De la previsión a la urgencia: relevamiento de los servicios de salud
Una investigación de la Facultad de Ingeniería obtuvo información indispensable sobre los recursos humanos, equipamiento e infraestructura de las instituciones de salud
Diego Kadur, es bioingeniero, tiene una Maestría en Gestión de Sistema y Servicios de Salud, ejerce la docencia y la investigación en la Carrera de Bioingeniería
en la Facultad de Ingeniería (UNER) y trabaja en el sistema de salud. Un equipo de la Facultad de Ingeniería de la UNER, dirigido por Diego Kadur, inició una investigación en 2019 que buscaba generar información sobre recursos humanos, equipamiento e infraestructura en áreas de gestión de tecnologías sanitarias en instituciones de salud en Argentina. La pandemia convirtió sus resultados en indispensables.
En Argentina, la producción de información en el campo de los Recursos Humanos en salud (RRHHS) es fragmentaria y dispersa y muchas veces con duplicaciones y ausencias de datos principales. Por eso un grupo de investigadores de la Facultad de Ingeniería comenzó a trabajar en una encuesta para relevar información sobre recursos humanos, equipamiento e infraestructura en Áreas de Gestión de Tecnologías Sanitarias (GTS) en instituciones de salud de nuestro país.
“Como ocurre en muchas áreas relacionadas con la medicina y en particular en el área de la GTS, la información sobre las que se sustentan las políticas de salud, es muchas veces parcial, incompleta o inexistente. En ese momento, se desconocían indicadores absolutos como números de camas de internación, de resonadores, entre muchos otros, que son determinantes para la toma de decisiones en el sistema de servicios de salud”, explicó Kadur.
Según el Registro Federal de Establecimientos de salud (REFES), en Argentina están registrados 944 establecimientos con terapia intensiva y terapia intensiva especializada y el número de camas no está declarado en muchos casos.
Siguiendo los datos obtenidos por la investigación de Kadur, el 57% de las organizaciones de salud declaran poseer formalmente un área encargada de la GTS dentro de la institución. En el 80% de ellas, la persona responsable es un Bioingeniero o Ing. Biomédico. Estos, con respecto a recursos humanos y sus funciones, tienen una participación del 32% en alguna de las etapas de la gestión de compra de nuevos equipos.
Los datos provinieron mayoritariamente de instituciones estatales, pero también algunas privadas de 16 provincias y/o ciudades participantes: Tierra del Fuego, Buenos Aires, CABA, Córdoba, Corrientes, Entre Ríos, La Rioja, Mendoza, Neuquén, Río Negro, Salta, San Juan, San Luis, Santa Fe, Tucumán y Misiones.
“Fue muy difícil conseguir los datos porque esta encuesta era con invitación previa. Existía un abismo desde nuestro punto de inicio a conseguir los datos de quienes eran nuestros colegas o gente que estuviera gestionando dentro los lugares que apuntamos”, contó el especialista. El 60 o 66% de esos lugares está entre Capital Federal y provincia de Buenos Aires y no tienen datos institucionales disponibles. Tampoco las mismas asociaciones de clínicas, de federaciones y gobiernos, ni el mismo Sistema Integrado de Información Sanitaria Argentino (SISA) tienen nombres, teléfonos y direcciones actualizados, lo cual dificulta mucho su indagación.
«Afectó y afecta»
Días antes de presentar el informe final, la emergencia sanitaria provocada por el Covid-19 cambió ineludiblemente el carácter de la investigación: sus resultados pasaron de ser necesarios a urgentes. Si bien explican que los datos no son extrapolables a la situación actual, éstos muestran cuáles son los desafíos a enfrentar si la cantidad de casos siguen aumentando y la importancia de contar con datos genéricos que puedan servir como insumo.
“Lo vimos los primeros meses de la pandemia. Si no sabes cuantas camas y recursos humanos tenes, tampoco sabes qué capacidad de atención tiene el sistema sanitario. Por ello el gobierno salió a comprar, encargar y captar el mercado. Sin caer en obviedades, si vos no sabes cuantos respiradores tenes en cada lugar tanto a nivel nacional tampoco sabes cuántos te faltan”, explicó Kadur.
Asimismo, remarcó la importancia de continuar investigando sobre los datos que están disponibles, a sabiendas que esta situación continuará proveyendo problemas a estudiar y solucionar: “Afectó y afecta a la totalidad de nuestro país. De estas experiencias nos hemos nutridos de evidencia científica local e internacional, lo que permite pensar los siguientes pasos priorizando el cuidado integral de la salud de la población argentina”.
“Sí son mayores las condiciones en este momento de lo que era previo a la pandemia en 2019. Hay al menos más gente cumpliendo este tipo de funciones, no sé si formalmente como áreas”, comentó. Algunas de estas incorporaciones fueron asociadas al contexto de ampliaciones de terapia o la creación de terapias donde no había. Asimismo “salió la adhesión de la provincia a la Ley 26906, que es el marco para que se regularicen las áreas de GTS, y se presentó un proyecto desde el Colegio de Ingenieros Especialistas de Entre Ríos (CIEER) para la creación de nuevas áreas”, contó Kadur.
No obstante, las potencialidades reales -y esperanzadoras- están sujetas a las limitaciones de un contexto político y socio-económico complicado y de gran incertidumbre, tanto local como nacional. “Es difícil aventurarse a decir qué pasará si no existe una clara planificación. Sé que tanto en Entre Ríos como el resto del país se ampliaron áreas de Unidades de cuidados intensivos (UTI) y se crearon salas nuevas, se incorporó gente y hay hospitales que se han ampliado y modernizado. Aunque no sé cómo van a continuar, no tengo contactos directos para saber si se creó un área nueva o no o cómo continuarán trabajando”.
Constantemente aumenta la urgencia de actualizar y adecuar las funciones esenciales para proteger y mejorar el cuidado de toda la población y con ello la necesidad de defender y sostener el compromiso con la salud pública. Reforzar estas funciones esenciales para afrontar los desafíos actuales y futuros es un modo de fortalecer los sistemas de salud y sostener el acceso universal y efectivo de la sociedad.
Durante la investigación, se contactaron con algunas áreas del ministerio de Salud de la Nación y con el presidente de la Sociedad Argentina de Terapia Intensiva, quien tiene relación con estas casi mil instituciones de terapias y prometió difundir la encuesta entre estas terapias. También, se reunieron con la ministra de salud de E.R. y gente del gabinete que habían iniciado un proyecto paralelo de relevamiento de hospitales: “Se interesaron para compartir datos, aunque eran de otros tipos, pero tal vez nos servían mutuamente”.
Por otro lado, están comenzando una nueva investigación sobre el aumento que hubo por los casos de Covid-19 en la zona, estudiarán el consumo de oxígeno y las tecnologías asociadas a su implementación. Su objetivo es introducir mejoras en la gestión y aplicación de las tecnologías médicas, como también lograr una reducción de los costos asociados al consumo de este medicamento.
El proyecto está conformado por: Mgr. Bioing. Diego O. Kadur El Ainie, Mg. Bioing. Claudia E. Bonell, Estud. Andrés R. Oiene, Estud. María J. Villavieja, Ing. José M. Flores, Bioing. Mónica Baroli, Bioing. Jorge F. Bellmann, Bioing. Fernando R. Aguirre, Bioing Rosa M. Weisz, Bioing. Emilce Preisz, Estud. Solange Milesi.
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