ABSTRACT
OBJETIVOS: analizar el empleo de los test de detección rápida de antígeno estreptocócico en Pediatría de Atención Primaria (AP), su impacto en la prescripción de antibióticos y la reducción de costes del tratamiento antibiótico. MATERIAL Y MÉTODOS: estudio descriptivo transversal, en menores de 15 años atendidos en AP, en 24 centros de salud, desde abril de 2017 hasta febrero de 2018. Se elaboró un protocolo de utilización del test de detección rápida de antígeno estreptocócico (TDRS). Se incluyeron pacientes con escala Centor mayor o igual a 2 puntos. Se extrajeron del sistema de facturación de recetas datos del número de dosis diaria definida (DDD) e importe de antibióticos en dicha temporada, comparándose con el gasto en los 12 meses previos. RESULTADOS: se realizaron 819 TDRS. Resultaron positivos 250 (30,5%), negativos 557 (68%) y 12 no valorables (1,5%). Se prescribió antibiótico al 33% de los pacientes (todos los positivos, 18 negativos, 3 no valorables). En 539 pacientes (97%) con resultado negativo no se instauró antibiótico. El número de DDD total disminuyó en 21 960 (12%), de las cuales 19 023 (86,6%) corresponden a los antibióticos más utilizados (penicilinas, amoxicilina, amoxicilina-clavulánico y azitromicina). La reducción económica fue de 11 320 (12,5%) y el gasto en TDRS fue de 991 , lo que supone un ahorro de 10 329. CONCLUSIONES: la introducción del TDRS en consultas de Pediatría de AP ha permitido que se eviten un elevado número de tratamientos antibióticos. Su utilización ha demostrado ser eficiente en la optimización del consumo de antibióticos, consiguiendo reducir su utilización, evitar efectos adversos y reducir el gasto farmacéutico innecesario
OBJECTIVE: the aim of the study was to analyse the use of the rapid Streptococcus antigen detection test in primary care paediatrics, its impact on antibiotic prescription of and the associated decrease in antibiotic treatment costs. MATERIAL AND METHODS: we conducted a cross-sectional descriptive study in children aged less than 15 years managed in 24 primary care centres between April 2017 and February 2018. We developed a protocol for the use of the rapid strep test (RST). We included patients with a Centor score equal to or greater than 2 points. We collected data on the number of daily defined doses (DDDs) and amount antibiotics prescribed in the study period from the prescription billing system and compared it with the costs corresponding to the previous 12-month period. RESULTS: 819 TDRS were performed. The results were positive in 250 (30.5%), negative in 557 (68%) and inconclusive in 12 (1.5%). Antibiotics were prescribed to 33% of the patients (all patients with a positive test, 18 with a negative test and 3 with an inconclusive test). Antibiotherapy was not prescribed to 539 of the patients with a negative result (97%). The total number of prescribed DDDs decreased by 21 960 (12%), of which 19 023 (86.6%) corresponded to the most frequently prescribed antibiotics (penicillins, amoxicillin, amoxicillin-clavulanic acid and azithromycin). We found a reduction of 11 320 in antibiotherapy costs (12.5%), while the total cost of rapid testing was 991, corresponding to total savings of 10 329. CONCLUSIONS: the introduction of the RST in primary care paediatrics has achieved a reduction in the frequency of antibiotherapy. Its use has proven effective in optimising antibiotic use, reducing antibiotic prescription and therefore preventing associated adverse events and reducing unnecessary pharmacotherapy costs
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Anti-Bacterial Agents/therapeutic use , Tonsillitis/drug therapy , Streptococcus pyogenes/isolation & purification , Streptococcal Infections/microbiology , Pharyngitis/drug therapy , Drug Prescriptions/statistics & numerical data , Primary Health Care/statistics & numerical data , Cross-Sectional Studies , Point-of-Care Testing/statistics & numerical data , Drug Costs/statistics & numerical dataABSTRACT
OBJECTIVE: The Organization for Economic Co-operation and Development (OECD) emphasize, in its report on health policies from 2017 that, Spain is one of the countries with largest consumption of antibiotics, 21.6 DHD (defined daily dose per 1000 inhibitants per day) in 2014 greater than the average 20.5 DHD in their countries, ranking according to the European Center for Disease Prevention and Control (ECDC) in the 11th place out of 30 European countries in 2016. The outpatient prescription of specialized care is analyzed less frequently, due to the greater contribution in consumption and expenditure of primary care. METHODS: A descriptive, observational, and retrospective study of the consumption and expenditure of the J01 group derived from outpatient prescription (outpatient and urgent care) of public hospitals in Asturias, in a period of ten years (2006-2015). Consumption data were obtained using the database of prescription billing of the Health Service of the Principality of Asturias, demographic data were provided by the National Institute of Statistics. Consumption was expressed in DHD and antibiotics expenditure in: expenditure per capita and expenditure in euros per defined daily dose. RESULTS: The average global ambulatory consumption for the period was 23.4 DHD, corresponding 11.5% (2.7 DHD) to the ambulatory specialty care prescription. In terms of expenditure, it accounted for 13.6% of overall outpatient spending on antibiotics. CONCLUSIONS: Outlay and consumption had opposite tendencies, the expenditure control measures did not have or had little impact on consumption, therefore, independent and spe-cific rationalization measures are required in this area.
Subject(s)
Anti-Bacterial Agents/supply & distribution , Drug Utilization/statistics & numerical data , Hospitals, General/statistics & numerical data , Ambulatory Care , Drug Utilization/trends , Europe , Humans , Primary Health Care/statistics & numerical data , Retrospective Studies , SpainSubject(s)
Cell Phone , Health Education/methods , Mobile Applications , Parents/education , Pediatrics/methods , HumansABSTRACT
Leclercia adecarboxylata is being increasingly diagnosed as a causative agent of infection due to the availability of rapid molecular diagnostic techniques Few cases of bacteraemia in subjects with underlying medical conditions have been reported. We report a case of L. adecarboxylata bacteraemia in an immunocompromised patient with metabolic syndrome.
Subject(s)
Bacteremia/diagnosis , Bacteremia/microbiology , Enterobacteriaceae Infections/diagnosis , Enterobacteriaceae/isolation & purification , Immunocompromised Host , Metabolic Syndrome/complications , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Bacteremia/therapy , Body Mass Index , Debridement/methods , Diabetes Mellitus, Type 2/complications , Enterobacteriaceae Infections/complications , Enterobacteriaceae Infections/therapy , Female , Humans , Hypertension/complications , Leg/pathology , Middle Aged , Risk Factors , Treatment OutcomeABSTRACT
OBJECTIVES: To conduct a pilot study of telephone consultation in the paediatric population of an urban health centre. To evaluate the telephone consultation as an effective tool when it comes to exercising prior triage of patients requiring urgent attention. MATERIAL AND METHODS: The study was conducted in two phases. In the first, data were collected from all calls received for six months. In a second phase, we conducted a telephone intervention study to analyse what a random sample of users remembered of the care provided. All those who requested a telephone consultation were included in the study. Demographic, social-welfare, epidemiological, and clinical features, of each patient were recorded. Data were processed using a statistical package SPSS version 17.0 for Windows. RESULTS: There were 439 telephone inquiries in our pilot project, of which 35.1% were attended by residents, 36% by paediatricians, and 28.9% by paediatric nurses. There were more telephone calls in the afternoons and on weekends. Patients less than or equal to 2 years accounted for 57.9% of cases handled, and there were no differences between sexes. The most frequent reasons for consultation were gastrointestinal symptoms, fever and respiratory problems. The health problem was resolved in 85.8% of cases, requiring only home care instructions, and only 13.3% of children were referred to emergency services. We obtained a mean score of satisfaction of 9.2. CONCLUSIONS: The pilot project had a high level of satisfaction and resolution, demonstrating cost savings by reducing 55% of face to face visits, with a saving of 35.2 euros per telephone consultation. A teleconsultation model for dealing with emergencies in primary care by telephone would be comparable to a practice staffed by trained paediatric nurses.
Subject(s)
Cell Phone , Emergency Medical Services/methods , Primary Health Care , Remote Consultation , Triage/methods , Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Pilot ProjectsABSTRACT
OBJECTIVES: To analyze trends in antibiotic use among the pediatric population of Castile and León from 2001 to 2005. MATERIAL AND METHODS: The antibiotics prescribed to the pediatric population in primary care were processed using the CONCYLIA database. The technical unit of measurement was the defined daily dose (DDD) and the comparative indicator used was the DDD per 1000 inhabitants/day (DID). RESULTS: Overall consumption was high (21.21 DID). Throughout the 5 years of the study we observed substantial variations, especially in 2005, the year in which consumption was highest (25.05 DID). The therapeutic subgroups most frequently prescribed were wide-spectrum penicillins (8.08 DID) and penicillins associated with beta-lactamase inhibitors (7.29 DID), followed by cephalosporins (2.81 DHD) and macrolides (2.52 DHD). The percentage of wide-spectrum penicillin prescription was higher than that of penicillins associated with beta-lactamase inhibitors between 2001 and 2002. These percentages were similar in 2003, and the percentage of wide-spectrum penicillin prescription was lower than that of penicillins associated with beta-lactamase inhibitors in the last 2 years of the study. CONCLUSIONS: Marked differences in consumption were observed over the study period. Changes in patterns of use were found, with an increase in the use of penicillins associated with beta-lactamase inhibitors in the last 2 years of the study.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Child , Drug Prescriptions/statistics & numerical data , Humans , SpainABSTRACT
OBJECTIVES: To compare systemic antibiotic prescribing in the pediatric population of Castile and Leon in relation to urban or rural setting. MATERIAL AND METHODS: Data on non-hospital antibiotic consumption in the pediatric population were gathered from the database that processes the antibiotics billed in the Health Service of Castile and Leon. These data were analyzed according to the Anatomical Therapeutic Chemical Classification System (ATC) and the results were expressed as defined daily doses per 1000 inhabitants per day (DID). RESULTS: Overall antibiotic consumption in the pediatric population was markedly higher in the rural setting (24.37 DID in rural areas vs. 19.54 DID in urban areas). Interannual variability was similar in both settings, with prescriptions reaching a peak in 2003. In the qualitative analysis, prescription of amoxicillin and, to a lesser extent, of cefixime and azithromycin was higher in rural areas. Differences in prescription in the urban and rural areas of the distinct health areas varied, the greatest differences being found in Segovia. CONCLUSIONS: Wide quantitative and qualitative variability in antibiotic use was found between the various urban and rural zones of basic health areas. Although we suspected that the results for the urban setting would be underestimated due to the excessive use of emergency services, more detailed studies are required to better understand the determinants of antibiotic use in children.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Prescriptions/statistics & numerical data , Primary Health Care , Age Factors , Amoxicillin/administration & dosage , Amoxicillin/therapeutic use , Anti-Bacterial Agents/administration & dosage , Azithromycin/administration & dosage , Azithromycin/therapeutic use , Cefixime/administration & dosage , Cefixime/therapeutic use , Child , Humans , Models, Theoretical , Rural Population , Spain , Urban PopulationABSTRACT
No disponible
Subject(s)
Male , Female , Child , Humans , Gastroenteritis/complications , Gastroenteritis/diagnosis , Gastroenteritis/therapy , Rotavirus Infections/complications , Rotavirus Infections/diagnosis , Signs and Symptoms , Rotavirus/isolation & purification , Rotavirus/pathogenicity , Immunologic Surveillance , Health Surveillance , Epidemiological Monitoring , Retrospective Studies , Enteritis/complications , Enteritis/epidemiologyABSTRACT
No disponible
Subject(s)
Male , Female , Child , Humans , Gastroenteritis/etiology , Enteritis/complications , Enteritis/etiology , Enteritis/microbiology , Enzyme-Linked Immunosorbent Assay/methods , Rotavirus Infections/complications , Rotavirus Infections/etiology , Rotavirus Infections/microbiology , Rotavirus/immunology , Rotavirus/isolation & purification , Rotavirus/pathogenicityABSTRACT
No disponible
No disponible
Subject(s)
Humans , Anti-Infective Agents/pharmacokinetics , Pulmonary Disease, Chronic Obstructive/drug therapy , Anti-Infective Agents/therapeutic useABSTRACT
No disponible
Subject(s)
Child , Humans , Influenza Vaccines , Influenza, Human/prevention & control , Vaccination/statistics & numerical dataABSTRACT
No disponible
Subject(s)
Humans , Bioterrorism , Tularemia , Plague , Anthrax , BrucellosisSubject(s)
Astroviridae Infections , Gastroenteritis/virology , Child , Gastroenteritis/diagnosis , HumansABSTRACT
No disponible
