Barreras y facilitadores en el acceso a la salud: un análisis coyuntural de la donación y trasplante de organos en Colombia
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2020
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Objetivo: Caracterizar facilitadores y barreras de acceso a la salud en la literatura global, y Red Nacional de Donación y Trasplante de Órganos en Colombia.
Métodos: Revisión de la literatura, publicada entre 2010-2020, En: ProQuest, ScienceDirect, ClinicalKey, Sage Journals, PubMed, Scielo, y Scopus. Se analizaron datos de la plataforma virtual (RedDataINS) e informes anuales de actividad de donación y trasplante de órganos del Instituto Nacional de Salud de Colombia (INS), identificando facilitadores y barreras al acceso a la salud basados en el Modelo de clasificación de Tanahashi, y el Modelo Socio-Ecológico (SEM), presentes en la literatura global y en la Red de Donación y Trasplante de Órganos Colombiana.
Resultados: Se seleccionaron 49 de 159 artículos científicos y 17 documentos de literatura gris, identificando 83 facilitadores distribuidos en el SEM. Se clasificaron 152 barreras bajo el modelo de cobertura de Tanahashi, subdividido en 4 dimensiones efectivas: 53,2% de aceptabilidad, 30,9% de disponibilidad, 13,1% de accesibilidad, y 2.6% de contacto. En Colombia se identificaron 7 facilitadores con igual distribución y 17 barreras, siendo la de la aceptabilidad la más prevalente con un 64,7%.
Conclusiones: Globalmente las barreras están relacionadas con factores asociados a la aceptabilidad y disponibilidad, hallazgos extrapolables al contexto nacional. Los facilitadores se relacionan con: capacitación interdisciplinaria del personal, promoción de campañas de concientización en medios de comunicación, e incentivación del debate en todos los niveles del SEM. En Colombia, las principales barreras se subdividen en dos categorías: el sistema de creencias individuales y las limitaciones estructurales del sistema.
Descripción
Abstract
Objective: During last decade in Colombia, there was a low organ transplantation index despite the existing current national legislation. Given the above, main objective is the characterization of the barriers to access and the facilitators described in the Colombian National Network of donation and Transplantation of Organs, carrying out a contrast of the findings obtained in the global literature.
Methods: A narrative review of national and international qualitative, quantitative scientific literature and grey literature, published between 2010 and 2020, found in the following databases: ProQuest, ScienceDirect, ClinicalKey, Sage Journals, PubMed, Scielo and Scopus.
Furthermore, the data published in the Colombian Health National Institute website (RedDataINS) and the administrative reports about organ donation and transplantation activities was analyzed, identifying either barriers and facilitators on health services access, based on the Tahanashi’s Qualifier model and the Socio-ecological Model (SEM), upon the global literature and in the Colombian Donation & Transplantation Network.
Results: The selection of 49 of 159 scientific articles and 17 grey literature documents was made. Upon these articles, there were identified 83 facilitators classified under the SEM Qualifier Model. Besides, 152 barriers were classified under the Tanahashi Health Coverage System, subdivided in 4 effective dimensions: 53.2% belongs to acceptability, 30.9% to availability, 13.1% to accessibility, and 2,6% belongs to contact. Likewise, in the Colombian Donation & Transplantation Network were distinguished 7 Facilitators and 83 barriers assorted in the Tanahashi’s dimensions, where the acceptability barrier was the most found variable, corresponding to the 64.7% of the results.
Conclusions: The worldwide findings show that either acceptability and availability are the most prevalent barriers. And these findings are also shown in Colombian context. Otherwise, the main facilitators found are related to: The high level of training among all types of healthcare professionals, the mainstream promotional campaigns and promoting the donation and transplantation debate on all SEM categories. Also, in Colombia, the barriers may be divided into two main categories: Those related to the own-belief system of the people, and those associated with own structure issues of the system.
Palabras clave
Donación de órganos, Trasplante de órganos, Acceso a salud, Barreras de acceso, Facilitadores de acceso, Cobertura en salud, Percepciones familiares
Keywords
Facilitators, Barriers to occess of health services, Tissue and organ procurement, Effective access to health services, Family perceptions