Chilean Health Services Research Articles

Migrant User Satisfaction in Chilean Health Services: Adaptation of the PSQ-III

1) culturally adapt the PSQ-III for migrants in Chile; 2) obtain evidence of validity, internal consistency, and temporal stability, and 3) compare satisfaction scores at two different times. The PSQ-III was culturally adapted with the collaboration of expert judges and migrants. Then, 283 migrants completed the questionnaire twice (2021 and 2022). Factorial, reliability, test-retest, and related sample tests were performed. The final version of the PSQ-III included 13 items grouped into "Satisfaction with healthcare staff" and "Aspects for improvement". Both factors showed excellent reliability and temporal stability. The second factor significantly decreased between times, while the first did not. User satisfaction is crucial in healthcare. The adapted version of the PSQ-III provides valid, reliable, stable, and culturally relevant measures over time. This instrument and its results can guide public policies focused on reducing health and access gaps in the migrant population.

Budget impact analysis of the implementation of a bone tissue bank in a Chilean health service

This research aimed to analyze the costs of bone grafting through a bone tissue bank in a Chilean regional health service. Methods: First, we developed a preliminary epidemiological study to obtain the necessary data for the analysis, specifically on bone graft procedures in a local health service (Servicio Salud Concepción). Next, we performed a budget impact analysis. Results: We analyzed a total of 6,252 cc of bone grafts, with a total cost of USD$156,000 per year. We found a potential recovering capacity of 302 ± 16 femoral heads per year from the total hip replacement procedures. Based on these results, bone tissue banks could save USD$145,000 hospital costs annually. Studying a representative health service from Chile, this analysis revealed a dependency on imported bone substitutes and autografts. These requirements can be supplied sustainably by a bone tissue bank based on donations of femoral heads under the current legislation of the Chilean health authority.

Unsafe abbreviations in medical prescriptions and their association with medication errors: a review

The prescription of medications is a weak link in the therapeutic chain of a drug. Medication errors can be associated with the use of so-called unsafe abbreviations in medical prescription. When they are mistakenly interpreted by the person who reads the prescription, error becomes imminent. We herein review the literature about the use of unsafe abbreviations in medical prescriptions and their association with medication errors. PubMed and Lilacs were reviewed, and 29 studies were analyzed, extracting information about the use of abbreviations, common abbreviations, reasons for their use and tools to reduce this conduct. A list with the main risky health abbreviations adapted to Chile was generated. It became clear that the use of abbreviations has increased, appearing in almost all medical prescriptions. The most commonly used abbreviations are the acronym "u" referring to units, followed by "sc" referring to subcutaneous. One of the causes for the use of acronyms the limited time that doctors have at the time of prescription. One way to reduce the use of these abbreviations, is to remind constantly about those that may have the greatest risk in each health institution. A list of unsafe abbreviations, to be used by Chilean health services, is proposed.

A new metaheuristic based on vapor-liquid equilibrium for solving a new patient bed assignment problem

Bio-inspired computing is an emerging paradigm which is based on the basics and inspiration of natural phenomena to design new and robust competing techniques. Various nature science areas have motivated the inspiration for the design of new intelligent systems. Chemical engineering is one of them. In Chemistry, the vapor-liquid equilibrium process describes the distribution of chemical species combining two essential phases: vapor phase and liquid phase. Using a binary system of compounds is possible to simulate a search process based on the equilibrium between both phases. In this paper, we propose a new algorithm inspired by this chemical phenomenon for solving a new patient bed assignment problem. This problem consists of assigning patients to beds by considering relevant medical requirements trying to maximize the most covered soft constraints. For that, we take a traditional model, and we transform it by using the constraint optimization paradigm. We test our algorithm on 30 benchmarks taken of Chilean health services. To verify results, we perform statistical comparatives with artificial bee algorithm, ant colony optimization, the bat method, cuckoo search, genetic algorithm, particle swarm optimization, and a random strategy. Computational experiments illustrate that the VLE algorithm properly solved 30 instances, finding all global optimal. In nineteen instances, VLE converged towards the best solution in its median value. In ten instances, the median, the average and the best value, all of them achieved the global optimal. Now, when comparing VLE against other techniques, we can note that VLE is surpassed by the artificial bee colony in two instances only. The rest of the results show VLE as a robust algorithm able to suppress classical, such as genetic algorithm and particle swarm optimization.

Automatic keyword retrieval from clinical texts: an application of natural language processing to massive data of Chilean suspected diagnosis

Free-text imposes a challenge in health data analysis since the lack of structure makes the extraction and integration of information difficult, particularly in the case of massive data. An appropriate machine-interpretation of electronic health records in Chile can unleash knowledge contained in large volumes of clinical texts, expanding clinical management and national research capabilities. To illustrate the use of a weighted frequency algorithm to find keywords. This finding was carried out in the diagnostic suspicion field of the Chilean specialty consultation waiting list, for diseases not covered by the Chilean Explicit Health Guarantees plan. The waiting lists for a first specialty consultation for the period 2008-2018 were obtained from 17 out of 29 Chilean health services, and total of 2,592,925 diagnostic suspicions were identified. A natural language processing technique called Term Frequency-Inverse Document Frequency was used for the retrieval of diagnostic suspicion keywords. For each specialty, four key words with the highest weighted frequency were determined. Word clouds showing words weighted by their importance were created to obtain a visual representation. These are available at cimt.uchile.cl/lechile/. The algorithm allowed to summarize unstructured clinical free-text data, improving its usefulness and accessibility.

Inequidad en el acceso a salud en Chile: estudio multifactorial basado en la Encuesta CASEN del año 2013

Objetivo: El estudio busca describir la inequidad en el acceso a salud entre los Servicios de Salud de Chile, evidenciando posibles estructuras de inequidad a nivel territorial mediante análisis multifactoriales. Método: Corresponde a un estudio descriptivo de corte cuantitativo. Se emplea una estrategia estadística exploratoria basada en Análisis de Correspondencias Múltiples (ACM) con los datos de la Encuesta CASEN del año 2013. La unidad de información del estudio es el servicio de salud. El análisis de la inequidad se hizo empleando los indicadores de acceso al sistema de salud y a prestaciones de salud incluidos en la medida multidimensional de pobreza, incorporada en esta versión de la encuesta CASEN. Como indicadores de desigualdad social, se utilizó el quintil de ingreso de la población y la medida de pobreza por ingresos. Resultados: Si bien hay diferencias estadísticamente significativas en las características demográficas y socioculturales de la población que habita las áreas de cobertura de los servicios de salud a lo largo del país, existe poca claridad en la conformación de estructuras de inequidad, lo que se aleja de lo buscado inicialmente. Lo anterior se confirma en los Análisis de Correspondencias Múltiples. Conclusiones: Los datos sectoriales de salud, provenientes de la CASEN 2013, no permiten establecer la existencia de inequidad en acceso a salud a nivel de los servicios de salud del país.

Abraham Horwitz (1910-2000) Padre de la Salud Pública Panamericana

The Chilean physician Abraham B Horwitz (1910-2000) was an outstanding personality of World and Pan American public health during the second half of the twentieth century. He was member of a family that, emigrating due to ethnic persecutions in Russia, took refuge in Chile. He became a relevant physician, a specialist in infectious diseases and public health. He was highly influential in the birth of the Public Health School at the University of Chile and the Chilean Health Service. He became Executive Director of the Pan American Health Organization, holding that position for 16 years. During this period, the institution experienced a great development. He stimulated research in the areas of basic sanitation, nutrition and eradication of transmissible diseases. He also opened unexplored areas such as the relation between economy, modern administration and health. During his last years, he chaired a successful Nutrition Committee at the United Nations. The most outstanding achievement of this Committee was the promotion of widespread vitamin A use. His intellectual and social deed is continued by The Pan American Foundation for Health and Education and this institution established an annual prize in his memory.

El programa IRA en Chile: hitos e historia

En Chile, las infecciones respiratorias agudas (IRA) constituyen un importante problema de salud publica. Durante la decada del 80, la tasa de mortalidad infantil por neumonia subio y las investigaciones operacionales demostraron que en muchos de estos fallecidos el deceso ocurria en domicilio o trayecto al hospital. Estos estudios identificaron los factores de riesgo y demostraron que la etiologia era preferentemente viral. Considerando estos antecedentes y el tipo de organizacion del sistema de salud chileno, se elaboro una propuesta de Programa de IRA, que posteriormente fue adoptado como oficial por el Ministerio de Salud. Este Programa incorpora el manejo moderno del sindrome bronquial obstructivo (SBO), agrega kinesiologos y transfiere tecnologia a los centros de atencion primaria para mejorar su capacidad resolutiva. En la actualidad, el Programa Nacional de IRA cuenta con 400 unidades en todo el territorio, y ha logrado llegar con una salud mas equitativa y de mejor calidad tecnica a la poblacion mas pobre de nuestro pais. Entre los resultados sanitarios mas importantes destaca la reduccion de las hospitalizaciones por SBO y especialmente el reiterado quiebre hacia el descenso de la mortalidad infantil por neumonia, en particular de su componente domiciliario. Las evaluaciones independientes han mostrado un alto rendimiento costo-beneficio de los recursos usados en este campo. En la actualidad, ante la baja mortalidad por neumonia, los esfuerzos deben enfocarse a mejorar la calidad de vida de nuestros ninos, en especial si se considera el creciente aumento de pacientes portadores de enfermedades respiratorias cronicas.