La utilización de servicios de salud y las medidas para la sostenibilidad de la Comunidad de Madrid / Health services utilization and the measures for the sostenibility of the Community of Madrid

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Approach to the epidemiology of venomous bites in Spain.

This review presents a geographic distribution of the three autochthonous venomous snake species, which are the only viperids present in Spain, among the Iberian fauna: Vipera aspid; Vipera seoianei and Vipera latasti. This is followed by a detailed descriptive analysis of hospital care provided to patients admitted into hospital due to venomous bites, in the period from 1997 to 2009, using the data from the Spanish hospital discharge registry database. This analysis reveals that in Spain, during this period, 1649 cases were recorded, which means that hospital care was required for more than one hundred cases per year, of which nearly 1% of the cases resulted in death. Cases were recorded in all the Autonomous communities, but more than half (54, 14%) were concentrated in the following four regions: Cataluña, Castilla and León, Galicia and Andalucía. It is notable that this concentration of cases is not associated only with the population demographics of the community, but is also the result of the concurrence of very diverse factors of exposure including: habitat of venomous fauna, volume of rural population, farming activities, and practice of outdoor leisure activities. We also carried out a gross economic calculation for the use of hospital resources by each snakebite case requiring hospital care in Spain, which provided us with an approximate figure of 2000€ per case.

Factores asociados a reingresos hospitalarios en pacientes de edad avanzada / Factors associated with hospital readmissions in the elderly

ObjetivoIdentificar factores asociados a reingreso hospitalario en personas de edad avanzada.DiseñoEstudio observacional descriptivo.EmplazamientoÁrea sanitaria 3 de Madrid.ParticipantesPacientes mayores de 74 años que han ingresado en el Hospital Universitario Príncipe de Asturias en 2006. Se han excluido aquellos con ingreso en los 6 meses previos. Participaron 1.051 pacientes.Mediciones principalesSe utilizaron el conjunto mínimo básico de datos al alta hospitalaria y el sistema de información de atención primaria para desarrollar modelos de regresión logística. La variable dependiente fue reingreso en seis meses y las variables independientes fueron sociodemográficas, de estado de salud del paciente, y de la actividad asistencial.ResultadosEl 22,6% reingresaron en los seis primeros meses. Las variables que se asocian con mayor fuerza al reingreso fueron la estancia hospitalaria (estancias superiores a 15 días presentan un OR: 1,73; IC del 95%: 1,17–2,54), el total de fármacos prescritos al paciente (OR: 1,05; IC del 95%: 1,01–1,09), padecer hipertensión (OR:1,56; IC del 95%: 1,11–2,18), insuficiencia cardiaca (OR: 1,56; IC del 95%: 1,00–2,44) o cardiopatía isquémica (OR: 1,51; IC del 95%: 1,00–2,26), y la presión asistencial media de enfermería (OR: 0,93; IC del 95%: 0,87–0,98). El modelo que identifica mayor número de factores asociados al reingreso es el que integra información de ambos sistemas.ConclusionesLos reingresos hospitalarios se han asociado a condiciones propias del paciente y a factores derivados de la asistencia sanitaria recibida. Integrar información de bases de datos clínico-administrativas de atención primaria y hospitalaria mejora la capacidad para identificar factores asociados con un mayor riesgo de reingreso que podrían servir para plantear estrategias(AU)

ObjectiveTo identify factors associated with hospital readmissions in the elderly.DesignObservational descriptive study.SettingHealth area 3 of Madrid.ParticipantsPatients 74 years-old and over with a hospital admission to Hospital Universitario Príncipe de Asturias in 2006. Those with a hospital admission in the previous 6 months were excluded. A total of 1051 patients were identified.Main MeasuresHospital Discharge Minimum Basic Data Set and primary care information system were used to develop logistical regression models. The dependent variable was the hospital readmission in a 6 month period. Independent variables were socio-demographics, health status and health care activity.ResultsThere were 22.6% readmissions in the first 6 months. Variables associated with higher risk of readmission were, hospital stay (hospital stay greater than 15 days had an OR: 1.73 (95% CI:1.17–2.54), the total number of medicines prescribed to the patient (OR: 1.05; 95% CI:1.01–1.09), having hypertension (OR:1.56; 95% CI:1.11–2.18), heart failure (OR: 1.56; 95% CI:1.00–2.44) or ischemic heart disease (OR: 1.51; 95% CI:1.00–2.26), and the primary care nursing mean attendance pressure (OR: 0.93; 95% CI:0.87–0.98). The model that integrates information from both systems explains a higher number of factors associated with readmission.ConclusionsHospital readmissions have been associated to patient medical condition and to factors related to the health care received. Integrating information from hospital and primary care administrative data bases improves the capacity to identify factors associated with a higher readmission risk(AU)

Mejora de la cobertura de la vacuna antigripal en mayores de 65 años, pero ¿a quién se vacuna? / Improvement of the anti - flu vaccine coverage in people older than 65 years, but to whom do we vaccinate?

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