RESUMO
No studies have evaluated the influence of pharmaceutical copayment on hospital admission rates using time series analysis. Therefore, we aimed to analyze the relationship between hospital admission rates and the influence of the introduction of a pharmaceutical copayment system (PCS). In July 2012, a PCS was implemented in Spain, and we designed a time series analysis (1978-2018) to assess its impact on emergency hospital admissions. Hospital admission rates were estimated between 1978 and 2018 each month using the Hospital Morbidity Survey in Spain (the number of urgent hospital admissions per 100,000 inhabitants). This was conducted for men, women and both and for all-cause, cardiovascular and respiratory hospital discharges. Life expectancy was obtained from the National Institute of Statistics. The copayment variable took a value of 0 before its implementation (pre-PCS: January 1978-June 2012) and 1 after that (post-PCS: July 2012-December 2018). ARIMA (Autoregressive Integrated Moving Average) (2,0,0)(1,0,0) models were estimated with two predictors (life expectancy and copayment implementation). Pharmaceutical copayment did not influence hospital admission rates (with p-values between 0.448 and 0.925) and there was even a reduction in the rates for most of the analyses performed. In conclusion, the PCS did not influence hospital admission rates. More studies are needed to design health policies that strike a balance between the amount contributed by the taxpayer and hospital admission rates.
Assuntos
Hospitalização , Preparações Farmacêuticas , Feminino , Hospitais , Humanos , Masculino , EspanhaRESUMO
OBJECTIVES: Although previous studies have assessed nonadherence to guidelines for prescribing antibiotic therapy in patients with pharyngotonsillitis (prescription of another antibiotic rather than one of first choice: amoxicillin and/or penicillin V, except in the case of penicillin allergy), none analyzed associated factors. Consequently, we conducted a study to assess the possible factors associated with the problem of nonadherence. METHODS: This cross-sectional study analyzed a sample of 417 patients with tonsillitis or pharyngotonsillitis treated with antibiotics during February 2014 in a Spanish region. The data were obtained through electronic records. INDEPENDENT VARIABLES: gender, disease (tonsillitis or pharyngotonsillitis), clinical specialty (primary care or pediatrics), age and physician's gender. To identify factors associated with nonadherence, the adjusted odds ratios (ORs) were calculated through a binary logistic regression model with all the independent variables. The confidence interval (CI) was calculated for all relevant parameters. RESULTS: Of 417 patients, 303 were categorized to the nonadherence group (72.7%, 95% CI: 68.4-76.9%). Two factors associated with the physician were relevant and close to statistical significance: primary healthcare as a clinical specialty (OR = 2.3, p = 0.055) and male gender (OR = 1.5, p = 0.088). CONCLUSIONS: Nonadherence in prescribing first-choice antibiotics to patients with tonsillitis or pharyngotonsillitis is highly prevalent. We emphasize the need to implement measures to help minimize this problem and, thus, antibiotic resistance, such as undertaking qualitative studies to assess the reasons for inappropriate prescription or the incorporation of alert systems in the electronic records. LIMITATIONS: As we analyzed data from all the patients in winter, it would be interesting to replicate this study at another time of the year.
