Epidemiological and georeferencial analysis of five-year patterns of use of medical services in captive patient population
The identification of health problems in the community and the implementation of intervention strategies usually collides with the difficulty of presenting clear, reliable data and mainly useful and intuitive to political decision makers, and it is in this sense that the geographical information sys...
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| Autores principales: | , , |
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| Formato: | Artículo revista |
| Lenguaje: | Español |
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Escuela de Salud Pública y Ambiente. Fac. Cs. Médicas UNC
2014
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| Acceso en línea: | https://revistas.unc.edu.ar/index.php/RSD/article/view/6799 |
| Aporte de: |
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I10-R360-article-6799 |
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ojs |
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Universidad Nacional de Córdoba |
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I-10 |
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R-360 |
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Revista de Salud Pública |
| language |
Español |
| format |
Artículo revista |
| topic |
georeference – use of health services – usage ratios – GIS (geographic information system) Investigación en servicios de salud georreferencia sig utilización de servicios tasas de uso |
| spellingShingle |
georeference – use of health services – usage ratios – GIS (geographic information system) Investigación en servicios de salud georreferencia sig utilización de servicios tasas de uso Lemus, Jorge D. Lucioni, Maria C. Aragües y Oroz, V. Epidemiological and georeferencial analysis of five-year patterns of use of medical services in captive patient population |
| topic_facet |
georeference – use of health services – usage ratios – GIS (geographic information system) Investigación en servicios de salud georreferencia sig utilización de servicios tasas de uso |
| author |
Lemus, Jorge D. Lucioni, Maria C. Aragües y Oroz, V. |
| author_facet |
Lemus, Jorge D. Lucioni, Maria C. Aragües y Oroz, V. |
| author_sort |
Lemus, Jorge D. |
| title |
Epidemiological and georeferencial analysis of five-year patterns of use of medical services in captive patient population |
| title_short |
Epidemiological and georeferencial analysis of five-year patterns of use of medical services in captive patient population |
| title_full |
Epidemiological and georeferencial analysis of five-year patterns of use of medical services in captive patient population |
| title_fullStr |
Epidemiological and georeferencial analysis of five-year patterns of use of medical services in captive patient population |
| title_full_unstemmed |
Epidemiological and georeferencial analysis of five-year patterns of use of medical services in captive patient population |
| title_sort |
epidemiological and georeferencial analysis of five-year patterns of use of medical services in captive patient population |
| description |
The identification of health problems in the community and the implementation of intervention strategies usually collides with the difficulty of presenting clear, reliable data and mainly useful and intuitive to political decision makers, and it is in this sense that the geographical information systems (GIS) can be of great utility. The technology of the georeference is already accepted as anessential tool for the effective use of the information. Also keeping in mind that in any organization that provides health services the information about use (and costs) of them as well as the characteristics of the user population should be articulated with the organizational development of information systems, using the so called epidemiological reasoning onto the administration of health services, it seemed to us of the most importance to make a critical analysis of the use of services and its patternsalong a five year period on a reference population. So we carried out an analytic observacional study, with a retrospective design, on a five-year period and over a captive population of 5700 people belonging to a health care provider of good socioeconomic level of the City of Buenos Aires, to define the consumption patterns and service usage among them, and to quantify and qualify their demand and variation along time, being also carried out a georeferencial analysis. The usagerates were stratified for diverse usual services as medical consultations, radiology, laboratory analysis, ecography tests and high diagnostic and therapeutic complexity tests, and hospitalizations, accordingto the reference habitat of the people (City of Bs. As., boundaries of the city (the so called Great BA), province of Bs. As. and three main cities: La Plata, Mar del Plata and Bahía Blanca), age group (younger or older than 60 years like first grouping criterion and age categories (10 years) as second grouping criterion, and sex. Accessorily we sub grouped in the Great BA according to one of 3 regions (South, North and Center West) and in the City of Bs. As. according to neighborhood or censal fraction. For each one of the variables we proceeded to the georeferencial plotting using the soft SPSS for stratified and multivariate analysis and the MAP INFO for SIG analysis. We present and comment here the most notorious results of our work, but it admits several other interpretations trata, which are not approached entirely in this occasion and will be object of other communications. Among the outstanding results of our work we mention the significant relationship among age group and sex, and use of services, being evident that those impact positively in the use (p <0.05) being always greater among females than among males (p<0.001) (except in the first year of lifewhen the relationship is inverse) and increasing progressively as the age decade increases, for anyone of the considered services. This fact is not really a new one and it has already been commented by several authors that observed that good part of health expenses is used in giving careto a small number of people, being the variables that more gravitates the age, the illness type, typically the chronic ones and the death. In this sense, our population presents a clear aging process. Linkage constants were generated among key services and the rest. For instance, medical consultations is used thoroughly between 75% and 85% according to the belonging area but if weorder the consumptions for age group and area in a continuum from maximum to minimum we see that the service is used as little as 53% in the males in general or in the males of the province between 21 and 30 years, or as much as 91% in the males or women of the city or the women of Great BA starting from 70 years. The rate average of medical consultations of the population is of 5.4 for user / year but it varies thoroughly among 1.83 for the males of the interior between the 21 and 30 years (p <0.01) and 13.64 (p <0.001) for the women of the city between the 81 and 90 years. The other key service, the hospitalization, was also clearly associated to age, sex and geographical region. This association was clear for the usage ratio, like for the ALOS, and also the expenditure for hospitalization event, per day and for patient/year, in general and for the discrimination made in clinical and surgical hospitalizations. The rates increased according to the decade in both sexs, being greater for the women up to the 5th. or 6th. decade, when the relationshipis inverted. Again, the combination of factors like sex, age decade and residence area conformed a more sensitive polynomial function to detect “risk” of hospitalization that any variable considered alone. Both the rates, ALOS and expenditures for event and for case were minimum among males of the first two decades with residence inside the province of Bs.As. (except in great cities) and were maximum among old women in the city of BA. Indeed, the cost for patient/year varied 2.28 times between masculine interior and feminine city of BA (p <0.01) and the expenditure for hospitalization 1.85 times among these same groups (p <0.05). A certain tendency was also evidenced to the increase in the use rate (although without reaching significance levels) inside a defined influence area of a preferential care giver in the City of Bs. Ace., which would indicate that patients living in the boundaries of this center would use it more than others, being this consistent with what the literature remarks in this sense and lighting fundamental questions on equity, accessibility and geographical distribution of facilities among health care providers that cover wide areas. In this sense it was very clear the almost absolute use of an obstetric center of great fame of this city that captates almost all births in the city of Bs. As. and great part of those from the Great BA, indicating the preference of women and illustrating the central rol that women exercises, as muchas “triagge” in the search of attention like wedge of insertion of the family in the health system. The distribution and characteristic of the beneficiaries and their grade of use of services can represent in operative and practical senses pieces of information of great value when planning the logistics of local resources, like the implementation of family doctors’ programs with population in charge, or the selection of a net system with preferential providers. We think that this is a field and investigation area in frank promising expansion. |
| publisher |
Escuela de Salud Pública y Ambiente. Fac. Cs. Médicas UNC |
| publishDate |
2014 |
| url |
https://revistas.unc.edu.ar/index.php/RSD/article/view/6799 |
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I10-R360-article-67992025-04-03T12:08:01Z Epidemiological and georeferencial analysis of five-year patterns of use of medical services in captive patient population Análisis epidemologico y georreferncial de patrones quinquenales de utilización de servicios médicos en una población cautiva de pacientes Lemus, Jorge D. Lucioni, Maria C. Aragües y Oroz, V. georeference – use of health services – usage ratios – GIS (geographic information system) Investigación en servicios de salud georreferencia sig utilización de servicios tasas de uso The identification of health problems in the community and the implementation of intervention strategies usually collides with the difficulty of presenting clear, reliable data and mainly useful and intuitive to political decision makers, and it is in this sense that the geographical information systems (GIS) can be of great utility. The technology of the georeference is already accepted as anessential tool for the effective use of the information. Also keeping in mind that in any organization that provides health services the information about use (and costs) of them as well as the characteristics of the user population should be articulated with the organizational development of information systems, using the so called epidemiological reasoning onto the administration of health services, it seemed to us of the most importance to make a critical analysis of the use of services and its patternsalong a five year period on a reference population. So we carried out an analytic observacional study, with a retrospective design, on a five-year period and over a captive population of 5700 people belonging to a health care provider of good socioeconomic level of the City of Buenos Aires, to define the consumption patterns and service usage among them, and to quantify and qualify their demand and variation along time, being also carried out a georeferencial analysis. The usagerates were stratified for diverse usual services as medical consultations, radiology, laboratory analysis, ecography tests and high diagnostic and therapeutic complexity tests, and hospitalizations, accordingto the reference habitat of the people (City of Bs. As., boundaries of the city (the so called Great BA), province of Bs. As. and three main cities: La Plata, Mar del Plata and Bahía Blanca), age group (younger or older than 60 years like first grouping criterion and age categories (10 years) as second grouping criterion, and sex. Accessorily we sub grouped in the Great BA according to one of 3 regions (South, North and Center West) and in the City of Bs. As. according to neighborhood or censal fraction. For each one of the variables we proceeded to the georeferencial plotting using the soft SPSS for stratified and multivariate analysis and the MAP INFO for SIG analysis. We present and comment here the most notorious results of our work, but it admits several other interpretations trata, which are not approached entirely in this occasion and will be object of other communications. Among the outstanding results of our work we mention the significant relationship among age group and sex, and use of services, being evident that those impact positively in the use (p <0.05) being always greater among females than among males (p<0.001) (except in the first year of lifewhen the relationship is inverse) and increasing progressively as the age decade increases, for anyone of the considered services. This fact is not really a new one and it has already been commented by several authors that observed that good part of health expenses is used in giving careto a small number of people, being the variables that more gravitates the age, the illness type, typically the chronic ones and the death. In this sense, our population presents a clear aging process. Linkage constants were generated among key services and the rest. For instance, medical consultations is used thoroughly between 75% and 85% according to the belonging area but if weorder the consumptions for age group and area in a continuum from maximum to minimum we see that the service is used as little as 53% in the males in general or in the males of the province between 21 and 30 years, or as much as 91% in the males or women of the city or the women of Great BA starting from 70 years. The rate average of medical consultations of the population is of 5.4 for user / year but it varies thoroughly among 1.83 for the males of the interior between the 21 and 30 years (p <0.01) and 13.64 (p <0.001) for the women of the city between the 81 and 90 years. The other key service, the hospitalization, was also clearly associated to age, sex and geographical region. This association was clear for the usage ratio, like for the ALOS, and also the expenditure for hospitalization event, per day and for patient/year, in general and for the discrimination made in clinical and surgical hospitalizations. The rates increased according to the decade in both sexs, being greater for the women up to the 5th. or 6th. decade, when the relationshipis inverted. Again, the combination of factors like sex, age decade and residence area conformed a more sensitive polynomial function to detect “risk” of hospitalization that any variable considered alone. Both the rates, ALOS and expenditures for event and for case were minimum among males of the first two decades with residence inside the province of Bs.As. (except in great cities) and were maximum among old women in the city of BA. Indeed, the cost for patient/year varied 2.28 times between masculine interior and feminine city of BA (p <0.01) and the expenditure for hospitalization 1.85 times among these same groups (p <0.05). A certain tendency was also evidenced to the increase in the use rate (although without reaching significance levels) inside a defined influence area of a preferential care giver in the City of Bs. Ace., which would indicate that patients living in the boundaries of this center would use it more than others, being this consistent with what the literature remarks in this sense and lighting fundamental questions on equity, accessibility and geographical distribution of facilities among health care providers that cover wide areas. In this sense it was very clear the almost absolute use of an obstetric center of great fame of this city that captates almost all births in the city of Bs. As. and great part of those from the Great BA, indicating the preference of women and illustrating the central rol that women exercises, as muchas “triagge” in the search of attention like wedge of insertion of the family in the health system. The distribution and characteristic of the beneficiaries and their grade of use of services can represent in operative and practical senses pieces of information of great value when planning the logistics of local resources, like the implementation of family doctors’ programs with population in charge, or the selection of a net system with preferential providers. We think that this is a field and investigation area in frank promising expansion. La identificación de problemas de salud en la comunidad y la implementación y monitoreo de estrategias de intervención suelen chocar con la dificultad de presentar datos claros, fiables y sobre todo fácilmente aprehensibles por los tomadores políticos de decisiones, y es en este sentido que los sistemas de información geográfica pueden ser de gran utilidad. La tecnología de la georeferencia ya es aceptada como una herramienta esencial para el uso efectivo de la información. Teniendo en cuenta además que en cualquier entidad que medie y/o provea servicios de salud la información relativa al uso (y costos) de los mismos, así como las características de los usuarios debería articularse con la incorporación y desarrollo organizacional de sistemas de información, empleando el raciocinio epidemiológico a la administración de servicios de salud. Nos pareció sustantivo efectuar un análisis critico del uso de servicios y sus patrones a lo largo del tiempo sobre una población de referencia. Se encaró un trabajo observacional - analítico, retrospectivo, sobre un período quinquenal y una población cautiva de 57000 personas de una cobertura de salud de buen nivel socio económico de la Ciudad de Bs. As., para definir el patrón de consumo de servicios entre ellos y cuantificar y cualificar su demanda y variación a lo largo del tiempo, realizándose además análisis georeferencial de la misma. Se estratificaron las tasas de uso para diversos servicios usuales como consultas, radiología, análisis de laboratorio, ecografías y alta complejidad diagnóstica y terapéutica, e internación, según hábitat de residencia del beneficiario (Ciudad deBs. As., GBA, interior de la Pcia. Bs. As. y tres ciudades principales: La Plata, Mar del Plata y Bahía Blanca), grupo de edad (mayor o menor de 60 años como primer criterio de agrupación y franjas etáreas de a 10 años como segundo criterio) y sexo. Accesoriamente se subagruparon en el GBA según una de 3 regiones (Sur, Norte y Centro Oeste) y en la Ciudad de Bs. As. según barrio o fracción censal. Para cada una de las variables se procedió al ploteo georeferencial de la misma usando como herramental informático el soft SPSS para análisis estratificado y multivariado y el MAP INFO para análisis SIG. En el presente trabajo se presentan los resultados más notorios de un análisis que admite varios estratos de lectura, los cuales no se abordan íntegramente en esta ocasión y serán objeto de otras comunicaciones. Entre los hallazgos destacados mencionamos las relaciones significativas entre grupo de edad y sexo, y uso de servicios, siendo evidente que aquéllos inciden positivamente en la utilización (p<0.05) siendo siempre mayor entre mujeres que entre varones (p<0.001) (salvo en el primer año de vida en que la relación se invierte) y aumentando progresivamente a medida que aumenta el decenio de edad, para cualquiera de los servicios considerados. Este hecho no es en sí novedoso y ya ha sido comentado por varios autores, que comprobaron que buena parte del gasto sanitario es empleado en atender a un pequeño número de personas, siendo las variables que más gravitan la edad, el tipo de enfermedad, típicamente las crónicas y la muerte. En este sentido, nuestra población presenta un claro proceso de ancianización. Se generaron constantes vinculantes entre servicios princeps (consultas y egresos) y el resto. Así, por ejemplo, el servicio consulta es utilizado ampliamente por entre un 75% y un 85% de la población de acuerdo a la zona considerada pero ordenando los consumos por grupo etáreo y zona en un contínuo de mayor a menor vemos que el servicio es usado tan poco como un 53% en los varones en general o del interior entre los 21 y 30 años, o tanto como un 91% en los varones omujeres de CF o las mujeres de GBA a partir de los 70 años. La tasa promedio de consultas (porafiliado de padrón) de la población es de 5,4 por beneficiario/año pero varia ampliamente entre 1,83 para los varones del interior entre los 21 y 30 años (p<0.01) y 13,64 (p<0.001) para las mujeres de CF entre los 81 y 90 años). El otro servicio princeps de atención de la salud, la internación, también se mostró claramente asociado a edad, sexo y región geográfica considerada. Esta asociación se dio tanto para las tasas de internación en sí, como para los ALOS, el montoerogado por internación, por día y por paciente/año, en general y para la discriminación efectuada en internaciones clínicas y quirúrgicas. Las tasas aumentaron de acuerdo al decenio en ambos sexos, siendo mayor para las mujeres hasta el 5to. o 6to. decenio, en que la relación se invierte. Nuevamente, la combinación de factores como sexo, decenio de edad y zona de residencia conformaron una suerte de función polinómica más sensible para detectar “riesgo” de internación que cualquier variable considerada aisladamente. Tanto las tasas, los ALOS y los importes por evento y por caso fueron mínimos entre varones de los dos primeros decenios con residencia en el interior de la provincia de Bs.As. (salvo ciudades importantes) y fueron máximos entre mujeres añosas en la CABA. En efecto, el costo por beneficiario/año varió 2.28 veces entre interior masculino y CABA femenino (p<0.01) y el costo por internación 1.85 veces entre estos mismo grupos (p<0.05). Se evidenció una cierta tendencia además al aumento en la tasa de utilización (si bien sin alcanzar niveles de significación) dentro de un determinado radio de influencia de un prestador preferencial en la Ciudad de Bs. As., lo cual indicaría de confirmarse que efectivamente los pacientes que vivenen las inmediaciones del centro lo utilizan más que sus contrapartes más alejados, lo cual sería coherente con lo que marca la literatura en este sentido y pone sobre la liza interesantes cuestiones fundamentales sobre equidad, accesibilidad y distribución geográfica de los prestadores en coberturas de salud que tienen oferta en zonas muy amplias. En este sentido fue muy clara la utilización casi absoluta de un centro obstétrico de renombre de esta CABA que capitaliza prácticamente la totalidad de nacimientos en la propia Ciudad de Bs. As. y gran parte del GBA, indicando la preferencia de las gestantes hacia él e ilustrando el papel central que ejerce la mujer, tanto como “triagge” en la búsqueda de atención como cuña de inserción de la familia en el sistema de salud.La distribución y características de los beneficiarios y su grado de utilización de servicios pueden representar en lo operativo y práctico del día a día piezas de información de gran valor a la hora de planificar la logística de recursos locales, como por ejemplo la implementación de programas de médicos de familia con población a cargo, o la selección de un sistema de redes con prestadores preferenciales, o incluso la contratación de una amplia variedad de servicios capitados. Creemos que se trata ésta de un área de investigación en franca expansión prometedora. Escuela de Salud Pública y Ambiente. Fac. Cs. Médicas UNC 2014-03-17 info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion application/pdf https://revistas.unc.edu.ar/index.php/RSD/article/view/6799 10.31052/1853.1180.v9.n2.6799 Revista de Salud Pública; Vol. 9 Núm. 2 (2005); 49-60 1852-9429 1853-1180 10.31052/1853.1180.v9.n2 spa https://revistas.unc.edu.ar/index.php/RSD/article/view/6799/7879 Derechos de autor 1969 Universidad Nacional de Córdoba https://creativecommons.org/licenses/by-nc/4.0 |