Frecuencia y pertinencia del perfil lipídico como examen inicial en vértigo periférico / Lipid profile frequency and relevancy as an initial test for peripheral vertigo

Objetivos Determinar la prevalencia de la solicitud del perfil lipídico como ayuda diagnóstica de primera línea en pacientes con impresión clínica de vértigo periférico, así como un análisis de la relación costo-beneficio de dicha solicitud. Métodos Estudio de tipo corte transversal retrospectivo. Revisión de 201 historias de pacientes atendidos en la consulta externa tanto de especialistas como de médicos generales de la Clínica Universitaria Teletón y Casa chía, con diagnóstico de vértigo periférico, en el periodo comprendido entre enero de 2005 y julio de 2008. Resultados Las edades de los pacientes oscilaron entre 6 y 87 años, el 36 % de sexo masculino y el 64 % femenino. El perfil lipídico fue solicitado como prueba diagnóstica inicial para el manejo de vértigo a un 76 % de los pacientes. Los perfiles lipídicos hallados fueron normales en el 80 % de los pacientes a quienes se les solicitó. Se presenta el análisis de la relación costo-beneficio de esta prueba. Conclusiones Existe una alta prevalencia de solicitud de perfil lipídico como estudio de primera línea en el abordaje de pacientes con vértigo periférico, aunque no existe evidencia que avale esta solicitud, se requiere retroalimentación al cuerpo médico tanto de atención primaria como especialistas.

Objective Determining the prevalence of requesting lipid profile as a first-line diagnostic method in patients having a clinical impression of peripheral vertigo and also determining such request's cost- benefit ratio. Methods This was a retrospective cross-sectional study of 201 clinical charts regarding patients diagnosed as having peripheral vertigo at the Teletón teaching hospital's outpatient services in Chía between January 2005 and July 2008. Clinical charts drawn up by both general practitioners and medical specialists at first-time visit were compiled and analyzed Results The patients were aged 6 to 87 years old; 36 % were males and 64 % females. Lipid profile was requested for 76 % of the patients as initial diagnostic method; it was found that 80 % of the results revealed no abnormality. Conclusion Although a high prevalence regarding a request for lipid profile first-line study was found for patients having peripheral vertigo, there was no scientific evidence supporting such requirement. Ordering this kind of study not only increases unnecessary costs concerning diagnostic methods but also involves unjustified treatment. Feedback is needed for both doctors and first attention staff to ensure that this type of practice becomes changed.

Fraturas do fêmur proximal no idoso: estudo de custo da doença sob a perspectiva de um hospital público no Rio de Janeiro, Brasil / Hip fractures in the elderly: cost of illness study in a public hospital perspective, Rio de Janeiro, Brazil

O artigo visa a estimar o custo direto médico do tratamento hospitalar de pacientes idosos com fraturas de fêmur proximal, no Hospital Municipal Lourenço Jorge, na cidade do Rio de Janeiro. Estudo observacional, prospectivo, para estimar a utilização de recursos e custos diretos médicos associados à hospitalização por fratura de fêmur proximal em idosos, em 2007 e 2008, sob a perspectiva do prestador de serviços. Foi utilizado um instrumento de coleta de dados através do qual foram registrados recursos identificados na revisão prospectiva dos prontuários. Aos recursos utilizados foram atribuídos custos em reais (R$) baseando-se em valores do ano 2010. Foram realizadas análises descritivas dos custos e utilização de recursos, bem como avaliada a associação de variáveis clínicas e demográficas com o custo final observado. Foram incluídos 82 pacientes, 81,7 por cento do sexo feminino, idade média de 76,96 anos, hospitalização média de 12,66 dias. A mediana de custo por paciente foi de R$ 3.064,76 (IC95 por cento: 2.817,63 a 3.463,98). Hospitalização clínica e procedimento cirúrgico foram responsáveis por 65,61 por cento e 24,94 por cento dos custos, respectivamente. Pacientes submetidos ao tratamento cirúrgico até o quarto dia de hospitalização apresentaram mediana de custos menor do que pacientes submetidos após o quarto dia (R$ 2.136,31 e R$ 3.281,45, p<0,00001). Observou-se também diferença significativa nos custos finais por tipo de procedimento cirúrgico realizado. O custo do tratamento das fraturas de fêmur proximal no idoso foi significativamente maior nos pacientes submetidos à cirurgia após o quarto dia de hospitalização. Hospitalização clínica e procedimento cirúrgico foram os principais componentes do custo final observado.

This paper aims to assess direct medical costs associated to hospital treatment of hip fractures in the elderly in the Municipal Hospital Lourenço Jorge (HMLJ), Rio de Janeiro. Observational, prospective study to assess resource utilization and direct medical costs associated to elderly hip fracture hospitalization in 2007 and 2008, under the health care provider perspective. A standard data collection instrument was used to register identified resources during prospective medical charts review. The resource utilization was converted into Brazilian Real (R$), based on 2010 prices. Descriptive analysis of costs and resource utilization and their association with clinical and demographic variables were performed. Eighty two patients were included, 81.7 percent female, mean age of 76.96 years, hospitalization mean time of 12.66 days. Median total costs per patient were R$ 3,064.76 (IC95 percent: 2,817.63 - 3,463.98). Clinical hospitalization and surgical procedure were responsible for 65.61 percent and 24.94 percent of costs, respectively. Median costs for patients submitted to surgical procedure until the fourth day of hospitalization were lower than median costs for patients submitted after the fourth day (R$ 2,136.45 and R$ 3,281.45, respectively, p<0.00001). A significant difference in average costs per type of surgical procedure was also observed. Cost associated to inpatient treatment of hip fractures in the elderly was higher in patients who performed surgery after the fourth day of hospitalization. Clinical hospitalization and surgical procedure were the main cost components observed.

Consumo de antidepresivos en Chile entre 1992 y 2004 / Consumption of antidepressants in Chile from 1992 to 2004

Background: Data from the Ministry of Health show that in Chile in 2004, 17 percent of the population had some form of depression and mood disorders are the tenth cause of disability-adjusted Ufe years (DALY) loss. Aim: To determine consumption of antidepressants (ADs) in Chile from 1992 to 2004. Material and methods: National sales data were obtained from the company IMS Health Chile and converted into defined daily doses (DDDs) per 1,000 inhabitants per day Available ADs were classified in four pharmacological groups (i.e., serotonin-norepinephrine reuptake inhibitors, SNRIs; selective-serotonin reuptake inhibitors, SSRIs; tricyclic antidepressants, TCAs; and others). Total economic burden of ADs utilization and cost per DDDs were also calculated. Trends over time were analyzed using Pearson-R2. Results: Total ADs consumption in Chile measured by DDDs per 1,000 inhabitants per day (DHD) increased linearly (y =0.901x+1.9129; R2 =0.9296; p <0.001) from 2.5 in 1992 to 11.7 in 2004 (total growth of 470.2 percent). SSRIs were the drug class with higher consumption, and fluoxetine the most commonly consumed antidepressant. SSRIs were the drugs that dominated the market representing 79 percent of the total drug consumption throughout the years. Total economic burden of ADs in Chile (total cost of DDDs consumed) increased from US$65.4 million in 2001 to US$74.6 million in 2004 (14 percent increase). Average cost per DDD of all AD increased linearly, however not significantly from US$ 0.94 in 2001 to US$ 1.04 in 2004 (y =0.0362x+0.8784; R2 =0.7382; p =0,262). Conclusions: DDDs per 1,000 inhabitants per day increased linearly over 470 percent from 1992-2004. SSRIs were the most commonly consumed drugs in Chile. Future research should evaluate the cost-effectiveness of antidepressants in Chile, comparing the results with drug utilization, and determining if unnecessary expenditures have been paid out.

It is time to wash the linen.

The unethical practice of commissions in private healthcare requires an open debate since it leads to expensive and hazardous healthcare. Doctors are accused of being sales agents and law breakers, private hospitals resemble luxury hotels, the consumer has become fair game whenever he/she has money, and our profession and society are rendered insensitive to human suffering. At the root of this malaise is the unplanned promotion of healthcare as a free market product. This very complex product, which is required in times of stress and vulnerability, has been institutionalized as a business for profiteering in the absence of adequate checks and balances. The product is inherently unsuited for the free market because the consumer cannot be king unless he is empowered to choose wisely. Not enough has been done to address this deficiency. Efforts are required to strengthen non-profit health facilities; to make the consumer wise and minimize her/his exposure to doctored health information. The present unethical practices of our profession are not the fault of doctors or the Medical Council of India, and punitive measures would be inappropriate. We should start with the creation of a government health website which educates the public about modern healthcare, and by regulating advertisement of health products. Since health personnel, officials and news media are directly benefited by the present malpractices, corrective will require consumer participation.

Quantificação do desperdício de medicamentos na prática clínica / Quantifying the drug waste in clinical practice

Objetivo: Analisar medicamentos, incluindo forma de apresentação e preço, visando adequar o produto comercializado à prática de prescrição médica e, conseqüentemente, reduzir gastos governamentais e pessoais.Métodos: Foi realizado um levantamento de drogas prescritas clinicamente incluindo nimesulida, paracetamol+ fosfato de codeína, cefalexina, amoxicilina, ciprofloxacino, omeprazol, loratadina e haloperidol. Foram relacionados o princípio ativo, a apresentação, a indicação terapêutica, a posologia, o tratamento administradoe os desperdícios financeiro e medicamentoso. A análise de custo dos medicamentos foi realizada comparando-se medicamentos genéricos com os de referência. Resultados: Nimesulida 100mg mostrou variação de preço sem torno de 60% em relação ao Nisulid®. Para cefalexina 500mg o custo variou de 37,5 a 62,2% comparado aoKeflex®. Amoxicilina 500mg apresentou variação de 36,5 a 58% do custo do Amoxil®. Para ciprofloxacino500mg o custo foi de 31 a 58,3% do valor do Cipro®. As variações para omeprazol 20mg foram de 52,3 e 67,1%do valor do Peprazol®. Loratadina 10mg variou seu preço de 57,2 a 65% do Claritin®. A apresentação denimesulida, paracetamol + fosfato de codeína, omeprazol, loratadina e haloperidol mostrou-se em desajusteà prescrição médica para as doenças ora associadas, refletindo em desperdício de dois a oito comprimidos evariação do prejuízo de R$ 0,32 a R$ 13,76. Conclusões: A apresentação da maioria dos medicamentosindicados no tratamento de doenças freqüentes na população está em desajuste com a prescrição médica, refletindo em desperdícios medicamentoso e financeiro. Isso confirma a necessidade da elaboração de estratégia para conscientização de indústrias, instituições e profissionais de saúde também na economia terapêutica medicamentosa.

The prescribing habits of doctors in a metropolitan city and economic consequences of such practices.

Four thousand prescriptions were studied to observe the prescription pattern and habit of the doctors practising in the city of Calcutta. Ten most common ailments were identified and their treatment and investigations were taken into account for judging the rationality of such action. Both, estimated rational prescription cost and actual cost of the prescription were determined to identify any cost variation between prescription written rationally and irrationally.