Acceso a colecistectomía en un programa de tamizaje ecográfico decolelitiasis en centros de medicina familiar

Marzo 2016

Art ículos de Investigaci ón 317 Rev Med Chile 2016; 144: 317-324 Acceso a colecistectomía en un programa de tamizaje ecográfico de colelitiasis en centros de medicina familiar CONSTANZA BAYa, MARCIA OCARES1, FERNANDO TOLEDO, NICOLÁS BARTICEVIC2, ISABEL MORA2, FRANCISCA VILLOUTA2, FRANCISCO CRUZ3, KLAUS PUSCHEL2, JUAN FCO. MIQUEL1 Access to cholecystectomy among patients attended at primary family health centers Background: Cholelithiasis (CL) represents a major health burden in Chile, with rates of cholecystectomy (CCT) of ~40.000 per year. The explicit health care guaranties (GES) program includes prioritized CCT for CL carriers between 35 and 49 years of age. Aim: To assess the access and opportunity of CCT in a screening program of CL in Family Medicine Centers, according to the age of the patients. Material and Methods: A systematic ultrasound screening program of CL was developed in Family Medicine Centers ANCORA-UC between March 2009 and March 2013 during which 1.450 individuals were assessed, (80% women) and 281 were identified as having CL (19.4%). After a minimum follow up interval of six months, patients with CL were contacted and surveyed by phone. They were categorized as being beneficiaries of the GES program (those aged between 35 to 49 years) or not (those aged < 35 o > 49 years). Results: Two hundred thirteen patients were contacted (76%), 81 beneficiaries of the program and 132 non-beneficiaries. The attending physician indicated CCT to 191 patients (89.6%). During a mean follow-up time of 641 days/person, 100 patients had CCT, 11% of which were emergency interventions due to complications. A greater proportion of program beneficiaries than non-beneficiaries had an elective CCT (74 and 21% respectively). The waiting interval for elective CCT was longer in non-beneficiaries compared with beneficiaries (340 ± 247 and 229 ± 201days respectively). Only 46% of the elective CCT in GES patients were done within deadlines determined by the program (≤ 150 days). Conclusions: The age of patients at the moment of CL diagnosis conditions the access and opportunity to CCT. Beneficiaries of the explicit health care guaranties program have higher rates of cholecystectomy with less waiting time. (Rev Med Chile 2016; 144: 317-324) Key words: Access, and Evaluation; Cholelithiasis; Cholecystectomy; Health Care Quality. 1Departamento de Gastroenterología, Facultad de Medicina, Pontificia Universidad Católica de Chile. 2Departamento de Medicina Familiar, Facultad de Medicina, Pontificia Universidad Católica de Chile. 3Departamento de Radiología, Facultad de Medicina, Pontificia Universidad Católica de Chile. aEstudiante de Medicina Facultad de Medicina, Pontificia Universidad Católica de Chile. Fuente de apoyo financiero: Este estudio ha sido financiado parcialmente por el proyecto Fondo Nacional de Desarrollo Científico y Tecnológico, Fondecyt, N°1130303 a JFM. Los autores declaran no tener conflictos de interés. Recibido el 17 de abril de 2015, aceptado el 1 de diciembre de 2015. Correspondencia a: Dr Juan Francisco Miquel P. Departamento de Gastroenterología Facultad de Medicina, Pontificia Universidad Católica de Chile. Alameda 340, Santiago de Chile. Teléfono: 56-2-3543820 jfmiquel@med.puc.cl La colelitiasis por cálculos de colesterol (CL) es una enfermedad altamente prevalente en la población adulta chilena, afectando al 35% en la población mapuche y al 27% en la hispana1,2. Las mujeres chilenas se encuentran entre las de más alto riesgo en el mundo, con una prevalencia que supera el 60% a partir de los 50 años de edad3,4. La CL puede permanecer asintomática o desarrollar diferentes complicaciones clínicas, desde un cólico biliar simple hasta cáncer de vesícula


Marzo 2016
To see the actual publication please follow the link above