Trends in gastrointestinal bleeding in the Region of Valencia (2000-2005). Relationship to sales of nonsteroidal anti-inflammatory drugs and acid suppression medication

OBJECTIVE

To describe 2000-2005 time trends of prescription for NSAIDs, proton pump inhibitors (PPIs) and hospital admissions for gastrointestinal (GI) bleeding.

METHODS

Time series analysis of gastrointestinal (GI) bleeding admission and drugs' Defined Daily Dose per 1000 people per day (DDD/1000/day) in the Region of Valencia, Spain, from January 2000 to December 2005.

RESULTS

Dispensation of NSAIDs went from 42.7 DDD/1000 people/day in 2000 to 58.3 DDD/1000 people/day in 2005. During the same period, dispensation of PPIs went from 26.3 DDD/1000 people/day to 68.5 DDD/1000 people/day (both are statistically significant). The rate of hospitalisations for gastrointestinal bleeding during this period oscillated between 142 and 126 admission per 100 000 inhabitants/year. No year showed significant differences compared to 2000.

CONCLUSION

A substantial increase in the NSAID use from 2000 to 2005 was not accompanied by changes in GI bleeding hospitalisation rates in Valencia, but GI bleeding rates continued to be high, suggesting a need to improve NSAIDs use.

[Interruption to treatment with combined lopinavir/ritonavir therapy in HIV positive patients]

OBJECTIVE

To describe the extent of interruptions to treatment with therapies which include the combination of lopinavir-ritonavir within the SNS (Spanish National Health System), as well as identify the causes of these interruptions and analyse the factors associated with the same.

METHOD

Retrospective cohort of 197 seropositive patients, who began treatment with lopinavir-ritonavir between January 2000 and October 2002. The patients attended the outpatient pharmaceutical care unit and were followed-up until December 2002. Interruptions and their causes were identified and the factors associated with the interruption were analysed using proportional hazard models.

RESULTS

The mean follow-up period was 263 days and 38.6% of patients interrupted therapy. The most common causes of interruption were intolerance (30.3%), non-compliance (21.1%) and therapy failure (5.26%). The mean treatment period was 487 days (95% CI: 432 to 542) and 50% of patients who interrupted treatment did so within the first 4 months. No associations were found between patient or treatment characteristics and the risk of interruption.

CONCLUSIONS

The percentage of interruptions was lower than those in other observational studies, but greater than those in clinical trials. The significance of the causes of interruption was similar and no factor associated with the risk of interruption was found.

[Efficacy of electroconvulsive therapy: a systematic review of scientific evidences]

We carried out a systematic study of bibliographical review of scientific evidence provided by clinical trials that assessed the short, medium and long-term efficacy of electroconvulsive therapy (ECT) from 1965 until June 2003. The studies with the following features have been excluded: a) those in which ECT is not the aim of the research; b) those that do not compare ECT with another different treatment; c) those in which the aim of the research is not to evaluate the efficacy of ECT, and d) those in which the studies are not randomized clinical trials. We have used the biomedical databases Medline, Psyclit, IME and Cochrane. On applying the corresponding search strategies on every bibliographical repertory, a total amount of 916 studies were found, which were reduced to 62 after having applied the specified exclusion criteria. The scientific evidence obtained, which compare the efficacy of ECT exclusively in depression, schizophrenia, mania and Parkinson disease, are systematized.

[Emergency department utilization by children aged less than two years old]

BACKGROUND

Emergency department visits are rising although birth rate is decreasing.

OBJECTIVE

To compare emergency department.(ED) utilization in the cohorts of children born in 1991 and 1996 in a health district.

METHOD

We performed a two-year retrospective cohort study in the health district of Mieres (Spain). All children born in the health district in 1991 (n 600) and 1996 (n 423) were included. The number of visits to the ED was obtained and the frequency and mean number of visits in the first 2 years of life were calculated according to age, sex, and area of residence.

RESULTS

The gross number of visits did not vary (1991: 852; 1996: 853), despite a decrease in birth rate. The number of children who attended the ED at least once increased by 34.8 % (1991, 60.6 %; 1996, 82 %) and the frequency of visits increased by 41.7 % (1991, 142.2 %; 1996, 201.4 %). More than 60 % of visits were made by 20 % (1991) of the children and by 29 % (1996). The percentage of children who attended the ED, the frequency rate and the mean number of visits were significantly higher in the municipality nearest the hospital than in the remaining municipalities in the health district.

CONCLUSIONS

Although the gross number of visits to the ED remained unchanged, ED utilization increased substantially in only 5 years.

[Senior citizen health conditions and hospitalization on geriatric, general and surgical floors, a population study conducted in Toledo]

BACKGROUND

The health condition and some clinical aspects configure a group of senior citizens in need of further care who could benefit from specialized geriatric care, although no consensus exists as to how to identify these patients. The aim of this study is to describe the profile of those patients over 64 years of age who are hospitalized in a geriatric unit and to compare this profile to the senior citizens hospitalized in general medical and surgical units.

METHOD

A cohort representative of the population over age 64 in the Judicial District of Toledo (n = 3214) was studied over an eighteen-month period for the purpose of identifying the income and length of stays at the public hospitals in the health care district in question. The health condition-related variables were gathered by means of personal interviews, and the income and the different aspects thereof by way of hospital admissions department data.

RESULTS

A total of 410 individuals were admitted (12.8%), 168 patients (30.7%) in geriatrics, 204 (37.3%) in medical units and 174 (32.0%) in surgical units. In geriatrics, the average age was significantly higher (age 77.4), there being no differences in the average length of stay (12.8 days; CI 95%) 10.6-14.0), 44 patients (8.1%) having died, 26 (59.1%) hospitalized in geriatrics. More females, younger patients having minor vision and hearing impairments were admitted to the surgical units. In geriatrics, as compared to the medical units, more patients over 80 years of age, living in senior citizen living facilities, having no spouse, moderate-to-severe functional dependence, impaired cognitive function, depression, poor quality of life and scanty social resources.

CONCLUSIONS

No differences were found to exist between the health conditions of those over age 64 who were hospitalized in non-surgical and surgical units. In geriatrics, as compared to the other groups of units, the patients were older, in worse condition, had a higher death rate and similar average length of stay.

[Nursing care in the home and in conventional hospitalization]

BACKGROUND

Nursing care is of especial importance in hospital care in the home (HH). This is as due to the characteristics of the patient as it is to the transfer to the informal carers for the patient. The aim of this study is to analyse the quantity and type of nursing care administered and required by patients in HH and conventional hospitalisation (CH).

METHODS

Project Research Nursing (PRN) was used to quantify the amount and types of nursing care administered and required in 2 groups of patients (HH: 148 patients, 1776 stays; CH: 148 patients, 1113 stays) having similar characteristics and treated in each way, together with how they evolved, analysing differences in terms of forms of attention and the characteristics of the patients.

RESULTS

In terms of the care administered, those patients in HH (647.8 minutes/episode) received less care than those in CH (1030 minutes/episode). This difference was fundamentally due to the fact that they received less basic care (HH: 96.6 min./episode; CH: 464.3 min./episode) and diagnostic work (HH: 84.4 min./episode; CH: 177.3). On the other hand, patients in HH received a greater quantity of communicational care (238.8 min., as opposed to 107.4 in CH). No significant differences were found between the care administered and that which was required.

CONCLUSIONS

Patients in HH received less nursing care than did those in CH, mainly due to the fact that they received less basic care from nurses, as this work was transferred to their careers. They also received less care associated with diagnostic tests (depending on styles of medical practice), although they received more care in the form of communication (health education). The lack of differences between the care that was actually administered and that which was required suggests that the quality of care provided is sufficient in both forms of hospitalisation.

[Analysis of opinions, attitudes and knowledge of physicians of health centers of Valencia concerning efficacy and efficiency of drug prescriptions]

OBJECTIVE

To find the views, attitudes and knowledge of Primary Care doctors concerning the efficacy and efficiency of medical prescription.

DESIGN

Descriptive, crossover study.

SETTING

10 Health Centres in the city of Valencia.

PARTICIPANTS

The 115 doctors, both general and family practitioners, working at these centres.

INTERVENTIONS

A survey gathered information on the doctors' views about the appropriateness of considering price when prescribing, on their assessment of ten strategies aimed at improving prescription efficiency, and their understanding of the efficacy and cost of certain medicines used in Primary Care.

RESULTS

1. 81% of those surveyed stated that prescription costs had to be considered at the moment of deciding patient treatment. 2. 70.4% of their opinions of the efficacy of medicines, as measured by the Intrinsic Therapeutic Value, were accurate. 3. 41% of the prices estimated by doctors were correct. There was a tendency to undervalue prices and to eliminate differences between products of identical composition. 4. In the area of strategies to improve prescription efficiency, doctors clearly favoured training strategies (prescription guidelines or in-work training) over strategies involving "assuming economic risks" (pharmacy self-management...).

[Factors determining costs of drug prescriptions in primary health care]

OBJECTIVE

To describe and explain the annual pharmaceutical expenditure generated by the professionals in a Health Area.

DESIGN

An observational crossover study.

SETTING

Primary Care. Doctors in a Health Area.

PARTICIPANTS

99 general practitioners who worked during 1992 in Area 3, Castellón.

INTERVENTIONS

We used as a variable reply the pharmaceutical expenditure of each doctor during 1992, the expenditure per inhabitant and the expenditure per inhabitant standardised for the percentage of passives. We gathered as explanatory variables of the same: age, gender, whether the post was provisional or permanent, rural or urban area, MIR (resident) training or not, the model of Primary Care, frequency of attendance, whether the doctors worked there exclusively, the number of pensioners and the number of patients at work registered.

MEASUREMENTS AND RESULTS

In the bivariant analysis we found a significant association of expenditure with being provisional in the post, the old model of primary care, an urban area, greater age of the doctor, greater frequency of attendance, non-exclusivity and the number of patients registered. These associations varied in line with the variable reply used. In the different models of multiple linear regression obtained, the influence of the number, non-exclusivity, gender and work-place characteristics predominated.

CONCLUSIONS

Greater pharmaceutical expenditure appears to be related to the number of patients registered, the absence of exclusivity, doctors being women and the features of the town where they work.

[Consensus doesn't always mean agreement: limitations of consensus methods in health services]

Taking decisions in uncertain situations has led to a high use of the consensus methods (Nominal Group Technique, Delphi Method, and Consensus Conferences) in the health services. The review made in this article shows that the appropriate use of these techniques requires a high degree of methodologic precision, especially in relation to the financer's declaration of objectives, the appropriate selection of the participants, previous realization of a synthesis of the preexistent information, the definition of the agreement degree which leads to the consensus and in the evaluation of its impact.

[Prospective payment per case and length of stay at coordinated private hospitals]

BACKGROUND

In 1991 the Valencian Health Service (SVS) introduced a system of prospective payment per process to reimburse some surgical interventions to coordinated private hospitals which, until then, had invoiced by retrospective payment per hospital stay. The impact of this change on the mean length of stay in seven groups of surgical interventions is evaluated.

METHODS

Retrospective analysis of the mean stay of 2025 admissions in private hospitals coordinated under both systems of payment (payment per process 66%, October 91 to February 92; payment by stay 64%, March 91 to February 92) for seven groups of surgical procedures: cataract surgery, cholecystectomy, hernioraphy, prostate resection, tonsillectomy-adenoidectomy, varicose vein and proctologic procedures was carried out.

RESULTS

Mean hospital stay decreased (mean = 5.4 days; p < 0.001) in all the groups reimbursed under PRP (from 72% in proctologic conditions to 43% for adenoidectomy-tonsillectomy) avoiding 8727 stays. The coinciding period under both systems demonstrated a decrease of mean hospital stay similar to the total period.

CONCLUSIONS

The coordinated hospitals demonstrated a surprisingly rapid capacity to modify their organizative behaviour or influence the styles of clinical practice or both to adopt the patterns of length of stay which optimize profits according to the system of payment used by the SVS.

[The possibilities for the participation of local corporations in the management of health services]

Strategies that stimulate the involvement of the community in the National Health System would provide more important role for the city councils in the management and control of public health care. This has currently proven to be difficult due to a new centralism at the Autonomous Community level. In this paper, recent collaborative experiences between municipalities and the National Health System are reviewed. Also, different ways for stimulating a real involvement of city councils in the health care are suggested: from managing new facilities and controlling existing facilities at the primary health care level, to a deep, not merely administrative, inclusion of the local health services into the National Health System.