Impact of hydrocolloid dressings in the prevention of pressure ulcers in high-risk patients: a randomized controlled trial (PENFUP).

It is uncertain whether hydrocolloid dressings, a more costly intervention than offering standard care with petrolatum, is superior to prevent pressure ulcers among hospitalized high-risk adults. Randomized, parallel-group, open-label, superiority trial with an active control group, blinded for investigators, event validators, and analysts (December 1, 2015 to December 12, 2017). Eligible patients were ≥ 18 years of age with intact skin judged as high-risk for skin ulcers (Braden scale), admitted to surgical or medical wards of two tertiary-level hospitals. Participants were randomized (1:1) to protection with hydrocolloid dressings or petrolatum. The primary outcome was the first occurrence of pressure ulcers (with post-injury photographs adjudicated by three judges) under intention-to-treat analysis. Based on prior cost analysis, and the available resources (assumed incidence of 6 ulcers/1000 patient-days in controls), inclusion of up to 1500 participants allowed to surpass a one-sided superiority threshold > 5% based on a target efficacy > 40% for dressings. We planned an economic analysis using a decision tree model based on the effectiveness of the study results from a perspective of the third payer of health care. After inclusion of 689 patients (69 events), the trial was stopped for futility after a planned interim analysis (conditional power < 0.1 for all scenarios if the trial was completed). Pressure ulcers had occurred in 34 (10.2%) patients in the intervention group [9.6 per 1000 patient-days] and 35 (9.9%) participants in the control group [7.9 per 1000 patient-days], HR = 1.07 [95% CI 0.67 to 1.71]. The estimated incremental cost for dressings (a dominated strategy) was USD 52.11 per patient. Using hydrocolloid dressings was found similar to petrolatum for preventing pressure ulcers among hospitalized high-risk patients. As it conveys additional costs, and in this study was unlikely to demonstrate enough superiority, this strategy did not overcome conventional skin care.Trial registration: ClinicalTrials.gov identifier (NCT number): NCT02565745 registered on December 1, 2015.

Characteristics, treatment, and nursing care of patients infected by Sars-CoV-2 hospitalized in intensive care units: multicenter study of colombian hospitals.

OBJECTIVES: To describe the clinical characteristics, treatment, evolution, and nursing care of adult patients with severe acute respiratory distress syndrome who were positive for SARS-CoV-2 and hospitalized in intensive care units (ICUs) during the first peak of the pandemic in Colombia, 2020. METHODS: Multicenter descriptive study of four high-complexity hospitals in Colombia, which included 473 consecutive adult patients admitted to intensive care units with a confirmed diagnosis of SARS CoV-2. Sociodemographic and clinical information - comorbidities, treatment and evolution - and nursing care provided were included. RESULTS: Of the patients included, 43.7% died, 88.8% had pneumonia, and 60.2% developed respiratory distress syndrome. Most of those who died were men. Those who died had a median age of 68.4 years and a higher frequency of comorbidities (hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and higher body mass index). They were admitted to the ICU with higher rate of dyspnea, lower oxygen saturation, and higher score of multiorgan failure. They also more often required mechanical ventilation and pronation therapy and were given more vasopressors and renal replacement therapy. CONCLUSIONS: People with severe acute respiratory distress syndrome due to COVID-19 who were hospitalized in the ICU had a high risk of death, especially older patients; males; those with cardiovascular, respiratory, and hypertension comorbidities; those who needed mechanical ventilation; and those with an elevated SOFA score. The nursing care of these critically ill patients focused on respiratory care and the prevention of associated complications.

Characteristics, treatment, and nursing care of patients infected by Sars-CoV-2 hospitalized in intensive care units: multicenter study of colombian hospitals / Características, tratamiento y cuidados de enfermería de pacientes infectados por SARS-CoV-2 hospitalizados en unidades de cuidados intensivos: estudio multicéntrico de hospitales colombianos / Características, tratamento e cuidados de enfermagem de pacientes infectados por SARS-CoV-2 hospitalizados em unidades de tratamento intensivos: estudo multicêntrico de hospitais colombianos

Objective. To describe the clinical characteristics, treatment, evolution, and nursing care of adult patients with severe acute respiratory distress syndrome who were positive for SARS-CoV-2 and hospitalized in intensive care units (ICUs) during the first peak of the pandemic in Colombia, 2020. Methods. Multicenter descriptive study of four high-complexity hospitals in Colombia, which included 473 consecutive adult patients admitted to intensive care units with a confirmed diagnosis of SARS CoV-2. Sociodemographic and clinical information - comorbidities, treatment and evolution - and nursing care provided were included. Results. Of the patients included, 43.7% died, 88.8% had pneumonia, and 60.2% developed respiratory distress syndrome. Most of those who died were men. Those who died had a median age of 68.4 years and a higher frequency of comorbidities (hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and higher body mass index). They were admitted to the ICU with higher rate of dyspnea, lower oxygen saturation, and higher score of multiorgan failure. They also more often required mechanical ventilation and pronation therapy and were given more vasopressors and renal replacement therapy. Conclusion. People with severe acute respiratory distress syndrome due to COVID-19 who were hospitalized in the ICU had a high risk of death, especially older patients; males; those with cardiovascular, respiratory, and hypertension comorbidities; those who needed mechanical ventilation; and those with an elevated SOFA score. The nursing care of these critically ill patients focused on respiratory care and the prevention of associated complications.

Objetivo. Describir las características clínicas, tratamiento, evolución y cuidados de enfermería de los pacientes adultos con síndrome de dificultad respiratoria aguda grave, positivos para SARS-CoV-2, hospitalizados en Unidades de Cuidados Intensivos (UCI) durante el primer pico de pandemia en Colombia en 2020. Métodos. Estudio descriptivo multicéntrico con la participación de cuatro hospitales de alto nivel de complejidad en Colombia, que incluyó 473 pacientes adultos, admitidos de forma consecutiva en unidades de cuidados intensivos -UCI-, con diagnóstico confirmado para SARS CoV-2. Se incluyó información sociodemográfica, clínica, comorbilidades, tratamiento y evolución, además de los cuidados de enfermería brindados. Resultados. Del total de pacientes incluidos fallecieron el 43.7%, presentaron neumonía el 88.8% y un 60.2% desarrollaron síndrome de dificultad respiratoria. Las personas que fallecieron en su mayoría fueron hombres, con una mediana de edad de 68.4 años, con mayor frecuencia de comorbilidades (hipertensión, enfermedad cardiovascular, enfermedad pulmonar obstructiva crónica y mayor índice de masa corporal); además ingresaron a UCI con mayor presencia de disnea, menor saturación de oxígeno, y con puntaje mayor de falla multiorgánica. Así mismo, requirieron con más frecuencia de ventilación mecánica, terapia de pronación, uso de vasopresores y terapia de reemplazo renal. Los cuidados de enfermería de estos pacientes en estado crítico se enfocaron al cuidado respiratorio y la prevención de complicaciones asociadas. Conclusión. Las personas con síndrome de dificultad respiratoria aguda grave por COVID-19 que se hospitalizaron en UCI tuvieron un riesgo elevado de fallecer, especialmente los pacientes de mayor edad, sexo masculino y con comorbilidades cardiovasculares, respiratorias e hipertensión arterial, uso de ventilación mecánica y un puntaje puntaje de SOFA elevado. Los cuidados de enfermería de estos pacientes en estado crítico se enfocaron al cuidado respiratorio y la prevención de complicaciones asociadas.

Objetivo. Descrever as características clínicas, tratamento, evolução e cuidados de enfermagem dos pacientes adultos com síndrome de dificuldade respiratória aguda grave, positivos para SARS-CoV-2, hospitalizados nas Unidades de tratamentos Intensivos (UTI) durante o primeiro pico de pandemia na Colômbia em 2020. Métodos. Estudo descritivo multicêntrico com a participação de quatro hospitais de alto nível de complexidade na Colômbia, que incluiu 473 pacientes adultos, admitidos de forma consecutiva nas unidades de tratamentos intensivos -UTI-, com diagnóstico confirmado para SARS CoV-2. Se incluiu informação sociodemográfica, clínica, comorbilidades, tratamento e evolução, além dos cuidados de enfermagens brindados. Resultados. Do total de pacientes incluídos faleceram 43.7%, apresentaram pneumonia 88.8% e um 60.2% desenvolveram síndrome de dificuldade respiratória. As pessoas que faleceram em sua maioria foram homens, com uma média de idade de 68.4 anos, com maior frequência de comorbilidades (hipertensão, doença cardiovascular, doença pulmonar obstrutiva crónica e maior índice de massa corporal); ademais ingressaram a UTI com maior presença de dispneia, menor saturação de oxigeno, e com pontuação maior de falha multiorgânica. Assim mesmo, requereram com mais frequência de ventilação mecânica, terapia de pronação, uso de vasopressores e terapia de substituição renal. Os cuidados de enfermagem destes pacientes em estado crítico se enfocaram ao cuidado respiratório e a prevenção de complicações associadas. Conclusão. As pessoas com síndrome de dificuldade respiratória aguda grave por COVID-19 que se hospitalizaram em UTI tinham um elevado risco de morte, especialmente os pacientes mais velhos; os homens; aqueles com comorbilidades cardiovasculares, respiratórias e hipertensão; aqueles que precisavam de ventilação mecânica; e aqueles com um escore SOFA elevado. Os cuidados de enfermagem destes pacientes criticamente doentes concentraram-se nos cuidados respiratórios e na prevenção de complicações associadas.

Systematic review and meta-analysis of experimental studies: In-hospital mobilization for patients admitted for medical treatment.

AIM: To determine the impact of strategies to promote mobilization on physical function in hospitalized adults with medical conditions. BACKGROUND: Slow progress is noted on the promotion of mobilization during hospitalization for adult patients admitted for medical conditions. This may reflect the limited evidence on the evaluation of the impact of progressive mobilization activities on clinical endpoints in adult patients throughout hospitalization. DESIGN: A systematic review and meta-analysis of published randomized controlled trials in any language. DATA RESOURCES: The literature search was performed in the MEDLINE, CINAHL online, HealthStar, EMBASE, the Cochrane Library Controlled Trials Registry and LILACS databases (January 2000-February 2017). REVIEW METHODS: Two authors independently identified randomized trials meeting inclusion criteria, assessed their quality and extracted relevant data. Outcomes assessed were the changes in physical function evaluated by scales measuring either the aerobic (metres walked/second) or the balance domain (using the Time Up and Go test, in seconds), length of hospital stay (days), and adverse clinical events. We calculated pooled mean differences or Mantel-Haenszel odds ratios and 95% confidence intervals for continuous or dichotomous outcome data and obtained heterogeneity statistics across studies. RESULTS: Thirteen studies, including in total 2,703 participants, met our eligibility criteria. Patients in the intervention group showed significant improvement in physical function (aerobic domain), reduced length of stay, and a reduction of pulmonary embolism. CONCLUSION: Patients and health providers should consider a course of therapy that enhances the functional capacity of medical patients during hospitalization.

Digital Photography: a Tool for Nursing on the Assessment of Pressure Lesions.

OBJECTIVES: This work sought to assess the inter-observer agreement among expert nurses by using digital photographs and between these experts and the nursing registries in the electronic clinical record in the identification and degree of PL. METHODS: This was an observational study, including 225 photographic records (184 patients, 97 with pressure lesion and 128 registries without lesion) randomly selected from the total of photographs registered in the PENFUP clinical trial (without lesion). Three expert evaluators assessed said photographs in masked manner. The notes from nursing of patients included related with the description of PL were evaluated. The Kappa index was calculated along with the composite agreement ratio for each evaluation. RESULTS: Good agreement was observed among expert evaluators of photographic records on the presence of PL and between good-moderate for the degree of PL (I-II). Likewise, upon evaluating the agreement between the nursing registries of PL and the photographic assessment of the three expert evaluators of the same areas, good agreement was observed to determine the presence of PL and moderate agreement for the degrees of PL. CONCLUSIONS: Photographic records are a tool that permits recognizing the types of wounds, as well as the visualization of the different layers of skin injured. The study highlights the importance of assessment and validation by experts, given that it permits identifying existing problems that can lead to the underestimation or overestimation of PL when conducted by a single caregiver.

Fotografía digital: Una herramienta para Enfermería en la evaluación de las Lesiones Por Presión (LPP) / Fotografia digital: Uma ferramenta para Enfermagem na avaliação das lesões por pressão / Digital Photography: a Tool for Nursing on the Assessment of Pressure Lesions

Objective. This work sought to assess the inter-observer agreement among expert nurses by using digital photographs and between these experts and the nursing registries in the electronic clinical record in the identification and degree of PL. Methods. This was an observational study, including 225 photographic records (184 patients, 97 with pressure lesion and 128 registries without lesion) randomly selected from the total of photographs registered in the PENFUP clinical trial (without lesion). Three expert evaluators assessed said photographs in masked manner. The notes from nursing of patients included related with the description of PL were evaluated. The Kappa index was calculated along with the composite agreement ratio for each evaluation. Results. Good agreement was observed among expert evaluators of photographic records on the presence of PL and between good-moderate for the degree of PL (I-II). Likewise, upon evaluating the agreement between the nursing registries of PL and the photographic assessment of the three expert evaluators of the same areas, good agreement was observed to determine the presence of PL and moderate agreement for the degrees of PL. Conclusion. Photographic records are a tool that permits recognizing the types of wounds, as well as the visualization of the different layers of skin injured. The study highlights the importance of assessment and validation by experts, given that it permits identifying existing problems that can lead to the underestimation or overestimation of PL when conducted by a single caregiver.(AU)

Objetivo. Evaluar la concordancia interobservador en la identificación y grado de las Lesiones Por Presión ­LPP- entre: i) enfermeros expertos utilizando fotografías digitales y, ii) entre estos expertos y los registros de enfermería en la historia clínica electrónica. Métodos. Estudio observacional, que incluyó 225 registros fotográficos (184 pacientes, 97 con lesión por presión y 128 registros sin lesión) seleccionados al azar del total de fotografías registradas en el ensayo clínico PENFUP. Tres evaluadores expertos valoraron las mismas fotografías de forma encubierta. Se evaluaron las notas de enfermería de los pacientes incluidos relacionadas con la descripción de LPP. Se calculó el índice Kappa y la proporción de acuerdo con el compuesto para cada evaluación. Resultados. Se observó una concordancia buena entre los evaluadores expertos de registros fotográficos sobre la presencia de LPP y entre buena y moderada para el grado de LPP (I-II). Así mismo, al evaluar la concordancia entre los registros de enfermería de LPP y la valoración fotográfica de los tres evaluadores expertos de las mismas áreas, se observó una concordancia buena para determinar la presencia de LPP moderada para la concordancia de los grados de LPP. Conclusión. Los registros fotográficos son una herramienta que permite el reconocimiento de los tipos de heridas al igual que la visualización de las diferentes capas de piel lesionadas. Se resalta la importancia de la evaluación y validación por expertos ya que nos permite identificar problemas existentes que pueden llevar a la subvaloración o sobrevaloración de las LPP cuando los realiza un solo cuidador. (AU)

Objetivo. Avaliar a concordância inter-observador na identificação e grau das Lesões Por Pressão ­LPP- entre: i) enfermeiros especialistas utilizando fotografias digitais e, ii) entre estes especialistas e os registros de enfermagem na história clínica eletrônica. Métodos. Estudo observacional, que incluiu 225 registros fotográficos (184 pacientes, 97 com lesão por pressão e 128 registros sem lesão) selecionados por azar do total de fotografias registradas no ensaio clínico PENFUP. Três avaliadores especialistas avaliaram as mesmas fotografias de forma encoberta. Se avaliaram as notas de enfermagem dos pacientes incluídos relacionadas com a descrição da LPP. Se calculou o índice Kappa e a proporção de acordo composto para cada avaliação. Resultados. Se observou uma boa concordância entre os avaliadores especialistas de registros fotográficos sobre a presença de LPP e entre boa e moderada para o grau de LPP (I-II). Assim mesmo, ao avaliar a concordância entre os registros de enfermagem de LPP e a valorização fotográfica dos três avaliadores especialistas das mesmas áreas, se observou uma boa concordância para determinar a presença de LPP e moderada para a concordância dos graus de LPP. Conclusão. Os registros fotográficos são uma ferramenta que permite o reconhecimento dos tipos de feridas ao igual que a visualização das diferentes capas de pele lesionadas. Se recalca a importância da avaliação e validação por especialistas já que nos permite identificar problemas existentes que podem levar à subvalorização ou sobrevalorização das LPP quando os realiza um único cuidador.(AU)

[Cost per capita in outpatients by gender]. / Costo anual per cápita en primer nivel de atención por género.

The objective of this study is to identify the annual cost per capita by gender in first level of attention. It is a cost study in Family Physician Units in Mexico. The information corresponded to the year of 2004 and the study divided in the use profile and cost attention. USE PROFILE OF SERVICES: it was studied 1,585 clinical registries of patients, use profile defined by average and attention reasons by department, gender and age group. COST ATTENTION: considered in American dollars it included fixed unit cost (departmentalization adjusted by productivity), variable unit cost (micro cost technical), department unite cost by type attention, and department unit cost by age and gender. The life expectancy was of 73 years for men and 78 for women. Three scenes were identified. The annual cost per capita is superior among woman [US$73.24 (IC 95% $11.38 - $197.49)] than in man [$ 53.11 (IC 95% 2.51 - 207.71)]. The conclusion found that in the first level of attention the cost per capita is greater in woman than in man.

Costo anual per cápita en primer nivel de atención por género / Cost per capita in outpatients by gender

El objetivo de este artículo es estimar el costo per cápita anual por género en primer nivel de atención. MÉTODOS: estudio de costo realizado en Unidades de Medicina Familiar en México. La información correspondió al año 2004 y el estudio se dividió en perfil de uso y costo de la atención. PERFIL DE USO DE LO SERVICIOS: se estudiaron los registros clínicos de 1,585 pacientes adscritos a unidades de medicina familiar. El perfil de uso se definió mediante el promedio y los motivos de atención por departamento, género y grupo de edad. COSTO DE LA ATENCIÓN: estimado en dólares estadounidenses incluyó costo unitario fijo (departamentalización ajustada por productividad), el costo unitario variable (técnica de microcosteo), costo unitario por departamento y motivo de atención, y costo unitario por departamento, quinquenio y género. La esperanza de vida fue de 73 años para los hombres y 78 para las mujeres. Se identificaron tres escenarios. RESULTADOS: el costo anual per capita es superior en la mujer US $73.24 (IC 95 por ciento $11.38 - $197.49) que en el hombre $ 53.11 (IC 95 por ciento 2.51 - 207.71). CONCLUSIÓN: en primer nivel de atención el costo per cápita en las mujeres es mayor que en los hombres, información valiosa en el proceso de planeación de los servicios de salud.

The objective of this study is to identify the annual cost per capita by gender in first level of attention. It is a cost study in Family Physician Units in Mexico. The information corresponded to the year of 2004 and the study divided in the use profile and cost attention. USE PROFILE OF SERVICES: it was studied 1,585 clinical registries of patients, use profile defined by average and attention reasons by department, gender and age group. COST ATTENTION: considered in American dollars it included fixed unit cost (departmentalization adjusted by productivity), variable unit cost (micro cost technical), department unite cost by type attention, and department unit cost by age and gender. The life expectancy was of 73 years for men and 78 for women. Three scenes were identified. The annual cost per capita is superior among woman [US$73.24 (IC 95 percent $11.38 - $197.49)] than in man [$ 53.11 (IC 95 percent 2.51 - 207.71)]. The conclusion found that in the first level of attention the cost per capita is greater in woman than in man.

[Unit cost variation in a social security company in Querétaro, México]. / Variación del costo unitario en una institución de seguridad social en Querétaro, México.

OBJECTIVE: Comparing unit cost variation between departments and reasons for consultation in outpatient health services provided by a social security company from Querétaro, Mexico. METHODS: A study of costs (in US dollars) was carried out in outpatient health service units during 2004. Fixed unit costs were estimated per department and adjusted for one year's productivity. Material, physical and consumer resources were included. Weighting was assigned to resources invested in each department. Unit cost was estimated by using the micro cost technique; medicaments, materials used during treatment and reagents were considered to be consumer items. Unit cost resulted from adding fixed unit cost to the variable unit cost corresponding to the reason for consulting. Units costs were then compared between the medical units. RESULTS: Unit cost per month for diabetic treatment varied from 34.8 US dollars, 32,2 US dollars to US 34 US dollars, pap smear screening test costs were 7,2 US dollars, 8,7 US dollars and 7,3 US dollars and dental treatment 27 US dollars, 33 US dollars, 6 and 28,7 US dollars. CONCLUSION: Unit cost variation was more important in the emergency room and the dental service.

Coste de la atención al paciente diabético-hipertenso en el primer nivel de atención / Cost of caring for the diabetic-hypertensive patient in primary care

Objetivo. Determinar el coste de la atención en el primer nivel de atención del paciente diabético-hipertenso. Diseño. Se trata de un análisis de coste realizado en unidades de medicina familiar en México. Emplazamiento. Medicina familiar en México. Participantes. Pacientes con diabetes-hipertensión. Medición. Incluye el perfil de uso de los servicios y el coste de la atención. El perfil se definió como el promedio anual de uso de los servicios de primer nivel, el coste unitario se calculó por motivo de uso en cada uno de los servicios utilizados, considerando los insumos fijos y variables; el coste promedio por motivo de atención se integró a partir de la relación uso-coste y el coste promedio anual de la suma de los costes promedio por motivo de atención. Resultados. El coste promedio anual en la consulta de medicina familiar fue de 180,65 € (intervalo de confianza [IC] del 95%, 168,31-193), en el laboratorio de 48,99 € (IC del 95%, 44,85-53,18) y en el resto de los servicios de primer nivel de 41,33 € (IC del 95%, 30,19-52,46). El coste promedio anual por paciente en primer nivel de atención fue de 271 € (IC del 95%, 243,36-298,65). Conclusión. El coste de la atención del paciente diabético-hipertenso en primer nivel se concentra en la medicina de familia y el laboratorio

Objective. To determine the cost of caring for the diabetic-hypertensive patient in primarycare. Design. A cost analysis carried out in family medicine units in Mexico. Setting. Family medicine units in Mexico. Participants. Patients with diabetes andhypertension. Measurements. Include the profile of use of the services and the cost of the care. The profile is defined as the average annual use of primary care services, the unit cost is calculated by reason for use in each of the services used, taking the fixed and variable consumables into account; the average cost by reason for care is calculated from use-cost ratio and the mean annual cost from the total average cost by reason for the care. Results. The mean annual cost in the family doctor clinic was €180.65 (95% confidence interval [CI], 168.31-193), in the laboratory, €48.99 (95% CI, 44.85-53.18), and in the rest of the primary care services, €41.33 (95% CI, 30.19-52.46). The mean annual primary care cost per patient was €271 (95% CI, 243.36- 298.65). Conclusion. The primary care costs of the diabetic-hypertensive patient are concentrated in the family doctor and laboratory services

Variación del costo unitario en una institución de seguridad social en Querétaro, México / Unit cost variation in a social security company in Querétaro, México

OBJETIVO: Estimar e identificar la variación del costo unitario por departamento final y motivo de atención, en unidades de medicina familiar de una institución de seguridad social en Querétaro, México.MÉTODOS: Se trata de un estudio de costo (dólares americanos $US) en unidades de medicina familiar para el año 2004. El costo unitario fijo se estimó utilizando la departamentalización ajustada por productividad para un año, se identificaron departamentos finales y generales. Se incluyeron recursos materiales, físicos y de consumo, se construyeron ponderadores para asignar los recursos invertidos en los departamentos generales a cada uno de los finales. La estimación del costo unitario variable se realizó mediante la técnica de micro-costeo apoyado por grupos de expertos, se consideraron como insumos variables los medicamentos, el material de curación y los reactivos. El costo unitario se integró con la suma del costo unitario fijo y el costo unitario variable correspondiente para el motivo de atención. El análisis contempló la comparación de los costos unitarios entre las unidades médicas. RESULTADOS: El costo unitario para un mes de manejo del diabético varió entre $US 34,8, $US 32,2 y $US 34,0; el costo de la detección de cáncer cervicouterino se encontró entre $US 7,2, $US 8,7 y $US 7,3; y el costo unitario de la atención de la caries fluctuó entre $US 27,0, $US 33,6 y $US 28,7. CONCLUSION: La variación del costo unitario es más importante en el departamento de urgencias y dental.

[Cost of caring for the diabetic-hypertensive patient in primary care]. / Coste de la atención al paciente diabético-hipertenso en el primer nivel de atención.

OBJECTIVE: To determine the cost of caring for the diabetic-hypertensive patient in primary care. DESIGN: A cost analysis carried out in family medicine units in Mexico. SETTING: Family medicine units in Mexico. PARTICIPANTS: Patients with diabetes and hypertension. MEASUREMENTS: Include the profile of use of the services and the cost of the care. The profile is defined as the average annual use of primary care services, the unit cost is calculated by reason for use in each of the services used, taking the fixed and variable consumables into account; the average cost by reason for care is calculated from use-cost ratio and the mean annual cost from the total average cost by reason for the care. RESULTS: The mean annual cost in the family doctor clinic was euro180.65 (95% confidence interval [CI], 168.31-193), in the laboratory, euro48.99 (95% CI, 44.85-53.18), and in the rest of the primary care services, euro41.33 (95% CI, 30.19-52.46). The mean annual primary care cost per patient was euro271 (95% CI, 243.36- 298.65). CONCLUSION: The primary care costs of the diabetic-hypertensive patient are concentrated in the family doctor and laboratory services.