CLINICAL EFFECTIVENESS OF PRIMARY HEALTH CARE IN CHILE: INNOVATIONS AND CHALLENGES

Abstract

Chile presents a dissociation between the high level of human development indexes and public health indicators achieved versus the existent relatively low clinical effectiveness level, especially at the primary health care (PHC) system. PHC in Chile has developed a number of pilot innovations that could be replicated and escalated at a national level, to improve clinical effectiveness and the health care level of the population. The development of new models in clinical effectiveness in Chile, has been associated with significant reductions in inappropriate referrals, hospitalizations, emergency care visits and even general mortality. The Chilean PHC system has implemented pilot and innovative interventions in cancer prevention, early detection of gallbladder disease, peptic ulcer disease and gastric cancer, as well as innovative clinical management initiatives on COVID-19 infections and cardiovascular disease. Specific instruments and strategies have been tested and validated to implement the person-centered family systems approach. New initiatives on rapid tests and clinical ultrasound for cardiovascular and respiratory disease should be inte­grated soon in PHC in Chile given the existent evidence on their effectiveness and relative low cost. It is recommended to assess locally clinical new practices at the primary care level before escalating them to the entire network given that in many cases, available clinical information comes from clinical scenarios that are not necessarily equivalent to primary care. The primary care system in Chile has the challenge to implement strategies of proven effectiveness at local level that should be escalated to a national level.