Fuster Sánchez Nicolás, Rivera López Diego, Sir Retamales Hugo, Gómez Pérez Constanza, Rodríguez Torres Magdalena
Universidad de Valparaiso, Valparaiso, Chile.
Int J Ment Health Syst. 2021 Jan 14;15(1):9. doi: 10.1186/s13033-021-00436-4.
In Europe, Latin-America, and Asia, poly-consultation has become a complex problem for managing different healthcare systems. However, in the current literature, little attention has been paid to exploring territorial and critical analysis perspectives to manage unexplained symptoms. The purpose of this study is to analyze the socio-structural elements that underlie the users' phenomenon of poly-consultation or hyperfrequency in the Chilean primary healthcare system (PHCS).
This paper represents qualitative data collected as part of an exploratory study that used mixed methods across three metropolitan areas of Santiago, Valparaíso, and Concepción, Chile. The study involved a sample of 24 subjects from administrative and management positions in PHC who were recruited from Family Health Care Centers, considering urban municipalities from the low, medium, and high stratum. The study collected data using one set of semi-standardized interviews during a year-data analysis using qualitative content analysis.
This article shows that poly-consultant patients provide a critical clinic category to management that cannot be cover by current biomedical models. Data showed the strain of a somatoform category, especially in the clinic and epistemological exercise. Precisely, the relevance of Chile's case, a mixed health system, and their effects: the naturalization of collective problems managed as individual problems.
The study results can inform healthcare professionals and managers of developing practical and territorially based. We conclude that hyperfrequency and poly-consultation in Chile reveal relevant stratification in the territory. Those particularities open an opportunity to study quantitative methods, including current analysis categories, to develop new research.
在欧洲、拉丁美洲和亚洲，多次就诊已成为管理不同医疗体系的一个复杂问题。然而，在当前文献中，很少有人关注从地域和批判性分析的角度来处理不明原因的症状。本研究的目的是分析智利初级医疗体系（PHCS）中患者多次就诊或高频就诊现象背后的社会结构因素。
本文呈现的是作为一项探索性研究一部分所收集的定性数据，该研究在智利圣地亚哥、瓦尔帕莱索和康塞普西翁三个大都市区采用了混合方法。该研究从家庭医疗中心招募了24名来自初级医疗行政和管理岗位的受试者作为样本，这些受试者来自低、中、高阶层的城市市政区域。该研究在一年时间里通过一组半标准化访谈收集数据，并使用定性内容分析法进行数据分析。
本文表明，多次就诊的患者给管理提供了一个当前生物医学模式无法涵盖的关键临床类别。数据显示了一种躯体形式类别的压力，尤其是在临床和认识论实践中。确切地说，智利这种混合医疗体系案例的相关性及其影响：将集体问题当作个体问题处理的自然化。
研究结果可为医疗专业人员和管理人员制定基于地域的实用方法提供参考。我们得出结论，智利的高频就诊和多次就诊揭示了该地域相关的分层情况。这些特殊性为研究定量方法（包括当前的分析类别）以开展新研究提供了契机。
