Original Title: Estudio de las prestaciones sanitarias urgentes y emergentes en la Comunidad Autónoma Vasca: análisis y propuestas de mejora

Authors' objectives: The aim of this report is to: 1) describe the social-demographic, professional, technological and organisational environment that affects urgent care; 2) examine and describe the emergency care provided in the Basque Autonomous Community, in both quantitative and qualitative terms; 3) through a review of the literature, analyse any possible alternatives currently in operation in communities with a similar health system to that of the Basque Community, their efficiency and possible application to our environment. In accordance with the results obtained and following their analysis by a group of experts, efficient and contextualised alternatives will be proposed for urgent care in the Autonomous Community of the Basque Country.

Authors' results and conclusions: The main factors that have an influence on the emergency health services in our Community are population ageing, the increase in chronic illnesses, the difficulty to find medical professionals to work in urgent services and the change in the sociological profile of patients. Patients are becoming clients and their concerns include taking part in decision-making either at an individual level as a patient or at a collective level as a citizen. Health professionals must be aware of this reality and optimise their relationship skills in order to guarantee the right of citizens to information and to be responsible for their decisions in health-related matters. The different levels of care, namely, primary care and the urgent/emergency care services of Osakidetza hospitals, often operate in isolation, although projects are currently underway to seek an improvement in continuity through agreements or care procedures. This continuity is conditioned by the absence of a tool to ensure the flow of information between different levels. The demand for care is rising annually, except at a level of the Urgent Hospital Services. Since 2007, the aforementioned decrease goes hand-in-hand with a number of positive aspects leading to an improvement in emergency hospital care, such as: a continuous increase in the percentage of hospital admissions, a drop in the pressure on urgent care services and, lastly, a maintained increase in the percentage of patients referred to these services by doctors. The profile of the users of the urgent Primary Care services (Urgent and Domiciliary Care) is similar, while the characteristics of users of Urgent and Emergency Hospital Services are also similar with regard to the factors that lead to their use. Between both groups there are statistically significant differences with regard to the existence of clinical disease, health and perceived seriousness as well as the awareness of the existence of other care services and the fact that they could have been attended to by another service. Among the alternatives analysed, the existence of urgent care telephone numbers, emergency outpatient centres, as stand-alone units or located next to the Urgent Hospital Services, as well as measures to be implemented in the Emergency Hospital Services such as rapid visit areas, short stay units and observation units, have been seen to be efficient. Home hospitalisation programmes have also seen to be efficient and safe and their suitability within the aforementioned health context has been proven.

Authors' recommendations: Twenty-six proposals are made, the main ones being the need to draw up a strategic plan for urgent and emergency care in the Autonomous Community of the Basque Country, treating this as an overall system in which accessibility, the continuity of care services and the flow of information through a common registration tool are key aspects. It is proposed that the procedural model is the most suitable one for managing urgent care from an overall perspective, including all the players involved in care: primary care, emergency and urgent hospital services, as well as the general public. The aforesaid process must guarantee the accessibility of the system and as a consequence, a single, common system for all the possible points of access to urgent care is proposed. The consequences of such a classification would be adapted to the standards to be drawn up. This process must establish a system of interaction with the preferential social-health care process, as the chronic and elderly patient is a potential and frequent user of the urgency process. strengthen organisational, technological and supportive measures with the chronic patient as a strategy to lessen his use of the urgency services so that after being admitted to this circuit an integral and continuous control can be guaranteed.

Authors' methods: This report comprises the following activities: 1) description and analysis of the emergency care environment in the Basque Community through a study of reports and publications concerning the areas contemplated, with regard to both offer and demand. 2) determination of the demand for urgent care in our Community. Its quantitative aspect is analysed through series analysis, the activity reports of the services organisations of Osakidetza involved or through the annual corporate report of Osakidetza. The user profile of each one of the emergency care services is determined through a user survey. 3) Strategic reflection on urgent care in the Basque Community by a group of experts, to define values, strategic targets and lines of action. 4) Search for studies that deal with proven alternatives for the management of urgent services.

Project Status: Completed

Year Published: 2009

URL for published report: https://www.euskadi.eus/contenidos/informacion/2009_osteba_publicacion/es_def/adjuntos/d_09_05_urg_emerg.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Basque Office for Health Technology Assessment (OSTEBA)</p>