¿Se puede ofrecer una mayor calidad a un menor coste? / Accessibility plan: can offer a higher quality for a lower cost?

Objetivos. Redireccionar la demanda de patología de gravedad nivel IV-V de los Servicios de Urgencias Hospitalarios (SUH) hacia la Atención Primaria (AP) de referencia, aumentar la tecnificación en la consulta y valorar la efectividad del proyecto Plan de Accesibilidad (PA). Mejorar la calidad asistencial ofertada, disminuyendo el coste económico para lograrla. Diseño. Estudio de investigación de calidad realizado en 2010 de datos recogidos durante todo 2009, y comparativa de estos versus los obtenidos en 2008. Emplazamiento y participantes. Población de referencia asignada al ABS Sagrada Familia (23.265 usuarios). Mediciones principales. Población atendida en SUH y AP; derivada a atención especializada; programada en procesos diagnósticos y terapéuticos (radiología, laboratorio, eco-doppler, crioterapia...); visitas totales anuales, frecuentación-reiteración,... Resultados. Aumento del 86,5% de radiografías urgentes realizadas en AP (evitando derivar al SUH); 7,4% menos derivaciones a urgencias; implantación del circuito de analíticas urgentes (descolapsando el laboratorio del SUH); 13,6% menos derivaciones a cirugía vascular (por el Eco-Doppler); 5,92% menos de analíticas (gracias al Cardio-Check); 297 derivaciones menos a dermatología (por la crioterapia); 9,65% menos de derivaciones a psiquiatría (gracias a talleres grupales de salud mental); disminución de frecuentación (1,4%) y reiteración (2,3%) respecto 2007; 23,9% de derivaciones evitadas al SUH por patología nivel IV-V atendida en AP; ahorro de 57.335 € en relación a 2007. Conclusiones. Los programas que incluye el PA han demostrado su eficacia; habiendo mejorado la calidad ofertada y satisfacción del usuario, y reduciendo el gasto económico; disminuyendo también, al ser atendidas y resueltas en AP, las visitas de nivel IV-V al SUH (AU)

Objectives. Redirect demand pathology severity level IV-V of the hospital emergency room (ED) to the Primary Health Care (AP) reference, increase in technical consultation and assess the effectiveness of the proposed Accessibility Plan (PA). Improving the quality of care offered, lowering the cost to achieve it. Design. Quality research study conducted in January-2010 data collected throughout 2009, and compare them versus those obtained in 2008. Setting and participants. Population allocated to the ABS Sagrada Familia (23,265 users). Measurements. Beneficiaries in HUS AP and population due to specialized care, population scheduled diagnostic and therapeutic procedures (radiology, laboratory, echo-doppler, cryosurgery ...), total annual visits, attendance, repetition,... Results. Increased 86.5% of emergency radiographs in AP (avoiding lead to ED), 7.4% fewer referrals to the emergency; implantation circuit urgent analytical (laboratory of HUS not collapsed) 13.6% fewer referrals to vascular surgery (the Eco-Doppler), 5.92% less analytical (thank Cardio-Check), 297 fewer referrals to dermatology (for cryotherapy), 9.65% less referrals to psychiatry (through group workshops mental health), decreased frequency (1.4%) and recurrence (2.3%) over 2007, 23.9% of referrals to ED pathology avoided level IV-V served in AP; save € 57,335 on 2007. Conclusions. Programs that includes the PA has proven its effectiveness, having offered improved quality and user satisfaction, spending economic decline, to be addressed and resolved in AP, visits to level IV-V ED(AU)

¿Qué gasto farmacológico genera un diabético bien controlado? / What are the pharmacological costs of a well-controlled diabetic?

Objetivo: Evaluar el coste del tratamiento farmacológico hipoglucemiante (TFH) de los pacientesdiabéticos atendidos en un centro de atención primaria.Diseño: Estudio descriptivo transversal.Emplazamiento: Centro de Salud urbano.Participantes: Muestra aleatoria de 294 pacientes diabéticos con TFH.Mediciones principales: Variable Principal: coste anual TFH. Variables secundarias: edad, sexo,tipo de DM, médico prescriptor, grado de control de la diabetes, número de fármacos hipoglucemiantes,factores de riesgo cardiovascular y complicaciones.Resultados: Se incluyen 294 diabéticos. Edad media 71,7±13,3 años; 52,7% mujeres; 93,2%DM2; coste total TFH: 82.979 euros/año, (281,9 euros/paciente/año). El médico de familiaoriginaba el 32,3% de los tratamientos (17,7% del gasto). Presentaron un gasto medio anualsignificativamente mayor los pacientes diabéticos tipo 1, los que recibían triple terapia y loscontrolados por endocrinólogo hospitalario. En el estudio de regresión lineal múltiple las variablesque explicaron la variación en el coste fueron el tipo de DM (p<0,0001), origen de laprescripción por endocrinólogo hospitalario (p:0,002), número de fármacos hipoglucemiantes(p<0,001), presencia de retinopatía diabética (p:0,019) y daño renal (p: 0,027).Estas variables explicaron el 44,5% de la variación del coste farmacológico hipoglucemianteanual (R2: 0,445).Conclusiones: Existe gran variabilidad en el gasto originado por el TFH de nuestros pacientesdiabéticos. Es necesaria una mayor coordinación entre todos los profesionales implicados en elmanejo de los pacientes diabéticos, y además la elaboración de guías clínicas y terapéuticascompartidas, conseguiría un control más eficiente de los pacientes diabéticos(AU)

Objective: To evaluate the cost of glucose lowering treatment (GLT) in our diabetic patiients(DP).Design: Cross-sectional descriptive study.Setting: Urban primary health care centre.Participants: Random sample of 294 DP with HPT.Measurements: Principal variable: annual cost of GLT. Secondary Variables: age, sex, type ofdiabetes (DM), prescribing doctor, level of control, number of glucose lowering drugs, cardiovascularrisk factors and complications.Results: A total of 294 diabetic patients were included, with a mean age 71.7+/−13.3 years;52.7% women; 93.2% DM2; Annual cost of GLT: 82.979 euros ,(281.9 euros /patient/year). General practitioner(GP) originated 32.3% of the treatments (17.7% of the costs). Annual average expenditurewas significantly higher in DM1 patients, patients on treatment with triple therapy and patientscontrolled by an endocrinologist in a reference hospital. In the multiple linear regressionthe variables that explained the variation in the cost were the type of Diabetes mellitus(P<0.0001), prescription by hospital endocrinologist (p=0,002), number of glucose loweringdrugs(P<0.0001), diabetic retinopathy(P: 0.019) and chronic renal failure (P: 0.027). Thesevariables explained 44.5% of the annual cost variation of the GLT (R2:0.445).Conclusions: There is a wide variation in the costs arising from GLT of our diabetic patients.We conclude, it is essential to improve coordination between levels of care, encourage thedesign and use of clinical guidelines to achieve more efficient control of our patients(AU)

[What are the pharmacological costs of a well-controlled diabetic?]. / ¿Qué gasto farmacológico genera un diabético bien controlado?

OBJECTIVE: To evaluate the cost of glucose lowering treatment (GLT) in our diabetic patients (DP). DESIGN: Cross-sectional descriptive study. SETTING: Urban primary health care centre. PARTICIPANTS: Random sample of 294 DP with HPT. MEASUREMENTS: Principal variable: annual cost of GLT. Secondary Variables: age, sex, type of diabetes (DM), prescribing doctor, level of control, number of glucose lowering drugs, cardiovascular risk factors and complications. RESULTS: A total of 294 diabetic patients were included, with a mean age 71.7+/-13.3 years; 52.7% women; 93.2% DM2; Annual cost of GLT: 82.979 €,(281.9 €/patient/year). General practitioner (GP) originated 32.3% of the treatments (17.7% of the costs). Annual average expenditure was significantly higher in DM1 patients, patients on treatment with triple therapy and patients controlled by an endocrinologist in a reference hospital. In the multiple linear regression the variables that explained the variation in the cost were the type of Diabetes mellitus (P<0.0001), prescription by hospital endocrinologist (p=0,002), number of glucose lowering drugs(P<0.0001), diabetic retinopathy(P: 0.019) and chronic renal failure (P: 0.027). These variables explained 44.5% of the annual cost variation of the GLT (R(2):0.445). CONCLUSIONS: There is a wide variation in the costs arising from GLT of our diabetic patients. We conclude, it is essential to improve coordination between levels of care, encourage the design and use of clinical guidelines to achieve more efficient control of our patients.

[Accessibility plan: can offer a higher quality for a lower cost?]. / ¿Se puede ofrecer una mayor calidad a un menor coste? Proyecto-plan de accesibilidad.

OBJECTIVES: Redirect demand pathology severity level IV-V of the hospital emergency room (ED) to the Primary Health Care (AP) reference, increase in technical consultation and assess the effectiveness of the proposed Accessibility Plan (PA). Improving the quality of care offered, lowering the cost to achieve it. DESIGN: Quality research study conducted in January-2010 data collected throughout 2009, and compare them versus those obtained in 2008. SETTING AND PARTICIPANTS: Population allocated to the ABS Sagrada Familia (23,265 users). MEASUREMENTS: Beneficiaries in HUS AP and population due to specialized care, population scheduled diagnostic and therapeutic procedures (radiology, laboratory echo-doppler, cryosurgery ...), total annual visits, attendance, repetition,... RESULTS: Increased 86.5% of emergency radiographs in AP (avoiding lead to ED), 7.4% fewer referrals to the emergency; implantation circuit urgent analytical (laboratory of HUS not collapsed) 13.6% fewer referrals to vascular surgery (the Eco-Doppler), 5.92% less analytical (thank Cardio-Check), 297 fewer referrals to dermatology (for cryotherapy), 9.65% less refe- rrals to psychiatry (through group workshops mental health), decreased frequency (1.4%) and recurrence (2.3%) over 2007, 23.9% of referrals to ED pathology avoided level IV-V served in AP; save ∈ 57,335 on 2007. CONCLUSIONS: Programs that includes the PA has proven its effectiveness, having offered improved quality and user satisfaction, spending economic decline, to be addressed and resolved in AP visits to level IV-V ED.

Análisis de las incapacidades laborales por depresión en mujeres / Analysis of work disability due to depression in women

Objetivo: Analizar la duración del proceso de incapacidad laboral (IT) en mujeres diagnosticadas de depresión endógena, depresión reactiva o trastorno ansioso-depresivo, de junio de 2004 a octubre de 2006, y ver las posibles diferencias con las IT en varones con los mismos diagnósticos y durante el mismo período. Material y método: Estudio descriptivo y transversal. Revisión de las IT informatizadas y codificadas según la clasificación CIAP-1 para atención primaria correspondientes a los diagnósticos estudiados, de junio de 2004 a octubre de 2006. Resultados: El total de IT fue de 6.079 (el 43,3% son varones y el 56,71%, mujeres); 423 (6,9%) IT tienen los diagnósticos estudiados y de éstas un 64,5% corresponde a mujeres. La distribución por grupos de edad fue: el 51% < 30 años; el 60,3%, 30-40 años; el 77,7%, 41-50 años; el 68,4%, 51-60 años, y el 59,1%, > 60 años. La duración media de las IT globales fue de 56,82 ± 8,44 días en las mujeres y de 47,29 ± 3,16 en los varones. La duración de las IT en días por diagnósticos estudiados es de 89,07 ± 13,15 días para las mujeres y de 73,94 ± 5,71 días para los varones. Conclusiones: Dado que la prevalencia y la duración de las IT en los diagnósticos estudiados es mayor en las mujeres, deberían incrementarse los programas específicos para mujeres de detección precoz, valoración, seguimiento y tratamiento de estas afecciones. Así se podría minimizar el impacto en la calidad de vida de la mujer y de su vida laboral

Objective: To analyze the duration of the process of work disability (WD) in women diagnosed with endogenous depression, reactive depression, or anxious-depressive disorder from June 2004 to October 2006 and to determine possible differences in WD for the same diagnoses in men during the same period. Material and method: A cross-sectional descriptive study was performed through a review of computerized WD coded according to the CIAP-1 classification for primary care and corresponding to the diagnoses included in this study from June 2004 to October 2006. Results: The total number of persons with work disability was 6,079 (43.30% men and 56.71% women). Of the total, 423 (6.9%) had received the diagnoses included in this study. Of these, 64.5% were women. Distribution by age groups and sex was as follows: < 30 years: 51.5%, 30-40 years: 60.3%, 41-50 years: 77.7%, 51-60 years: 68.4%, > 60 years: 59.1%. The mean duration in days of WD as a whole was 56.82 ± 8.44 in women and 47.29 ± 3.16 in men. The duration in days of WD for the study diagnoses was 89.07 ± 13.15 in women and 73.94 ± 5.71 in men. Conclusions: The prevalence and duration of WD for the diagnoses included in this study was greater in women. Consequently, specific programs for the early detection, evaluation, follow-up, and treatment of these disorders in women should be implemented to minimize their impact on women's quality of life and occupational life