Utilización de servicios de atención primaria, atención especializada y consumo de medicamentos por la población de 65 años y más en la Comunidad de Madrid

Background: Ageing of the Spanish population results in an increa¬se in health services required. Therefore, determine the frequency of the health services utilization in this age group and analyze their determinants has a great interest.The aim was to analyze the utilization of health services among older people living in two urban neighborhoods of northern Madrid. Method: cross-sectional population-based study. It is studied a cohort of 1327 individuals ≥ 65 years, stratified by age and sex. Nine utilization indicators were defined. For each indicator frequencies and the association of each with the other variables were calculated by multivariate analysis. Results: The distribution of indicators expressed as a percentage of the user population is: GP appoiments/month 64.8% (95%CI 62.3 to 67.4); nur¬sing appoiments/month 44.6% (95% CI 41.2 to 47.2); home medical visits/month 3.1% (95%CI 2.2 to 4.1); home nursing visits/month 3% (95%CI 2.1 to 3.9); hospitalization/year 16.4% (95%CI 14.4 to 18.4); appoiments rheumatologist/orthopedic/year 25.1% (95%CI 22.7 to 27.4); physiothera¬pist appoiments/year 12.9% (95% CI 11.1 to 14.7); podiatrist appoiments/year 30.6% (95%CI 28.1 to 33.1) and polypharmacy (≥5 drugs) 55.7% (95% CI 53 to 58.4). Comorbidity was the best predictor of health care utilization ranging from OR 4.10 (95%CI: 3.07-5,49) to OR 1.39 (95%CI: 0.97-1.99) in polymedicated and visit the physiotherapist respectively. Cardiovascular disease (OR 1.34; 95%CI 1.03-1,76) and diabetes (OR 1.46; 95%CI: 1.05 -2.02) were independently associated with increased use of family doctor. Dependence was the main determinant for home healthcare (OR 3.38; 95%CI: 1.38-8.28) and nurses (OR 9.71; 95%CI: 4.19-22.48) Mood disor¬ders were associated to polypharmacy (OR 2.06; 95%CI: 1,48-2.86) and to visits to family doctor (OR 1.52; 95%CI: 1,13-2.04). Conclusions: The comorbidity is the strongest predictor of health ser¬vices utilization. Cardiovascular diseases and diabetes are independently associated to greater use. Dependence is the main determinant of home care. Mood disorders associated with polypharmacy and increased attendances to the General PractitionerFundamento: El envejecimiento de la población española se traduce en un aumento de las prestaciones sanitarias requeridas por la población mayor, por ello conocer la frecuencia de la utilización de los servicios sanitarios de este grupo de edad y analizar sus factores determinantes es de especial interés. El objetivo fue analizar la utilización de servicios sanitarios de la población mayor residente en dos barrios urbanos del norte de Madrid. Métodos: Estudio transversal de base poblacional. Se estudió una cohorte de 1.327 individuos igual o mayor a 65 años, estratificada por edad y sexo. Se definieron 9 indicadores de utilización durante el mes anterio o durante el último año. Para cada indicador se calcularon las frecuencias y la asociación con el resto de variables mediante análisis multivariante. Resultados: la distribución de los indicadores expresada como proporción de la población usuaria fue: consultas médico/mes 64,8% (IC95%:62,3-67,4); consultas enfermería/mes 44,6% (IC95%:41,2-47,2); domicilios médico/mes 3,1% (IC95%:2,2-4,1); domicilios enfermería/mes 3%(IC95%:2,1-3,9); hospitalización/año 16,4% (IC95%:14,4-18,4); consultas reumatólogo/traumatólogo/año 25,1% (IC95%:22,7-27,4); consultas fisioterapeuta/año 12,9% (IC95%:11,1-14,7); consultas podólogo/año 30,6% (IC95%:28,1-33,1) y polimedicados (≥5 fármacos) 55,7% (IC95%: 53-58,4). La comorbilidad fue la variable que mejor predijo la utilización de servicios sanitarios oscilando entre OR 4.10 (IC95%:3.07-5,49) y OR 1,39 (IC95%: 0.97-1.99) para estar polimedicado y visitar al fisioterapeuta respectivamente. Enfermedades cardiovasculares (OR 1,34; IC95%:1.03-1,76) y diabetes (OR 1,46; IC95%:1,05-2,02) se asociaron de forma independiente a mayor utilización del médico de familia. La dependencia fue el principal determinante de atención domiciliaria para el médico (OR 3,38; IC95%: 1,38-8,28) y para enfermería (OR 9.71; IC 95%: 4.19-22.48). Trastornos del ánimo se asociaron a mayor polimedicación (OR 2.06; IC95%: 1,48-2.86) y visitas al médico de familia (OR 1,52; IC 95%:1,13-2.04). Conclusiones: La comorbilidad fue la variable que mejor predijo la utilización de servicios sanitarios. Las enfermedades cardiovasculares y la diabetes se asocian de forma independiente a mayor utilización de servicios. Los trastornos del ánimo se asocian a mayor polimedicación y más visitas al médico de familiaThis project is partially funded with a grant from the Ministry of Health,Instituto de Salud Carlos III (FIS: PI 09/2143) and RETICEF (Red Temática de Investigación Cooperativa en Envejecimiento y Fragilidad, RD 06/0013/1013

Predictive model of gait recovery at one month after hip fracture from a national cohort of 25,607 patients: The hip fracture prognosis (HF-prognosis) tool

The aim of this study was to develop a predictive model of gait recovery after hip fracture. Data was obtained from a sample of 25,607 patients included in the Spanish National Hip Fracture Registry from 2017 to 2019. The primary outcome was recovery of the baseline level of ambulatory capacity. A logistic regression model was developed using 40% of the sample and the model was validated in the remaining 60% of the sample. The predictors introduced in the model were: age, prefracture gait independence, cognitive impairment, anesthetic risk, fracture type, operative delay, early postoperative mobilization, weight bearing, presence of pressure ulcers and destination at discharge. Five groups of patients or clusters were identified by their predicted probability of recovery, including the most common features of each. A probability threshold of 0.706 in the training set led to an accuracy of the model of 0.64 in the validation set. We present an acceptably accurate predictive model of gait recovery after hip fracture based on the patients’ individual characteristics. This model could aid clinicians to better target programs and interventions in this population.This project was funded by AMGEN SA, UCB PharmaSA, Abbott Laboratories SA and FAES Farma, as well as a research grant awarded by the Fundación Mutua Madrileña (grant number AP169672018) and Fundación Mapfr

Spanish National Hip Fracture Registry (RNFC) : First-year results and comparison with other registries and prospective multi-centric studies from Spain

Fundamentos: El Registro Nacional de Fracturas de Cadera (RNFC) es un registro español multicéntrico, prospectivo y continuo, que comenzó en 2017. El objetivo de este artículo fue presentar los datos del primer informe anual y compararlos con los registros autonómicos y los estudios multicéntricos realizados recientemente en España. Métodos: Se incluyeron las personas de 75 años o más atendidas con el diagnóstico de fractura de cadera por fragilidad en alguno de los hospitales participantes en el RNFC, entre enero y octubre de 2017. En el análisis estadístico se utilizó la media y desviación estándar o mediana y rangos intercuartílicos para las variables numéricas y los porcentajes para las variables categóricas. Se realizó un análisis descriptivo global de la casuística y se comparó con los datos disponibles de los estudios previos mencionados. Resultados: Se registraron 7.208 personas de 54 hospitales, con una edad media de 86,7 años (DE 5,6). El 75,4% fueron mujeres y el 36,4% presentaron deterioro cognitivo previo. La demora quirúrgica media fue de 75,7 horas (DE 63,6) y la estancia media fue de 10,9 días (DE 6,7). De las personas que vivían en un domicilio antes de la fractura (75,4%), menos de la mitad (37,0%) volvieron a él tras el alta hospitalaria. Al mes, había fallecido el 7,1%. La comparación con los otros estudios mostró algunas diferencias importantes, sobre todo en la ubicación previa, en el porcentaje de pacientes institucionalizados de novo (7,7-29,4%) y en el porcentaje con tratamiento antiosteoporótico al alta (14,5-36,7%). Conclusiones: El RNFC es la mayor base de datos prospectiva que aporta datos sobre el perfil de los pacientes hospitalizados por fractura de cadera en España. La comparación con otros estudios recientes muestra algunas diferencias importantes.OBJECTIVE: The Spanish National Hip Fracture Registry (Registro Nacional de Fracturas de Cadera or RNFC) is a Spanish, prospective, multi- centric registry, commenced in 2017. The goal of this paper is to present the data from the first annual report and to compare them with autonomic registries and recent prospective multi-centric studies performed in Spain. METHODS: We included persons 75 years or older treated for fragility hip fractures in any of the centers participating in the RNFC between January and October 2017. The descriptive statistics of each variable used the mean (and standard deviation) or the median (and interquartile ranges) for the ordinal variables and the percentage for the categoric variables. A descriptive analysis of the casemix was performed and compared with available data from the aforementioned studies. RESULTS: The RNFC included 7.208 patients from 54 hospitals, with a mean age of 86.7 (SD 5.6) years; 75.4% were women, and 36.4% showed cognitive decline. Mean surgical delay was 75.7 (SD 63.6) hours, and length of stay averaged 10.9 (SD 6.7) days. Of the patients who lived at home (75.4%), less than half (37.0%) returned home at discharge. One-month mortality was 7.1%. Comparison with other studies showed important differences, especially regarding patients newly sent to nursing homes (7.7-29.4%) and with antiosteoporotic treatment at discharge (14.5-36.7%). CONCLUSIONS: The RNFC is the largest prospective database to date that offers data regarding the characteristics of patients hospitalized for hip fractures in Spain. Comparison with recent studies showed some important differences

Registro Nacional de Fracturas de Cadera (RNFC): Resultados del primer año y comparación con otros registros y estudios multicéntricos españoles

Background: The Spanish National Hip Fracture Registry (Registro Nacional de Fracturas de Cadera or RNFC) is a Spanish, prospective, multi- centric registry, commenced in 2017. The goal of this paper is to present the data from the first annual report and to compare them with autonomic registries and recent prospective multi-centric studies performed in Spain. Methods: We included persons 75 years of age or older treated for fragility hip fractures in any of the centers participating in the RNFC between January and October 2017. The descriptive statistics of each variable used the mean (and standard deviation) or the median (and interquartile ranges) for the ordinal variables and the percentage for the categoric variables. A descriptive analysis of the casemix was performed and compared with available data from the aforementioned studies. Results: The RNFC included 7.208 patients from 54 hospitals, with a mean age of 86.7 (SD 5.6) years; 75.4% were women, and 36.4% showed cognitive decline. Mean surgical delay was 75.7 (SD 63.6) hours, and length of stay averaged 10.9 (SD 6.7) days. Of the patients who lived at home (75.4%), less than half (37.0%) returned home at discharge. One-month mortality was 7.1%. Comparison with other studies showed important differences, especially regarding patients newly sent to nursing homes (7.7-29.4%) and with antiosteoporotic treatment at discharge (14.5-36.7%). Conclusions: The RNFC is the largest prospective database to date that offers data regarding the characteristics of patients hospitalized for hip fractures in Spain. Comparison with recent studies showed some important differencesFundamentos: El Registro Nacional de Fracturas de Cadera (RNFC) es un registro español multicéntrico, prospectivo y continuo, que comenzó en 2017. El objetivo de este artículo fue presentar los datos del primer informe anual y compararlos con los registros autonómicos y los estudios multicéntricos realizados recientemente en España. Métodos: Se incluyeron las personas de 75 años o más atendidas con el diagnóstico de fractura de cadera por fragilidad en alguno de los hospitales participantes en el RNFC, entre enero y octubre de 2017. En el análisis estadístico se utilizó la media y desviación estándar o mediana y rangos intercuartílicos para las variables numéricas y los porcentajes para las variables categóricas. Se realizó un análisis descriptivo global de la casuística y se comparó con los datos disponibles de los estudios previos mencionados. Resultados: Se registraron 7.208 personas de 54 hospitales, con una edad media de 86,7 años (DE 5,6). El 75,4% fueron mujeres y el 36,4% presentaron deterioro cognitivo previo. La demora quirúrgica media fue de 75,7 horas (DE 63,6) y la estancia media fue de 10,9 días (DE 6,7). De las personas que vivían en un domicilio antes de la fractura (75,4%), menos de la mitad (37,0%) volvieron a él tras el alta hospitalaria. Al mes, había fallecido el 7,1%. La comparación con los otros estudios mostró algunas diferencias importantes, sobre todo en la ubicación previa, en el porcentaje de pacientes institucionalizados de novo (7,7-29,4%) y en el porcentaje con tratamiento antiosteoporótico al alta (14,5-36,7%). Conclusiones: El RNFC es la mayor base de datos prospectiva que aporta datos sobre el perfil de los pacientes hospitalizados por fractura de cadera en España. La comparación con otros estudios recientes muestra algunas diferencias importantesThe RNFC has been financed through donations by AMGEN SA, UCB Pharma, Abbott Laboratories and FAES Farma, as well as a Research Grant from the Fundación Mutua Madrileña (AP169672018)

Recurrence of Vertebral Fracture in Patients With Osteoporotic Vertebral Fractures: Retrospective Review in Moncloa University Hospital. Preliminary Results

Background Current drugs for patients who suffer from stablished osteoporosis (OP) with osteoporotic vertebral fracture (VF) have demonstrated their efficacy with different levels of evidence for secondary prevention of fractures1. In fact, this level of efficacy can be limited in real clinical practice, with pluripathological and previously polimedicated patients. Objectives Main objective of this study is to describe the percentage of patients with VF in which the therapeutic goal of avoiding new VF during their follow-up has been achieved. As a secondary objective, clinical and therapeutic differences will be analyzed among distinct groups arisen from achieving or not the therapeutic goal. Methods Retrospective, observational, longitudinal, descriptive study of patients from Rheumatology Departament in Moncloa University Hospital who have suffered a osteoporotic VF. Results 133 cases have been reviewed, 115 (86.5%) females and 18 males (13.5%). Average age is 72 years (+/- 7) and average follow-up time is 2.68 years (+/- 2.3). 25 cases (18.5%) were smokers, 9 (6.8%) oncologic patients, 33 (24%) with chronic corticotherapy and 28 (21%) with immune-mediated diseases. 81 patients (60.9%) had previous VF (0.933 fracture /patient) and 14 (10.5%) non-vertebral fracture (NVF). The average VF was 1.967/patient and 0.133/patient for NVF. 52 patients (39.1%) had received prior treatment for OP (36 Biphosphonate, 23 Denosumab, 5 SERM, 2 strontium ranelate and 1 teriparatide) and in 39 cases (29.3%) a cementoplasty was performed. Initial treatments prescribed by Rheumatology Departament were Biphosphonates (48%),Denosumab (31%) and Teriparatide (21%). 35 patients received sequencial-treatment (26.9%). 86.5 % of patients haven’t presented new VF. 18 cases (13.5%) have been registered with new VF. This group is composed by 13 females and 5 males; the average age was 75 years (+/-7.5) and the average follow-up time 2.8 years (+/- 2.46); 14 (77.8 %) patients presented previous VF and 3 (16.7 %) previous NVF. The average number of previous VF was 2.0/patient and 0.33/patient for NVF. 14 cases (78.8%) of new VF ocurred during the first year of follow-up. The treatment they were receiving at the time of the new VF was in 8 cases with Denosumab (44%), 4 with Teriparatide (22%), 2 Alendronate (11%), 3 Riserdronate (16%) and 1 case without treatment. Conclusion These are preliminary data from a register for prognosis evaluation of patients who suffer VF in Moncloa University Hospital. A larger sample size is necessary to developed a strategic conclusion in this patients, pluripathological, with previous osteoporotic fractures and treatment.78 % of new VF ocurred during the first year of the follow-up, 44% of them were receiving Denosumab, 77% (vs. 58% of the patients without new VF) had previous VF and 44% (vs. 37% patients without new VF) had received previous OP treatment.Sin financiación16.102 JCR (2019) Q1, 2/32 Rheumatology6.142 SJR (2019) Q1, 6/280 Biochemistry, Genetics and Molecular Biology (miscellaneous)No data IDR 2019UE

Mortality among older Spanish people with hip fractures: a population-based matched cohort study

Hospital La Paz Institute for Health Research (PI-1339 Project)Spanish Ministry of Health, Carlos III Institute (FIS: PI 09/2143)RETICEF (Network Research in aging and frailty) (RD 06/0013/1013)4.481 Q2 JCR 20210.911 Q2 SJR 2021No data IDR 2021UE

Handgrip strength predicts 1-year functional recovery and mortality in hip fracture patients

Objectives: Muscle strength is a possible predictor of adverse events. It could have prognostic value in patients with hip fracture (HF). The aim of this study was to determine if handgrip strength is associated with functional impairment, readmissions, and mortality at one year in elderly patients with HF. Design: A prospective observational study was carried out. It included a cohort of patients aged 65 years or older with a diagnosis of fragility HF, consecutively from January 2013 to February 2014 and seen in follow-up at one year. Statistical analysis was performed using SPSS v21 software. Main outcome measures: Five hundred and nine patients with a mean age of 85.4 ± 0.3 years were included, of whom 403 (79.2 %) were women. Clinical and functional outcomes, laboratory parameters and anthropometric measurements were collected. Results: Of the total sample, 339 (66.6 %) had reduced handgrip strength, and these patients were older, more frequently institutionalized, had poorer functional and cognitive status, higher comorbidity, higher surgical risk, lower body mass index and a greater intra-hospital mortality (all p < 0.01). At one year, patients with lower handgrip strength had a major change in their ability to walk (32.7 % vs. 10.9 %, p < 0.001) and a higher mortality rate (30.4 % vs. 8.8 %, p < 0.001). However, in patients over 91 years of age, there was no association between lower handgrip strength and change in ability to walk. There were no differences in the number of readmissions. Conclusion: Low handgrip strength in elderly patients with HF predicts greater functional disability and higher long-term mortality.Sin financiación3.623 JCR (2020) Q2, 79/162 Chemistry, Physical|0.682 SJR (2020) Q2, 128/448 Condensed Matter PhysicsNo data IDR 2020UE

Spanish National Hip Fracture Registry (RNFC): First-year results and comparison with other registries and prospective multi-centric studies from Spain

Fundamentos: El Registro Nacional de Fracturas de Cadera (RNFC) es un registro español multicéntrico, prospectivo y continuo, que comenzó en 2017. El objetivo de este artículo fue presentar los datos del primer informe anual y compararlos con los registros autonómicos y los estudios multicéntricos realizados recientemente en España. Métodos: Se incluyeron las personas de 75 años o más atendidas con el diagnóstico de fractura de cadera por fragilidad en alguno de los hospitales participantes en el RNFC, entre enero y octubre de 2017. En el análisis estadístico se utilizó la media y desviación estándar o mediana y rangos intercuartílicos para las variables numéricas y los porcentajes para las variables categóricas. Se realizó un análisis descriptivo global de la casuística y se comparó con los datos disponibles de los estudios previos mencionados. Resultados: Se registraron 7.208 personas de 54 hospitales, con una edad media de 86,7 años (DE 5,6). El 75,4% fueron mujeres y el 36,4% presentaron deterioro cognitivo previo. La demora quirúrgica media fue de 75,7 horas (DE 63,6) y la estancia media fue de 10,9 días (DE 6,7). De las personas que vivían en un domicilio antes de la fractura (75,4%), menos de la mitad (37,0%) volvieron a él tras el alta hospitalaria. Al mes, había fallecido el 7,1%. La comparación con los otros estudios mostró algunas diferencias importantes, sobre todo en la ubicación previa, en el porcentaje de pacientes institucionalizados de novo (7,7-29,4%) y en el porcentaje con tratamiento antiosteoporótico al alta (14,5-36,7%). Conclusiones: El RNFC es la mayor base de datos prospectiva que aporta datos sobre el perfil de los pacientes hospitalizados por fractura de cadera en España. La comparación con otros estudios recientes muestra algunas diferencias importantesBackground: The Spanish National Hip Fracture Registry (Registro Nacional de Fracturas de Cadera or RNFC) is a Spanish, prospective, multi-centric registry, commenced in 2017. The goal of this paper is to present the data from the first annual report and to compare them with autonomic registries and recent prospective multi-centric studies performed in Spain. Methods: We included persons 75 years of age or older treated for fragility hip fractures in any of the centers participating in the RNFC between January and October 2017. The descriptive statistics of each variable used the mean (and standard deviation) or the median (and interquartile ranges) for the ordinal variables and the percentage for the categoric variables. A descriptive analysis of the casemix was performed and compared with available data from the aforementioned studies. Results: The RNFC included 7.208 patients from 54 hospitals, with a mean age of 86.7 (SD 5.6) years; 75.4% were women, and 36.4% showed cognitive decline. Mean surgical delay was 75.7 (SD 63.6) hours, and length of stay averaged 10.9 (SD 6.7) days. Of the patients who lived at home (75.4%), less than half (37.0%) returned home at discharge. One-month mortality was 7.1%. Comparison with other studies showed important differences, especially regarding patients newly sent to nursing homes (7.7-29.4%) and with antiosteoporotic treatment at discharge (14.5-36.7%). Conclusions: The RNFC is the largest prospective database to date that offers data regarding the characteristics of patients hospitalized for hip fractures in Spain. Comparison with recent studies showed some important differences.Sin financiación0.746 JCR (2019) Q4, 159/171 Public, Environmental & Occupational Health0.256 SJR (2019) Q3, 1811/2805 Medicine (miscellaneous)No data IDR 2019UE

Comparison of clinical features and outcomes in different older age groups with hip fracture

Sin financiación4.507 JCR (2020) Q2, 53/146 Endocrinology & Metabolism1.280 SJR (2020) Q1, 48/232 Endocrinology, Diabetes and MetabolismNo data IDR 2020UE

Registro Nacional Español de Fracturas de Cadera (RNFC): descripción de sus objetivos, metodología e implementación

To ascertain the current situation and clinical variability of the provision of care for Hip Fracture (HF) in Spain and the factors related to it by using a National Registry (NHFR) with high patient numbers and territorial representation NHFR, and to compare results on a national and international level and propose standards and criteria to improve healthcare quality.Sin financiaciónNo data JCR 20180.244 SJR (2018) Q3, 77/114 Geriatrics and Gerontology, 1828/2844 Medicine (miscellaneous); Q4, 28/36 AgingNo data IDR 2018UE