Pharmaceutical Expenditure for Diabetes Mellitus in a Region of Spain as Clinical Risk Group, 2012

El contenido de los artículos es de exclusiva responsabilidad de los autores. Los textos pueden reproducirse total o parcialmente citando la fuente.[ES] Se pretende estimar la multimorbilidad asociada con diabetes mellitus tipo 2 y su relación con el gasto farmacéutico, para lo cual se realizó un estudio de corte transversal durante el año 2012. Se identificó a 350 015 individuos diabéticos, a través de códigos clínicos, usando la Clasificación Internacional de Enfermedades y el software 3M Clinical Risk Groups. Todos los pacientes fueron clasificados en cuatro grupos de morbilidad. El primer grupo corresponde al estadio inicial, el segundo grupo incluye el núcleo de multimorbilidad de pacientes en fases intermedia y avanzada, el tercer grupo incluye pacientes con diabetes y enfermedades malignas, y el último grupo es de pacientes en estado catastrófico, principalmente enfermos renales crónicos. La prevalencia bruta de diabetes fue de 6,7 %. El gasto promedio total fue de € 1257,1. La diabetes se caracteriza por una fuerte presencia de otras condiciones crónicas y tiene un gran impacto en el gasto farmacéutico[EN] Estimations of multimorbidity associated with Type 2 Diabetes Mellitus and its relationship to pharmaceutical expenditure. Cross-sectional study during 2012. 350,015 diabetic individuals, identified through clinical codes using the International Statistical Classification of Diseases and Related Health Problem and the 3M Clinical Risk Groups software. The raw prevalence of diabetes was 6.7 %. All patients were stratified into four morbidity groups. The first group corresponds to the initial state; the second group includes the core multimorbidity patients in the intermediate and advanced stages; the third group includes patients with diabetes and malignancies; the last group patients with catastrophic statuses, manly chronic renal patients. The raw prevalence of diabetes was 6.7 %. The average total cost was € 1257.1. Diabetes is characterized by a strong presence of other chronic conditions have a great impact on pharmaceutical spending.Alvis, L.; Vivas-Consuelo, D.; Caballer Tarazona, V.; Usó Talamantes, R.; Sancho Mestre, C.; Buigues Pastor, L. (2016). Gasto farmacéutico en diabetes mellitus en una región de España según el Clinical Risk Group, 2012. Revista Gerencia y Políticas de Salud. 15(30):68-78. doi:10.11144/Javeriana.rgyps15-30.gfdmS6878153

Predictability of pharmaceutical spending using Clinical Risk Groups in the Valencian Community, Valencia

Elsevier user license: Permitted: For non-commercial purposes: Read, print & download Text & data mine Translate the article Not Permitted: Reuse portions or extracts from the article in other works Redistribute or republish the final article Sell or re-use for commercial purposesThe Valencian Community, with 5,000,000 inhabitants, is implementing a system of pharmaceutical management to reduce costs. This system is based on classifying patients in groups using the case mix system, Clinical Risk Groups. An electronic tool has been developed based on www to manage patients with chronic conditions and monitor pharmaceutical expenditure in primary health care. GPs receive a report on the real pharmaceutical cost that is being incurred and the optimum cost adjusted by CRG.Usó Talamantes, R.; Caballer Tarazona, M.; Buigues Pastor, L.; Trillo Mata, JL.; Guadalajara Olmeda, MN.; Vivas Consuelo, DJJ. (2011). Predictability of pharmaceutical spending using Clinical Risk Groups in the Valencian Community, Valencia. Value in Health. 14(7):A341-A341. doi:10.1016/j.jval.2011.08.596SA341A34114

Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups

Background: Risk adjustment instruments applied to existing electronic health records and administrative datasets may contribute to monitoring the correct prescribing of medicines. Objective: We aim to test the suitability of the model based on the CRG system and obtain specific adjusted weights for determined health states through a predictive model of pharmaceutical expenditure in primary health care. Methods: A database of 261,054 population in one health district of an Eastern region of Spain was used. The predictive power of two models was compared. The first model (ATC-model) used nine dummy variables: sex and 8 groups from 1 to 8 or more chronic conditions while in the second model (CRG-model) we include sex and 8 dummy variables for health core statuses 2-9. Results: The two models achieved similar levels of explanation. However, the CRG system offers higher clinical significance and higher operational utility in a real context, as it offers richer and more updated information on patients. Conclusions: The potential of the CRG model developed compared to ATC codes lies in its capacity to stratify the population according to specific chronic conditions of the patients, allowing us to know the degree of severity of a patient or group of patients, predict their pharmaceutical cost and establish specific programmes for their treatment. (C) 2014 Elsevier Ireland Ltd. All rights reserved.This study was financed by a grant from the Fondo de Investigaciones de la Seguridad Social Instituto de Salud Carlos III, the Spanish Ministry of Health (FIS PI12/0037). The authors would like to thank members (Juan Bru and Inma Sauri) of the Pharmacoeconomics Office of the Valencian Health Agency. The opinions expressed in this paper are those of the authors and do not necessary reflect those of the afore-named. Any errors are the authors' responsibility. We would also like to thank John Wright for the English editing.Vivas Consuelo, DJJ.; Usó Talamantes, R.; Trillo Mata, JL.; Caballer Tarazona, M.; Barrachina Martínez, I.; Buigues Pastor, L. (2014). Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups. Health Policy. 116(2-3):188-195. https://doi.org/10.1016/j.healthpol.2014.01.012S1881951162-

Pharmaceutical Cost Management in an Ambulatory Setting Using a Risk Adjustment Tool

© 2014 Vivas-Consuelo et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.Background Pharmaceutical expenditure is undergoing very high growth, and accounts for 30% of overall healthcare expenditure in Spain. In this paper we present a prediction model for primary health care pharmaceutical expenditure based on Clinical Risk Groups (CRG), a system that classifies individuals into mutually exclusive categories and assigns each person to a severity level if s/he has a chronic health condition. This model may be used to draw up budgets and control health spending. Methods Descriptive study, cross-sectional. The study used a database of 4,700,000 population, with the following information: age, gender, assigned CRG group, chronic conditions and pharmaceutical expenditure. The predictive model for pharmaceutical expenditure was developed using CRG with 9 core groups and estimated by means of ordinary least squares (OLS). The weights obtained in the regression model were used to establish a case mix system to assign a prospective budget to health districts. Results The risk adjustment tool proved to have an acceptable level of prediction (R2 0.55) to explain pharmaceutical expenditure. Significant differences were observed between the predictive budget using the model developed and real spending in some health districts. For evaluation of pharmaceutical spending of pediatricians, other models have to be established. Conclusion The model is a valid tool to implement rational measures of cost containment in pharmaceutical expenditure, though it requires specific weights to adjust and forecast budgets.This study was financed by a grant from the Fondo de Investigaciones de la Seguridad Social Instituto de Salud Carlos III, the Spanish Ministry of Health (FIS PI12/0037). The authors would like to thank members (Juan Bru and Inma Saurf) of the Pharmacoeconomics Office of the Valencian Health Department. The opinions expressed in this paper are those of the authors and do not necessary reflect those of the afore-named. Any errors are the authors' responsibility. We would also like to thank John Wright for the English editing.Vivas Consuelo, DJJ.; Usó Talamantes, R.; Guadalajara Olmeda, MN.; Trillo Mata, JL.; Sancho Mestre, C.; Buigues Pastor, L. (2014). Pharmaceutical Cost Management in an Ambulatory Setting Using a Risk Adjustment Tool. 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Desarrollo del indicador Población Estandarizada Equivalente para el control del gasto farmacéutico ambulatorio

Fundamentos: El gasto farmacéutico representa un elevado porcentaje del gasto sanitario total en la mayoría de los países desarrollados, por lo que es importante utilizar herramientas que permitan hacer un uso eficiente. El objetivo del presente trabajo es construir un indicador de gasto farmacéutico estandarizado con el fin de disponer de una herramienta objetiva de evaluación y control del gasto más precisa que el indicador utilizado hasta el momento en la Comunitat Valenciana. Métodos: Para la construcción de este indicador se introdujo el concepto de �paciente equivalente� en la estandarización de la población, lo que permitió discriminar pacientes con perfiles de consumo diferentes. Dicha estandarización tiene en cuenta una serie de variables sociodemográficas que ofrecen una estandarización de los pacientes más ajustada que la que ofrecía el modelo utilizado hasta 2011, sustituido ahora por este nuevo indicador: el anterior indicador de importe estandarizado solo consideraba como característica diferenciadora del gasto la condición de farmacia (prestación farmaceútica sin o con aportación del 40%). Las variables consideradas en el nuevo proceso de estandarización fueron, la edad, el género, la condición de prestación farmaceútica y la cobertura internacional. Resultados: Después de aplicar el método de estandarización de la población se obtuvieron 160 grupos de pacientes con consumos diferentes a los que se les adjudicó unos pesos de 0,10 a 4,39 pacientes equivalentes. Conclusiones: El indicador obtenido permite comparar poblaciones homogéneas a través del proceso de su estandarización, lo que facilita la evaluación y control del gasto farmacéutico ambulatorio considerando los patrones de consumo de cada estructura poblacional. El indicador se puede aplicar a cualquier nivel organizativo, desde departamentos de salud a facultativos, por lo que ofrece información necesaria para el establecimiento de incentivos encaminados a promover una prescripción más eficiente