ABSTRACT
No disponible
Subject(s)
Humans , Hypertension , Spain , Quality Indicators, Health Care , Cross-Sectional Studies , Costs and Cost AnalysisABSTRACT
Objetivo. Analizar la prescripción farmacológica en función del modelo de gestión a partir de una serie de indicadores cuantitativos y cualitativos.Diseño. Estudio descriptivo retrospectivo del período enero-junio de 2000.Emplazamiento. Atención primaria del Sector Sanitario Badalona-Sant Adrià del Besòs (Badalona).Mediciones y resultados principales. Se han agrupado los centros de atención primaria del sector (13) según su entidad proveedora y modelo de gestión en 3 grupos: a) red empresarial (RE), que incluye una entidad con financiación pública, provisión empresarial de servicios y un sistema organizativo reformado; b) red reformada (REF), es decir, centros con financiación y provisión de servicios públicas y un sistema organizativo reformado, y c) red no reformada (SNR), formada por centros con financiación y provisión públicas y un modelo organizativo no reformado.El número de envases prescritos en los 13 centros ha sido de 1.774.565, que han generado un gasto de 3.209.225.749 ptas. Los resultados obtenidos presentan diferencias estadísticamente significativas en el importe por habitante asignado, que ha sido de 10.707,2 ñ 2.365 (RE), 11.053,8 ñ 2.859 (REF) y 14.191,6 ñ 3.857 ptas. (SNR) (p = 0,033). El número de envases consumidos, tanto en activos (p = 0,000), pensionistas (p = 0,003) como en cifras globales ha sido de 1.664,6 ñ 362,5 (RE), 1.751,8 ñ 355,6 (REF) y 1.925,6 ñ 357,5 (SNR) (p = 0,006). El porcentaje de VIFE ha sido de un 90,9 por ciento en RE, un 88,5 por ciento en REF y un 83,9 por ciento en SNR (p = 0,000). El porcentaje de medicamentos genéricos utilizado en los tres modelos ha sido del 10,2, 5,7 y 1,1 por ciento, respectivamente (p = 0,000).Se incluye una serie de indicadores de selección o uso relativo medidos en dosis diaria definida por 1.000 habitantes y día (DHD). Conclusiones. Los resultados obtenidos demuestran un potencial ahorro siguiendo el modelo más eficiente entre un 3-5 por ciento y un 13-24 por ciento en la contención del gasto en el sector, si no se modifican las circunstancias del entorno. Este efecto está directamente relacionado con una mayor utilización de medicamentos genéricos (AU)
Subject(s)
Humans , Primary Health Care/organization & administration , Drug Prescriptions/statistics & numerical data , Organization and Administration , Retrospective Studies , Spain , Chi-Square Distribution , Drug Prescriptions/standardsABSTRACT
OBJECTIVES: To find the evolution of quality and price in the supply of medicines financed over the last 28 years. DESIGN: A descriptive, crossover study of the catalogue of products. SAMPLE: Analysis of 11,482 drugs packages financed by the public health system. MEASUREMENTS AND MAIN RESULTS: The intrinsic value of each package, its potential use and its indicator of chronicity were analysed. Me-agains were identified in 3,285 products and me-toos among 879 different active principles. The medicines no longer financed after Act 83/1993 were compared with those still being financed. CONCLUSIONS: The supply of medicines financed has tended towards increases in intrinsic value, single-component products and price. Most of the drugs affected by the act are: older, cheaper, poorer quality and with more active principles. 31% of the supply has still not shown any clinical efficacy.
Subject(s)
Financing, Government/trends , Pharmaceutical Services/trends , Public Health/trends , Quality of Health Care/trends , Cross-Sectional Studies , Drug Costs/legislation & jurisprudence , Drug Costs/trends , Financing, Government/economics , Financing, Government/legislation & jurisprudence , Pharmaceutical Services/economics , Pharmaceutical Services/legislation & jurisprudence , Primary Health Care/economics , Primary Health Care/legislation & jurisprudence , Primary Health Care/trends , Public Health/economics , Public Health/legislation & jurisprudence , Quality of Health Care/economics , Quality of Health Care/legislation & jurisprudence , SpainABSTRACT
OBJECTIVE: To design a mathematical model which permits pharmacy budgets to be assigned to Health Centres (HC), examining the social and demographic variables and health service usage which explain the variability of the pharmaceutical expenditure (PE) of the HCs. DESIGN: A descriptive, crossover study. SETTING: 17 HC of the Insitut Català de la Salut (Catalan Health Service) in the city of Barcelona during 1994. MEASUREMENTS AND MAIN RESULTS: Relationships among the following variables at the 17 HCs were studied: pharmaceutical expenditure per inhabitant (PEi), frequency of attendance (FRA), care pressure (CP), percentage of the population 65 or over (P65), percentage of the population with medical records (PPR), index of family economic capacity (IFEC), ratio of comparative mortality (RCM) and ratio of potential years of life lost (RPYLL). In the bivariant analysis, those variables with a statistically significant linear correlation with PEi were FRA (r = 0.67; p < 0.01), PPR (r = 0.56; p <0.01), IFEC (r = -0.68; p < 0.01), RCM (r = 0.61; p < 0.01) and RPYLL (r = 0.62; p <0.01). In the multivariant analysis, IFEC, P65 and FRA enabled 94% of the PEi variability to be explained (r2 = 0.94; p < 0.001). Through multiple regression a mathematical formula for calculating the PE of HCs was obtained. CONCLUSION: The model presented enables pharmacy budgets to be assigned to the HCs if the IFEC, P65 and FRA of the population attended is known.
