Costes directos de atención médica del pie diabético en el segundo nivel de atención médica / Direct costs in the management of diabetic foot

Introducción: Una de las complicaciones frecuentes de la diabetes mellitus es el pie diabético; su manejo oportuno define el futuro funcional del paciente y disminuye el gasto en la atención de estos pacientes. Objetivo: Analizar los costos directos en la atención de pacientes con pie diabético con base en la escala de Wagner. Material y métodos: Estudio transversal en pacientes con pie diabético en el que se analizaron los costes directos de la atención médica; se evaluaron días de hospitalización, estudios de laboratorio e imagen, debridaciones quirúrgicas, amputaciones menores y amputaciones mayores. En todo momento se conservó el anonimato de los participantes. Resultados: Se incluyeron 68 pacientes con pie diabético. De estos, 22 se eliminaron por tener expedientes clínicos incompletos, quedando finalmente 46 pacientes. Treinta y tres (72%) eran hombres, con una edad promedio de 59 años. Se observó incremento de los costos promedio/totales en forma ascendente desde el Wagner 1 al Wagner 5. Los costos directos más altos de hospitalización se atribuyeron a los costes día/cama y a las debridaciones quirúrgicas. Conclusiones: El incremento del coste de atención es directamente proporcional a la escala de Wagner. Este estudio constituye un punto de partida hacia la cuantificación de la carga económica del pie diabético en instituciones de seguridad social. La atención médica en estos pacientes es menor en el I nivel comparada con el II nivel de atención. El diagnóstico precoz disminuiría los costes de la atención de estos pacientes.

Introduction: Diabetic foot is one of the common complications of diabetes mellitus, early management defines the functional future of the patient and reduces the cost in attention. Objective: To analyze the direct costs of patients diagnosed with diabetic foot based on Wagner Scale. Material and methods: Cross-sectional study, in patients with diabetic foot; direct costs of medical care were evaluated: days of hospitalization, laboratory and imaging tests, surgical debridations, minor and major amputations were evaluated. At all times the anonymity of the participants was preserved. Results: There were 68 patients with diabetic foot, of these 22 were removed for having incomplete medical records, being included 46 patients: 33(72%) men, mean age 59 years-old. Ascending increase in average and total costs was observed, from 1 to 5 Wagner Classification. Direct costs were higher in day hospitalization and debridations compared to others. Conclusions: This study is a starting point for the quantification of the economic burden of diabetic foot in Social Security Institutions. A guide based treatment for diabetic foot whould lower direct costs for these patients. Medical attention costs in these patients are less in I Level Medical Facility compared with II Level.

Socio-economic inequalities in the financing of cardiovascular & diabetes inpatient treatment in India.

Background & objectives: Cardiovascular disease (CVD) and diabetes have become a leading threat to public health in India. This study examines socio-economic differences in self-reported morbidity due to CVD and diabetes, where people having these conditions seek care, how much households pay for and how they finance hospital treatment for these conditions. Methods: Data for this study are taken from the National Sample Survey Organization (NSSO) 60th round on ‘Morbidity and Health Care’ conducted between January and June 2004. Information from 2,129 and 438 individuals hospitalized for CVD and diabetes was analyzed. Results: The self-reported prevalence among adults was 12 per cent for CVD, 4 per cent (7% urban and 3% rural) for heart disease and 6 per cent (10% in urban and 4% in rural) for diabetes. Both self-reported CVD and diabetes appeared to afflict the wealthier more. The private sector was the main provider of outpatient and inpatient care for CVD and diabetes treatment, though the poor depended more on the public sector. Out-of-pocket payments (OOPS) for hospital treatment claimed a large share of annual household expenditures; 30 per cent for CVD and 17 per cent for diabetes. The OOPS share for diabetes treatment declined with increasing income. The majority of OOPS for hospital treatment paid by the poor was financed through borrowings. Interpretation & conclusions: The considerable financial strain which households, particularly the poor, face in treating CVD and diabetes is alarming. As the burden due to CVD and diabetes increases in India, more households will be subject to these financial strains and unfortunately, the economically vulnerable among them will be the worst affected. While primary prevention of these conditions need more emphasis, in addition, insurance schemes targeted at the poor like the RSBY have an important role to play in financially protecting vulnerable households.

Custo do diabetes mellitus tipo 2 no município de Piracicaba, SP / Cost of diabetes mellitus type 2 in Piracicaba, SP, Brazil

Com o objetivo de levantar o custo da assistência médica prestada pelo Sistema Unico de Saúde (SUS) a pessoas com Diabtes Mellitus (DM) tipo 2 no município de Piracicaba nos níveis primário, secundário e terciário, identificou-se, mediante aplicaçäo de formulário de entrevistas, os protocolos de rotinas e fluxos dos serviços de atençäo primária e sencudária dirigidos às pessoas com diagnóstico de DM tipo2, quantificando seus custos (a preços do SUS), e caracterizou-se pessoas hospitalizadas com DM como causa básica ou associada identificando seu custo de hospitalizaçäo (custo real obtido pela central de custos do hospital). Os resultados evidenciaram diferenças na organizaçäo de atendimento, nos procedimentos realizados, na avaliaçäo do controle metabólico e, consequentemente, nos respectivos custos da atençäo primária e secundária. A análise da incidência das hospitalizaçöes sugeriu a ocorrência de possíveis falhas no processo de atençäo e educaçäo da pessoa com DM pelas unidades primárias e secundárias de saúde, visto que a maioria das pessoas hospitalizadas por DM relatou ser usuária destes serviços. O envelhecimento do indivíduo com DM e o motivo da hospitalizaçäo esteve diretamente relacionado ao aumento no valor da internaçäo e no tempo de permanência hospitalar. A educaçäo em saúde enquanto medida de prevençäo do diagnóstico do DM é uma ferramenta importante para a reduçäo de custos para os serviços de saúde, portanto há a necessidade da sensibilizaçäo dos profissionais de saúde do nível de atençäo primário para a promoçäo de programas de educaçäo continuada em DM