Evaluación económica de un programa de coordinación entre niveles para el manejo de pacientes crónicos complejos / Economic evaluation of a program of coordination between levels for complex chronic patients’ management

OBJETIVO: El programa del paciente crónico complejo (PCC) del Alt Penedès tiene por objetivo mejorar la coordinación asistencial. El objetivo del presente trabajo fue evaluar la relación entre los costes asociados al programa y sus resultados en forma de ingresos evitados. DISEÑO: Análisis coste-efectividad desde la perspectiva del sistema sanitario a partir de un estudio antes-después. Emplazamiento: Comarca del Alt Penedès. MEDICIONES PRINCIPALES: Los resultados en utilización de servicios hospitalarios (ingresos, urgencias, hospital de día) y visitas de primaria del programa PCC se compararon con los anteriores a su implementación. El coste asignado a cada recurso correspondió al concierto del hospital con CatSalut y las tarifas del ICS para atención primaria. Se llevó a cabo un análisis de sensibilidad a partir del método de bootstrapping. La intervención se consideró coste-efectiva si la ratio coste-efectividad incremental (RCEI) no superaba el coste de un ingreso (1.742,01 Euros). RESULTADOS: Se incluyó a 149 pacientes. Los ingresos se redujeron de 212 a 145. El RCEI fue 1.416,3 Euros (94.892.9 Euros/67). El análisis de sensibilidad mostró que en el 95% de los casos los costes podrían variar entre 70.847,3 Euros y 121.882,5 Euros, y los ingresos evitados entre 30 y 102. En el 72,4% de las simulaciones el programa fue coste-efectivo. CONCLUSIONES: El análisis de sensibilidad muestra que en la mayoría de situaciones el programa del PCC sería coste-efectivo, aunque en un porcentaje de casos el programa podría suponer un aumento global del coste de la atención, a pesar de suponer siempre una reducción en el número de ingresos

OBJECTIVE: The complex chronic patient program (CCP) of the Alt Penedès aims to improve the coordination of care. The objective was to evaluate the relationship between the costs associated with the program, and its results in the form of avoided admissions. DESIGN: Dost-effectiveness analysis from the perspective of the health System based on a before-after study. LOCATION: Alt Penedès. MAIN MEASUREMENTS: Health services utilisation (hospital [admissions, emergency visits, day-care hospital] and primary care visits). CCP Program results were compared with those prior to its implementation. The cost assigned to each resource corresponded to the hospital CatSalut's concert and ICS fees for primary care. A sensitivity analysis using boot strapping was performed. The intervention was considered cost-effective if the incremental cost-effectiveness ratio (ICER) did not exceed the cost of admission (Euros 1,742.01). RESULTS: 149 patients were included. Admissions dropped from 212 to 145. The ICER was Euros 1,416.3 (94,892.9 Euros/67). Sensitivity analysis showed that in 95% of cases the cost might vary between Euros 70,847.3 and Euros 121,882.5 and avoided admissions between 30 and 102. In 72.4% of the simulations the program was cost-effective. CONCLUSIONS: Sensitivity analysis showed that in most situations the PCC Program would be cost-effective, although in a percentage of cases the program could raise overall cost of care, despite always reducing the number of admissions

[Economic evaluation of a program of coordination between levels for complex chronic patients' management]. / Evaluación económica de un programa de coordinación entre niveles para el manejo de pacientes crónicos complejos.

OBJECTIVE: The complex chronic patient program (CCP) of the Alt Penedès aims to improve the coordination of care. The objective was to evaluate the relationship between the costs associated with the program, and its results in the form of avoided admissions. DESIGN: Dost-effectiveness analysis from the perspective of the health System based on a before-after study. LOCATION: Alt Penedès. MAIN MEASUREMENTS: Health services utilisation (hospital [admissions, emergency visits, day-care hospital] and primary care visits). CCP Program results were compared with those prior to its implementation. The cost assigned to each resource corresponded to the hospital CatSalut's concert and ICS fees for primary care. A sensitivity analysis using boot strapping was performed. The intervention was considered cost-effective if the incremental cost-effectiveness ratio (ICER) did not exceed the cost of admission (€ 1,742.01). RESULTS: 149 patients were included. Admissions dropped from 212 to 145. The ICER was €1,416.3 (94,892.9€/67). Sensitivity analysis showed that in 95% of cases the cost might vary between €70,847.3 and €121,882.5 and avoided admissions between 30 and 102. In 72.4% of the simulations the program was cost-effective. CONCLUSIONS: Sensitivity analysis showed that in most situations the PCC Program would be cost-effective, although in a percentage of cases the program could raise overall cost of care, despite always reducing the number of admissions.

Impacto en la función de los músculos del suelo pélvico de un programa de entrenamiento específico incluido en el control habitual del embarazo y el posparto: ensayo clínico controlado no aleatorizado / Impact on the function of the pelvic floor muscles of a specific training program

OBJETIVO: Evaluar el impacto de un programa de entrenamiento de los músculos del suelo pélvico (EMSP) durante el embarazo y después del parto. PERSONAS Y MÉTODO: Ensayo clínico no aleatorizado, abierto, en el que se evaluaron los cambios en la percepción de la incontinencia urinaria (IU) y la fuerza de los músculos del suelo pélvico (MSP). Se incluyó a las mujeres embarazadas controladas en dos centros de salud de Cataluña entre enero de 2008 y febrero de 2009, desde la semana 20 del embarazo hasta la 12 del posparto. La intervención constó de 3 fases: información, valoración y entrenamiento de los MSP. Como instrumentos de medición se utilizaron el tacto muscular vaginal (TMV) a partir de la escala de Oxford modificada, la perineometría y el ICIQ-SF. RESULTADOS: Se incluyeron 55 mujeres en el grupo intervención y 55 en el control. Al comparar los resultados entre ambos grupos, se observó mayor fuerza muscular en el grupo intervención respecto al control, tanto medida a través del TMV (> 3: 58,2 frente al 36,4%; p <0,01) como de la perineometría (máxima: 41,3 frente a 31,6 [p = 0,01]; tiempo de contracción: 11,6 frente a 9,4 [p= 0,01]). Sin embargo, no se observaron diferencias estadísticamente significativas en la percepción de IU, aunque los valores fueron mejores en el grupo intervención (ICIQ-SF = 0: 92,7 frente al 81,8%; p = 0,11). CONCLUSIONES: El EMSP incorporado a la práctica habitual en el control del embarazo y el posparto mejora la fuerza de los MSP sin necesidad de visitas adicionales. La incorporación de los EMSP por parte de las matronas de atención primaria podría contribuir a mejorar la calidad de vida de las mujeres después del parto

OBJECTIVE: Assess the impact of a training program for the muscles of the pelvic floor (PFM) during pregnancy and after childbirth. SUBJECTS AND METHOD: Non-randomised open clinical trial in which changes were evaluated in the perception of urinary incontinence (UI) and the strength of the PFM. Pregnant women controlled in a two health centers in Catalonia were included between January 2008 and February 2009, from week 20 of pregnancy and up to 12 postpartum. The intervention consisted of three steps: information, evaluation and training of the PFM. As instruments of measuring we used the vaginal muscle touch (VMT) according the Modified Oxford Scale, the perineome try and the ICIQ-SF. RESULTS: 55 women were included in the group intervention and 55 in the control group. Comparing the results between the two groups, was observed more muscle strength in the intervention group regarding the results of the VMT (> 3: 58.2% vs. 36.4%; p <0.01) and the perineometry (maximum: 41.3 vs. 31.6 [p= 0.01]; time of contraction: 11.6 vs. 9.4 [p = 0.01]). However, there were not statistically significant differences in UI perception though the values were better in the intervention group (ICIQ-SF = 0: 92.7% vs. 81.8%; p = 0.11). CONCLUSIONS: A training program of the PFM incorporated into routine practice of the control of pregnancy and postpartum improves the strength of the PFM without the need for aditional visits. The incorporation of the training program of PFM by midwives on primary care could help to improve the quality of life of women after childbirth

An approach to the study of potentially preventable nosocomial infections.

OBJECTIVE: To analyze a method that identifies potentially preventable nosocomial infections, as a tool to evaluate the performance of infection control programs through quantification of their potential for reducing nosocomial infections. METHODS: The database of the Study of the Prevalence of Nosocomial Infections in Spain (EPINE) was reanalyzed. The method was based on the use of false negatives of the classification table obtained from application of a fixed multiple logistic regression model, as an estimator of the number of potentially preventable nosocomial infections. RESULTS: The calculated number of patients with preventable infections was 7,493, which constituted 21.6% of the infected patients. Among hospital areas, intensive care had the lowest preventability rate (4.6%), whereas gynecology and obstetrics had the highest (40.6%). There was a significant inverse exposure-effect relationship between the proportion of preventable infections and the National Nosocomial Infections Surveillance (NNIS) System risk index. No correlation was observed between the prevalence of patients with nosocomial infection and the percentage of preventable infections. CONCLUSION: This analysis suggests that fewer nosocomial infections may be preventable in Spanish hospitals than previously assumed.

[Influenza vaccine and health-care workers: strategies to achieve compliance in a tertiary hospital]. / Vacuna antigripal y personal sanitario: estrategias para aumentar las coberturas en un hospital de tercer nivel.

BACKGROUND: The effectiveness of immunization of health-care workers (HCWs) to reduce nosocomial transmission of influenza is well established. The objective of this study is to evaluate HCWs vaccination rates in a tertiary hospital. PATIENTS AND METHOD: Data of influenza immunization rates among HCWs during two consecutive campaigns have been examined. A descriptive analysis of coverage by age, sex, occupation and job areas is performed. RESULTS: Vaccination rates ranged from 12.7 to 14.7%. Vaccine acceptance among medical residents was significantly higher than in other occupation categories (31.5 and 25.5%, respectively). HCWs at maternal and pediatric areas showed higher immunization rates. CONCLUSIONS: Despite active immunization campaigns, influenza vaccination rates among HCWs are quite low.

Vacuna antigripal y personal sanitario: estrategias para aumentar las coberturas en un hospital de tercer nivel / Influenza vaccine and health-care workers: strategies to achieve compliance in a tertiary hospital

FUNDAMENTO: La efectividad de la inmunización del personal sanitario en la reducción de la transmisión nosocomial del virus influenza es un hecho bien documentado. El objetivo de este estudio es analizar las coberturas de vacunación antigripal en el personal sanitario de un hospital de tercer nivel. SUJETOS Y MÉTODO: Se analizan los datos de dos campañas sucesivas de vacunación y se realiza un análisis descriptivo de las coberturas según edad, sexo, categoría laboral y área de trabajo. RESULTADOS: Las coberturas alcanzadas han sido del 12,7 y del 14,7 por ciento, respectivamente. Los médicos residentes son el colectivo profesional con mayor aceptación de vacunación (coberturas del 31,5 y el 25,5 por ciento, respectivamente), así como el personal que trabaja en el área Maternoinfantil. CONCLUSIONES: La cobertura de vacunación antigripal en el personal sanitario es muy baja a pesar de la utilización de estrategias de inmunización activa. (AU)