Efectividad e impacto económico de un programa de atención integrada con soporte de telemedicina a pacientes diabéticos tipo 2 tratados con insulina (estudio GITDIABE)

Objetivo: Evaluar si pacientes diabéticos tipo 2 con insulina y autocontrol (DIA) incluidos en un programa de gestión integrada de la diabetes mellitus (DM) con seguimiento telemático alcanzan un grado de control metabólico a los 12 meses mejor que los no incluidos, así como el impacto en la utilización y el coste de servicios sanitarios, consumo de fármacos y tiras reactivas. Diseño: Estudio prospectivo de cohortes paralelas. Emplazamiento: Cuatro áreas básicas de salud de una organización sanitaria integrada. Participantes: Ciento veintiséis pacientes DIA de 15 o más años en tratamiento con insulina rápida o intermedia con autocontroles: 42 casos y 84 controles emparejados según edad, sexo, grado de control de la DM y perfil de morbilidad. Intervención: Comunicación telemática médico-paciente y volcado de glucemias mediante la plataforma Emminens eConecta®; suministro a domicilio de tiras reactivas según consumo. Controles ocultos, con seguimiento habitual. Mediciones principales: Hemoglobina glucosilada (% HbA1c); percepción de calidad de vida (EuroQol-5 y EsDQOL); riesgo cardiovascular; utilización de recursos sanitarios; consumo de tiras reactivas y medicamentos; gasto sanitario total. Resultados: Reducción de %HbA1c en casos respecto a controles de 0,38% (IC95% −0,89% a 0,12%). Sin diferencias significativas respecto a ninguna de las actividades registradas, ni cambios significativos en la calidad de vida. Conclusiones: Los resultados obtenidos no difieren de otros estudios equiparables. El perfil es de un paciente anciano y pluripatológico que tiene todavía limitaciones tecnológicas. Para superar estas barreras se debería dedicar más tiempo a la formación y a la resolución de problemas tecnológicos

Estimating lifetime healthcare costs with morbidity data

Background: In many developed countries, the economic crisis started in 2008 producing a serious contraction of the financial resources spent on healthcare. Identifying which individuals will require more resources and the moment in their lives these resources have to be allocated becomes essential. It is well known that a small number of individuals with complex healthcare needs consume a high percentage of health expenditures. Conversely, little is known on how morbidity evolves throughout life. The aim of this study is to introduce a longitudinal perspective to chronic disease management./nMethods: Data used relate to the population of the county of Baix Empordà in Catalonia for the period 2004–2007 (average population was N = 88,858). The database included individual information on morbidity, resource consumption, costs and activity records. The population was classified using the Clinical Risk Groups (CRG) model. Future morbidity evolution was simulated under different assumptions using a stationary Markov chain. We obtained morbidity patterns for the lifetime and the distribution function of the random variable lifetime costs. Individual information on acute episodes, chronic conditions and multimorbidity patterns were included in the model./nResults: The probability of having a specific health status in the future (healthy, acute process or different combinations of chronic illness) and the distribution function of healthcare costs for the individual lifetime were obtained for the sample population. The mean lifetime cost for women was €111,936, a third higher than for men, at €81,566 (all amounts calculated in 2007 Euros). Healthy life expectancy at birth for females was 46.99, lower than for males (50.22). Females also spent 28.41 years of life suffering from some type of chronic disease, a longer period than men (21.9)./nConclusions: Future morbidity and whole population costs can be reasonably predicted, combining stochastic microsimulation with a morbidity classification system. Potential ways of efficiency arose by introducing a time perspective to chronic disease management