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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">Determinar el patr&#243;n de uso de servicios y costes en pacientes que demandan atenci&#243;n por problemas mentales &#40;PM&#41; en asistencia primaria en situaci&#243;n de pr&#225;ctica cl&#237;nica habitual&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo&#46; Se incluyeron pacientes mayores de 15 a&#241;os&#44; con al menos una demanda de atenci&#243;n por PM&#44; atendidos por 5 equipos de atenci&#243;n primaria durante el a&#241;o 2004&#46; Se form&#243; un grupo comparativo con el resto de pacientes sin PM&#46; Las variables fueron&#58; edad&#44; sexo&#44; casu&#237;stica&#47; comorbilidad&#44; utilizaci&#243;n de recursos sanitarios y costes ambulatorios correspondientes &#40;medicamentos&#44; procedimientos diagn&#243;sticos y visitas&#41;&#46; Se emple&#243; el an&#225;lisis de regresi&#243;n log&#237;stica m&#250;ltiple y modelos de ANCOVA&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 64&#46;072 pacientes&#44; de los cuales 11&#46;128 presentaron alg&#250;n PM &#40;17&#44;4&#37;&#59; intervalo de confianza &#91;IC&#93; del 95&#37;&#44; 16&#44;7-18&#44;1&#41;&#46; Los pacientes que demandaron atenci&#243;n por PM presentaron un mayor n&#250;mero de problemas de salud &#40;6&#44;7 frente a 4&#44;7&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; y de utilizaci&#243;n de recursos sanitarios&#44; particularmente visitas m&#233;dicas&#47;paciente&#47;a&#241;o &#40;10&#44;7 frente a 7&#44;2&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46; El coste medio anual en pacientes con PM fue significativamente superior &#40;851&#44;5 frente a 519&#44;2 euros&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41; y se mantuvo despu&#233;s de corregir por edad&#44; sexo y comorbilidades&#44; con un coste diferencial de 72&#44;7 euros &#40;IC del 95&#37;&#44; 59&#44;2-85&#44;9&#41;&#46; Todos los componentes del coste por paciente fueron mayores en el grupo de pacientes con PM&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">Los pacientes que han demandado atenci&#243;n por alg&#250;n PM presentan un elevado n&#250;mero de comorbilidades y un mayor coste anual por paciente en el &#225;mbito de la atenci&#243;n primaria&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p class="elsevierStyleSimplePara elsevierViewall">To determine the pattern of services use and costs of patients requiring care for mental disorders &#40;MD&#41; in primary care in the context of routine clinical practice&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p class="elsevierStyleSimplePara elsevierViewall">We performed a retrospective study of patients older than 15 consulting primary care at least once for MD&#44; attended by 5 primary care teams in 2004&#46; A comparative group was formed with the remaining outpatients without MD&#46; The main measurements were age&#44; gender&#44; case-mix&#47;comorbidity and health resource utilization and corresponding outpatient costs &#40;drugs&#44; diagnostic tests and visits&#41;&#46; Multiple logistic regression analysis and ANCOVA models were applied&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">A total of 64&#44;072 patients were assessed&#44; of which 11&#44;128 had some type of MD &#40;17&#46;4&#37;&#59; 95&#37; CI&#44; 16&#46;7-18&#46;1&#41;&#46; Patients consulting for MD had a greater number of health problems &#40;6&#46;7 vs&#46; 4&#46;7&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41; and higher resource consumption&#44; mainly all-type medical visits&#47;patient&#47;year &#40;10&#46;7 vs&#46; 7&#46;2&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46; The mean annual cost per patient was higher for patients with MD &#40;851&#46;5 vs&#46; 519&#46;2 euros&#59; p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#44; and this difference remained significant after adjusting by age&#44; sex and comorbidities&#44; with a differential cost of euros 72&#46;7 &#40;95&#37; CI&#44; 59&#46;2-85&#46;9&#41;&#46; All components of outpatient management costs were significantly higher in the MD group&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Outpatients seeking care for some type of MD had a high number of comorbidities and showed greater annual cost per patient in the primary care setting&#46;</p>"
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Vol. 21. Núm. 4.
Páginas 306-313 (julio - agosto 2007)
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Vol. 21. Núm. 4.
Páginas 306-313 (julio - agosto 2007)
Originales
Open Access
Costes y patrón de uso de servicios en pacientes que demandan atención por problemas mentales en asistencia primaria
Patterns of health services use and costs in patients with mental disorders in primary care
Visitas
1083
Antoni Sicras Mainara,
Autor para correspondencia
asicras@bsa.gs

Correspondencia: Antoni Sicras Mainar. Dirección de Planificación y Desarrollo Organizativo. C/ Gaietà Soler, 6-8, entlo. 08911 Badalona. Barcelona. España.
, Javier Rejas Gutiérrezb, Ruth Navarro Artiedaa, Josep Serrat Tarrésc, Milagrosa Blanca Tamayod, Silvia Díaz Cerezoe
a Dirección de Planificación, Badalona Serveis Assistencials, Badalona, Barcelona, España
b Departamento de Investigación de Resultados en Salud, Unidad Médica, Pfizer España, Alcobendas, Madrid, España
c Departamento de Medicina Interna, Badalona Serveis Assistencials, Badalona, Barcelona, España
d Departamento de Psiquiatría, Badalona Serveis Assistencials, Badalona, Barcelona, España
e Investigación de Resultados en Salud, Artac Bioestudios, Madrid, España
Este artículo ha recibido

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Información del artículo
Resumen
Objetivos

Determinar el patrón de uso de servicios y costes en pacientes que demandan atención por problemas mentales (PM) en asistencia primaria en situación de práctica clínica habitual.

Métodos

Estudio retrospectivo. Se incluyeron pacientes mayores de 15 años, con al menos una demanda de atención por PM, atendidos por 5 equipos de atención primaria durante el año 2004. Se formó un grupo comparativo con el resto de pacientes sin PM. Las variables fueron: edad, sexo, casuística/ comorbilidad, utilización de recursos sanitarios y costes ambulatorios correspondientes (medicamentos, procedimientos diagnósticos y visitas). Se empleó el análisis de regresión logística múltiple y modelos de ANCOVA.

Resultados

Se incluyeron 64.072 pacientes, de los cuales 11.128 presentaron algún PM (17,4%; intervalo de confianza [IC] del 95%, 16,7-18,1). Los pacientes que demandaron atención por PM presentaron un mayor número de problemas de salud (6,7 frente a 4,7; p<0,0001) y de utilización de recursos sanitarios, particularmente visitas médicas/paciente/año (10,7 frente a 7,2; p<0,0001). El coste medio anual en pacientes con PM fue significativamente superior (851,5 frente a 519,2 euros; p<0,0001) y se mantuvo después de corregir por edad, sexo y comorbilidades, con un coste diferencial de 72,7 euros (IC del 95%, 59,2-85,9). Todos los componentes del coste por paciente fueron mayores en el grupo de pacientes con PM.

Conclusiones

Los pacientes que han demandado atención por algún PM presentan un elevado número de comorbilidades y un mayor coste anual por paciente en el ámbito de la atención primaria.

Palabras clave:
Trastorno mental
Utilización de recursos
Estudio de costes
Atención primaria
Abstract
Objectives

To determine the pattern of services use and costs of patients requiring care for mental disorders (MD) in primary care in the context of routine clinical practice.

Methods

We performed a retrospective study of patients older than 15 consulting primary care at least once for MD, attended by 5 primary care teams in 2004. A comparative group was formed with the remaining outpatients without MD. The main measurements were age, gender, case-mix/comorbidity and health resource utilization and corresponding outpatient costs (drugs, diagnostic tests and visits). Multiple logistic regression analysis and ANCOVA models were applied.

Results

A total of 64,072 patients were assessed, of which 11,128 had some type of MD (17.4%; 95% CI, 16.7-18.1). Patients consulting for MD had a greater number of health problems (6.7 vs. 4.7; p<0.0001) and higher resource consumption, mainly all-type medical visits/patient/year (10.7 vs. 7.2; p<0.0001). The mean annual cost per patient was higher for patients with MD (851.5 vs. 519.2 euros; p<0.0001), and this difference remained significant after adjusting by age, sex and comorbidities, with a differential cost of euros 72.7 (95% CI, 59.2-85.9). All components of outpatient management costs were significantly higher in the MD group.

Conclusions

Outpatients seeking care for some type of MD had a high number of comorbidities and showed greater annual cost per patient in the primary care setting.

Key words:
Mental disorders
Health care resource utilization
Costs study
Primary health care
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