Despite the fact that the implementation last year of a plan to improve accessibility to the healthcare system in Catalonia has given good results in general terms, primary and community care continues to be the level with the most difficulties of access for users The Department of Health has resorted to technology and this year has begun to apply a tool called programming by reason, consisting of an algorithm that identifies the patient’s care needs to schedule the visit based on urgency.
According to Ministry of Health barometer data corresponding to 2023, Catalonia was the community with the most days of delay (12.4 on average) in a primary school consultation. And that the situation has improved substantially compared to 2022, according to the Department of Health: 64% had an in-person visit after five days or less of the request (the objective of the accessibility plan was to reach 70% ), and 86% waited ten days or less (the target was 90%).
The data from the pre-pandemic period are improving, but the evolution is considered insufficient and Salut aims to “offer more resolute attention to the public”. He has identified that the causes of the difficulty of accessing the system are in the reception, where there are duplications and there is variability in the response to the user, aspects that then lead to the saturation of the agendas of the health personnel.
In order to unblock this filter, an algorithm has been developed with the participation of 120 administrative and care professionals from 120 primary care teams. Likewise, the user’s demands have been identified (by now, 285 cataloged reasons for visit), the personnel who should attend to each case (doctor, nurse), the appropriate type of visit (face-to-face, telephone, home) and the permissible delay for each consultation according to the type. The system also takes into account the sex and age of the user (administrators cannot access the medical history) and is ready to analyze other parameters – even to learn – in order to personalize the response as much as possible .
Programming by reasons (the program makes the visit proposal prioritizing the urgency of the reasons) has been tested with a pilot program in 14 EAPs, will be applied in 60 more teams during this month and will be extended to the 376 EAPs in Catalonia this year same “It must make it possible to adjust much more the visit requested by the user, in person or by telephone, and to be attended by the corresponding professional, be it nursing, administrative reasons, the family doctor, paediatrics, etc.,” explained Manel Balcells . At this point, the Minister of Health thinks that it no longer makes sense to quantify the deficit of access to the system in days of waiting: “Serving before five days is not an objective of the system. A change of approach is needed, because accessibility is not the same as immediacy. It is necessary to fine-tune for each case”. Of the 285 consultation reasons entered into the system, 65 require a visit in the first 24 hours.
The 100 million euros introduced in the last Health budget for the shock plan to improve accessibility will remain in the accounts, said the minister, who expressed satisfaction with the results. According to Health, with 164,000 visits to the specialist more than the previous year, in 2023 the percentage of visits outside the deadline was reduced by 12% (at the end of the year there were 67% of users within the deadline, of 3 months, and the rest, abroad). Last year, 935,000 diagnostic tests were carried out, 21% more, and the percentage out of date decreased by 30%.
Regarding surgical activity, waiting lists improved compared to 2022: oncology remained in 99% of cases within the stipulated deadlines, cardiac surgery increased to 100%, guaranteed operations (cataracts, hip and knee) went from 90% to 97%, and other surgeries from 92% to 97%.
“There are people on the waiting list, but very few people have been determined, it is a great success of the public system”, the councilor celebrated. A system, he remarked, designed for 6 million inhabitants, although Catalonia has already reached 8 million.
