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De la Torre-Lima J, Oteo JA, Pinilla J, Mansilla R, Zamora C, Ayala Vargas V, Morillo-Verdugo R, Moreno S, Fuster-Ruiz de Apodaca MJ, Pérez-Molina JA, Colom J. Study on the approach to HIV: health management and the healthcare process in Spain. Enferm Infecc Microbiol Clin (Engl Ed) 2023; 41:604-611. [PMID: 36624033 DOI: 10.1016/j.eimce.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 01/09/2023]
Abstract
INTRODUCTION HIV continues to represent a problem of great relevance for public health in Spain. This study aims to carry out an analysis that will provide in-depth knowledge of the resources, clinical care, and management during the diagnosis, follow-up, and treatment phases of HIV infection in Spain. METHODS In the first phase, a multidisciplinary Scientific Committee designed an information collection tool in the form of a survey. In the second phase, carried out in the autonomous communities of Andalusia, Catalonia, and La Rioja, a multidisciplinary group of 42 experts, representatives of the public administration, clinical profiles, and representatives of NGOs in the field of HIV answered the survey. RESULTS The assessment of HIV resources is generally positive. As regards diagnosis, the experts considered that there was good coordination between Primary and Hospital care. Regarding treatment, the evaluations reflected good opinions on therapeutic conciliation and adherence, with a negative opinion in the evaluation of drug interactions with antiretroviral treatment. Regarding follow-up, the perception expressed was disparate concerning the coordination between Hospital and Primary Care as well as the adaptation of care to chronicity, aging, fragility, mental health, and oncological processes. CONCLUSION There are certain processes that can be improved in the management of HIV infection in people with HIV in Spain, including protocols for follow-up and coordination between primary and hospital care in the treatment and follow-up of the disease.
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Affiliation(s)
- Javier De la Torre-Lima
- Plan Andaluz frente al VIH/sida y otras ITS, Consejería de Salud y Consumo de la Junta de Andalucía, Spain; Grupo de Enfermedades Infecciosas de la Unidad de Medicina Interna, Hospital Costa del Sol, Málaga, Spain.
| | - José Antonio Oteo
- Centro de Rickettsiosis y Enfermedades Transmitidas por Artrópodos Vectores, Departamento de Enfermedades Infecciosas, Hospital Universitario San Pedro-Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Javier Pinilla
- Servicio de Medicina Interna, Complejo Hospitalario San Millán-San Pedro, Logroño, Spain; Comisión Ciudadana Anti-Sida de La Rioja (CCASLR), Logroño, La Rioja, Spain
| | - Rosa Mansilla
- Vigilancia, Prevención y Control de las Infecciones de Transmisión Sexual y el VIH, Subdirección General de Vigilancia y Respuesta a Emergencias de Salud Pública, Agencia de Salud Pública de Cataluña, Departamento de Salud, Generalidad de Cataluña, Barcelona, Spain
| | - Carmen Zamora
- Plan Andaluz frente al VIH y otras ITS, Consejería de Salud y Consumo de la Junta de Andalucía, Spain
| | | | - Ramón Morillo-Verdugo
- Servicio de Farmacia, Hospital de Valme, Área de Gestión Sanitaria Sur de Sevilla, Sevilla, Spain
| | - Santiago Moreno
- Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
| | - María José Fuster-Ruiz de Apodaca
- Departamento de Psicología Social y de las Organizaciones, UNED, Madrid, Spain; Sociedad Española Interdisciplinaria del Sida (SEISIDA), Madrid, Spain
| | - José A Pérez-Molina
- CSUR de Enfermedades Tropicales, Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - Joan Colom
- Programa de Prevención, Control y Atención al VIH, las ETS y las Hepatitis Víricas de la Agencia de Salud Pública de Catalunya, Generalitat de Catalunya, Barcelona, Spain
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Quirós-González V, Bueno I, Goñi-Echeverría C, García-Barrio N, Del Oro M, Ortega-Torres C, Martín-Jurado C, Pavón-Muñoz AL, Hernández M, Ruiz-Burgos S, Ruiz-Morandy M, Pedrera M, Serrano P, Bernal JL. [What about the weekend effect? Impact of the day of admission on in-hospital mortality, length of stay and cost of hospitalization]. J Healthc Qual Res 2022; 37:366-373. [PMID: 35659444 DOI: 10.1016/j.jhqr.2022.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/04/2022] [Accepted: 04/18/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION There is no agreement on the existence of the weekend effect in healthcare or, if it exists, on its possible causes. The objective of the study was to evaluate the differences in healthcare outcomes between patients admitted on weekdays or weekends in a high-complexity hospital. METHODS Observational and retrospective study of patients admitted between 2016 and 2019 in a public hospital with more than 1300 beds. Hospitalization episodes were classified according to whether admission took place between Friday at 3:00 p.m. and the following Monday at 8:00 a.m. (weekend admission) or not (admission on weekdays). Mortality, length of stay and associated costs were compared, applying their respective risk-adjustment models. RESULTS Of the total 169,495 hospitalization episodes analyzed, 48,201 (28.44%) corresponded to the weekend, presenting an older age (54.9 years vs. 53.9; P<.001), a higher crude mortality rate (5.22% vs. 4.59%; P<0.001), and a longer average length of stay (7.42 days vs. 6.74; P<.001), than those admitted on weekdays. The median crude cost of stay was lower (€731.25 vs. €850.88; P<0.001). No significant differences were found when applying the adjustment models, with a risk-adjusted mortality ratio of 1.03 (0.99-1.08) vs. 0.98 (0.95-1.01), risk-adjusted length of stay of 1.002 (0.98-1.005) vs. 0.999 (0.997-1.002) and risk-adjusted cost of stay of 0.928 (0.865-0.994) vs. 0.901 (0.843-0.962). CONCLUSION The results of the study reveal that the assistance provided during the weekends does not imply worse health outcomes or increased costs. Comparing the impact between hospitals will require a future homogenization of temporal criteria and risk adjustment models.
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Affiliation(s)
- V Quirós-González
- Oficina Estrategia 2020-2024 «Transforma 12», Hospital Universitario 12 de Octubre, Madrid, España.
| | - I Bueno
- Facultada de Ciencias Jurídicas y Sociales, Universidad Carlos III de Madrid, Madrid, España
| | - C Goñi-Echeverría
- Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, España; Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - N García-Barrio
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Del Oro
- Servicio de Gestión Económica y Contabilidad, Hospital Universitario 12 de Octubre, Madrid, España
| | - C Ortega-Torres
- Servicio de Gestión Económica y Contabilidad, Hospital Universitario 12 de Octubre, Madrid, España
| | - C Martín-Jurado
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - A L Pavón-Muñoz
- Oficina Estrategia 2020-2024 «Transforma 12», Hospital Universitario 12 de Octubre, Madrid, España
| | - M Hernández
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - S Ruiz-Burgos
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Ruiz-Morandy
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
| | - M Pedrera
- Servicio de Informática, Hospital Universitario 12 de Octubre, Madrid, España
| | - P Serrano
- Dirección de Planificación, Hospital Universitario 12 de Octubre, Madrid, España
| | - J L Bernal
- Servicio de Análisis de Información y Control de Gestión, Hospital Universitario 12 de Octubre, Madrid, España
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Matarredona-Quiles S, Martínez Ruíz de Apodaca P, Serrano Badía E, Ortega Beltrá N, Dalmau-Galofre J. Factors associated with diagnosis delay in head and neck cancer. Acta Otorrinolaringol Esp (Engl Ed) 2022; 73:19-26. [PMID: 35190084 DOI: 10.1016/j.otoeng.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 10/13/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION AND OBJECTIVES Tumour stage is an important prognostic factor in head and neck tumours. Many tumours are diagnosed in advanced stages despite almost universal healthcare and their being symptomatic. This paper seeks to determine the diagnostic delay in head and neck tumours in our health department, to analyse factors associated with delay and if it is associated with diagnosis in advanced stages. METHODS Retrospective study of 137 patients with head and neck cancer diagnosed from 2016-2018. Patient delay, delay in primary health care, delay in secondary health care, diagnostic delay and possible associated factors (smoking, location, stage, …) were evaluated. RESULTS Many patients (44.5%) were diagnosed in advanced stages. The median patient delay was 30 days. The median referral to otorhinolaryngology was 3.5 days. If the referral was made by another specialist (p = .008), the patients were under previous treatment (P=.000) and the tumours were in initial stages (P=.038) this delay was greater. The median from the first visit to otorhinolaryngology was 15 days, higher in regular referrals (43%) (P=.000). The median diagnostic delay was 12 days, higher in surgical biopsies (P=.000). The median professional delay was 58.5 days and total delay was 118.5 days. CONCLUSIONS Many head and neck tumours are diagnosed in advanced stages. A relationship was not found between diagnosis in advanced stages and diagnostic delay. However, steps must be taken to reduce these excessive delays.
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Affiliation(s)
| | | | - Ester Serrano Badía
- Servicio de Otorrinolaringología, Hospital Francesc de Borja, Gandía, Valencia, Spain
| | - Noelia Ortega Beltrá
- Servicio de Otorrinolaringología, Hospital Universitario Doctor Peset, Valencia, Spain
| | - José Dalmau-Galofre
- Servicio de Otorrinolaringología, Hospital Universitario Doctor Peset, Valencia, Spain
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4
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Matarredona-Quiles S, Martínez Ruíz de Apodaca P, Serrano Badía E, Ortega Beltrá N, Dalmau-Galofre J. Factors associated with diagnosis delay in head and neck cancer. Acta Otorrinolaringol Esp (Engl Ed) 2021; 73:S0001-6519(20)30195-3. [PMID: 33714451 DOI: 10.1016/j.otorri.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION AND OBJECTIVES Tumour stage is an important prognostic factor in head and neck tumours. Many tumours are diagnosed in advanced stages despite almost universal healthcare and their being symptomatic. This paper seeks to determine the diagnostic delay in head and neck tumours in our health department, to analyse factors associated with delay and if it is associated with diagnosis in advanced stages. METHODS Retrospective study of 137 patients with head and neck cancer diagnosed from 2016-2018. Patient delay, delay in primary health care, delay in secondary health care, diagnostic delay and possible associated factors (smoking, location, stage, …) were evaluated. RESULTS Many patients (44.5%) were diagnosed in advanced stages. The median patient delay was 30 days. The median referral to otorhinolaryngology was 3.5 days. If the referral was made by another specialist (p=.008), the patients were under previous treatment (P=.000) and the tumours were in initial stages (P=.038) this delay was greater. The median from the first visit to otorhinolaryngology was 15 days, higher in regular referrals (43%) (P=.000). The median diagnostic delay was 12 days, higher in surgical biopsies (P=.000). The median professional delay was 58.5 days and total delay was 118.5 days. CONCLUSIONS Many head and neck tumours are diagnosed in advanced stages. A relationship was not found between diagnosis in advanced stages and diagnostic delay. However, steps must be taken to reduce these excessive delays.
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Affiliation(s)
| | | | - Ester Serrano Badía
- Servicio de Otorrinolaringología, Hospital Francesc de Borja, Gandía, Valencia, España
| | - Noelia Ortega Beltrá
- Servicio de Otorrinolaringología, Hospital Universitario Doctor Peset, Valencia, España
| | - José Dalmau-Galofre
- Servicio de Otorrinolaringología, Hospital Universitario Doctor Peset, Valencia, España
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Garcia-Casanovas A, Bisbe E, Colomina MJ, Arbona C, Varela J. [Health policy strategies for Patient Blood Management implementation throughout the Spanish health systems]. J Healthc Qual Res 2020; 35:319-327. [PMID: 32972901 PMCID: PMC7505576 DOI: 10.1016/j.jhqr.2020.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 03/12/2020] [Accepted: 06/30/2020] [Indexed: 01/01/2023]
Abstract
Los programas de Patient Blood Management (PBM) permiten reducir intervenciones sanitarias innecesarias e incorporar prácticas clínicas de alto valor que mejoran los resultados en salud y la eficiencia. Su adopción en España es todavía limitada y con una alta variabilidad entre hospitales. Las recientes guías de la Unión Europea sobre cómo implementar el PBM, así como las recomendaciones de expertos, indican que para conseguir un avance en este campo se requiere, no solo de la implicación de los profesionales, sino también de las autoridades sanitarias y direcciones hospitalarias. Este artículo proporciona algunas propuestas en materia de gestión y política sanitaria para promover el desarrollo del PBM en los sistemas de salud en España.
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Affiliation(s)
- A Garcia-Casanovas
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España.
| | - E Bisbe
- Servicio de Anestesiología, Hospital del Parc de Salut Mar, Barcelona, España
| | - M J Colomina
- Servicio de Anestesiología, Hospital Universitari Bellvitge, Barcelona, España
| | - C Arbona
- Centro de Transfusión de la Comunitat Valenciana, Valencia, España
| | - J Varela
- Gesclinvar Consulting S.L., Barcelona, España
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Matías-Guiu J, Matias-Guiu JA, Alvarez-Sabin J, Ramon Ara J, Arenillas J, Casado-Naranjo I, Castellanos M, Jimenez-Hernandez MD, Lainez-Andres JM, Moral E, Morales A, Rodriguez-Antigüedad A, Segura T, Serrano-Castro P, Diez-Tejedor E. Will neurological care change over the next 5 years due to the COVID-19 pandemic? Key informant consensus survey. Neurologia 2020; 35:252-257. [PMID: 32364126 PMCID: PMC7165283 DOI: 10.1016/j.nrl.2020.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The COVID-19 pandemic will give rise to long-term changes in neurological care, which are not easily predictable. MATERIAL AND METHODS A key informant survey was used to enquire about the changes expected in the specialty over the next 5 years. The survey was completed by heads of neurology departments with broad knowledge of the situation, having been active during the pandemic. RESULTS Despite a low level of consensus between participants, there was strong (85%) and moderate consensus (70%) about certain subjects, mainly the increase in precautions to be taken, the use of telemedicine and teleconsultations, the reduction of care provided in in-person consultations to avoid the presence of large numbers of people in waiting rooms, the development of remote training solutions, and the changes in monitoring visits during clinical trials. There was consensus that there would be no changes to the indication of complementary testing or neurological examination. CONCLUSION The key informant survey identified the foreseeable changes in neurological care after the pandemic.
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Affiliation(s)
- J Matías-Guiu
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España.
| | - J A Matias-Guiu
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España
| | - J Alvarez-Sabin
- Servicio de Neurología, Hospital Universitario de Vall d'Hebron, Barcelona, España
| | - J Ramon Ara
- Servicio de Neurología, Hospital Miguel Servet, Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, España
| | - J Arenillas
- Servicio de Neurología, Hospital Clínico de Valladolid, Valladolid, España
| | - I Casado-Naranjo
- Servicio de Neurología, Complejo Hospitalario Universitario de Cáceres, Cáceres, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, A Coruña, España
| | | | - J M Lainez-Andres
- Servicio de Neurología, Hospital Clínico Universitario de Valencia, Valencia, España
| | - E Moral
- Hospital Moisès Broggi y Hospital General de l'Hospitalet, Barcelona, España
| | - A Morales
- Servicio de Neurología, Hospital Universitario Virgen de la Arrixaca, Murcia, España
| | | | - T Segura
- Servicio de Neurología, Hospital General Universitario de Albacete, Albacete, España
| | - P Serrano-Castro
- Servicio de Neurología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
| | - E Diez-Tejedor
- Servicio de Neurología, Hospital Universitario La Paz, Madrid, España
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Matías-Guiu J, Porta-Etessam J, Lopez-Valdes E, Garcia-Morales I, Guerrero-Solá A, Matias-Guiu JA. Management of neurological care during the COVID-19 pandemic. Neurologia 2020; 35:233-237. [PMID: 32336528 PMCID: PMC7151454 DOI: 10.1016/j.nrl.2020.04.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION The COVID-19 epidemic has led to the need for unprecedented decisions to be made to maintain the provision of neurological care. This article addresses operational decision-making during the epidemic. DEVELOPMENT We report the measures taken, including the preparation of a functional reorganisation plan, strategies for hospitalisation and emergency management, the use of telephone consultations to maintain neurological care, provision of care at a unit outside the hospital for priority patients, decisions about complementary testing and periodic in-hospital treatments, and the use of a specific telephone service to prioritise patients with epileptic seizures. CONCLUSION Despite the situation of confinement, neurology departments must continue to provide patient care through different means of operation. Like all elements of management, these must be evaluated.
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Affiliation(s)
- J Matías-Guiu
- Servicio de Neurología, Instituto de Neurociencias Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España.
| | - J Porta-Etessam
- Servicio de Neurología, Instituto de Neurociencias Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
| | - E Lopez-Valdes
- Servicio de Neurología, Instituto de Neurociencias Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
| | - I Garcia-Morales
- Servicio de Neurología, Instituto de Neurociencias Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
| | - A Guerrero-Solá
- Servicio de Neurología, Instituto de Neurociencias Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
| | - J A Matias-Guiu
- Servicio de Neurología, Instituto de Neurociencias Hospital Clínico San Carlos, San Carlos, IdISSC, Madrid, España
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Martínez Menéndez B, Escolar Escamilla E, Pinel González A, Cerezo García M, Martínez Sarries FJ, Morlán Gracia L. Has clinical activity in paediatric neurology changed in the past 11 years? Neurologia 2014; 31:606-612. [PMID: 25529177 DOI: 10.1016/j.nrl.2014.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 09/16/2014] [Accepted: 09/22/2014] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION We believe that the demand for paediatric neurology (PN) care has increased over the past decade, and that reasons for requesting consultations have also changed. The objective of this study is to complete a registry study to profile the demand for PN care in 2013 and compare results to those from a study performed in 2002. METHODS A prospective registry of PN healthcare activities was completed at Hospital Universitario de Getafe in 2013. Results were compared with those from a prospective registry study conducted in 2002. RESULTS The number of visits increased from 1,300 in 2002 to 1,982 in 2013 (a 52.46% increase), and from 32.6 visits per 1,000 children to 57.48 (a 76.32% increase). Outpatient consultations accounted for 92.2% of all PN consultations in 2013. Currently, attention deficit-hyperactivity disorder (ADHD) is the most frequent diagnosis (27.6% in 2013 vs. 8.1% in 2002). Although the percentage of headache consultations has decreased (19% in 2013 vs. 22% in 2002), headache was still the most common reason for an initial visit in 2013 (32.1%), followed by ADHD (19.1%). Epilepsy remains the most frequent diagnosis in hospitalised patients (30.3% in 2013 vs. 36.7% in 2002). CONCLUSIONS PN is fundamentally an outpatient activity that has increased considerably in recent years. This increase is mainly due to neurodevelopmental disorders, especially ADHD. We might state that the role of ADHD in PN is comparable to that of dementia in general neurology.
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Affiliation(s)
- B Martínez Menéndez
- Unidad de Neurología Pediátrica, Sección de Neurología, Hospital Universitario de Getafe, Getafe, Madrid, España.
| | - E Escolar Escamilla
- Unidad de Neurología Pediátrica, Sección de Neurología, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - A Pinel González
- Unidad de Neurología Pediátrica, Sección de Neurología, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - M Cerezo García
- Unidad de Neurología Pediátrica, Sección de Neurología, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - F J Martínez Sarries
- Unidad de Neurología Pediátrica, Sección de Neurología, Hospital Universitario de Getafe, Getafe, Madrid, España
| | - L Morlán Gracia
- Unidad de Neurología Pediátrica, Sección de Neurología, Hospital Universitario de Getafe, Getafe, Madrid, España
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Matías-Guiu JA, García-Azorín D, García-Ramos R, Basoco E, Elvira C, Matías-Guiu J. Study of outpatient neurological care in the Region of Madrid: The impact of implementing free choice of hospital. Neurologia 2014; 30:479-87. [PMID: 24856217 DOI: 10.1016/j.nrl.2014.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 04/05/2014] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION A new model permitting free choice of hospital has been introduced in the Region of Madrid. This may result in changes in how outpatient neurological care is provided and managed. The purpose of this study is to analyse initial visits to a general neurology department in the Region of Madrid and record the health district corresponding to each patient's residence. METHODS Observational and prospective study of a cohort of patients making initial outpatient visits to a neurology department between 16 September 2013 and 16 January 2014. RESULTS The study included 1109 patients (63.8% women, mean age 55.2±20.5). The most frequent diagnostic groups were periodic headache, cognitive disorders, and neuromuscular diseases. Non-neurological diseases were diagnosed in 1.1% of the cases. The mean time of delay was 7.2±5.1 days. Residents within the hospital's health district made up 73.8% of the total, while 26.2% chose a hospital outside of the health district corresponding to their residences. In the latter group, 59.5% made the choice based on the level of care offered, while 39.7% changed hospitals due to shorter times to consultation. The patients who came from another health district were younger (50.7 vs 57.3, P<.0001) and had a lower rate of discharges on the first visit (16.4% vs 30.1%, P<.0001). CONCLUSION The model of free choice of hospital delivers significant changes in healthcare management and organisation. Reasons given for choosing another hospital are more ample experience and shorter delays with respect to the home district hospital. Management of patients from outside the health district is associated with greater complexity.
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Affiliation(s)
- J A Matías-Guiu
- Servicio de Neurología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria «San Carlos», Universidad Complutense, Madrid, España.
| | - D García-Azorín
- Servicio de Neurología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria «San Carlos», Universidad Complutense, Madrid, España
| | - R García-Ramos
- Servicio de Neurología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria «San Carlos», Universidad Complutense, Madrid, España
| | - E Basoco
- Servicio de Admisión, Hospital Clínico San Carlos, Madrid, España
| | - C Elvira
- Servicio de Admisión, Hospital Clínico San Carlos, Madrid, España
| | - J Matías-Guiu
- Servicio de Neurología, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria «San Carlos», Universidad Complutense, Madrid, España
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