ABSTRACT
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
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
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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
Subject(s)
Female , Child, Preschool , Male , Child , Humans , Parotitis/epidemiology , Parotitis/blood , Parotitis/immunology , Vaccination/methods , Vaccination/standards , Immunoassay/methods , Mumps Vaccine/administration & dosage , Mumps Vaccine/standards , Mumps Vaccine/supply & distribution , Spain/epidemiology , Cross-Sectional StudiesABSTRACT
Los virus se sitúan en un lugar preferente entre los agentes causales de diarrea aguda, en particular en la infancia. En este contexto el papel de los astrovirus, coronavirus, torovirus y picobirnavirus es emergente. Los astrovirus se han detectado en las heces entre el 1,2 y el 20 % de niños con diarrea que requieren atención médica en una gran variedad de localizaciones geográficas. Se han descrito brotes epidémicos en escuelas, guarderías y salas pediátricas, y son más frecuentes entre niños de menos de 3 años. En climas templados se ha demostrado una mayor incidencia invernal, y en climas tropicales ésta es similar en todo el año, siendo su transmisión preferente por vía orofecal. Se han reconocido siete serotipos de astrovirus humanos, de los cuales el más común es el uno. Los viriones pueden eliminarse durante amplios períodos y detectarse mediante microscopia electrónica. En estudios epidemiológicos se emplean técnicas de enzimoinmunoanálisis para detectar el antígeno común de grupo y se han desarrollado también técnicas basadas en la detección de ácidos nucleicos mediante hibridación y amplificación (reacción en cadena de la polimerasa).Los coronavirus entéricos se han asociado con frecuencia con enfermedad gastrointestinal en recién nacidos y niños menores de 12 años. El papel de los torovirus y picobirnavirus como causa de gastroenteritis es también emergente. Se necesitan estudios epidemiológicos para determinar su verdadera frecuencia en la comunidad, identificar sus mecanismos de transmisión y explicar la fisiopatología de los cuadros provocados por estos agentes (AU)
