RESUMEN
Objective. A retrospective evaluation of waiting times for elective procedures was conducted in a sample of Mexican public hospitals from the following institutions: the Mexican Institute for Social Security (IMSS), the Institute for Social Security and Social Services for Civil Servants (ISSSTE) and the Ministry of Health (MoH). Our aim was to describe current waiting times and identify opportunities to redistribute service demand among public institutions. Materials and methods. We examined current waiting times and productivity for seven elective surgical and four diagnostic imaging procedures, selected on the basis of their relative frequency and comparability with other national health systems. Results. Mean waiting time for the seven surgical procedures in the three institutions was 14 weeks. IMSS and ISSSTE hospitals showed better performance (12 and 13 weeks) than the MoH hospitals (15 weeks). Mean waiting time for the four diagnostic procedures was 11 weeks. IMSS hospitals (10 weeks) showed better average waiting times than ISSSTE (12 weeks) and MoH hospitals (11 weeks). Conclusion. Substantial variations were revealed, not only among institutions but also within the same institution. These variations need to be addressed in order to improve patient satisfaction.
Objetivo. Se llevó a cabo una evaluación retrospectiva de los tiempos de espera para procedimientos electivos en una muestra de hospitales públicos en México de las siguientes instituciones: Instituto Mexicano del Seguro Social (IMSS), Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) y Secretaría de Salud (SS). El propósito era describir la situación actual en materia de tiempos de espera e identificar oportunidades de redistribución de la demanda de servicios entre instituciones públicas. Material y métodos. Se analizaron los tiempos de espera y la productividad para siete procedimientos quirúrgicos y cuatro procedimientos diagnósticos seleccionados sobre la base de su frecuencia relativa y comparabilidad con otros sistemas de salud nacionales. Resultados. El tiempo de espera promedio para los siete procedimientos quirúrgicos en las tres instituciones fue de 14 semanas. Los hospitales del IMSS y el ISSSTE mostraron un mejor desempeño (12 y 13 semanas) frente a los hospitales de la SS (15 semanas). El tiempo de espera promedio para los cuatro procedimientos diagnósticos fue de 11 semanas. Los hospitales del IMSS mostraron un tiempo de espera promedio mejor (10 semanas) que los hospitales del ISSSTE (12 semanas) y la SS (11 semanas). Conclusión. Se identificaron variaciones importantes no sólo entre instituciones sino también al interior de cada una de ellas. Estas variaciones deben atenderse para así mejorar la satisfacción de los usuarios de los servicios.
Asunto(s)
Adulto , Anciano , Humanos , Persona de Mediana Edad , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Desoxicitidina/análogos & derivados , Fluorouracilo/sangre , Modelos Biológicos , Neoplasias/tratamiento farmacológico , Algoritmos , Protocolos de Quimioterapia Combinada Antineoplásica/farmacocinética , Área Bajo la Curva , Camptotecina/administración & dosificación , Camptotecina/análogos & derivados , Capecitabina , Cromatografía Líquida de Alta Presión , Desoxicitidina/administración & dosificación , Desoxicitidina/sangre , Desoxicitidina/farmacocinética , Relación Dosis-Respuesta a Droga , Floxuridina/sangre , Estructura Molecular , Metástasis de la Neoplasia , Neoplasias/metabolismo , Neoplasias/patología , Profármacos/administración & dosificación , Profármacos/farmacocinética , Sesquiterpenos/administración & dosificaciónRESUMEN
OBJECTIVE: A retrospective evaluation of waiting times for elective procedures was conducted in a sample of Mexican public hospitals from the following institutions: the Mexican Institute for Social Security (IMSS), the Institute for Social Security and Social Services for Civil Servants (ISSSTE) and the Ministry of Health (MoH). Our aim was to describe current waiting times and identify opportunities to redistribute service demand among public institutions. MATERIALS AND METHODS: We examined current waiting times and productivity for seven elective surgical and four diagnostic imaging procedures, selected on the basis of their relative frequency and comparability with other national health systems. RESULTS: Mean waiting time for the seven surgical procedures in the three institutions was 14 weeks. IMSS and ISSSTE hospitals showed better performance (12 and 13 weeks) than the MoH hospitals (15 weeks). Mean waiting time for the four diagnostic procedures was 11 weeks. IMSS hospitals (10 weeks) showed better average waiting times than ISSSTE (12 weeks) and MoH hospitals (11 weeks). CONCLUSION: Substantial variations were revealed, not only among institutions but also within the same institution. These variations need to be addressed in order to improve patient satisfaction.
Asunto(s)
Técnicas y Procedimientos Diagnósticos/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Estudios Transversales , Eficiencia , Hospitales Federales/estadística & datos numéricos , Hospitales Generales/estadística & datos numéricos , Hospitales Urbanos/estadística & datos numéricos , Humanos , México/epidemiología , Estudios Retrospectivos , Muestreo , Seguridad Social , Factores de Tiempo , Tiempo de Tratamiento , Estados UnidosRESUMEN
Abstract-This article uses political economy analysis to identify the factors that contributed to the adoption of policies to expand social protection in health (SPH) in Mexico in the early years of the 21st century. It focuses on the adoption stage of these policies to answer two questions: (1) Which contextual factors created the window of opportunity where SPH reforms could be adopted in Mexico? (2) What political strategies did the main actors driving the reform use to promote its adoption? Two types of analysis were developed: an analysis of the context and a stakeholder analysis. The analysis of the context was used to identify the "enabling factors" (epidemiological, political, and economic) that created the window of opportunity to place the problem of limited health care coverage in Mexico on the national policy agenda. The stakeholder analysis was used to (1) construct a map of actors, positions, and power during the deliberation of these policies in the Mexican Congress; (2) evaluate the behavior, intentions, interrelations, agendas, and interests of key actors; and (3) assess the influence and resources that actors brought to the debate and the strategies used by proponents to pursue and achieve adoption of the policies. This article shows that actors with high political power can take advantage of a propitious context (a window of opportunity for major change) through effective political strategies to design, promote, and successfully negotiate SPH policies, even in the absence of beneficiary mobilization. This was the case in the adoption of Mexico's health reform in 2003.
RESUMEN
Objetivo. Cuantificar el abasto en farmacia y el nivel de surtimiento de medicamentos en las unidades de especialidades médicas de enfermedades crónicas (UNEMES-EC) de México. Material y métodos. Los indicadores de abasto y surtimiento se midieron en 30 de 86 UNEMES-EC existentes en el país. El abasto de medicamentos se registró mediante una lista de cotejo que incluía 17 medicamentos básicos relacionados con la atención de diabetes mellitus, hipertensión y sobrepeso/obesidad. La información sobre surtimiento de recetas procede de un cuestionario aplicado directamente a 1 200 usuarios. Resultados. Sólo 13.3% de las unidades reportó abasto completo de medicamentos esenciales y dicho abasto fue más frecuente en aquellas unidades con servicio tercerizado de farmacia. Del total de pacientes entrevistados, 35% alguna vez tuvo que comprar medicamentos con recursos propios. Conclusión. Las UNEMES-EC deben mejorar su abasto de medicamentos y el surtimiento completo de recetas para evitar que sus usuarios incurran en gastos de bolsillo.
Objective. To quantify the supply of essential drugs and the fully filled-in prescription level in the Units Specialized in the Treatment of Chronic Diseases (UNEMES-EC) in Mexico. Materials and methods. The supply and prescription indicators were measured in 30 of the 86 existing UNEMES-EC. The supply of drugs was recorded using a list of 17 essential drugs related to the treatment of diabetes, hypertension, overweight and obesity. The information on fully filled-in prescriptions was obtained through a questionnaire applied to 1 200 health care users. Results. Only 13.3% of these units showed a complete supply of the 17 essential drugs: Supply levels were higher in units with external drugstore service. 35% of the interviewed patients reported out-of-pocket expenditures in medicines. Conclusion. UNEMES-EC should improve their levels of drug supply and fully filled-in prescriptions to reduce out-of-pocket expenditures.
Asunto(s)
Humanos , Enfermedad Crónica/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricos , Medicamentos Esenciales/provisión & distribución , MéxicoRESUMEN
Objetivo. Presentar los resultados de la carga de enfermedad en México de 1990 a 2010 para las principales enfermedades, lesiones y factores de riesgo, por sexo. Materiales y métodos. Se realizó un análisis secundario del estudio de la carga mundial de la enfermedad 2010. Resultados. En 2010 se perdieron 26.2 millones de años de vida saludable (AVISA), 56% en hombres y 44% en mujeres. Las principales causas de AVISA en hombres fueron violencia, cardiopatía isquémica y los accidentes de tránsito. En las mujeres fueron la diabetes, la enfermedad renal crónica y la cardiopatía isquémica. Los trastornos mentales y musculoesqueléticos concentran 18% de la carga. Los factores de riesgo que más afectan a los hombres son sobrepeso/obesidad; niveles de glucosa en sangre y de presión arterial elevados; y el consumo de alcohol y tabaco (35.6% de AVISA perdidos). En las mujeres, el sobrepeso y la obesidad; glucosa elevada; hipertensión arterial; baja actividad física; y el consumo de alcohol y tabaco fueron responsables de 40% de los AVISA perdidos; en ambos sexos, la dieta contribuye con 12% de la carga. Conclusiones. El panorama epidemiológico en México demanda una urgente adecuación y modernización del sistema de salud.
Objective. To present the results of the burden of disease, injuries and risk factors in Mexico from 1990 to 2010 for the principal illnesses, injuries and risk factors by sex. Materials and methods. A secondary analysis of the study results published by the Global Burden of Disease 2010 for Mexico performed by IHME. Results. In 2010, Mexico lost 26.2 million of Disability adjusted live years (DALYs), 56 % were in male and 44 % in women. The main causes of DALYs in men are violence, ischemic heart disease and road traffic injuries. In the case of women the leading causes are diabetes, chronic kidney disease and ischemic heart diseases. The mental disorders and musculoskeletal conditions concentrate 18% of health lost. The risk factors that most affect men in Mexico are: alcohol consumption, overweight/obesity, high blood glucose levels and blood pressure and tobacco consumption (35.6 % of DALYs lost). In women, overweight and obesity, high blood sugar and blood pressure, lack of physical activity and consumption of alcohol are responsible for 40 % of DALYs lost. In both sexes the problems with diet contribute 12% of the burden. Conclusions. The epidemiological situation in Mexico, demands an urgent adaptation and modernization of the health system.
Asunto(s)
Femenino , Humanos , Masculino , Costo de Enfermedad , Atención a la Salud , Heridas y Lesiones/epidemiología , Causas de Muerte , Personas con Discapacidad , Esperanza de Vida , México/epidemiología , Factores de RiesgoRESUMEN
OBJECTIVE: To describe and quantify hospital services given by units of the Ministry of Health (MoH) to patients with social security or living in states different to those where the hospitals are located. MATERIALS AND METHODS: With data from the automatized system for hospital discharges patients were classified, according to the place of living, into locals or outsiders; and, according to their insurance status, into social security beneficiaries or not beneficiaries. Frequencies of services for these groups were estimated, and characteristics of patients and services were described. RESULTS: 5.6% of patients of MoH hospitals were outsiders. This percentage reaches 50% in the National Institutes of Health. Only 1.7% of the patients had social security insurance. Sociodemographic and services characteristics are quite different between outsiders or social security patients and those without those attributes. CONCLUSION: Despite its segmentation, in the National Health System there is a continuous process of exchange of services between different providers.
Asunto(s)
Hospitales/estadística & datos numéricos , Admisión del Paciente/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Humanos , Masculino , MéxicoRESUMEN
OBJETIVO: Describir y cuantificar los servicios prestados en hospitales de la Secretaría de Salud a pacientes con seguridad social o que habitan en entidades distintas a la del hospital del que egresaron. MATERIAL Y MÉTODOS: Utilizando el Sistema Automatizado de Egresos Hospitalarios, los pacientes se clasificaron, según su residencia, en locales o foráneos; y por tipo de aseguramiento, en derechohabientes o no derecho-habientes. Se calculó la frecuencia de servicios otorgados y se analizaron las características diferenciales de los pacientes y los servicios. RESULTADOS: De los pacientes 5.6% fueron foráneos. En los Institutos Nacionales de Salud este porcentaje alcanzó 50%. Sólo 1.7% de los pacientes registraron ser derechohabientes. Las características sociodemográficas y del perfil de servicios son claramente distinguibles entre pacientes foráneos y derechohabientes y aquellos sin estos atributos. DISCUSIÓN: Independientemente del carácter segmentado y fragmentado del Sistema Nacional de Salud, existe un proceso de intercambio de servicios entre proveedores.
OBJECTIVE: To describe and quantify hospital services given by units of the Ministry of Health (MoH) to patients with social security or living in states different to those where the hospitals are located. MATERIALS AND METHODS: With data from the automatized system for hospital discharges patients were classified, according to the place of living, into locals or outsiders; and, according to their insurance status, into social security beneficiaries or not beneficiaries. Frequencies of services for these groups were estimated, and characteristics of patients and services were described. RESULTS: 5.6% of patients of MoH hospitals were outsiders. This percentage reaches 50% in the National Institutes of Health. Only 1.7% of the patients had social security insurance. Sociodemographic and services characteristics are quite different between outsiders or social security patients and those without those attributes. CONCLUSION: Despite its segmentation, in the National Health System there is a continuous process of exchange of services between different providers.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Hospitales , Admisión del Paciente/estadística & datos numéricos , Estudios Transversales , MéxicoRESUMEN
OBJECTIVE: To present the results of the burden of disease, injuries and risk factors in Mexico from 1990 to 2010 for the principal illnesses, injuries and risk factors by sex. MATERIALS AND METHODS: A secondary analysis of the study results published by the Global Burden of Disease 2010 for Mexico performed by IHME. RESULTS: In 2010, Mexico lost 26.2 million of Disability adjusted live years (DALYs), 56 % were in male and 44 % in women. The main causes of DALYs in men are violence, ischemic heart disease and road traffic injuries. In the case of women the leading causes are diabetes, chronic kidney disease and ischemic heart diseases. The mental disorders and musculoskeletal conditions concentrate 18% of health lost. The risk factors that most affect men in Mexico are: alcohol consumption, overweight/obesity, high blood glucose levels and blood pressure and tobacco consumption (35.6 % of DALYs lost). In women, overweight and obesity, high blood sugar and blood pressure, lack of physical activity and consumption of alcohol are responsible for 40 % of DALYs lost. In both sexes the problems with diet contribute 12% of the burden. CONCLUSIONS: The epidemiological situation in Mexico, demands an urgent adaptation and modernization of the health system.
Asunto(s)
Costo de Enfermedad , Atención a la Salud , Heridas y Lesiones/epidemiología , Causas de Muerte , Personas con Discapacidad , Femenino , Humanos , Esperanza de Vida , Masculino , México/epidemiología , Factores de RiesgoRESUMEN
OBJECTIVE: To quantify the supply of essential drugs and the fully filled-in prescription level in the Units Specialized in the Treatment of Chronic Diseases (UNEMES-EC) in Mexico. MATERIALS AND METHODS: The supply and prescription indicators were measured in 30 of the 86 existing UNEMES-EC. The supply of drugs was recorded using a list of 17 essential drugs related to the treatment of diabetes, hypertension, overweight and obesity. The information on fully filled-in prescriptions was obtained through a questionnaire applied to 1 200 health care users. RESULTS: Only 13.3% of these units showed a complete supply of the 17 essential drugs: Supply levels were higher in units with external drugstore service. 35% of the interviewed patients reported out-of-pocket expenditures in medicines. CONCLUSION: UNEMES-EC should improve their levels of drug supply and fully filled-in prescriptions to reduce out-of-pocket expenditures.
Asunto(s)
Enfermedad Crónica/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricos , Medicamentos Esenciales/provisión & distribución , Humanos , MéxicoRESUMEN
OBJECTIVE: To assess health care quality provided to type-2 diabetic and hypertensive patients in primary care settings from the Mexican Ministry of Health and to evaluate whether accredited clinics providing services to the Mexican Seguro Popular performed better in terms of metabolic control of those patients compared to the non-accredited. MATERIAL AND METHODS: Cross-sectional study performed on 2008. Previous year clinical measures were obtained from 5 444 diabetic and 5 827 hypertensive patient's clinical records. Adequate metabolic control (glucose <110 mg/dl for diabetes and blood pressure <140/90 mmHg for hypertension) associated factors were assessed by multiple-multilevel logistic regression methods. RESULTS: Patients attending accredited clinics were more likely to be controlled, however, metabolic control was not constant over time of accreditation. CONCLUSIONS: Additional efforts are required to monitor accredited clinics' performance in order to maintain both metabolic control and clinical assessment of patients.
Asunto(s)
Diabetes Mellitus/terapia , Hipertensión/terapia , Atención Primaria de Salud/normas , Calidad de la Atención de Salud , Femenino , Humanos , Masculino , México , Persona de Mediana Edad , Programas Nacionales de SaludRESUMEN
OBJECTIVE: To introduce the Hospital Standardized Mortality Ratio (HSMR) as an alternative to assess the quality of hospital care in Mexico. MATERIAL AND METHODS: Data-sets of public hospital discharges were used as source of information. The analyses were based in a logistic model to estimate the risk of hospital death adjusting by sex, age, length of stay and main diagnosis. The HSMR is estimated dividing the observed deaths by the addition of the risk for each discharge by hospital. RESULTS: The ISSSTE had the lowest HSMR. At state level, the best figure was obtained by the hospitals of the ISSSTE in Veracruz, while the worst performance corresponds to hospitals of the SS in Nayarit. CONCLUSION: Our results suggest that this indicator can be used as a suitable alternative to evaluate the performance of hospitals in terms of mortality.
Asunto(s)
Mortalidad Hospitalaria , Garantía de la Calidad de Atención de Salud/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , México , Persona de Mediana Edad , Adulto JovenRESUMEN
OBJECTIVE: To measure the prevalence of adverse events (AE) in surgical adult patients from the main public health institutions in Mexico. MATERIAL AND METHODS: A two stage retrospective medical record review was carried out. A total of 6 119 medical records were randomly selected. The medical records were evaluated by a doctor. Logistic regression was used to identify likely associated variables. RESULTS: The AE prevalence was 4.1%. There were no significant differences by sex or institution. The patients 65 years or older who are served in big hospitals have more risk of suffering an AE. Patients with an AE remained in the hospital an average of nine more days than those without one. CONCLUSION: According to our results, in 2008 there were at least 128 400 AE in Mexico. It is necessary to develop further studies to investigate the main factors associated to surgical adverse events and to improve patient safety.
Asunto(s)
Complicaciones Posoperatorias/epidemiología , Adulto , Femenino , Hospitales Públicos , Humanos , Masculino , México , Persona de Mediana Edad , Prevalencia , Estudios RetrospectivosRESUMEN
OBJETIVO. Medir la calidad técnica de la atención a pacientes con diabetes mellitus tipo 2 (DM) e hipertensión arterial (HAS) en los centros de salud (CS) de los Servicios Estatales de Salud de México, al comparar su desempeño según condición de acreditación al Seguro Popular (SP). MATERIAL Y MÉTODOS. Estudio transversal realizado en 2008. Durante el año previo fue recolectado el historial de atención de 5 444 expedientes de pacientes con DM y 5 827 con HAS. Se determinaron los factores asociados al buen control metabólico de DM (glucosa<110 mg/dl) y HAS (tensión arterial <140/90 mmHg) mediante modelos de regresión logística multinivel. RESULTADOS. Fue estimado mejor control metabólico en los pacientes de los CS acreditados, sin embargo, este no fue constante de acuerdo con el tiempo de acreditación. CONCLUSIONES. Es necesario monitorear el desempeño de las unidades acreditadas para mantener constante el buen control metabólico y el tratamiento clínico de estos pacientes.
OBJECTIVE. To assess health care quality provided to type-2 diabetic and hypertensive patients in primary care settings from the Mexican Ministry of Health and to evaluate whether accredited clinics providing services to the Mexican Seguro Popular performed better in terms of metabolic control of those patients compared to the non-accredited. MATERIAL AND METHODS. Cross-sectional study performed on 2008. Previous year clinical measures were obtained from 5 444 diabetic and 5 827 hypertensive patient's clinical records. Adequate metabolic control (glucose <110 mg/dl for diabetes and blood pressure <140/90 mmHg for hypertension) associated factors were assessed by multiple-multilevel logistic regression methods. RESULTS. Patients attending accredited clinics were more likely to be controlled, however, metabolic control was not constant over time of accreditation. CONCLUSIONS. Additional efforts are required to monitor accredited clinics' performance in order to maintain both metabolic control and clinical assessment of patients.
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Diabetes Mellitus/terapia , Hipertensión/terapia , Atención Primaria de Salud/normas , Calidad de la Atención de Salud , México , Programas Nacionales de SaludRESUMEN
OBJETIVO. Presentar la Razón Estandarizada de Mortalidad Intrahospitalaria (REMI) como alternativa para medir la calidad de atención hospitalaria en México. MATERIAL Y MÉTODOS. Las fuentes de información fueron los registros de egresos hospitalarios del Instituto Mexicano del Seguro Social (IMSS), del Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE) y de la Secretaría de Salud en 2008. Mediante regresión logística se estimó la probabilidad de muerte intrahospitalaria controlando por sexo, edad, días de estancia y diagnóstico. La REMI es el resultado de dividir las muertes observadas entre la suma de las probabilidades estimadas para cada hospital. RESULTADOS. La REMI más baja correspondió a los hospitales del ISSSTE. Por entidad, los servicios con mejores resultados fueron los del ISSSTE en Veracruz, y los que tuvieron peor desempeño fueron los de la SS en Nayarit. CONCLUSIÓN. Los resultados obtenidos sugieren que la REMI puede constituirse como una alternativa adecuada para monitorear el desempeño de los hospitales en términos de la mortalidad observada.
OBJECTIVE. To introduce the Hospital Standardized Mortality Ratio (HSMR) as an alternative to assess the quality of hospital care in Mexico. MATERIAL AND METHODS. Data-sets of public hospital discharges were used as source of information. The analyses were based in a logistic model to estimate the risk of hospital death adjusting by sex, age, length of stay and main diagnosis. The HSMR is estimated dividing the observed deaths by the addition of the risk for each discharge by hospital. RESULTS. The ISSSTE had the lowest HSMR. At state level, the best figure was obtained by the hospitals of the ISSSTE in Veracruz, while the worst performance corresponds to hospitals of the SS in Nayarit. CONCLUSION. Our results suggest that this indicator can be used as a suitable alternative to evaluate the performance of hospitals in terms of mortality.
Asunto(s)
Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Adulto Joven , Mortalidad Hospitalaria , Garantía de la Calidad de Atención de Salud/métodos , MéxicoRESUMEN
OBJETIVO. Cuantificar la prevalencia de eventos adversos (EA) en pacientes quirúrgicos adultos atendidos en instituciones públicas de México. MATERIAL Y MÉTODOS. Se evaluaron 6 119 expedientes clínicos de pacientes quirúrgicos seleccionados aleatoriamente. La prevalencia de EA se estimó mediante la aplicación de dos instrumentos secuenciales por parte de médicos capacitados. Se efectuó análisis multivariado por regresión logística para identificar variables asociadas. RESULTADOS. La prevalencia de EA fue de 4.1 por ciento. No existieron diferencias significativas por institución ni sexo. Los pacientes mayores de 64 años y los atendidos en hospitales grandes presentaron mayor riesgo de tener un EA. Los pacientes con EA permanecieron hospitalizados en promedio nueve días más que aquellos sin EA. 62 por ciento de los EA fueron considerados prevenibles. CONCLUSIÓN. La prevalencia encontrada significa que, durante el 2008, se presentaron por lo menos 128 400 EA quirúrgicos en México. Es necesario seguir investigando la naturaleza de estos últimos para mejorar la seguridad de los pacientes.
OBJECTIVE. To measure the prevalence of adverse events (AE) in surgical adult patients from the main public health institutions in Mexico. MATERIAL AND METHODS. A two stage retrospective medical record review was carried out. A total of 6 119 medical records were randomly selected. The medical records were evaluated by a doctor. Logistic regression was used to identify likely associated variables. RESULTS. The AE prevalence was 4.1 percent. There were no significant differences by sex or institution. The patients 65 years or older who are served in big hospitals have more risk of suffering an AE. Patients with an AE remained in the hospital an average of nine more days than those without one. CONCLUSION. According to our results, in 2008 there were at least 128 400 AE in Mexico. It is necessary to develop further studies to investigate the main factors associated to surgical adverse events and to improve patient safety.
Asunto(s)
Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Hospitales Públicos , México , Prevalencia , Estudios RetrospectivosRESUMEN
OBJECTIVE: Measure and compare the percentage of prescriptions fully dispensed to persons with and without Popular Health Insurance (SPS in Spanish) who use ambulatory and general hospital services associated with the Mexico State Health Services (SESA in Spanish), and taking into account insurance status. SESA user satisfaction was also measured with respect to access to medication. MATERIAL AND METHODS: Information for the study was taken from four surveys of SESA ambulatory and hospital units that included probabilistic samples with state representativity. Samples of ambulatory units were selected by stratification according to level of care and association to the SPS service network. RESULTS: The findings indicate that the percentage of prescriptions fully dispensed in SESA ambulatory units has improved, reaching approximately 90%, especially among those units offering services to persons affiliated with SPS. Nevertheless, these percentages continue to be lower than those of ambulatory units associated with social security institutions. Percentages of prescriptions fully dispensed have also improved in SESA hospital units, but continue to be relatively low. In nearly all states, as the percentage of prescriptions fully dispensed has increased, user satisfaction with access to medication has also improved. CONCLUSIONS: In 2006 more than 50% of the states had high levels of fully dispensed prescriptions among persons with SPS (> or =90%). The more significant problem exists among hospitals, since only 44% of users who received a prescription in SESA hospitals in 2006 had their prescriptions fully dispensed. This finding requires a review of SPS medication policies, which have favored highly prescribed low-cost medications at ambulatory services at the expense of higher cost and more therapeutically effective medications for hospital care, the latter having a greater impact on household budgets.
Asunto(s)
Seguro de Servicios Farmacéuticos/estadística & datos numéricos , Asistencia Médica/estadística & datos numéricos , Prescripciones/estadística & datos numéricos , Instituciones de Atención Ambulatoria/estadística & datos numéricos , Costos de los Medicamentos , Utilización de Medicamentos , Política de Salud , Hospitales Generales/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Humanos , Seguro de Servicios Farmacéuticos/economía , Asistencia Médica/economía , Asistencia Médica/organización & administración , México , Satisfacción del Paciente , Servicio de Farmacia en Hospital/estadística & datos numéricos , Honorarios por Prescripción de Medicamentos , Garantía de la Calidad de Atención de Salud , Medicina Estatal/economía , Medicina Estatal/organización & administración , Medicina Estatal/estadística & datos numéricosRESUMEN
OBJETIVO: Medir y comparar el porcentaje de recetas surtidas completamente a los usuarios de servicios ambulatorios y de los hospitales generales de los Servicios Estatales de Salud de México (SESA) afiliados y no afiliados al Seguro Popular de Salud (SPS) según condición de aseguramiento, además de medir la satisfacción de los usuarios de los SESA con el acceso a los medicamentos. MATERIAL Y MÉTODOS: La información del estudio procede de cuatro encuestas de unidades ambulatorias y hospitalarias de los SESA que contaron con muestras probabilísticas de representatividad estatal. Las muestras de las unidades ambulatorias se seleccionaron mediante estratificación por nivel de atención y por condición de pertenencia a la red de servicios del SPS. RESULTADOS: Los hallazgos indican que el porcentaje de recetas completamente surtidas ha mejorado en las unidades ambulatorias de los SESA, sobre todo en aquellas que ofrecen servicios a los afiliados al SPS y que alcanzan porcentajes de casi 90 por ciento. Estos porcentajes, sin embargo, siguen siendo inferiores a los de las unidades ambulatorias de las instituciones de seguridad social. Los porcentajes de recetas surtidas en las unidades hospitalarias de los SESA también han mejorado, pero siguen siendo relativamente bajos. En casi todas las entidades federativas, conforme se ha incrementado el porcentaje de surtimiento completo de recetas, ha aumentado la satisfacción de los usuarios con el acceso a los medicamentos. CONCLUSIONES: En 2006, más de 50 por ciento de las entidades federativas presentaron altos niveles de surtimiento completo de recetas entre los afiliados al SPS (>90 por ciento). El mayor problema en este sentido se encuentra en los hospitales, ya que sólo 44 por ciento de los usuarios que recibieron una prescripción en los hospitales de los SESA en 2006 obtuvieron el surtimiento completo de sus recetas. Este hallazgo obliga a revisar la política de medicamentos del SPS, que ha privilegiado...
OBJECTIVE: Measure and compare the percentage of prescriptions fully dispensed to persons with and without Popular Health Insurance (SPS in Spanish) who use ambulatory and general hospital services associated with the Mexico State Health Services (SESA in Spanish), and taking into account insurance status. SESA user satisfaction was also measured with respect to access to medication. MATERIAL AND METHODS: Information for the study was taken from four surveys of SESA ambulatory and hospital units that included probabilistic samples with state representativity. Samples of ambulatory units were selected by stratification according to level of care and association to the SPS service network. RESULTS: The findings indicate that the percentage of prescriptions fully dispensed in SESA ambulatory units has improved, reaching approximately 90 percent, especially among those units offering services to persons affiliated with SPS. Nevertheless, these percentages continue to be lower than those of ambulatory units associated with social security institutions. Percentages of prescriptions fully dispensed have also improved in SESA hospital units, but continue to be relatively low. In nearly all states, as the percentage of prescriptions fully dispensed has increased, user satisfaction with access to medication has also improved. CONCLUSIONS: In 2006 more than 50 percent of the states had high levels of fully dispensed prescriptions among persons with SPS (>90 percent). The more significant problem exists among hospitals, since only 44 percent of users who received a prescription in SESA hospitals in 2006 had their prescriptions fully dispensed. This finding requires a review of SPS medication policies, which have favored highly prescribed low-cost medications at ambulatory services at the expense of higher cost and more therapeutically effective medications for hospital care, the latter having a greater impact on household budgets.
Asunto(s)
Humanos , Seguro de Servicios Farmacéuticos/estadística & datos numéricos , Asistencia Médica/estadística & datos numéricos , Prescripciones/estadística & datos numéricos , Instituciones de Atención Ambulatoria , Costos de los Medicamentos , Utilización de Medicamentos , Política de Salud , Hospitales Generales/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Seguro de Servicios Farmacéuticos/economía , Asistencia Médica/economía , Asistencia Médica/organización & administración , México , Satisfacción del Paciente , Servicio de Farmacia en Hospital , Honorarios por Prescripción de Medicamentos , Garantía de la Calidad de Atención de Salud , Medicina Estatal/economía , Medicina Estatal/organización & administración , Medicina Estatal/estadística & datos numéricosRESUMEN
Objetivo: Análisis comparativo del reporte en línea de eventos adversos al Sistema Nacional de Registro y Aprendizaje de Eventos Centinela(SiNRAECe) de dos hospitales generales durante 2005 y 2006. Material y método: Análisis retrospectivo de la base de datos contenida en el SiNRAECe, de octubre de 2005 a diciembre de 2006, de dos hospitales generales. Se contó con 371 registros, la totalidadde ese período. Se realizó el análisis mediante comparación de proporciones ( 2), ANOVA y cálculo de riesgo expresado en odds ratio, y se consideró significativa la diferencia cuando p 0,05. Resultados: Se encontraron diferencias significativas entre los hospitales comparados respecto a los siguientes aspectos: aparición de eventos adversos (EA) en urgencias (el 32,3 y el 7,9%; p 0,001); seocasionó o se pudo ocasionar un daño con pérdida permanente de funciones o muerte (el 22,7 y el 46,7%; p 0,001); EA clasificado como infección nosocomial (el 57,8 y el 4,3%; p 0,001); opiniónde que el EA era evitable (el 96,1 y el 36,1%; p 0,001), y acciones correctivas (el 97 y el 48,8%; p 0,001). En el hospital 2, la probabilidad de un EA que causara daño fue 2,4 veces mayorque en el hospital 1 (p = 0,001; intervalo de confianza del 95%, 1,4-4,2). Conclusiones: El reporte en línea facilita la comparación de los casosde EA hospitalarios, tanto en su frecuencia como en las condiciones organizacionales que pudieran identificar las áreas de riesgo, y ayuda a identificar áreas de oportunidad de mejora en los procesos.La información derivada del análisis de dicha información será útil para la toma de decisiones en la gerencia hospitalaria
Objective: We performed a comparative analysis of the on-line reports of adverse events made to the National Sentinel Event Registration and Learning System (SiNRAECe) by two general hospitalsin 2005 and 2006. Material and method: A retrospective analysis of the database containedin the SiNRAECe from October 2005 to December 2006 fromtwo general hospitals was performed. There were a total of 372 records in this period. Analysis was performed by means of proportion comparison ( 2), ANOVA and risk calculus expressed in odds ratio. Significance was set at p 0,05. Results: Significant differences were found between the two hospitals in the following variables: the occurrence of adverse events (AE) in theemergency department (32.3 vs. 7.9%; p 0.001); the occurrence or possible occurrence of death or injury with permanent loss of function(22.7% vs. 46.7%; p 0.001); AE classified as in-hospital infection (57.8% vs. 4.3%; p 0.001); the opinion that the AE were preventable(96.1% vs. 36.1; p 0.001), and corrective actions (97% vs. 48.8%; p 0.001). In hospital 2, the probability of having an AE causing injury was 2.4 times greater (p 0.001; 95% confidence interval, 1.4-4.2) than in hospital 1. Conclusions: On-line reporting facilitates comparison of the occurrence of in-hospital AE, both their frequency and the organizationalconditions that could identify the risk areas. Likewise, this system helps to identify opportunities for improvement. Information derivedfrom analysis of these data will be useful in decision making in hospital management