The doctor gives me three weeks; can you send me to emergency department?

Pere Vivó

The train crash returns between the professionals and the managers, the perception of some users and their own reality... The best thing is to verify it: call and request a visit with your doctor at the users’ care centre and you will see that in the best of cases they will probably give you an appointment within a few days. Then try to call your doctor for a consultation over the phone; you most likely receive a call in a few minutes. Finally, go to your health centre and ask for an appointment and you will see that they will probably offer you an emergency visit within a very short time.

If we analyse validated surveys systematically carried out on patients by public insurers the perceived accessibility in relation to the system is not low. Last year we launched a brief survey on this issue on Twitter and the results correlate with these surveys. However, the results of the accessibility indicators of the different centres are usually frankly improvable. On the other hand, the perception of the professionals is that the system exerts pressure on them: "why do they tell me that I am not accessible, when I manage to attend to anyone who requests it?”

But what is accessibility? We could say that a health system capable of satisfying an immediate demand with a face-to-face or telephone consultation, or using the innovative remote consultation systems, configures a totally accessible system. So, why are the standards and accessibility indicators of insurers always in red and are they a source of concern for managers?

The first factor that explains this inconsistency is that the accessibility indicator, as we know it, is always in the permanent review phase and usually, lags behind the foreseeable behaviour of the system. For example, currently in Catalonia a consultation project is being implemented through mobile platforms, with a response commitment of less than 48 hours. In some environments, 20% of users are already registered in the platform, with a progressive increase in their frequency of use, but the system itself doesn’t include asynchronous non-contact visits as an item included in the accessibility standards. The same applies to telephone consultations with immediate resolution, with face-to-face visits of the day or urgent demands for home care.

The second determining factor is the distribution of the systems’ resources, which also determines the supply capacity and therefore the accessibility. The care loads and the professional staff are sometimes out of sync and as shown historically have a simply quantitative allocation and do not consider socio-economic indicators, the immigration rate or the indicators of complexity of the pathologies - large factors that condition the pattern of actual consumption of users. Although it’s true that new support indicators have recently been incorporated in the decision-making and budgetary allocations in an effort to correct this allocation bias, there’s still a long way to go and it’s too early to assess the influence of these measures on accessibility.

The third key element - and perhaps the one with the greatest impact - is the professional factor and the organization’s own design. The incorporation of new technologies that affect the various phases of a process, both assistance and support, such as the incorporation of scientific evidence in decision making, detection and correction of practices that do not provide clinical or managerial value or improved communication and performance are all pending issues in some environments where it would be crucial to innovate the organization.

We ought to also advance the formula with which we measure accessibility and adjust it to the real behaviour of the system; it’s necessary to create a modern indicator that takes into account the change of consumption pattern towards a distance model that not only takes into account the quantitative sphere, but also evaluates the implementation of some successful organizational measures and innovations. Tested. The evolution in this sense would be an important advance to avoid frustrations, and would constitute a motivating element for users, managers and professionals. Are we facing up to the challenge?