Jorge Ramírez

The Chilean Rural Practitioner Programme: a multidimensional strategy to attract and retain doctors in rural areas

Developing countries currently face internal and external migration of their health workforce and interventions are needed to attract and retain health professionals in rural areas. Evidence of multidimensional interventions, however, is scarce. This study explores a long-standing strategy to attract and retain doctors to rural areas in Chile: the Rural Practitioner Programme. The main objective is to describe the programme, characterize its multidimensional set of incentives and appraise preliminary programme outcomes.Retrospective national data were employed to examine recruitment, retention and incentives provided to extend the length of stay and motivate non-clinical work. The programme has successfully recruited a large number of applicants, with acceptance rates close to 100%. Retention rates are nearly 100% (drop-outs are exceptional), but only 58% of participants stay for the maximum period. Areas with greater work difficulty are attracting the best-ranked applicants, but incentives to engage in community projects, management responsibilities, continuous medical education and research have achieved mixed results. Rural doctors are satisfied with their experience and 70% plan to practise as specialists in a referral hospital.The programme has successfully matched the interests of physicians in specialization with the countrys need for rural doctors. However, a gap might be forming between the demand for certain specialties and what the programme can offer. There is a need to conciliate both parties, which will require a more refined strategy than before. This should be grounded in robust knowledge based on programme outcomes and evidence of the interests and motivations of health professionals.

Implementing a Community Model of Mental Health Care in Chile: Impact on Psychiatric Emergency Visits

OBJECTIVE The community model of mental health care (CMMHC) is recommended as the best way to organize mental health care, but evidence of its successful implementation and effectiveness is scarce, particularly in resource-poor settings. This study aimed to evaluate the impact of CMMHC on the rate of psychiatric emergency visits in Santiago, Chile. METHODS The rate of psychiatric emergency visits from 2006 to 2011 was compared between two health care administrative districts: district 1 (D1), in which CMMHC was being systematically implemented, and D2, where CMMHC implementation was very limited and inconsistent. In addition, rates of psychiatric emergency visits in ten D1 municipalities were compared by the degree to which they had implemented CMMHC. RESULTS Compared with D2, D1 had higher rates of psychiatric emergency visits during the observation period. In D1, the rate of visits per 100,000 inhabitants declined from 541 in 2006 to 414 in 2011. In D2, the rate increased from 104 in 2006 to 130 in 2011. In D1 municipalities, the reduction in the rate of psychiatric emergency visits was greater in those with well-implemented CMMHC compared with those with partially implemented CMMHC. When distance to the emergency room was taken into account, the 2011 rate of emergency visits in the ten D1 municipalities was 21% (p<.01) lower in those with well-implemented CMMHC than in those with partially implemented CMMHC. CONCLUSIONS CMMHC implementation leads to reduction in psychiatric emergency visits, which are burdensome to both users and providers. Results support CMMHC implementation in resource-poor settings.

Niveles de hemoglobina glicosilada y diferencia en el gasto en salud de pacientes diabéticos: un estudio econométrico

BACKGROUND Complications increase treatment costs of diabetes mellitus (DM). An adequate metabolic control of the disease could reduce these costs. AIM To evaluate the costs of medical care for a cohort of patients with DM, according to their degree of metabolic compensation. MATERIAL AND METHODS All diabetic patients attended in a regional hospital from 2005 to 2010 were analyzed. A correlational study between costs of individual healthcare and levels of glycosylated hemoglobin (HbA1c), was performed in a series of annual cross-sectional measurements. RESULTS The study comprised 1,644 diabetic patients. During the study period the average cost of healthcare per patient increased from

Implementing the Community Mental Health Care Model in a Large Latin-American Urban Area

878,000 to more than

Dificultades en la prescripción racional de insulina: La percepción de los médicos tratantes de enfermos diabético de atención primaria de salud

1,000,000 Chilean pesos (CLP) during the study period. The percentage of patients with HbA1c levels below 7.0% varied between 43.0% and 54.9%. Costs for patients with HbA1c levels between 7 and 8.9% were 1.3 to 1.5 times greater. For the group of patients with HbA1c levels between 9 and 10.9% the costs increased 1.4 to 1.6 times. For patients with HbA1c levels greater than 11.0%, healthcare costs doubled. CONCLUSIONS Healthcare expenditure varied according to metabolic control, which is consistent with international findings. This study was limited by its selected population, incomplete information on health expenditures, and the inclusion of only direct costs to the health system. If all patients would achieve metabolic compensation, the yearly savings would be CLP

Primary care consultation liaison and the rate of psychiatric hospitalizations: a countrywide study in Chile

308,000,000 (or USD

Estudio determinación de brechas de médicos generales y especialistas según metodología de tasas de uso de prestaciones médicas y especializadas en Chile

657,000).Background: Complications increase treatment costs of diabetes mellitus (DM). An adequate metabolic control of the disease could reduce these costs. Aim: To evaluate the costs of medical care for a cohort of patients with DM, according to their degree of metabolic compensation. Material and methods: All diabetic patients attended in a regional hospital from 2005 to 2010 were analyzed. A correlational study between costs of individual healthcare and levels of glycosylated hemoglobin (HbA1c), was performed in a series of annual cross-sectional measurements. Results: The study comprised 1,644 diabetic patients. During the study period the average cost of healthcare per patient increased from

Assessment of the Chilean rural practitioner program by its participating physicians

878,000 to more than

Implementing the Community Mental Health Care Model in a Large Latin-American Urban Area: The Experience from Santiago, Chile

1,000,000 Chilean pesos (CLP) during the study period. The percentage of patients with HbA1c levels below 7.0% varied between 43.0% and 54.9%. Costs for patients with HbA1c levels between 7 and 8.9% were 1.3 to 1.5 times greater. For the group of patients with HbA1c levels between 9 and 10.9% the costs increased 1.4 to 1.6 times. For patients with HbA1c levels greater than 11.0%, healthcare costs doubled. Conclusions: Healthcare expenditure varied according to metabolic control, which is consistent with international findings. This study was limited by its selected population, incomplete information on health expenditures, and the inclusion of only direct costs to the health system. If all patients would achieve metabolic compensation, the yearly savings would be CLP

Consulta de urgencia psiquiátrica y modelo comunitario de atención en salud mental

308,000,000 (or USD