83% of the total population of Catalonia was treated by primary care last year, more than half a million people (21%) more than in 2019. But if in that pre-pandemic year, in-person visits represented 84% of the total , now they are 58%, and the rest (42%) are telephone or telematic attention modalities. These are data that appear in the Results Central, a report that compiles 257 indicators of the Catalan health system in recent years. If the impact of Covid has meant a before and after, there are things that do not change, and access to primary school and hospital emergency services continue to be two of the great deficits of an organization that can also improve in areas such as excessive medicalization or the number of avoidable hospitalizations: one in six.
The data, which can be consulted on the Aquas website (Agència de Qualitat i Avaluació Sanitàries de Catalunya), reflects the situation of the system and will serve to guide the policies of the Generalitat. “This instrument gives us absolute transparency in what is happening, tools to make decisions and also elements to compare what is happening throughout the territory,” said Health Minister Manel Balcells. In this sense, the indicators can be compared by territories, health centers or characteristics of the population such as socioeconomic level, sex or age.
With 7.6 million citizens assigned, primary care made 59.9 million visits in 2022 (2.8% more than in 2019), an average of 7.8 visits per person. Frequency increases significantly among users between 20 and 55 years old. But the loyalty rate and satisfaction of primary users has fallen by 6% since 2018, while it remains at high levels in other healthcare settings such as hospitals or intermediate care. According to experts, difficulties in obtaining a face-to-face visit with the reference professional, interpreted as a difficulty of access, decisively influence negative evaluations. Unlike what happens with the counter staff, the treatment of medical and nursing professionals continues to have a very high score.
Clinics prescribe too much: 150.6 million prescriptions last year (7.8% more than in 2019), 19.4 for each user. “A part, perhaps important, of this consumption may not be necessary,” it may even be harmful in some cases, experts warn: 143,000 patients are being treated with proton pump inhibitors without gastroprotection criteria (half of the who take PPIs for more than 3 months), 73,430 people with low cardiovascular risk received lipid-lowering agents, more than half of the adults with pharyngitis were prescribed antibiotics without a diagnosis of bacterial pharyngitis, 36,677 adults with an anxiety incident received a prescription of long-term benzodiazepines… One in 5 people over 75 years of age take more than 10 drugs on a regular basis: pharmaceutical expenditure is related to age, but a relationship is also observed with socioeconomic level.
Regarding hospital activity, it has been recovering from the downturn of the pandemic thanks essentially to the growth of major outpatient surgery. The number of hospital discharges stands at 925,898 (2.3% more than in 2019) and the average stay remains at 6.4 days. Users are satisfied: 9 out of 10 would repeat admission to the same hospital.
But emergencies, described as “the Achilles heel of the hospital environment”, do not raise their heads. The number of emergencies considered less serious (61.2%) and the percentage of patients admitted to the emergency room for more than 24 hours (19%) have not decreased. 70.5% of hospital admissions come from the emergency department – when experts put the maximum at 60% – which “has a considerable impact on the functioning of the hospital, since it aggravates the availability of beds for the activity.” programmed, very directly related to waiting lists for surgical procedures”, another of the structural weaknesses of the system.
On the other hand, the Central Results shows notable increases in the mental health and addictions section. The 75 adult mental health centers served 180,881 people in 2022 (2.8% of the population). Depression (20%) has been the most frequent diagnosis. Children and youth outpatient care services served 72,005 minors (5.7% of the census), an increase of 9% compared to 2020, with neurodevelopmental disorders as the main diagnosis.