Costes directos de la bronquitis crónica en atención primaria. Análisis de un estudio prospectivo

ObjetivoEvaluar el consumo de recursos sanitarios directos originado por una cohorte de pacientes con patología bronquial crónica: bronquitis crónica (BC) y enfermedad pulmonar obstructiva crónica (EPOC) en atención primaria en España.DiseñoEstudio de cohorte prospectivo de pacientes con BC y EPOC controlados en el ámbito de la atención primaria en España. Se incluyeron los 10 primeros pacientes adultos no seleccionados que acudieran a la consulta de cada investigador y en los que el diagnóstico fuera de agudización de su patología bronquial crónica. Mediante visitas programadas, se realizó un seguimiento durante un año para evaluar el consumo de recursos sanitarios de esta cohorte. Se realizó un análisis de costes sanitarios directos.ResultadosParticiparon 268 médicos que incluyeron 2.414 pacientes. Un total de 1.510 pacientes completaron los 12 meses de seguimiento (62,6%). Todos los pacientes recibieron tratamiento farmacológico para su enfermedad pulmonar. Las exploraciones complementarias más comúnmente realizadas fueron analítica general de sangre (1,5 por paciente/año), radiografía de tórax (1,2) y ECG (0,9), seguidas de práctica de espirometría (0,5) y gasometría arterial (0,4). La media de agudizaciones durante un año fue de 1,9 y el de ingresos de 0,2.El coste global, que incluyó pruebas, visitas médicas, gastos hospitalarios y tratamiento farmacológico fue de 420.264.000 pts. para el total de la cohorte. El coste directo anual promedio por paciente ascendió a 278.321 pts. El coste generado por los pacientes tratados con cefixima en la primera agudización fue inferior en 77.365 pts., sobre todo a expensas de los costes hospitalarios.ConclusionesEl coste directo anual promedio por paciente con BC o EPOC es elevado y superior al de otras patologías respiratorias crónicas como el asma bronquial. Destaca la mayor relevancia de los costes hospitalarios en la BC y la EPOC, dato que se explica por la mayor edad media y el deterioro no reversible o progresivo de la función respiratoria de estos pacientes.ObjectiveTo evaluate the consumption of the direct health resources of primary care (PC) in Spain by a cohort of patients with chronic bronchial pathology: chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD).DesignProspective cohort study of patients with CB and COPD monitored in PC in Spain. The first 10 adult patients who attended at random each researcher's clinic and who were diagnosed as suffering an exacerbation of their chronic bronchial pathology were included. Scheduled follow-up visits for a year evaluated the cohort's consumption of health resources. Direct health costs were analysed.Results268 doctors, with 2414 patients, took part. 1510 patients completed the 12 months follow-up (62.6%). All the patients received pharmacological treatment for their pulmonary disease. The most common complementary investigations performed were: general blood analysis (1.5 per patient/year), chest x-ray (1.2) and ECG (0.9), followed by spirometry (0.5) and arterial gasometry (0.4). Mean number of exacerbations per year were 1.9; and admissions, 0.2. Overall cost, including tests, medical visits, hospital expenditure and pharmacological treatment, was 420264000 pesetas for the entire cohort. The direct annual cost per patient ran at 278321 pesetas. The cost caused by patients treated with Cefixime on the first exacerbations was 77365 pesetas less, which was mostly due to less hospital expense.ConclusionsThe direct annual cost per patient with CB or COPD is high, above the cost of other chronic respiratory pathologies such as bronchial asthma. There are notably greater hospital costs for CB and COPD, explained by these patients' mean greater age and the non-reversible and progressive deterioration of their respiratory function

Beyond FEV1 in COPD: a review of patient-reported outcomes and their measurement

Abstract: Patients with chronic obstructive pulmonary disease (COPD) present with a variety of symptoms and pathological consequences. Although primarily viewed as a respiratory disease, COPD has both pulmonary and extrapulmonary effects, which have an impact on many aspects of physical, emotional, and mental well-being. Traditional assessment of COPD relies heavily on measuring lung function, specifically forced expiratory volume in 1 second (FEV1). However, the evidence suggests that FEV1 is a relatively poor correlate of symptoms such as breathlessness and the impact of COPD on daily life. Furthermore, many consequences of the disease, including anxiety and depression and the ability to perform daily activities, can only be described and reported reliably by the patient. Thus, in order to provide a comprehensive view of the effects of interventions in clinical trials, it is essential that spirometry is accompanied by assessments using patient-reported outcome (PRO) instruments. We provide an overview of patient-reported outcome concepts in COPD, such as breathlessness, physical functioning, and health status, and evaluate the tools used for measuring these concepts. Particular attention is given to the newly developed instruments emerging in response to recent regulatory guidelines for the development and use of PROs in clinical trials. We conclude that although data from the development and validation of these new PRO instruments are emerging, to build the body of evidence that supports the use of a new instrument takes many years. Furthermore, new instruments do not necessarily have better discriminative or evaluative properties than older instruments. The development of new PRO tools, however, is crucial, not only to ensure that key COPD concepts are being reliably measured but also that the relevant treatment effects are being captured in clinical trials. In turn, this will help us to understand better the patient's experience of the disease

The concept of control in chronic obstructive pulmonary disease: Development of the criteria and validation for use in clinical practice

Guidelines of treatment of chronic obstructive pulmonary disease (COPD) identify symptom reduction and prevention of exacerbations as the main goals of therapy. Initial pharmacological treatment must be guided by these parameters, and effectiveness must be assessed at each clinical visit. However, there is no clear guidance as to how this assessment must be performed. The concept of control has been well developed in asthma, but it has been elusive in COPD. Patients with COPD may not be completely free from symptoms or exacerbations even under optimized therapy; therefore, control in COPD does not mean cure or absence of symptoms, but rather reaching the best clinical status possible according to the level of disease severity. A control tool has been developed based on a cross sectional evaluation of the impact of the disease and a longitudinal evaluation of stability. Low impact is a disease status defined by at least 3 of the following: low levels of dyspnoea, absence of or white sputum, low use of rescue medication and self-declared walking time of more than 30 minutes a day, and stability is the absence of moderate or severe exacerbations in the previous 3 months. Control can also be defined by COPD Assessment Test (CAT) scores ≤ 10 units for patients with FEV1 ≥ 50% and 16 for patients with FEV1 < 50% and stability as a change in CAT ≤ 2 units. Control of COPD is then defined as a status of low impact and stability. The control tool has been validated prospectively in several studies and has demonstrated to be sensitive to clinical changes and to have a good predictive value for poor outcomes. Clinical criteria are more reliable than CAT scores for the evaluation of control. The control tool is a quick and inexpensive method to evaluate clinical status and future risk of exacerbations that can be used at all levels of healthcare. Концепция контроля при лечении хронической обструктивной болезни легких: разработка критериев и валидация для клинического применения (перевод с английского)По данным рекомендаций, при лечении хронической обструктивной болезни легких (ХОБЛ) в качестве главных целей лечения выделяются купирование симптомов и предотвращение обострений. При первоначальной медикаментозной терапии следует руководствоваться именно этими параметрами, а эффективность должна оцениваться при каждом посещении пациентом врача. Однако четких рекомендаций о том, как именно проводить такую оценку, не существует. Концепция контроля хорошо разработана при лечении бронхиальной астмы, однако для ХОБЛ сформулировать таковую оказалось намного труднее. Пациенты с ХОБЛ могут продолжать испытывать симптомы болезни, даже получая оптимальную терапию; таким образом, контроль над ХОБЛ означает не полное излечение или отсутствие симптомов, а достижение наилучшего возможного клинического статуса при данной степени тяжести заболевания. Авторами данной статьи разработан инструмент для определения контроля над ХОБЛ на основе поперечного среза данных о нагрузке на здоровье пациента и лонгитюдинальной оценки стабильности его состояния. Низкая нагрузка определяется как удовлетворяющая минимум 3 критериям из следующих: низкий уровень одышки; отсутствие мокроты или белая мокрота; малое использование симптоматической терапии; 30 мин ходьбы пешком в день согласно самооценке. Стабильность определяется как отсутствие умеренно тяжелых или тяжелых обострений в предшествующие 3 мес. Контроль также осуществляется по результатам теста по оценке степени тяжести ХОБЛ (COPD Assesment Test – CAT) следующим образом: ≤ 10 единиц – для пациентов, у которых показатель объема форсированного выдоха за 1-ю секунду (ОФВ1) составляет ≥ 50 %; ≤ 16 – при ОФВ1 < 50 %; стабильность определяется как изменение оценки по CAT ≤ 2 единиц. Таким образом, контроль над ХОБЛ определяется как состояние стабильно низкой нагрузки на здоровье. Инструмент для определения контроля валидирован проспективно по данным ряда исследований, при этом продемонстрированы чувствительность к изменениям клинического состояния пациентов и бόльшая прогностическая ценность по отношению к негативным исходам. Кли - нические критерии оказались надежнее в определении статуса контроля, чем баллы по CAT. Таким образом, концепция контроля – это быстрый и недорогой метод оценки клинического статуса и риска обострений в будущем, который пригоден к использованию на всех уровнях здравоохранения

Estructura cristalina y molecular de la 2-Cloro Isonitroacetanilida

En este trabajo se presenta la estructura cristalina y molecular de la 2-cloro isonitrosoacetanilida, derivado de la isonitrosoacetanilida, serie que constituye una línea de investigación de la Sección de Cristalografía del C.S.I.C. de Barcelona. La estructura ha sido resuelta por difracción de rayos-X. Las dimensiones de la celda elemental son: (...

Estructura cristalina y molecular de la dihidrazida malonica anhidra

En este trabajo se presenta la estructura cristalina y molecular de la hidracida malónica anhidra. La estructura cristalina ha sido resuelta por difracción de Rayos X. Las dimensiones de la celda elemental son: (...

Estructura cristalina y molecular de la 2 etoxi isonitrosoacetanilida

In this paper, the crystal and molecular structure of the 2 ethosy isonitroseacetanilide has been solved by means of the X-ray diffraction and the direct methods. This compound is a isonitroseacetanilide derivative by sustitution of the ORTO hydrogen benzene ring by an ethoxy group. Space group: Pccn. Unit cell dimensions : n : 10.964 4 b : 21.884 A, c: 9.463 A, Z : 8

Estructura cristalina y molecular de la dihidrazida malonica anhidra

[ES] En este trabajo se presenta la estructura cristalina y molecular de la hidracida malónica anhidra. La estructura cristalina ha sido resuelta por difracción de Rayos X. Las dimensiones de la celda elemental son: a = 6.986Å, b0 = 4.828Å, c0 = 17.619Å, β = 93.490, V = 593.19Å y su grupo espacial es el P21/c, Z = 4.[EN] In this paper, the crystal and molecular structure of the nalonic dihydrazide has been solved by means of the X-Ray difraction and the direct methods. The unit cell dimensions are: a = 6.986Å, b0 = 4.828Å, c0 = 17.619Å, β = 93.490, V = 593.19Å y su grupo espacial es el P21/c, Z = 4.Peer reviewe