Originales
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
Antoni Sicras Mainara,
, Javier Rejas Gutiérrezb, Ruth Navarro Artiedaa, Josep Serrat Tarrésc, Milagrosa Blanca Tamayod, Silvia Díaz Cerezoe
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.
Correspondencia: Antoni Sicras Mainar. Dirección de Planificación y Desarrollo Organizativo. C/ Gaietà Soler, 6-8, entlo. 08911 Badalona. Barcelona. España.
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
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Dirección de Planificación y Desarrollo Organizativo. C/ Gaietà Soler, 6-8, entlo. 08911 Badalona. Barcelona. España." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Patterns of health services use and costs in patients with mental disorders in primary care" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2006-05-31" "fechaAceptado" => "2006-11-06" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec13966" "palabras" => array:4 [ 0 => "Trastorno mental" 1 => "Utilización de recursos" 2 => "Estudio de costes" 3 => "Atención primaria" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec13965" "palabras" => array:4 [ 0 => "Mental disorders" 1 => "Health care resource utilization" 2 => "Costs study" 3 => "Primary health care" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">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<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001) y de utilización de recursos sanitarios, particularmente visitas médicas/paciente/año (10,7 frente a 7,2; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001). El coste medio anual en pacientes con PM fue significativamente superior (851,5 frente a 519,2 euros; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>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.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">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.</p>" ] "en" => array:2 [ "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 (MD) in primary care in the context of routine clinical practice.</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, 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.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">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<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001) and higher resource consumption, mainly all-type medical visits/patient/year (10.7 vs. 7.2; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0001). The mean annual cost per patient was higher for patients with MD (851.5 vs. 519.2 euros; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>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.</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.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:29 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1." 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Información del artículo
ISSN: 02139111Idioma original: Español
DOI:10.1157/13108503
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