«En los centros de salud no debería haber listas de espera», dicen los médicos de familia

Sala de espera del área de urgencias en el centro de salud de Puerta la Villa, en Gijón. / PALOMA UCHA
Sala de espera del área de urgencias en el centro de salud de Puerta la Villa, en Gijón. / PALOMA UCHA

Aplauden la «refundación de la Atención Primaria» que prevé el Ministerio de Sanidad con su plan estratégico, pero echan en falta financiación

LAURA MAYORDOMO GIJÓN. Viernes, 19 abril 2019, Dierio «El Comercio»

El Marco Estratégico de Atención Primaria diseñado por el Ministerio de Sanidad para potenciar los centros de salud ha cosechado el visto bueno de las sociedades de medicina de familia y pediatría de Asturias. Sus presidentes reconocen que se trata de «un buen marco conceptual» que ahora habrá que desarrollar. Señalan, eso sí, algunos puntos débiles en el documento. El primero, el hecho de que no se incluya en él referencia alguna al coste de las seis líneas estratégicas, 23 objetivos y cien medidas que se pretenden aplicar de aquí a 2022. Tampoco a su financiación. «Es la gran debilidad del plan. Las buenas intenciones están bien, pero sin financiación tienen una viabilidad dudosa», opina el presidente nacional de la Sociedad Española de Medicina de Familia y Comunitaria (Semfyc), el ovetense Salvador Tranche, médico de familia en El Cristo.

José Ignacio Pérez Candás, presidente de la Asociación de Pediatría de Atención Primaria (Aepap) en Asturias, señala otro «punto flaco»: la escasez de médicos. Disponer de recursos humanos es fundamental, considera, para cumplir objetivos como el de reducir los cupos a 1.500 cartillas en el caso de los médicos de familia y a mil, en el de los pediatras. Una cifra que «siempre hemos reivindicado desde la sociedad asturiana y la nacional», recuerda. «El problema es la falta de profesionales, sobre todo en pediatría. A ver de dónde los van a sacar. Ese es a mi juicio el gran desafío del plan estratégico», añade.

En Asturias, apunta Manuel Fernández Barrial, presidente de la Sociedad Española de Médicos de Atención Primaria (Semergen), pese a que el límite de los 1.500 pacientes «se cumple más o menos, salvo en zonas urbanas de Oviedo, Gijón y Avilés», sigue habiendo un reparto dispar, «con médicos con doscientas o trescientas cartillas y otros dos mil». Este médico adscrito al consultorio periférico de Blimea reclama «profesionales y más recursos» para los centros de salud, que como «primer eslabón» de la cadena sanitaria que son, «no deberían tener lista de espera». Y lo dice porque precisamente una de las medidas que Sanidad pretende aplicar este mismo año es que las consultas no urgentes puedan atenderse en un máximo de 48 horas. «Que se le pueda ver en el día es lo adecuado, aunque hay consultas, como las que se piden para ir a por una receta, que se podrían demorar más sin problema», opina.

A Tranche la propuesta tampoco le parece mal. De hecho, entiende que los pacientes la aplaudan. Pero señala que puede entrañar riesgos. «¿Cómo se va a hacer?», se pregunta, «¿forzando las agendas?». La consecuencia directa en ese caso, señala, sería que los médicos tendrían aún menos tiempo para dedicar a cada paciente. De ahí la necesidad de que «las plantillas se dimensionen adecuadamente y además se contemplen cambios organizativos» que permitan por ejemplo eximir a los médicos de ciertas tareas administrativas y dar más peso a la enfermería, apunta.

«Es imposible»

En el sindicato médico son mucho más críticos en su análisis de la estrategia. «Son medidas que sobre el papel quedan bien, pero si no las dotas de presupuesto resultan utópicas», opina Javier Alberdi. Dice el presidente del Simpa que «lo de las 48 horas es imposible» salvo que se cuente con más personal, «pero, ¿de dónde lo van a sacar si no hay recambio ni para los que se van a jubilar?».

Para Pérez Candás hay cuestiones más importantes que el tiempo en que se consigue cita para una consulta que no es urgente. «La salud es mucho más que el hecho de que te vea un médico. De hecho, la Atención Primaria volvería a fracasar si vuelve a centrarse en lo inmediato y no se detiene en cuestiones como la prevención o la atención comunitaria», remarca insistiendo en la necesidad de que los ciudadanos «sean corresponsables de su salud». Es básico, anota, que los médicos de familia tengan tiempo para salir de los centros de salud, para potenciar la educación sanitaria mediante conferencias. Ahora es imposible «porque las agendas nos comen». «No hacemos nada más que asistencia», coincide Tranche.

El presidente de la Semfyc ve un avance en que el ministerio plantee que los contratos a los residentes que finalizan su formación tengan una duración de dos años y se circunscriban a un área sanitaria concreta. Por un lado «garantiza su estabilidad» y, por otro, mejora la calidad de la asistencia al paciente, destaca.

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