Servicios ambulatorios de medicina familiar en Colombia y su relación con desigualdades económicas y de salud.
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| Title: | Servicios ambulatorios de medicina familiar en Colombia y su relación con desigualdades económicas y de salud. |
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| Alternate Title: | Ambulatory family medicine services in Colombia and their relationship with economic and health inequalities. Serviços ambulatoriais de medicina de família na Colômbia e sua relação com as desigualdades econômicas e de saúde. |
| Authors: | Mendieta Leiva, Harold Mauricio1 harold.mendieta@uptc.edu.co, Virgüez Ramos, Oscar Andrés1, Muñoz González, Nathalia Milena1 |
| Source: | Revista Salud Bosque. 2025, Vol. 15 Issue 2, p1-19. 19p. |
| Subjects: | HEALTH equity, WEALTH inequality, FAMILY medicine, MATERNAL mortality, SPATIAL analysis (Statistics), OUTPATIENT medical care, POVERTY rate |
| Geographic Terms: | BOYACA (Boyaca, Colombia), COLOMBIA |
| Abstract (English): | Introduction: Inequalities affect health outcomes worldwide and in Colombia. Family medicine can contribute to addressing this issue through a social determinant of health approach. Objective: To describe the characteristics of family medicine outpatient services and analyze their territorial distribution. To correlate the adjusted family medicine outpatient services rate with indicators of economic inequality and of health inequality. Methods: Ecological cross-sectional study. The study population comprised the 32 departments of Colombia plus Bogotá D.C. (n = 33). From the Special Registry of Health Services, we extracted the number and characteristics of family medicine outpatient services. Frequencies, percentages, rates, maps, and measures of dispersion and central tendency were used. The described economic and health inequality indicators were obtained, and Spearman’s rank correlation test was used to correlate them with the adjusted rate of family medicine outpatient services. Results: We identified 1279 family medicine outpatient services, with 87.87% located in private institutions, 11.70% in state social enterprise settings, and 91.47% operating in an intramural modality. The national adjusted rate was 1.83 family medicine outpatient services per 100,000 inhabitants (minimum = 0.27, maximum = 3.91; coefficient of variation = 0.58). Low rates were observed in highly rural departments, such as Vichada (0.38), while high rates were found in central departments, including Valle del Cauca (3.91) and Boyacá (3.09). A statistically significant inverse correlation was found between the adjusted family medicine outpatient services rate and multidimensional poverty index (Spearman’s rho = -0.440), infant mortality rate (rho = -0.421), and Maternal Mortality Ratio (rho = -0.408). Conclusions: Family medicine outpatient services in Colombia are provided mainly by private actors and predominantly in an intramural modality. The territorial availability of the service was highly uneven. An increase in the adjusted family medicine outpatient services rate correlated with lower values of the multidimensional poverty index, infant mortality rate, and maternal mortality ratio MMR. This relationship does not imply causality but contributes to understanding the implementation of primary health care in the country. [ABSTRACT FROM AUTHOR] |
| Abstract (Spanish): | Introducción. En el mundo y en Colombia las desigualdades afectan los resultados en salud. La medicina familiar puede contribuir a mejorar esta problemática con un enfoque de determinantes sociales de la salud. Objetivo. Describir las caracteristicas de los servicios ambulatorios de medicina familiar y analizar su distribución te-rritorial. Correlacionar la tasa ajustada con los indicadores de desigualdades económicas y de desigualdades en salud. Metodologia. Se trata de un estudio transversal ecológico, la población estudiada incluyó los 32 departamentos de Colombia y Bogotá D.C. (n=33). El número y las características de los servicios ambulatorios de medicina familiar se extrajeron del Registro Especial de Prestadores de Servicios de Salud. Se utilizaron frecuencias, porcentajes, tasas, mapas, medidas de dispersión y de tendencia central. Se registraron los indicadores de desigualdad económica y de salud y se utilizó la prueba de Spearman para corre-lacionarlos con la tasa ajustada de los servicios ambulatorios de medicina familiar. Resultados. Se encontraron 1279 servicios ambulatorios de medicina familiar. el 87,87% pertenecia a instituciones privadas, el 11,70 % a las empresas sociales del Estado. El 91,47 % de los servicios se prestaban en modalidad intra-mural. La tasa ajustada nacional fue de 1,83 servicios ambulatorios de medicina familiar por 100 000 habitantes (mínimo = 0,27-máximo = 3,91; coeficiente de variación = 0,58) Se presentaron tasas bajas en departamentos de alta ruralidad como Vichada (0,38) y tasas altas en los departamentos centrales del Valle del Cauca (3,91) y Boyacá (3,09). Se encontró una correlación inversa estadísticamente significativa entre la tasa ajustada de estos servicios y los indicadores del índice de pobreza multidimensional (Rho = -0,440), de la tasa de mortalidad infantil (Rho = -0,421) y de la razón de mortalidad materna (Rho = -0,408). Conclusiones. Los servicios ambulatorios de medicina familiar en Colombia fueron prestados principalmente por actores privados en la modalidad intramural. La disponibilidad territorial del servicio fue ampliamente desigual. Un aumento en la tasa ajustada de estos servicios se correlacionó con menores valores de índice de pobreza multidimensional, tasa de mortalidad infantil y razón de mortalidad materna. Esta relación no implica causalidad, pero aporta valor a entender la implementación de la atención primaria en salud en el país. [ABSTRACT FROM AUTHOR] |
| Abstract (Portuguese): | Introdução. As desigualdades afetam os resultados de saúde em todo o mundo e na Colômbia. A medicina de família pode contribuir para a melhoria desse problema, abordando os determinantes sociais da saúde. Objetivo. Descrever as características dos serviços ambulatoriais de medicina de família e analisar sua distribuição territorial. Correlacionar a taxa ajustada com indicadores de desigualdades econômicas e desigualdades em saúde. Metodologia. Este foi um estudo transversal ecológico. A população do estudo incluiu os 32 departamentos da Colômbia e Bogotá D.C. (n = 33). O número e as características dos serviços ambulatoriais de medicina de família foram extraídos do Registro Especial de Prestadores de Serviços de Saúde. Frequências, porcentagens, taxas, mapas, medidas de dispersão e tendência central foram utilizados. Indicadores de desigualdade econômica e em saúde foram registrados, e o teste de Spearman foi utilizado para correlacioná-los com a taxa ajustada de serviços ambulatoriais de medicina de família. Resultados. Foram encontrados 1.279 serviços ambulatoriais de medicina de família: 87,87 % eram prestados por instituições privadas e 11,70 % por empresas sociais estatais. 91,47 % dos serviços foram prestados em regime de internação. A taxa nacional ajustada foi de 1,83 serviços ambulatoriais de medicina de família por 100.000 habitantes (mínimo = 0,27 – máximo = 3,91; coeficiente de variação = 0,58). Taxas baixas foram encontradas em departamentos altamente rurais, como Vichada (0,38), e altas taxas nos departamentos centrais de Valle del Cauca (3,91) e Boyacá (3,09). Foi encontrada uma correlação inversa estatisticamente significativa entre a taxa ajustada desses serviços e indicadores como o índice de pobreza multidimensional (Rho = -0,440), a taxa de mortalidade infantil (Rho = -0,421) e a taxa de mortalidade materna (Rho = -0,408). Conclusões. Os serviços ambulatoriais de saúde da família na Colômbia eram prestados principalmente por prestadores privados, em regime de internação. A disponibilidade desses serviços era bastante desigual em todo o país. Um aumento na taxa ajustada desses serviços foi correlacionado a valores mais baixos para o índice de pobreza multidimensional, taxa de mortalidade infantil e razão de mortalidade materna. Essa relação não implica causalidade, mas agrega valor à compreensão da implementação da atenção primária à saúde no país. [ABSTRACT FROM AUTHOR] |
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| Database: | MedicLatina |
| Abstract: | Introduction: Inequalities affect health outcomes worldwide and in Colombia. Family medicine can contribute to addressing this issue through a social determinant of health approach. Objective: To describe the characteristics of family medicine outpatient services and analyze their territorial distribution. To correlate the adjusted family medicine outpatient services rate with indicators of economic inequality and of health inequality. Methods: Ecological cross-sectional study. The study population comprised the 32 departments of Colombia plus Bogotá D.C. (n = 33). From the Special Registry of Health Services, we extracted the number and characteristics of family medicine outpatient services. Frequencies, percentages, rates, maps, and measures of dispersion and central tendency were used. The described economic and health inequality indicators were obtained, and Spearman’s rank correlation test was used to correlate them with the adjusted rate of family medicine outpatient services. Results: We identified 1279 family medicine outpatient services, with 87.87% located in private institutions, 11.70% in state social enterprise settings, and 91.47% operating in an intramural modality. The national adjusted rate was 1.83 family medicine outpatient services per 100,000 inhabitants (minimum = 0.27, maximum = 3.91; coefficient of variation = 0.58). Low rates were observed in highly rural departments, such as Vichada (0.38), while high rates were found in central departments, including Valle del Cauca (3.91) and Boyacá (3.09). A statistically significant inverse correlation was found between the adjusted family medicine outpatient services rate and multidimensional poverty index (Spearman’s rho = -0.440), infant mortality rate (rho = -0.421), and Maternal Mortality Ratio (rho = -0.408). Conclusions: Family medicine outpatient services in Colombia are provided mainly by private actors and predominantly in an intramural modality. The territorial availability of the service was highly uneven. An increase in the adjusted family medicine outpatient services rate correlated with lower values of the multidimensional poverty index, infant mortality rate, and maternal mortality ratio MMR. This relationship does not imply causality but contributes to understanding the implementation of primary health care in the country. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 22485759 |
| DOI: | 10.18270/rsb.4862 |
