Balance de la consulta por correo electrónico en la pandemia COVID-19 / E-mail consultation assessment during COVID-19 pandemic

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Valoración económica de la consulta por correo electrónico y su importancia en COVID-19; experiencia de cinco años / Economic evaluation of e-mail consulting and its impact on COVID-19. A five-year experience

INTRODUCCIÓN: este trabajo expone la experiencia del uso del correo electrónico en consulta de un centro de salud de Aragón (España) durante cinco años. Se valora el impacto económico, la satisfacción del usuario y su utilización durante la pandemia de COVID-19. MÉTODOS: en la primera consulta con los padres se ofrece el uso del correo electrónico para consultas no urgentes con pediatra y enfermera. Se entregan instrucciones. Trascurridos dos años se valora el uso del servicio realizando encuestas de satisfacción del usuario. Tras tres años se analiza el número de consultas realizadas y el ahorro de tiempo y recursos que supone. Finalmente, valoramos su uso durante el tiempo de confinamiento de la pandemia de 2020. RESULTADOS: el uso del correo electrónico aumenta los primeros meses y posteriormente se mantiene constante. Durante la pandemia el uso ha sido masivo. Los padres demuestran estar muy satisfechos con su uso, incluso solicitan que se aplique a otras consultas del centro. Respecto al impacto económico, calculamos un ahorro de 37 271,5 (Euro) anuales, por el menor tiempo que requiere al pediatra la respuesta por correo respecto a la presencial. Pero al estimar el número de consultas que se hubieran atendido sin correo, se observa que no revierte en disminución de consultas presenciales, quizás por la mayor accesibilidad que reporta. Pero en la pandemia su uso ha sido clave para mantener el aislamiento. CONCLUSIONES: la consulta por correo electrónico en Pediatría está muy bien valorada, y el ahorro económico es significativo. Durante la pandemia de COVID-19 ha resultado muy útil

INTRODUCTION: in this study, we describe our experience with an email consultation service in a primary care centre in Aragon (Spain) over a 5-year period. We evaluated the economic impact of the service, user satisfaction and use of the service during the COVID-19 pandemic. METHOD: in the first in-person appointment with the parents, we offered the use of email consultation with the paediatrician or nurse for non-urgent concerns. We provided directions. Two years after introducing the service, we performed a user satisfaction survey to evaluate the use of the service. At 3 years, we analysed the number of email consultations and the time and resources that they saved. Lastly, we assessed the use of the service during the lockdown imposed in the COVID-19 pandemic of 2020. RESULTS: the use of email consultations increased in the early months and remained stable thereafter. During the pandemic, the use of the service was massive. Parents reported high satisfaction with the service, and even requested that it be extended to other clinics in the primary care centre. As for the economic impact, we estimated annual savings of (Euro)37 271.5 based on the time the paediatrician needed to spend on responding by email compared to in person. But when we estimated the number of visits that would have been made if the email service was not available, we found it did not result in a decrease in in-person visits, perhaps due to the increased accessibility achieved with the service. Still, its use during the pandemic was essential to maintain confinement measures. CONCLUSIONS: the email consultation service in paediatrics was perceived positively and achieved significant reductions in health care costs. The service has been very useful during the COVID-19 pandemic

Estudio coste-beneficio de la vacunación contra varicela en Aragón / A cost-benefit analysis of varicella vaccination in Aragón

Fundamento. La varicela, enfermedad infecto-contagiosa que afecta a la infancia de forma benigna, puede complicarse en adultos y niños vulnerables y ser mortal. Existen vacunas eficaces. Se estudiaron retrospectivamente los costes que supuso esta enfermedad en la población aragonesa en el período 2004-2014 y las hospitalizaciones generadas. Se compararon con los gastos que supondría haber vacunado a esas personas y también los gastos de vacunar a la población de 1 año de edad durante todo ese período. Mediante un análisis coste-beneficio, se evaluó el impacto económico de la vacunación. Método. Se utilizaron datos de la Autonomía de Aragón (España) de estos 11 años (incidencia anual de varicela, altas hospitalarias por este motivo, precio de la consulta de atención primaria y de hospitalización de cada año, así como el coste de días de trabajo según el salario mínimo anual y medicaciones utilizadas). Se calcularon los costes capitalizados, se compararon con los gastos capitalizados de vacunación y se realizó un análisis de sensibilidad. Resultados. Se obtuvo un índice beneficio-coste de 1,6 vacunando y revacunando a todos los niños que se enfermaron. Resultó un índice beneficio-coste de 1,24 al vacunar a toda la población de 12 meses con vacuna de 28,59€. En estos 11 años, el 53% de las hospitalizaciones fueron niños menores de 5 años. Conclusiones. Las campañas públicas de vacunación con 2 dosis a población menor de 4 años suponen ahorro y rentabilidad porque el precio de la vacuna permite un índice beneficio-coste superior a 1. Es esperable una gran disminución de hospitalizaciones en la población de 3-4 años.

Background. Varicella, a contagious and infectious disease that is usually benign in children, may become complicated among adults and vulnerable children and may even be life-threatening. There are effective vaccines. A retrospective study was conducted about costs and resulting hospitalizations related to this disease in the population of Aragón in the 2004-2014 period. Costs were compared to the expenses that would have been incurred if those people had received the vaccine and also to the expenses of vaccinating the 1-year-old population over the entire period. A cost-benefit analysis was done to assess the economic impact of varicella vaccination. Method. Data for the 11-year period were provided by the Autonomous Community of Aragón (Spain) and included annual varicella incidence, hospital discharges of varicella cases, costs of primary health care visits and hospitalizations for each year, costs of each workday as per the minimum annual salary and of drugs used). Capitalized costs were estimated and compared to capitalized expenses of vaccination, and a sensitivity analysis was performed. Results. A benefit-cost ratio of 1.6 was obtained considering that all children who had varicella had been vaccinated and had received a booster dose. A benefit-cost ratio of 1.24 was obtained considering that the vaccine had been administered to every 1-year-old individual at a price of EUR 28.59 per vaccine. Over the 11-year period, 53% of hospitalizations corresponded to children younger than 5 years old. Conclusions. Public campaigns for the immunization of children younger than 4 years old with 2 doses lead to cost savings and are cost-effective because the vaccine price results in a benefit-cost ratio greater than 1. A major reduction is expected in the number of hospitalizations among children aged 3-4 years.

A cost-benefit analysis of varicella vaccination in Aragón. / Estudio coste-beneficio de la vacunación contra varicela en Aragón.

BACKGROUND: Varicella, a contagious and infectious disease that is usually benign in children, may become complicated among adults and vulnerable children and may even be life-threatening. There are effective vaccines. A retrospective study was conducted about costs and resulting hospitalizations related to this disease in the population of Aragón in the 2004-2014 period. Costs were compared to the expenses that would have been incurred if those people had received the vaccine and also to the expenses of vaccinating the 1-year-old population over the entire period. A cost-benefit analysis was done to assess the economic impact of varicella vaccination. METHOD: Data for the 11-year period were provided by the Autonomous Community of Aragón (Spain) and included annual varicella incidence, hospital discharges of varicella cases, costs of primary health care visits and hospitalizations for each year, costs of each workday as per the minimum annual salary and of drugs used). Capitalized costs were estimated and compared to capitalized expenses of vaccination, and a sensitivity analysis was performed. RESULTS: A benefit-cost ratio of 1.6 was obtained considering that all children who had varicella had been vaccinated and had received a booster dose. A benefit-cost ratio of 1.24 was obtained considering that the vaccine had been administered to every 1-year-old individual at a price of EUR 28.59 per vaccine. Over the 11-year period, 53% of hospitalizations corresponded to children younger than 5 years old. CONCLUSIONS: Public campaigns for the immunization of children younger than 4 years old with 2 doses lead to cost savings and are cost-effective because the vaccine price results in a benefit-cost ratio greater than 1. A major reduction is expected in the number of hospitalizations among children aged 3-4 years.

FUNDAMENTOS: La varicela, enfermedad infecto-contagiosa que afecta a la infancia de forma benigna, puede complicarse en adultos y niños vulnerables y ser mortal. Existen vacunas eficaces. Se estudiaron retrospectivamente los costes que supuso esta enfermedad en la población aragonesa en el período 2004-2014 y las hospitalizaciones generadas. Se compararon con los gastos que supondría haber vacunado a esas personas y también los gastos de vacunar a la población de 1 año de edad durante todo ese período. Mediante un análisis coste-beneficio, se evaluó el impacto económico de la vacunación. MÉTODO: Se utilizaron datos de la Autonomía de Aragón (España) de estos 11 años (incidencia anual de varicela, altas hospitalarias por este motivo, precio de la consulta de atención primaria y de hospitalización de cada año, así como el coste de días de trabajo según el salario mínimo anual y medicaciones utilizadas). Se calcularon los costes capitalizados, se compararon con los gastos capitalizados de vacunación y se realizó un análisis de sensibilidad. RESULTADOS: Se obtuvo un índice beneficio-coste de 1,6 vacunando y revacunando a todos los niños que se enfermaron. Resultó un índice beneficio-coste de 1,24 al vacunar a toda la población de 12 meses con vacuna de 28,59€. En estos 11 años, el 53% de las hospitalizaciones fueron niños menores de 5 años. CONCLUSIONES: Las campañas públicas de vacunación con 2 dosis a población menor de 4 años suponen ahorro y rentabilidad porque el precio de la vacuna permite un índice beneficio-coste superior a 1. Es esperable una gran disminución de hospitalizaciones en la población de 3-4 años.

Interrupción de la cadena de frío vacunal en un centro de atención primaria y su valoración económica / Vaccine cold chain interruption in a primary care center and economic evaluation

OBJETIVOS: El control de la cadena de frío constituye uno de los eslabones más importantes para garantizar la efectividad de las vacunas, por lo que es necesario disponer de recursos materiales y humanos específicos para su gestión. El objetivo principal es valorar las interrupciones de la cadena de frío de los últimos 6 años y el posible ahorro económico que supondrían nuevas mejoras. MÉTODO: Estudio retrospectivo, descriptivo, basado en la revisión de todas las interrupciones de la cadena de frío en los últimos 6 años, en el Centro de Salud Valdefierro. RESULTADOS: Cinco interrupciones, con temperatura máxima de 23,1±3,4°C y 25,2±20,7 h de interrupción; 1.611 vacunas fueron afectadas y 165 desechadas. La pérdida económica total fue 2.098,10 € y el ahorro 33.611,64 €. El fallo de suministro eléctrico fue la causa de interrupción en los 5 casos. CONCLUSIONES: El equipamiento y el personal son esenciales. Se tomaron medidas como minimizar los periodos entre controles sobre la nevera, control de stocks mínimos y, valorar cambios en la población, y se ha solicitado un sistema de suministro eléctrico

OBJECTIVES: Cold chain control is one of the most important facts to ensure the effectiveness of vaccines links, which requires specific material and human resources for management. The principal objective is to evaluate the interruptions in cold chain of the last 6 years and the possible cost savings that would result in further improvements. Method: A retrospective and descriptive study based on a review of all cold chain interruptions during the last 6 years, at Valdefierro Primary Health Center. RESULTS: We had 5 interruptions, the maximum temperature reached was 23.1±3.4°C and the longest interruption lasted 25.2±20.7 hours.1611 vaccines were affected and 165 discarded. Total economic loss was 2.098,10 € and 33.611,64 € were savings. The electrical failure was the disruption cause in 5 cases. CONCLUSIONS: Equipment and staff are essential. The center did some corrective actions, such as minimizing refrigerator time control, minimum stock control, considering population changes, and the center has requested a electrical supply system

[Vaccine cold chain interruption in a primary care center and economic evaluation]. / Interrupción de la cadena de frío vacunal en un centro de atención primaria y su valoración económica.

OBJECTIVES: Cold chain control is one of the most important facts to ensure the effectiveness of vaccines links, which requires specific material and human resources for management. The principal objective is to evaluate the interruptions in cold chain of the last 6 years and the possible cost savings that would result in further improvements. METHOD: A retrospective and descriptive study based on a review of all cold chain interruptions during the last 6 years, at Valdefierro Primary Health Center. RESULTS: We had 5 interruptions, the maximum temperature reached was 23.1±3.4°C and the longest interruption lasted 25.2±20.7hours. 1611 vaccines were affected and 165 discarded. Total economic loss was 2.098,10 € and 33.611,64 € were savings. The electrical failure was the disruption cause in 5 cases. CONCLUSIONS: Equipment and staff are essential. The center did some corrective actions, such as minimizing refrigerator time control, minimum stock control, considering population changes, and the center has requested a electrical supply system.