Gestor informatizado de prestación farmacéutica: evaluación de la satisfacción social y modelización del gasto farmacéutico ajustado por las condiciones crónicas de los pacientes

El sistema de receta electrónica (RELE) implica la mejora de los procesos de prescripción y dispensación farmacoterapéutica, así como una potenciación de la coordinación de los profesionales de la salud. En la presente Tesis Doctoral se explica cómo ha sido posible su desarrollo, a partir de la interconexión de los sistemas de información integrados adecuadamente. También se realiza una evaluación del funcionamiento y la satisfacción de los usuarios con el nuevo sistema RELE para identificar los aspectos de mejora. El diseño de investigación escogido es un estudio transversal, con una encuesta a una muestra (n=587) de usuarios de centros de atención primaria de la provincia de Castellón, para evaluar el sistema RELE implantado desde 2008. El 81,9% de los encuestados considera que le aporta ventajas como usuario del sistema sanitario y el 60% acude menos al centro de salud desde su implantación. Los aspectos que más influyen en la satisfacción de enfermos crónicos son: la menor frecuencia de visitas a los centros de salud (odd ratio 2,413), la calidad de la información de las hojas de tratamientos (odd ratio 3,646) y la no reducción del tiempo de consulta médica (odd ratio 3,352). Por otra parte, los sistemas sanitarios deben incorporar para su financiación propuestas de ajuste con base capitativa, que permitan mejorar el perfil farmacoterapéutico, reduciendo la prescripción de fármacos de dudosa utilidad y mejorando la selección de fármacos utilizados. La Agencia Valenciana de Salud, en su modelo de gestión capitativo a los departamentos de salud de la Comunidad Valenciana, necesita disponer de instrumentos modelizados que faciliten la asignación de recursos. En base a la implantación de los sistemas de información descritos en el entorno de RELE, se realiza una modelización y explicación del consumo de medicamentos asociados a enfermedades crónicas, por mínimo cuadrados ordinarios, utilizando para ello una base de datos de prestación farmacéutica en los centros de atención primaria de la provincia de Castellón (625.246 pacientes potenciales), entre noviembre de 2008 a octubre de 2009. Se obtienen cuatro modelos retrospectivos lineales, que explican la variabilidad del gasto farmacéutico, por paciente en atención primaria. Las variables explicativas son: género, estatus de copago farmacéutico y 8 variables dicotómicas según el número de condiciones crónicas de cada paciente, desde 1 hasta 8 o más enfermedades. La condición crónica se obtuvo a partir de la clasificación anatómica, terapéutica y clínica (ATC), sobre los medicamentos prescritos. La bondad de ajuste conseguido es del 57% para la transformada logarítmica del gasto farmacéutico, mucho mayor que la explicación aportada por otros modelos.Trillo Mata, JL. (2013). Gestor informatizado de prestación farmacéutica: evaluación de la satisfacción social y modelización del gasto farmacéutico ajustado por las condiciones crónicas de los pacientes [Tesis doctoral no publicada]. Universitat Politècnica de València. https://doi.org/10.4995/Thesis/10251/30315TESI

Epidemiology and sociodemographic characterization of the fibromyalgia in Comunidad Valenciana

Fundamentos: La elevada prevalencia de la fibromial-gia y su clínica polipatológica supone un importante proble-ma de salud pública en España. El presente estudio tuvo por objeto realizar una aproximación a la epidemiología del sín-drome, con la finalidad de colaborar en el avance del cono-cimiento científico de las personas que sufren fibromialgia, en este caso mediante el análisis sociodemográfico de los pa-cientes en la Comunidad Valenciana (España).Métodos: Se realizó un estudio epidemiológico des-criptivo transversal, mediante extracción y análisis de va-riables epidemiológicas en fuentes oficiales de información sanitaria de la Comunidad Valenciana (Abucasis II, SIA, GAIA, SIP, SIE). El estudio presentó dos procesos de análi-sis diferenciados: el primero fue el examen de la evolución de la prevalencia de la fibromialgia en toda la Comunidad Valenciana, considerando a la totalidad de las personas diagnosticadas entre 2012 y 2016. El segundo supuso la caracterización sociodemográfica de las personas afecta-das de fibromialgia, utilizando una muestra de 9.267 perso-nas con diagnóstico activo de la enfermedad en uno de los 25 departamentos de salud del sistema público valenciano, observando variables tales como edad, sexo, procedencia, asistencialidad, actividad laboral y nivel económico. El tra-tamiento estadístico de los datos fue descriptivo univaria-ble, y realizado con valores porcentuales, de media, media-na y moda. El intervalo de confianza para la media, cuando fue requerido, se estableció en el 95 por ciento.Resultados: La fibromialgia fue una enfermedad de ele-vada prevalencia en la Comunidad Valenciana (3,7%) en el periodo de estudio, situándose por encima de las prevalencias medias estudiadas en el mundo, Europa o España. Presentó además una especial gravedad en la prevalencia masculina. Su evolución reflejó un crecimiento interanual del orden del 28 por ciento, con una tasa de incidencia media de 5,39 nuevos casos por cada mil habitantes/año. Afectó especialmente a las mujeres (63 por ciento de la muestra) y la edad media fue de 54 años. Además, las personas con fibromialgia presentaron bajos niveles económicos y dificultades laborales definidas por la baja tasa de empleo, la elevada tasa de paro y la frecuen-cia y duración de sus bajas laborales. Conclusiones: La fibromialgia tiene una especial im-portancia epidemiológica en la Comunidad Valenciana, con alta prevalencia e incidencia. En su sociodemografía básica encontramos un porcentaje elevado de mujeres en edades comprendidas entre los 51 y los 70 años, pero también una prevalencia masculina de especial consideración compara-tivamente con otros estudios. Observamos un importante menoscabo de las condiciones socioeconómicas y sociola-borales entre las personas con diagnóstico de fibromialgia.Background: The elevated prevalence of the fi-bromyalgia and its polypathologic clinic suppose an impor-tant Public Health problem in Spain. The purpose of this study was to carry out an approach of the syndrome’s epi-demiology, with the finality of collaborate in the scientific knowledge progress of the people who suffer fibromyal-gia, in this case, through the sociodemographic analysis of Comunidad Valenciana patients, in Spain.Methods: It was done an epidemiologic descriptive transversal study, by extractions and analysis of epidemio-logical variables in official resources of health information of Comunidad Valenciana (Abucasis II, SIA, GAIA, SIP, SIE). The study presented two different analysis processes: the first one was the exam of the fibromyalgia prevalence evolution of the whole Comunidad Valenciana, considering the totality of diagnosed people between 2012 and 2016. The second one, supposed the sociodemographic charac-terization of people who are affected with fibromyalgia, using a sample of 9,267 people with active diagnostic of the disease in one of the 25 health department of the valen-cian public system, observing variables such as age, sex, origin, asistenciality, labour activity and economic level. The datum statistic treatment was descriptive univariable and it was made with percentage values of means, median and mode. The confidence interval for the average when required was set at 95 percent.Results: Fibromyalgia was an elevated prevalence di-sease in Comunidad Valenciana (3.7%) in the study’s period, establishing itself above the world media prevalence studied, Europe or Spain. What is more, it presented a special gravity in the male prevalence. Its evolution reflected a growth year-to-year of the order of 28 percent, with an average incidence rate of 5.39 new cases per thousand inhabitants / year. It spe-cially affected women (it had it the 63% of the sample) and the average age of 54 years. Besides, people with fibromyal-gia presented low economic levels and laboural difficulties defined by low employment rate, the elevated unemploy-ment rate and the frequency and length of their work leaves.Conclusions: Fibromyalgia has a special epidemio-logical importance in Comunidad Valenciana, with a high prevalence and incidence. In its basic sociodemography we found an elevated percent of women with ages between 51 and 70 years, but also, we find a male prevalence of special consideration comparatively with other studies. We observe an important reduce of the socioeconomic and sociodemo-graphic conditions between fibromyalgia diagnosed people.Medicin

Ambulatory Pharmaceutical Spending Analysis Based on Risk Stratification in Patients with Chronic Conditions

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 purposesRisk adjustment models allow stratifying the population, considering chronic disease as a predictor of drug costs. In this paper, we analyze outpatient drug spending using Clinical Risk Groups (CRG) to obtain patient risk stratification.Usó Talamantes, R.; Trillo Mata, JL.; Guadalajara Olmeda, MN.; Sancho Mestre, C.; Vivas Consuelo, DJJ. (2012). Ambulatory Pharmaceutical Spending Analysis Based on Risk Stratification in Patients with Chronic Conditions. Value in Health. 15(7):A297-A297. doi:10.1016/j.jval.2012.08.592SA297A29715

Electronic prescription and dispensation pharmaceutical system at the Health Valencian Agency, Spain

The electronic prescription and dispensation system is a breakthrough in the use of new technologies in the National Health System. It involves the improvement of processes of prescribing and dispensing pharmacotherapy and the coordination of health professionals. Also, for patients with long-term treatments, the system helps to reduce the frequency of primary care center visits and improves patient safety by reducing mistakes in prescriptions written by hand. The system requires the interconnection and functioning of many information systems to be integrated and work well together with the infrastructure of the data processing center that is responsible for distributing information to all healthcare centers. In this way, improvements of the electronic prescription system on healthcare will be analyzed (decrease of physician visits, reduction in medical errors, increase in therapeutic compliance by patients)

The contribution of fenfluramine to the treatment of Dravet syndrome in Spain through Multi-Criteria Decision Analysis

Introduction: Dravet Syndrome (DS) is a severe, developmental epileptic encephalopathy (DEE) that begins in infancy and is characterized by pharmaco-resistant epilepsy and neurodevelopmental delay. Despite available antiseizure medications (ASMs), there is a need for new therapeutic options with greater efficacy in reducing seizure frequency and with adequate safety and tolerability profiles.Fenfluramine is a new ASM for the treatment of seizures associated with DS as add-on therapy to other ASMs for patients aged 2 years and older. Fenfluramine decreases seizure frequency, prolongs periods of seizure freedom potentially helping to reduce risk of Sudden Unexpected Death in Epilepsy (SUDEP) and improves patient cognitive abilities positively impacting on patients' Quality of Life (QoL).Reflective Multi-Criteria Decision Analysis (MCDA) methodology allows to determine what represents value in a given indication considering all relevant criteria for healthcare decision-making in a transparent and systematic manner from the perspective of relevant stakeholders. The aim of this study was to determine the relative value contribution of fenfluramine for the treatment of DS in Spain using MCDA.Method: A literature review was performed to populate an adapted a MCDA framework for orphan-drug evaluation in Spain. A panel of ten Spanish experts, including neurologists, hospital pharmacists, patient representatives and decision-makers, scored four comparative evidence matrices.Results were analyzed and discussed in a group meeting through reflective MCDA discussion methodology. Results: Dravet syndrome is considered a severe, rare disease with significant unmet needs. Fenfluramine is perceived to have a higher efficacy profile than all available alternatives, with a better safety profile than stiripentol and topiramate and to provide improved QoL versus studied alternatives. Fenfluramine results in lower other medical costs in comparison with stiripentol and clobazam. Participants perceived that fenfluramine could lead to indirect costs savings compared to available alternatives due to its efficacy in controlling seizures. Overall, fenfluramine's therapeutic impact on patients with DS is considered high and supported by high-quality evidence.Conclusions: Based on reflective MCDA, fenfluramine is considered to add greater benefit in terms of effi-cacy, safety and QoL when compared with available ASMs.(c) 2022 The Authors. Published by Elsevier Inc

Cost of Type 2 Diabetes Patients with Chronic Kidney Disease Based on Real-World Data: An Observational Population-Based Study in Spain

[EN] This study analyzed the prevalence, costs and economic impact of chronic kidney disease CKD in patients with T2D in a Spanish Health District using real-world data. Observational cross-sectional study in adult patients with T2D was through data extracted from the information systems of the Valencia Clinico-La Malvarrosa Health District in the year 2015. Patients were stratified with the KDIGO classification for CKD. Additionally, patients were assigned to Clinical Risk Groups (CRGs) according to multimorbidity. Direct costs of primary and specialized care, and medication were estimated. The prevalence of T2D in the database population (n = 28,345) was 10.8% (mean age (SD) = 67.8 years (13.9); 51.5% male). Up to 14.935 patients (52.6%) had data on kidney function. According to the KDIGO classification, 66.2% of the patients were at low risk of CKD, 20.6% at moderately increased risk, 7.9% at high risk, and 5.2% at very high risk. The average healthcare costs associated with these four risk groups were EUR 3437, EUR 4936, EUR 5899 and EUR 7389, respectively. The large number of T2D patients with CKD in the early stages of the disease generated a significant increase in direct healthcare costs. The economic impact could be mitigated by early and comprehensive therapeutic approaches.This research was funded by Boehringer-Ingelheim Espana, S.A.Usó-Talamantes, R.; González-De Julián, S.; Díaz-Carnicero, J.; Saurí-Ferrer, I.; Trillo-Mata, JL.; Carrasco-Pérez, M.; Navarro-Pérez, J.... (2021). Cost of Type 2 Diabetes Patients with Chronic Kidney Disease Based on Real-World Data: An Observational Population-Based Study in Spain. International Journal of Environmental research and Public Health (Online). 18(18):1-14. https://doi.org/10.3390/ijerph18189853S114181

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

Rationale and methods of the cardiometabolic valencian study (escarval-risk) for validation of risk scales in mediterranean patients with hypertension, diabetes or dyslipidemia

BackgroundThe Escarval-Risk study aims to validate cardiovascular risk scales in patients with hypertension, diabetes or dyslipidemia living in the Valencia Community, a European Mediterranean region, based on data from an electronic health recording system comparing predicted events with observed during 5 years follow-up study.Methods/DesignA cohort prospective 5 years follow-up study has been designed including 25000 patients with hypertension, diabetes and/or dyslipidemia attended in usual clinical practice. All information is registered in a unique electronic health recording system (ABUCASIS) that is the usual way to register clinical practice in the Valencian Health System (primary and secondary care). The system covers about 95% of population (near 5 million people). The system is linked with database of mortality register, hospital withdrawals, prescriptions and assurance databases in which each individual have a unique identification number. Diagnoses in clinical practice are always registered based on IDC-9. Occurrence of CV disease was the main outcomes of interest. Risk survival analysis methods will be applied to estimate the cumulative incidence of developing CV events over time.DiscussionThe Escarval-Risk study will provide information to validate different cardiovascular risk scales in patients with hypertension, diabetes or dyslipidemia from a low risk Mediterranean Region, the Valencia Community

Impact of a multifaceted intervention to improve the clinical management of osteoporosis. The ESOSVAL-F study

<p>Abstract</p> <p>Background</p> <p>A study to evaluate the impact of a combined intervention (in-class and on-line training courses, a practicum and economic incentives) to improve anti-osteoporosis treatment and to improve recordkeeping for specific information about osteoporosis.</p> <p>Methods/design</p> <p>A before/after study with a non-equivalent control group to evaluate the impact of the interventions associated with participation in the ESOSVAL-R cohort study (intervention group) compared to a group receiving no intervention (control group). The units of analysis are medical practices identified by a Healthcare Position Code (HPC) referring to a specific medical position in primary care general medicine in a Healthcare Department of the Region of Valencia, Spain. The subjects of the study are the 400 participating "practices" (population assigned to health care professionals, doctors and/or nurses) selected by the Healthcare Departments of the Valencia Healthcare Agency for participation as associate researchers in the ESOSVAL-R study (intervention group), compared to 400 participating "practices" assigned to primary care professionals NOT selected for participation as associate researchers in the ESOSVAL-R study, who are selected on the basis of their working in the same Healthcare Centers as the practices receiving the interventions (control group). The study's primary endpoint is the appropriateness of treatment according by the Spanish National Health System guide (2010) and the National Osteoporosis Foundation (NOF, 2008) and International Osteoporosis Foundation guidance (IOF, 2008).</p> <p>The study will also evaluate a series of secondary and tertiary endpoints. The former are the suitability of treatment and evaluation of the risk of fracture; and the latter are the volume of information registered in the electronic clinical records, and the evaluation of risks and the suitability of treatment.</p