ABSTRACT
OBJECTIVE: To study the impact of depressive disorders (DD) on health care expenditure and to measure associated comorbidity in patients in primary care settings (PCS) under normal clinical practice conditions. METHOD: A retrospective cohort study was carried out. The study cohort consisted of outpatients aged over 14 years of age with an established diagnosis of DD (ICPC; P76) treated in a PC health centre during 2004. A comparative cohort was formed with the remaining outpatients without DD, treated in that health centre. Main factors for calculation were: age, gender, history/comorbidity and health resource use and the corresponding outpatient costs; drugs, diagnostic tests, visits to specialists and PC physicians. Multiple logistic regression analysis and ANCOVA models were used in order to adjust costs and comorbidities between the cohorts of patients. RESULTS: A total of 64,072 subjects were assessed; 6,592 patients with DD [10.3% (CI: 8.2-12.4%), 74.5% (CI: 73.4%-75.6%) females]. DD outpatients displayed a higher number of episodes of comorbidities/year (mean +/- SD; 7.4 +/- 4.3 vs. 4.7 +/- 3.3, p < 0.0001) and global medical visits/patient/year (12.0 +/- 9.3 vs. 7.4 +/- 7.6, p < 0.0001). The main comorbidities associated to DD were neurological disorders [Odds ratio (95% CI); 2.1 (CI: 1.5-2.6), p < 0.0001], alcoholism [1.6 (CI: 1.3-1.9), p < 0.0001] and malignancies [1.3 (CI: 1.1-1.5), p < 0.0001]. DD were associated with significantly higher adjusted total costs; 1,083.8 euro (SEM; 8.4 euro) vs. 684.1 euro (3.4 euro), p < 0.0001. Higher costs were displayed for elderly patients. Sixty-two percent of the total cost was related to drugs. CONCLUSIONS: Prevalence of DD was higher, particularly in women. Following adjustment in accordance with comorbidity, age and sex, DD outpatients used more health care resources and implied higher costs. Higher costs were associated with age.
Subject(s)
Ambulatory Care/economics , Depression/complications , Depression/economics , Health Care Costs , Primary Health Care , Adolescent , Adult , Aged , Cohort Studies , Costs and Cost Analysis , Female , Humans , Male , Middle Aged , Retrospective StudiesABSTRACT
Objetivo: Medir el impacto económico de los trastornos depresivos (TD) y la comorbilidad asociada en en población atendida por equipos de atención primaria (EAP) en condiciones de práctica clínica habitual. Método: Estudio de cohortes retrospectivo. Se incluyeron pacientes mayores de 14 años, con diagnóstico de TD (CIAP; P76) atendidos por EAP durante el año 2004. Se formó una cohorte comparativa con el resto de pacientes sin TD. Las variables fueron: edad, sexo, historial/comorbilidad, utilización de recursos sanitarios y costes correspondientes (medicamentos, procedimientos diagnósticos, visistas a especialistas y a EAP). Se efectuó un análisis de regresión logística múltiple y modelos ANCOVA para comparar los costes, totales y desagregados, y las comorbilidades. Resultados: Se incluyeron 64.072 pacientes; 6.592 con TD [10,3% (CI: 8,2-12,4%); 7,5% (CI: 73,4-756%) mujeres]. Los pacientes con TD presentaron un mayor número de episodios de comorbilidades/año (media ± DE; 7,4 ± 4,3 vs. 4,7 ± 3,3; p < 0,0001) y de todo tipo de visitas médicas/paciente/año (12,0 ± 9,3 vs. 7,4 ± 7,6; < 0,0001). Las principales episodios de comorbilidad asociados con los TD fueron los trastornos neurológicos [Odd ratio (IC 95%); 2,1 (1,5-2,6); p < 0,0001], alcoholismo [1,6 (1,3-1,9), p < 0,0001] y neoplasias malignas [1,3 (1,1-1,5); p < 0,0001]. Los TD se asociaron con unos costes totales ajustados significativamente mayores; 1.083,8 (EEM; 8,4 ) vs. 684,1 (3,4 ); p < 0,0001. Las personas mayores mostraron mayores costes. El 62% de los costes totales se derivó de los medicamentos. Conclusiones: La prevalencia de los TD es elevada, particularmente en mujeres. Después del ajuste por comorbilidad, edad y sexo, los pacientes con TD utilizaron más recursos sanitarios y ocasionaron unos costes más altos. Los costes más elevados se asociaron con la edad
Objective: To study the impact of depressive disorders (DD) on health care expenditure and to measure associated comorbidity in patients in primary care settings (PCS) under normal clinical practice conditions. Method: A retrospective cohort study was carried out. The study cohort consisted of outpatients aged over 14 years of age with an established diagnosis of DD (ICPC; P76) treated in a PC health centre during 2004. A comparative cohort was formed with the remaining outpatients without DD, treated in that health centre. Main factors for calculation were: age, gender, history/comorbidity and health resource use and the corresponding outpatient costs; drugs, diagnostic tests, visits to specialists and PC physicians. Multiple logistic regression analysis and ANCOVA models were used in order to adjust costs and comorbidities between the cohorts of patients. Results: A total of 64,072 subjects were assessed; 6,592 patients with DD [10.3% (CI: 8.2-12.4%), 74.5% (CI: 73.4%- 75.6%) females]. DD outpatients displayed a higher number of episodes of comorbidities/year (mean ± SD; 7.4 ± 4.3 vs. 4.7 ± 3.3, p < 0.0001) and global medical visits/patient/year (12.0 ± 9.3 vs. 7.4 ± 7.6, p < 0.0001). The main comorbidities associated to DD were neurological disorders [Odds ratio (95% CI); 2.1 (CI: 1.5-2.6), p < 0.0001], alcoholism [1.6 (CI: 1.3-1.9), p < 0.0001] and malignancies [1.3 (CI: 1.1-1.5), p < 0.0001]. DD were associated with significantly higher adjusted total costs; 1,083.8 (SEM; 8.4) vs. 684.1 ( 3.4), p < 0.0001. Higher costs were displayed for elderly patients. Sixty-two percent of the total cost was related to drugs. Conclusions: Prevalence of DD was higher, particularly in women. Following adjustment in accordance with comorbidity, age and sex, DD outpatients used more health care resources and implied higher costs. Higher costs were associated with age
Subject(s)
Male , Female , Adolescent , Adult , Middle Aged , Aged , Humans , Depressive Disorder/economics , Health Care Costs , Ambulatory Care/economics , Comorbidity , Depressive Disorder/drug therapy , Ambulatory Care Facilities/economics , Retrospective Studies , Cohort Studies , Alcoholism/complications , Nervous System Diseases/complications , Age FactorsABSTRACT
La gestión por procesos es una manera de horizontalizar el funcionamiento de una organización y aportar un valor añadido a la organización, posibilitando la mejora continua y así incrementar la calidad de servicio. El análisis, optimización y puesta en marcha de las mejoras de los procesos que una organización determina como críticos, son indispensables para su óptimo funcionamiento. La revisión del proceso preoperatorio en el Hospital Municipal de Badalona -centro eminentemente quirúrgico- incluye un alto rendimiento de las agendas de los servicios implicados y una detección precoz de incidencias que permite una baja repercusión en el funcionamiento habitual de quirófano
No disponible
Subject(s)
Humans , Outcome and Process Assessment, Health Care , Preoperative Care , Surgery Department, Hospital/organization & administration , Organization and Administration , Managed Care Programs/organization & administration , Health Programs and PlansABSTRACT
La digitalización es un proceso iniciado en diversos centros sanitarios, a menudo de manera fragmentada; aún son pocas las organizaciones sanitarias que han conseguido integrar las imágenes diagnósticas en una historia clínica informatizada, suprimir totalmente el papel y difundir telemáticamente dichas imágenes hacia otros centros sanitarios periféricos, como es el caso del Hospital Municipal de Badalona. En este artículo pretendemos divulgar nuestra experiencia en el proceso que nos ha llevado a la digitalización integral de nuestra organización: las dificultades y los beneficios, las ventajas y puntos débiles, con el deseo de facilitar el camino a quienes vayan a emprenderlo (AU)
The authors of this article concisely relate their experience in the process which has been carried out in the integral digitalization of the hospital: The difficulties and the benefits, the advantages and weak points (AU)
Subject(s)
Humans , Male , Female , Automation/methods , Computer Communication Networks/instrumentation , Medical Informatics/methods , Image Processing, Computer-Assisted/methods , Image Processing, Computer-Assisted/trends , Diagnostic Imaging/methods , Diagnostic Imaging/trends , Software/standards , Signal Processing, Computer-Assisted/instrumentation , /trends , Image Processing, Computer-Assisted/supply & distribution , Computer Systems/standardsABSTRACT
El siguiente artículo analiza el innovador proyecto de informatización global que Badalona Serveis Assistencials que le ha permito alcanzar el continuum asistencial entre todos su centros y niveles de atención (primaria, hospitalaria sociosanitaria y domiciliaria). El objetivo de proyecto era facilitar a los profesionales asistenciales el acceso a toda la información clínica generada en la organización desde cualquier puesto de trabajo, independientemente de su ubicación geográfica y con altos niveles de seguridad y confidencialidad. El proyecto ha comportado una considerable mejora asistencial que ha ido ligada a una reducción de costes (AU)
The article analyses the global computerisation Project of Badalona Serveis Assistencias (Badalona Healthcare Services). The objective of the project was to provide nursing professionals with access to all the clinical information generate in the organization from any work post regardless of their geographical location (AU)
Subject(s)
Humans , Male , Female , Medical Records/standards , Medical Informatics/history , Medical Informatics/methods , Medical Informatics/organization & administration , Health Knowledge, Attitudes, Practice , Costs and Cost Analysis/statistics & numerical data , Costs and Cost Analysis/trends , Direct Service Costs/standards , /standards , Medical Informatics Applications , Telecommunications/standards , Telecommunications , /organization & administration , /trends , Quality of Health Care/organization & administrationABSTRACT
We report a case of a 18-year-old male patient with his fourth relapse of a desmoid tumour of the left popliteal hollow after a traumatism in this area. Arterial displacement and extrinsic compression were showed by arteriography. Tumoration was extirpated including popliteal artery, in this way a terminal by-pass from distal femoral to peroneo-tibial trunks with contralateral great saphena was made. Diagnosis of intestinal polyposis and of the little osseous malformations, was discarded these pathologies frequently are related with these tumours. The research for 8 years and 4 months doesn't show any relapse, nor local neither multicentral. Furthermore, some considerations about this theme are reported.
