Salud Pública de México (Jun 2004)
Factores asociados a la gestión de quejas contra médicos que laboran en hospitales del Instituto Mexicano del Seguro Social Factors associated with complaints against physicians working at Mexican Institute of Social Security hospitals
Abstract
OBJETIVO: Identificar los factores asociados a la gestión de quejas contra los médicos que trabajan en hospitales generales del Instituto Mexicano del Seguro Social. MATERIAL Y MÉTODOS: Se revisaron las quejas presentadas y los expedientes clínicos correspondientes, en los nueve hospitales de la Delegación Estado de México Oriente, del Instituto Mexicano del Seguro Social. Por cada expediente clínico con queja se seleccionaron como controles dos expedientes sin queja, de la misma unidad y servicio. Se buscaron asociaciones por medio de razón de momios y regresión logística. RESULTADOS: Se incluyeron 130 expedientes motivo de queja y 260 expedientes control. Se identificaron siete factores asociados a queja de 14 investigados: complicaciones durante la atención RM 2.8 (IC 95% 1.3-5.8), error diagnóstico RM 3.18 (IC 95% 1.7-5.6), utilización de estudios de gabinete RM 3.7 (IC 95% 1.2-11.3), información deficiente por parte del médico RM 2.64 (IC 95% 1.2-5.7), alta voluntaria RM 7.2 (IC 95% 2.2-23.6), falta de vigilancia durante la hospitalización RM 19.12 (IC 95% 2.2-162.6) y revisiones vaginales múltiples durante el trabajo de parto RM 5.17 (IC 95% 1.5-17.07). Hubo tendencia a la presentación de quejas cuando se reportaron: mala relación médico-paciente, deficiente atención del trabajo de parto, error terapéutico y diferimiento de cirugía, sin significancia estadística. CONCLUSIONES: Las quejas contra médicos de hospitales del Instituto Mexicano del Seguro Social en el Estado de México se asocian con aspectos técnicos en el diagnóstico y con la percepción del derechohabiente de recibir información y vigilancia deficientes durante la hospitalización.OBJECTIVE: To identify the factors associated with complaints of patients against physicians who work at general hospitals of the Mexican Institute of Social Security (MISS). MATERIAL AND METHODS: All the medical complaint files in a three-year period at the nine general hospitals of Mexico State MISS East District were examined. For each complaint filed, two control files were selected from the same hospital and clinical area. Associations were assessed using odds ratios and logistic regression. RESULTS: A total of 130 complaint cases and 260 controls were included. Seven out of 14 risk factors were selected: complications during hospitalization (OR 2.8, 95% CI 1.3-5.8), diagnostic error (OR 3.18, 95% CI 1.7-5.6), use of diagnostic tests (OR 3.7, 95% CI 1.2-11.3), insufficient information given by physicians (OR 2.64, 95% CI 1.22-5.7), voluntary hospital discharge (OR 7.2, 95% CI 2.22-23.6), lack of clinical monitoring during hospitalization (OR 19.12, 95% CI 2.25-162.6), and multiple vaginal revisions during labor (OR 5.17, 95% CI 1.5 17.07). Complaints were filed more often when there was a poor patient-physician relationship, deficient monitoring during labor, therapeutic error, and delay in surgery. Statistical significance was not attained. CONCLUSIONS: Complaints against Mexico State MISS hospital physicians were associated with diagnostic technical factors, as well as with the patients' perception of receiving deficient information and care during hospitalization
