Abstract: Both users and doctors should participate in the debate to try and influence the inappropriate use of the health services, both through excess and by default.

Cited by 8 publications

References 12 publications

Identificación de problemas y propuestas para mejorar la atención de las urgencias extrahospitalarias en Navarra: un estudio Delphi

Identificación de problemas y propuestas para mejorar la atención de las urgencias extrahospitalarias en Navarra: un estudio Delphi

Psychosocial Stressors and Salivary Cortisol Levels in A Sample of Healthy Young Adults

State of emergency medicine in Spain

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