[Access to cholecystectomy among patients attended at primary family health centers].
BACKGROUND
Cholelithiasis (CL) represents a major health burden in Chile, with rates of cholecystectomy (CCT) of ~40.000 per year. The explicit health care guaranties (GES) program includes prioritized CCT for CL carriers between 35 and 49 years of age.


OBJECTIVE
To assess the access and opportunity of CCT in a screening program of CL in Family Medicine Centers, according to the age of the patients.


METHODS
A systematic ultrasound screening program of CL was developed in Family Medicine Centers ANCORA-UC between March 2009 and March 2013 during which 1.450 individuals were assessed, (80% women) and 281 were identified as having CL (19.4%). After a minimum follow up interval of six months, patients with CL were contacted and surveyed by phone. They were categorized as being beneficiaries of the GES program (those aged between 35 to 49 years) or not (those aged < 35 o > 49 years).


RESULTS
Two hundred thirteen patients were contacted (76%), 81 beneficiaries of the program and 132 non-beneficiaries. The attending physician indicated CCT to 191 patients (89.6%). During a mean follow-up time of 641 days/person, 100 patients had CCT, 11% of which were emergency interventions due to complications. A greater proportion of program beneficiaries than non-beneficiaries had an elective CCT (74 and 21% respectively). The waiting interval for elective CCT was longer in non-beneficiaries compared with beneficiaries (340 ± 247 and 229 ± 201 days respectively). Only 46% of the elective CCT in GES patients were done within deadlines determined by the program (≤ 150 days).


CONCLUSIONS
The age of patients at the moment of CL diagnosis conditions the access and opportunity to CCT. Beneficiaries of the explicit health care guaranties program have higher rates of cholecystectomy with less waiting time.
Constanza
C
Bay
Marcia
M
Ocares
Fernando
F
Toledo
Nicolás
N
Barticevic
Isabel
I
Mora
Francisca
F
Villouta
Francisco
F
Cruz
Klaus
K
Puschel
Juan Fco
JF
Miquel
D000328:Adult; D000367:Age Factors; D000368:Aged; D002677:Chile; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D002769:Cholelithiasis / Q000000981:diagnostic imaging / Q000601:surgery*; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D018709:Statistics, Nonparametric; D013997:Time Factors; D014850:Waiting Lists