Análisis del sistema XIDE en la gestión de la sobredemanda asistencial

Abstract

ObjectiveTo assess the impact and suitability of the XIDE citation system in the management of over-demand for care at the Monforte de Lemos Health Center (Lugo, Spain). Material and methodsDescriptive, cross-sectional, observational and analytical study. The study population was the patients with appointments to the elderly in the ordinary agenda as «forced» or «urgent forced». The population sample was obtained during the period from July 15 to August 15, 2022. The comparative analysis was performed with periods prior to the implementation of XIDE and the XIDE/observer concordance was estimated by calculating Cohen's kappa index. ResultsWe observed an increase in care pressure, both in the number of consultations/day and in the proportion of forced consultations, which have increased by 30-34%. The group over 85 years of age and women are the majority in excess demand. The 83.04% of urgent consultations were cited through the XIDE system, the most frequent reason for consultation being «suspected COVID» (24.64%), with a concordance of 51.4% in this group and 65.5% globally. We appreciate a high overtriage in the assigned attention times, even when the reason for consultation coincides, with a poor statistical concordance with the observers. The high proportion in the overdemand of patients belonging to other places in the health center stands out, so that adequate management of human resources with adequate coverage of absences would reduce it by 48.5%, while the XIDE system (in the ideal assumption of absolute concordance) would only manage to reduce it by 43%. ConclusionsThe low reliability of the XIDE is mainly due to inadequate triage, rather than the failure to reduce overdemand, so it cannot replace a triage system performed by health personnel.