ABSTRACT
Objetivo: Identificar las barreras en el acceso a la atención de la salud de los adultos mayores y asociarlas a cada una de las etapas del proceso de acceso a los bienes y servicios de salud. Metodología: Se realizó una revisión narrativa de la literatura entre los años 2005 y 2017 en español, inglés y portugués en las bases de datos PubMed, LILACS, SciELO y Redalyc. Resultados: Se identificaron barreras económicas, fisicogeográficas, socioculturales y administrativas organizacionales con diferente intensidad, según la etapa del proceso de atención del que se trate. Conclusiones: Esta investigación puede ser de utilidad para el diseño de instrumentos que sirvan como herramienta de gestión para quienes se propongan mejorar la equidad en el acceso a los servicios de salud de la población envejecida (AU)
Objective: To identify the barriers in access to health care for the elderly and associate them with each of the stages of the process of access to health goods and services. Methodology: A narrative review of the literature was carried out between 2005 and 2017 in Spanish, English and Portuguese in the PubMed, LILACS, SciELO and Redalyc databases. Results: Economic, physical geographical, socio-cultural and administrative-organizational barriers were identified with different intensity according to the stage of the care process in question. Conclusions: This research may be useful for the design of instruments that serve as a management tool for those who intend to improve equity in access to health services for the aging population (AU)
Subject(s)
Humans , Aged , Health Services Accessibility , Health Services for the Aged , Quality of Health CareABSTRACT
Introducción: El envejecimiento poblacional trae aparejado un incremento de individuos en situación de dependencia funcional, que se entiende como la necesidad de asistencia para realizar las actividades de la vida diaria. Objetivo: Evaluar si existe inequidad en la distribución de la dependencia funcional entre adultos mayores de Argentina y cuáles son los factores que mayormente la explican. Métodos: Con datos de la Encuesta Nacional sobre Calidad de Vida de los Adultos Mayores para el año 2012 se llevaron a cabo los siguientes pasos: i) cómputo del índice de concentración corregido para variables asociadas a la dependencia funcional y explicativas de la inequidad en su distribución mediante la transformación de Erreygers y ii) descomposición de la inequidad en la distribución de dependencias básicas y ampliadas, siguiendo la metodología propuesta por Wagstaff. Resultados: La distribución de todas las dependencias funcionales (tanto básicas como ampliadas) es propobre. El ingreso per cápita, el hecho de presentar algún tipo de deficiencia visual o auditiva y vivir en hogares unipersonales son las variables explicativas que más contribuyen a incrementar la inequidad en la distribución de las dependencias funcionales básicas o ampliadas. Conclusiones: Los resultados que se desprenden de este estudio constituyen un insumo importante a la hora de procurar programas de asistencia a los adultos mayores que permitan evitar consecuencias negativas a futuro sobre su salud (y disminuir los gastos del sistema de salud en su conjunto). Estas acciones deben estar enfocadas específicamente en los adultos mayores de bajo nivel socioeconómico y que viven solos(AU)
Introduction: Population aging brings about an increase in the number of individuals in situations of functional dependence, which is understood as the need for assistance to carry out daily life activities. Objective: To assess whether there is inequity in the distribution of functional dependence among older adults in Argentina and what are the fundamental causative factors. Methods: With data from the 2012 National Survey on Quality of Life of Older Adults, the following steps were carried out: i) calculation of corrected concentration index for variables associated with functional dependence and explanatory of distributed inequity, using Erreygers transformation and ii) decomposition of inequality in the distribution of basic and extended dependences, following the methodology proposed by Wagstaff. Results: The distribution of all functional dependencies (both basic and extended) is poor. Per capita income, the fact of having any type of visual or hearing impairment, and living in one-person households are the explanatory variables that most contribute to increasing inequality regarding the distribution of basic or extended functional dependencies. Conclusions: The results derived from this study are an important input when it comes to ensuring assistance programs for older adults that make it possible to avoid negative consequences on their health in the future; as well as reduce expenses to the health system as a whole). These actions should be focused specifically on older adults of low socioeconomic status and who live alone(AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Health of the Elderly , Quality-Adjusted Life Years , Health Status Disparities , ArgentinaABSTRACT
Schizophrenia is considered a serious mental disorder that affects over 21 million people worldwide, and is associated with disability that frequently affects the patient's educational and working performance. In Argentina, two of the most widely used antipsychotics in the treatment of this disorder are haloperidol and risperidone. Both are provided free to patients without health coverage in public healthcare facilities. In this paper we seek to review the clinical and economic benefits of prescribing psychotropic therapies based on haloperidol (a first-generation antipsychotic that is part of the butyrophenone group of drugs) versus risperidone [an atypical or second-generation antipsychotic (neuroleptic) drug] in adult patients who have been diagnosed with schizophrenia. To achieve this objective, an exhaustive search of relevant articles published between 2006 and April 2017 was conducted. This literature search showed that intermittent treatment usually fails to prevent relapses due to irregular protection, therefore continuous treatment is more effective. Although the injectable formats of both drugs [haloperidol depot and long-acting injectable risperidone (LAIR)] have not proven to have significant differences with regard to clinical effectiveness vis-à-vis the tablet formats, they showed a lower cost-effectiveness ratio by reducing patients' relapses. Moreover, LAIR exhibits superior cost effectiveness compared with haloperidol depot. Haloperidol is less expensive than risperidone but is less cost effective; in comparison with haloperidol, treatment with risperidone produces (1) an improvement in quality-adjusted life-years, and (2) a significant reduction in negative symptoms. In most cases, antipsychotic treatments are effective in controlling the positive and negative symptoms associated with schizophrenia, allowing patients to live in their communities without any impairments. However, it is extremely important to combine pharmacological treatment with other measures that constitute psychosocial therapy.
