Persistencia en el tratamiento según el tipo de dispositivo inhalador en pacientes con asma y enfermedad pulmonar obstructiva crónica / Persistence to treatment by type of inhaler device in patients with asthma and chronic obstructive pulmonary disease

Objetivo. Evaluar la persistencia inicial al tratamiento con corticosteroides y beta-2 agonistas de larga duración (CSI/LABA) según el tipo de dispositivo inhalador (MDI o DPI) para el tratamiento del asma y la EPOC. Material y métodos. Estudio observacional multicéntrico. Se incluyeron sujetos en tratamiento inicial con CSI/LABA durante 2007-2011, y con un periodo de seguimiento de 3 años. Se confeccionaron 2 grupos de estudio (asma, EPOC) y 2 subgrupos según el tipo de dispositivo inhalador (MDI o DPI). Las principales medidas fueron: sociodemográficas, comorbilidad, adherencia (ratio de posesión del medicamento, RPM), medicación, exacerbaciones y uso de los recursos y sus costes (directos, indirectos). Se utilizaron modelos multivariantes para la corrección de las variables. Significación estadística: p < 0,05. Resultados. Se seleccionó a 2.082 sujetos asmáticos (MDI: N = 566, 27,2%; DPI: N = 1.516, 72,8%). Los pacientes con dispositivos MDI mostraron un mayor grado de persistencia (32,5 vs. 27,8%; p = 0,037), adherencia al tratamiento (RPM: 83,1 vs. 80,5%; p < 0,001), menos exacerbaciones (17,7 vs. 24,9%; p = 0,001) y menor coste sanitario (2.583 vs. 2.938 EUR; p = 0,042). También se analizaron 1.418 pacientes con EPOC (MDI: N = 594, 41,9%; DPI: N = 824, 58,1%). Los pacientes con dispositivos MDI también mostraron un mayor grado de persistencia (31,5 vs. 24,8%; p = 0,005), adherencia al tratamiento (RPM: 83,3 vs. 80,1%; p = 0,001), menos exacerbaciones (40,1 vs. 48,2%; p = 0,002) y menor coste sanitario (3.922 vs. 4.588 EUR; p = 0,021). Conclusiones. Los dispositivos MDI (tratamiento inicial con CSI/LABA) pueden asociarse a un mayor grado de persistencia en el tratamiento, tanto en asma como en EPOC, con menores tasas de exacerbaciones y consumo de recursos sanitarios y costes (AU)

Objective. To assess the initial treatment persistence with inhaled corticosteroids and long-acting beta-2 adrenergic bronchodilators (ICS/LABA) depending on the inhaler device used (pMDI or DPI), for the treatment of asthma and COPD. Material and methods. An multicenter observational study. Subjects in initial treatment with ICS/LABA during 2007-2011 were included, and a follow-up period of 3 years. 2 groups of study (asthma, COPD) and 2 subgroups were prepared according to the device type inhaler (pMDI or DPI). The main measurements were: sociodemographic, comorbidity, adherence (rate possession medication -RPM-), persistence, drugs, exacerbation rates, resources use, and their costs (direct and indirect costs). Multivariate methods were used for the variables correction, with significance level of P<.05. Results. The study included 2,082 asthma patients (pMDI: N = 566, 27.2%; DPI = 1,516, 72.8%). Patients with MDI devices showed a higher degree of persistence (32.5 vs. 27.8%; P=.037), treatment adherence (RPM: 83.1 vs. 80.5%; P<.001), fewer exacerbations (17.7 vs. 24.9%; P=.001) and lower health care costs (2,583 vs. 2,938 EUR; P = 0.042). 1,418 patients with COPD also were analyzed (pMDI: N = 524, 41.9%; DPI: N = 824, 58.1%) were analyzed. Patients with MDI devices also showed a higher degree of persistence (31.5 vs. 24.8%; P=.005), treatment adherence (RPM: 83.3 vs. 80.1%; P= .001), less exacerbations (40.1 vs. 48.2%; P=.002) and lower health care costs (3,922 vs. 4,588 EUR; P=.021). Conclusions. pMDI devices (as ICS/LABA initial treatment) are associated with higher treatment persistence either in asthma or COPD, with lower exacerbation rates, and use of health resources and cost (AU)

[Persistence to treatment by type of inhaler device in patients with asthma and chronic obstructive pulmonary disease]. / Persistencia en el tratamiento según el tipo de dispositivo inhalador en pacientes con asma y enfermedad pulmonar obstructiva crónica.

OBJECTIVE: To assess the initial treatment persistence with inhaled corticosteroids and long-acting beta-2 adrenergic bronchodilators (ICS/LABA) depending on the inhaler device used (pMDI or DPI), for the treatment of asthma and COPD. MATERIAL AND METHODS: An multicenter observational study. Subjects in initial treatment with ICS/LABA during 2007-2011 were included, and a follow-up period of 3 years. 2 groups of study (asthma, COPD) and 2 subgroups were prepared according to the device type inhaler (pMDI or DPI). The main measurements were: sociodemographic, comorbidity, adherence (rate possession medication -RPM-), persistence, drugs, exacerbation rates, resources use, and their costs (direct and indirect costs). Multivariate methods were used for the variables correction, with significance level of P<.05. RESULTS: The study included 2,082 asthma patients (pMDI: N = 566, 27.2%; DPI = 1,516, 72.8%). Patients with MDI devices showed a higher degree of persistence (32.5 vs. 27.8%; P=.037), treatment adherence (RPM: 83.1 vs. 80.5%; P<.001), fewer exacerbations (17.7 vs. 24.9%; P=.001) and lower health care costs (2,583 vs. 2,938 EUR; P = 0.042). 1,418 patients with COPD also were analyzed (pMDI: N = 524, 41.9%; DPI: N = 824, 58.1%) were analyzed. Patients with MDI devices also showed a higher degree of persistence (31.5 vs. 24.8%; P=.005), treatment adherence (RPM: 83.3 vs. 80.1%; P= .001), less exacerbations (40.1 vs. 48.2%; P=.002) and lower health care costs (3,922 vs. 4,588 EUR; P=.021). CONCLUSIONS: pMDI devices (as ICS/LABA initial treatment) are associated with higher treatment persistence either in asthma or COPD, with lower exacerbation rates, and use of health resources and cost.

Uso de recursos y costes asociados a las exacerbaciones de enfermedad pulmonar obstructiva crónica: estudio retrospectivo de base poblacional / Use of resources and associated costs of chronic obstructive pulmonary disease exacerbations: A population based retrospective study

Objetivo: Las exacerbaciones son una característica clínica común de la enfermedad pulmonar obstructiva crónica (EPOC). El objetivo de este estudio fue determinar la utilización de recursos y los costes asociados a las exacerbaciones de la EPOC. Pacientes y métodos: Estudio observacional realizado a partir de la revisión retrospectiva de registros de pacientes pertenecientes a un hospital y sus 6 centros de atención primaria. Se incluyeron pacientes EPOC > 40 años que demandaron atención sanitaria durante los años 2010- 2011 y cumplieron criterios de inclusión/exclusión. Se calculó el consumo de recursos sanitarios y costes asociados a un episodio de exacerbación (moderada/grave). Asimismo, se calculó el uso de recursos sanitarios y no sanitarios, así como los costes asociados al seguimiento, distinguiendo entre pacientes sin/con exacerbaciones. Análisis estadístico: modelo de regresión logística y ANCOVA, p < 0,05. Resultados: Se incluyeron 1.210 pacientes, de los que el 51,2% sufrió alguna exacerbación, con un promedio de 4 exacerbaciones/paciente. La presencia de exacerbaciones se asoció con la edad, la gravedad de la EPOC, la presencia de comorbilidades y el tiempo transcurrido desde el diagnóstico. El coste sanitario medio de una exacerbación fue de 481 D (moderada: 357 D ; grave: 863 D ). Los pacientes que sufrieron alguna exacerbación presentaron un mayor consumo de recursos y costes asociados (p < 0,001). Así, el coste total del seguimiento de los pacientes sin exacerbaciones fue de 1.392 D , frente a 3.175 D en los pacientes con exacerbaciones. Conclusiones: La presencia de exacerbaciones en los pacientes con EPOC se asoció con un incremento del consumo de recursos sanitarios y no sanitarios, así como de los costes (AU)

Objective: Exacerbations are a clinical characteristic of chronic obstructive pulmonary disease (COPD). The objective of the study was to estimate the resource use and costs associated with COPD exacerbations Patients and methods: Observational study performed by retrospective review of patient clinical charts of a Hospital and 6 associated Primary Care Centers. COPD patients > 40 years old who were followed-up during 2010-2011, and who fulfilled inclusion/exclusion criteria wereincluded in the study. Healthcare resource use and costs associated to COPD exacerbations (moderate/severe) were estimated. Healthcare resource use, loss of productivity and costs associated to the follow-up of COPD patients (with/without exacerbations) were also estimated. Statistical analysis: regression model and ANCOVA, P < .05. Results: A total of 1,210 patients were included in the study, of whom 51.2% experienced an exacerbation, and with an average of 4 exacerbations/patient. Presence of exacerbations was associated with age, COPD severity, presence of comorbidities, and time from diagnosis. The average healthcare cost of an exacerbation was D 481 (moderate: D 375; severe: D 863). Patients who experienced an exacerbation had a higher resource use and costs (P < .001). Thus, the follow-up cost of patients without exacerbations was D 1,392 versus D 3,175 for patients with exacerbations. Conclusion: The presence of exacerbations in COPD patients was associated with an increase in resource use and associated costs (AU)

[Use of resources and associated costs of chronic obstructive pulmonary disease exacerbations: A population based retrospective study]. / Uso de recursos y costes asociados a las exacerbaciones de enfermedad pulmonar obstructiva crónica: estudio retrospectivo de base poblacional.

OBJECTIVE: Exacerbations are a clinical characteristic of chronic obstructive pulmonary disease (COPD). The objective of the study was to estimate the resource use and costs associated with COPD exacerbations PATIENTS AND METHODS: Observational study performed by retrospective review of patient clinical charts of a Hospital and 6 associated Primary Care Centers. COPD patients >40years old who were followed-up during 2010-2011, and who fulfilled inclusion/exclusion criteria were included in the study. Healthcare resource use and costs associated to COPD exacerbations (moderate/severe) were estimated. Healthcare resource use, loss of productivity and costs associated to the follow-up of COPD patients (with/without exacerbations) were also estimated. STATISTICAL ANALYSIS: regression model and ANCOVA, P<.05. RESULTS: A total of 1,210patients were included in the study, of whom 51.2% experienced an exacerbation, and with an average of 4exacerbations/patient. Presence of exacerbations was associated with age, COPD severity, presence of comorbidities, and time from diagnosis. The average healthcare cost of an exacerbation was €481 (moderate: €375; severe: €863). Patients who experienced an exacerbation had a higher resource use and costs (P<.001). Thus, the follow-up cost of patients without exacerbations was €1,392 versus €3,175 for patients with exacerbations. CONCLUSION: The presence of exacerbations in COPD patients was associated with an increase in resource use and associated costs.

Control de calidad en cirugía mayor y menor ambulatoria / No disponible

Introducción: Entre los medios para conseguir una mejor asistencia progresiva en la unidad de cirugía ambulatoria (UCMA )están la medición y evaluación de los resultados, comparándolos con otras unidades y la posterior aplicación de correcciones. Las publicaciones citan unos indicadores constantes y otros variables no figurando siempre la complejidad de los procedimientos. La cirugía menor ambulatoria (cma) es una alternativa a la UCMA cada vez mayor para determinados procedimientos y sus indicadores de calidad no están establecidos. Material y métodos: Exponemos nuestra casuística de 13 años en la UCMA y de 7,5 en cma. Utilizamos como indicadores de calidad en la UCMA: índice de sustitución, ingresos (inmediatos y diferidos), anulaciones, visitas a urgencias y llamadas telefónicas; los comparamos con otras series. En cma hemos valorado los casos fallidos. Entregamos una encuesta de satisfacción y dos escala spsiquiátricas para evaluar el estado de ansiedad a 117 pacientes. Resultados: Asistimos en la UCMA 1.467 pacientes. Ingresos 3%, reingresos 0,34%, anulaciones 0,75%, llamadas 10,4%,índice de sustitución general 25%. En las 1.346 pacientes asistidas en cma los fracasos oscilaron, según los procedimientos, entre 2,5 y 22%. Promedio de satisfacción en CMA 9,4/10 y en cma8,9/10. Conclusiones: La evolución de nuestra calidad es favorable aunque podemos mejorar algunos aspectos. Convendría unificarlos índices utilizados para hacer más fácil el estudio comparativo entre unidades. El índice de sustitución debería referirse a los procedimientos susceptibles de realizarse en la UCMA. Sería conveniente notificar las intervenciones que han pasado de efectuarse en la UCMA a cma (AU)

Introduction: One of the means used to achieve a better progressive assistance in the Ambulatory Surgical Unit (ASU) is, first of all, to measure and to evaluate the results, comparing them with those of other units, and, then, to apply improvements. Publications mention some changing and some unchanging indicators, and the complexity of the procedures is not always mentioned. Outpatient Surgery (OS) is an increasing alternative to Ambulatory Surgery for certain procedures, and its quality indicators have not yet been established. Material and methods: We present our case history of the last 13 years in the ASU and of 7.5 years in the OS. The ASU quality indicators being used were: the replacement index, admissions(immediate and deferred), cancellations, visits to the emergency room and phone calls, and we compared them with other case histories. In OS, we have valued the unsuccessful cases. We handed out a satisfaction questionnaire and two psychiatric scalesto evaluate the anxiety state of 117 patients. Results: We attended 1,467 patients in the ASU. The admissions represented a 3%; readmissions, 0.34%; cancellations,0.75%; phone calls, 10.4%, and general substitution index, 25%. Amongst the 1,346 patients attended in OS, the unsuccessful cases varied from 2.5% to 22%, depending on the procedures. The average of satisfaction in the ASU was 9.4/10, and in OS was 8.9/10.Conclusions: The development of our quality control index is favorable, although some aspects may be improved. Some of the indexes being used should be unified in order to make the comparative study amongst Units easier. The replacement index should refer to procedures susceptible to being carried out in the ASU. It would be advisable to notify which surgical procedures were performed in the ASU and are now performed in OS (AU)

Prevalence, resource utilization and costs of vascular dementia compared to Alzheimer's dementia in a population setting.

OBJECTIVES: To determine the prevalence of dementia and to measure the monetary impact and health resources utilization of vascular dementia (VD) compared to Alzheimer's dementia (AD) in persons aged over 64 years in a population setting. METHODS: Retrospective, cross-sectional study. In the initial phase, information was obtained on specific clinical characteristics from the subjects with an active diagnosis of dementia. The second phase consisted of a clinical evaluation and validation of the cases. Mini-Mental State Examination was used to assess cognitive impairment. Dementia and its subtypes were determined using established diagnostic criteria. Information was obtained on the use of health care resources (direct costs) and the number of hours devoted by the primary caregiver (indirect costs) for patients with a documented diagnosis of AD or VD within the last 6 months prior to the interview. A multiple logistic regression analysis was performed to correct the model. RESULTS: A total of 6,004 subjects were analyzed, 258 with diagnosis of dementia (overall prevalence: 4.3%). An evaluation was made of 224 patients, and gross prevalence of AD and VD was 2.4 and 1.0%, respectively. Cost per patient per semester was EUR 8,086 for AD and EUR 11,039 for VD (p = 0.016). 85.5% of the cost was attributable to primary caregiver time in AD and 84.4% in VD. CONCLUSIONS: The prevalence of AD and VD increases with age. No sociodemographic differences were seen between AD and VD. Costs associated with health care resource and primary caregiver utilization were high, being higher in VD than in AD.

[Drug-cholinesterase-inhibitors persistence patterns in treated patients with dementia of Alzheimer type: retrospective comparative analysis of donepezil, rivastigmine and galantamine]. / Patrón de persistencia de tratamientos anticolinesterásicos en la demencia tipo Alzheimer: análisis comparativo retrospectivo de donepecilo, rivastigmina y galantamina.

INTRODUCTION AND OBJECTIVE: Long term duration of treatment of the dementia of Alzheimer type, the most frequent type of dementia in our environment, is associated with delay in patient functional and cognitive impairment. The aim of the study was to determine retrospectively the persistence of treatment with donepezil, rivastigmine and galantamine in patients with dementia of the Alzheimer type in a population setting. PATIENTS AND METHODS: Retrospective study performed in Primary Care Health Centres. The study included patients who were treated between January, 2000 and September, 2003. Kaplan-Meier survival analysis was applied to assess pattern of treatment persistence. RESULTS: A total of 95 patients (78.8% female), with a mean age of 77.6 years (SD: 6.2) were included; 39 donepezil, 35 rivastigmine, and 21 galantamine, with a mean MMSE score of 10.3 +/- 7.8, 9.7 +/- 8.4 and 13.6 +/- 7.1, respectively (p = 0.256). Mean treatment duration was donepezil: 80.3 (SD: 7.7) weeks, rivastigmine: 52.4 (SD: 5.3) weeks and galantamine: 49.8 (SE: 4.0) weeks, p < or = 0.01. Median persistence of treatment was 129.3 weeks for donepezil, 59.1 for rivastigmine and 45.0 for galantamine, p < or = 0.001 in both cases. At week 52, 62% of donepezil-treated patients maintained the initial therapy, compared with 40% rivastigmine-treated and 33% galantamine-treated, p < 0.05. CONCLUSION: This retrospective study found that patients with dementia of the Alzheimer type treated with donepezil showed more persistence of treatment compared which those who received rivastigmine or galantamine.

Patrón de persistencia de tratamientos anticolinesterásicos en la demencia de tipo alzheimer: análisis comparativo retrospectivo del donepecilo, la rivastigmina y la galantamina / Drug-cholinesterase-inhibitors persistence patterns in treated patients with dementia of alzheimer type: retrospective comparative analysis of donepezil, rivastigmine and galantamine

Introducción y objetivo. El mantenimiento del tratamiento de la demencia tipo Alzheimer, la causa más frecuente de demencia en nuestro medio, se asocia a un retraso del deterioro funcional y cognitivo del paciente. El objetivo de este estudio ha sido determinar, de forma retrospectiva, la persistencia del tratamiento con donepecilo, rivastigmina y galantamina en pacientes con demencia de tipo Alzheimer en un ámbito poblacional. Pacientes y métodos. Se realizó un estudio retrospectivo, realizado en centros de atención primaria. Se incluyeron pacientes de ambos sexos tratados con anticolinesterásicos entre enero de 2000 y septiembre de 2003. Se utilizaron las curvas de supervivencia de Kaplan-Meier para analizar la persistencia del tratamiento. Resultados. Se analizaron 95 pacientes (78,9 por ciento mujeres), de 77,6 (DE: 6,2) años como media; a 39 se les había administrado donepecilo, a 35, rivastigmina, y a 21, galantamina, y obtuvieron una puntuación en el MMSE de 10,3 ñ 7,8, 9,7 ñ 8,4, y 13,6 ñ 7,1, respectivamente (p = 0,256). La duración media del tratamiento fue 80,3 (DE: 7,7) semanas para el donepecilo, 52,4 (DE: 5,3) para la rivastigmina, y 49,8 (DE: 4,0) para la galantamina (p 0,01). La persistencia mediana del tratamiento fue de 129,3 semanas para el donepecilo, frente a 59,1 con rivastigmina y 45,0 con galantamina (p 0,001) en ambos casos. Un 62 por ciento de los pacientes con donepecilo continuaban en tratamiento tras 52 semanas, frente a un 40 por ciento de los de la rivastigmina y un 33 por ciento de los de la galantamina (p < 0,05). Conclusión. Este estudio retrospectivo muestra que los pacientes con demencia de tipo Alzheimer tratados con donepecilo presentaron una mayor persistencia del tratamiento que los que recibían rivastigmina o galantamina (AU)

Introduction and aim. Long term duration of treatment of the dementia of Alzheimer type, the most frequent type of dementia in our environment, is associated with delay in patient functional and cognitive impairment. The aim of the study was to determine retrospectively the persistence of treatment with donepezil, rivastigmine and galantamine in patients with dementia of the Alzheimer type in a population setting. Patients and methods. Retrospective study performed in Primary Care Health Centres. The study included patients who were treated between January, 2000 and September, 2003. Kaplan-Meier survival analysis was applied to assess pattern of treatment persistence. Results. A total of 95 patients (78.8% female), with a mean age of 77.6 years (SD: 6.2) were included; 39 donepezil, 35 rivastigmine, and 21 galantamine, with a mean MMSE score of 10.3 ± 7.8, 9.7 ± 8.4 and 13.6 ± 7.1, respectively (p = 0.256). Mean treatment duration was donepezil: 80.3 (SD: 7,7) weeks, rivastigmine: 52.4 (SD: 5.3) weeks and galantamine: 49.8 (SE: 4,0) weeks, p ≤ 0.01. Median persistence of treatment was 129.3 weeks for donepezil, 59.1 for rivastigmine and 45.0 for galantamine, p ≤ 0.001 in both cases. At week 52, 62% of donepeziltreated patients maintained the initial therapy, compared with 40% rivastigmine-treated and 33% galantamine-treated, p < 0.05. Conclusion. This retrospective study found that patients with dementia of the Alzheimer type treated with donepezil showed more persistence of treatment compared which those who received rivastigmine or galantamine (AU)

Hacia la definición de un conjunto mínimo básico de datos de atención primaria / Towards the definition of a set of basic minimun data in primary care

No disponible