Out-of-pocket costs for patients with psoriasis in an outpatient dermatology referral service

Abstract Background: Psoriasis is a chronic disease that derives great costs to the health care system. In Colombia, due to deficiencies in this system, patients are more likely to incur in out-of-pocket expenses; money that has never been quantified in this country. Objectives: To quantify out-of-pocket expenses and to analyze their relation to patients' clinical and labor characteristics in a cohort of psoriatic patients. Methods: A single-center, cross-sectional study was performed, evaluating psoriasis patients. Results: A total of 100 psoriasis patients were analyzed. We identified that patients with higher dermatology life quality index and in phototherapy treatment were the ones that had higher out-of-pocket costs (p = 0.006 and 0.005, respectively). We found no correlation between out-of-pocket costs and occupational status, psoriasis area severity index or other types of treatment. The largest amount of money was used to buy medications and bus transportation with a maximum up to 440.50 and 528.60 USD, respectively. Among the 100 participants the total expense was 11131.90 USD in a 6-month period. Study limitations: Lack of measurement of the labor productivity and labor absenteeism secondary to sick leave. Conclusion: Out-of-pocket costs are similar with what was shown in previous studies. We found statistically significant differences for the DLQI in comparison with out-of-pocket expenses, regardless of the PASI level. Phototherapy treatment also had statistically significant differences in relationship with out-of-pocket expenses, when compared to other treatments, because it requires higher expenses in transportation, copayments, and alimentation during appointment assistance.

Factores asociados a eventosadversos en pacientes hospitalizadosen una entidad de salud en Colombia / Factors associated with adverse events in hospitalized patients in a health institution of Colombia

Introducción: los eventos adversos entendidos como un “daño o complicación no intencionadacausado por el tratamiento de una enfermedad que resulta en discapacidad, muerte o prolongaciónde la estancia hospitalaria y no obedece a la enfermedad o estado subyacente del paciente”ocurren de manera frecuente en los hospitales. Se ha evidenciado que un 50 % de los casos sonevitables, incrementan el costo del sistema de salud y producen discapacidad y muerte en algunospacientes. Este estudio constituye un punto de partida para la mejora de la calidad asistencial delos pacientes.Objetivo: determinar si algunos factores de riesgo, tales como el tipo de tratamiento, sexo, edady la estancia, se relacionan con la presencia de eventos adversos hospitalarios en instituciones desalud adscritas a una aseguradora en Antioquia y el Eje Cafetero (Manizales, Risaralda y Quindío)durante el segundo semestre de 2008. Metodología: se realizó un estudio de casos y controlesen pacientes hospitalizados con y sin eventos adversosdurante su estancia de julio 1 a diciembre 31 de 2008.Se utilizó prueba de chi cuadrado y un modelo logísticomultivariado. Resultados: entre los 21 219 pacientes atendidos enlas clínicas y hospitales de Antioquia y Eje Cafetero de la institución aseguradora, 6,8 % presentaron eventos adversos. Se observó que la edad mayor de 45 años, eltratamiento quirúrgico, la estancia en UCE, estancia en UCI y estancia general igual o superior a cinco días secomportaron como factores de riesgo asociados a eventos adversos hospitalarios. Conclusión: la presencia de eventos adversos hospitalarioses una situación común en los hospitales de Antioquia y Eje Cafetero.

Introduction: adverse events, understood as“unintentional complications or injuries caused by the treatment of a particular disease that resultin incapacity, death or prolonged intrahospital stay and that are not a consequence of the disease or the patient’s underlying status” occurfrequently in hospitals. It has been shown that 50 % of the cases of adverse events can be avoided,also increase the health system’s financial costs and produce incapacity and death in somepatients. This study might be the basis for the improvement of the quality of care in Colombia.Objective: To determine if some risk factors, such as type of treatment, gender, age and intrahospitalstay, are related with the presenceof intrahospital adverse events in some health institutions ascribed to a health insurance companyin Antioquia and Eje Cafetero (Manizales, Risaralda and Quindio) during the second semesterof 2008. Materials and methods: a case-control studywas performed in intrahospital patients with and without adverse effects during a six months (from July 1st to December 31st, 2008). A Chisquare test and a multivariate logistic model were used.Results: Of 21,219 patients were seen in clinics and hospitals from Antioquia and Eje Cafetero.6,8 % of these patients presented with adverse effects. It was observed that an age over 45years, surgical treatment, a stay in the SCU or the ICU, and a stay equal to or over five dayswere risk factors associated intrahospital adverseevents. Conclusion: the presence of adverse events isa common situation in hospitals from Antioquia and Eje Cafetero.