THE “EMERGENCIALIZATION” OF PRIMARY CARE IN TALCAHUANO, CHILE

Introduction: Talcahuano is a Chilean city with a population of 178.052 inhabitants. The 70,3% is covered by public health insurance, and the rest of the population has a private or an army force insurance. The city has four Family Health Centers and four Community Health Centers that take care of 125.000 persons. These health centers have interdisciplinary working teams integrated by physicians, nurses, obstetricians, physical therapists, psychologists, dentists and social workers. Additionally, there are four primary care emergency centers (SAPU), two of them inaugurated in 2011. These centers provide immediate care but don’t provide the integral care of the Family and Community health centers. Since the inauguration of the SAPU we have seen a shift in the medical demand patterns toward an “emergencialization” of the primary care services. Objective: To describe the shift in the visitation patterns to health professionals in the primary care centers of Talcahuano, 2011-2014. Method: Ecological study. We compared the number of visits per 1.000 persons to health professionals in SAPU and Family and Community Health Centers. Results: The number of emergency visits per 1.000 persons increased from 703 in 2011 to 1.118 in 2014. Simultaneously, the number of acute morbidity visits per 1.000 persons decreased from 768 to 635. Associated to this, we observe a decrease in the number of visits per 1.000 persons to psychologists and nurses. We conclude that there is an “emergencialization” of primary care that shifts the consultation patterns toward an immediate medical attention, lessening the integrality of care.