Albergues temporales como apoyo a la accesibilidad al tercer nivel de atención para poblaciones rurales dispersas: experiencias de pacientes y acompañantes

Introducción: los servicios de salud en salud zonas rurales dispersas se han focalizado en la atención primaria. Para lograr integralidad es necesario brindar accesibilidad a los servicios de tercer nivel, lo que representa un reto para los sistemas de salud por los costos y la disponibilidad de profesionales. Varios países desplazan especialistas y equipos a las zonas rurales; en Colombia son los pacientes quienes se trasladan a los centros especializados y las aseguradoras en salud administran dineros provenientes del estado para cubrir los costos. Para ello se requiere el apoyo de albergues temporales que brinden alojamiento y alimentación a pacientes y familiares de bajos recursos. Métodos: estudio cualitativo de caso con enfoque fenomenológico para conocer la experiencia de los usuarios de dos albergues que atienden pacientes y acompañantes provenientes de una zona distante 700 km de Bogotá. Resultados: los servicios de los albergues son bien percibidos por los usuarios, aunque se destacan aspectos locativos por mejorar. El servicio se focaliza en hospedaje, transporte y alimentación quedando un vacío en otras necesidades como ocupación del tiempo libre, apoyo emocional y social. La demora en la atención en salud es la principal causa de inconformidad pues afecta la cotidianidad de las familias por el desplazamiento y la incomunicación.  Conclusiones: la atención especializada trasladando pacientes de las zonas dispersas a los centros urbanos representa una experiencia innovadora que debe ser evaluada desde el punto de vista económico y emocional para analizar su relación costo beneficio y su sostenibilidad.

Reviewing reliance on overseas-trained doctors in rural Australia and planning for self-sufficiency: applying 10 years' MABEL evidence

BACKGROUND

The capacity for high-income countries to supply enough locally trained doctors to minimise their reliance on overseas-trained doctors (OTDs) is important for equitable global workforce distribution. However, the ability to achieve self-sufficiency of individual countries is poorly evaluated. This review draws on a decade of research evidence and applies additional stratified analyses from a unique longitudinal medical workforce research program (the Medicine in Australia: Balancing Employment and Life survey (MABEL)) to explore Australia's rural medical workforce self-sufficiency and inform rural workforce planning. Australia is a country with a strong medical education system and extensive rural workforce policies, including a requirement that newly arrived OTDs work up to 10 years in underserved, mostly rural, communities to access reimbursement for clinical services through Australia's universal health insurance scheme, called Medicare.

FINDINGS

Despite increases in the number of Australian-trained doctors, more than doubling since the late 1990s, recent locally trained graduates are less likely to work either as general practitioners (GPs) or in rural communities compared to local graduates of the 1970s-1980s. The proportion of OTDs among rural GPs and other medical specialists increases for each cohort of doctors entering the medical workforce since the 1970, peaking for entrants in 2005-2009. Rural self-sufficiency will be enhanced with policies of selecting rural-origin students, increasing the balance of generalist doctors, enhancing opportunities for remaining in rural areas for training, ensuring sustainable rural working conditions and using innovative service models. However, these policies need to be strongly integrated across the long medical workforce training pathway for successful rural workforce supply and distribution outcomes by locally trained doctors. Meanwhile, OTDs substantially continue to underpin Australia's rural medical service capacity. The training pathways and social support for OTDs in rural areas is critical given their ongoing contribution to Australia's rural medical workforce.

CONCLUSION

It is essential for Australia to monitor its ongoing reliance on OTDs in rural areas and be considerate of the potential impact on global workforce distribution.