RESUMEN
AIM: To assess patient and disease characteristics, treatment patterns and associated costs in patients with locally advanced or metastatic gastric cancer in Argentina, in the public and private sectors. METHODS: A historic cohort of patients who had received first-line chemotherapy treatment (platinum analog and/or a fluoropyrimidine) and were followed-up for at least three months after the last administration of a first-line cytotoxic agent were eligible. Case-report forms were prepared based on medical records from four Argentinian hospitals. Estimates of treatment costs were also calculated using the unit costs of the participating hospitals. RESULTS: Of 101 patients, more than three quarters (79.2%) were male, 41.6% were diagnosed with metastatic stage IV disease (mean age, 57.7years), and 27.7 % had a smoking history. Before locally advanced or metastatic gastric cancer diagnosis, 42.4% of the patients had received total gastrectomy. Ninety-seven percent of the patients received a doublet or triplet therapy, of which epirubicin in combination with oxaliplatin and capecitabine was the most common treatment (38%), followed by capecitabine plus oxaliplatin (29%). Around 36% of the patients responded to first-line treatment (complete and partial response). Out of the 76.2% of the patients who followed a second-line treatment, 37.7% were still administered a platinum analog and/or fluoropyrimidine. During the reported follow-up period, 50% of the patients progressed, and 32.8% had stable disease. The best supportive care consisted mostly of outpatient visits after last-line therapy (16.8%), palliative radiotherapy (16.8%), and surgery (30.7%). We observed significant differences between public and private hospital costs. CONCLUSIONS: Understanding treatment patterns in patients with locally advanced or metastatic gastric cancer may help address unmet medical needs for better patient management and improvement of their clinical outcome in Argentina.
OBJETIVO: Describir las características clínicas, los patrones de tratamiento y los costos asociados en pacientes con cáncer gástrico localmente avanzado o metastásico en Argentina, en los sectores público y privado. MÉTODOS: Una cohorte histórica de pacientes que recibieron tratamiento de quimioterapia de primera línea (análogo de platino y/o una fluoropirimidina) y fueron seguidos durante al menos tres meses después de la última administración de un agente citotóxico de primera línea fueron elegibles. Se extrajeron los datos a través de un cuestionario estructurado a partir de los registros médicos de cuatro hospitales argentinos. Las estimaciones de los costos de tratamiento también se calcularon utilizando los costos unitarios de los hospitales participantes. RESULTADOS: Entre los 101 pacientes, más de tres cuartas partes (79,2%) eran hombres, 41,6% fueron diagnosticados con enfermedad metastásica en estadio IV, la edad media fue de 57,7 años y el 27,7% tenían antecedentes de tabaquismo. Antes del diagnóstico de cáncer gástrico metastásico, el 42,4% de los pacientes habían recibido gastrectomía total. El 97% de los pacientes recibió una terapia doble o triplete, de los cuales el tratamiento más frecuente fue la epirubicina en combinación con oxaliplatino y capecitabina (38%), seguida de capecitabina + oxaliplatino (29%). Alrededor del 36% de los pacientes respondieron al tratamiento de primera línea (respuesta completa y parcial). Del 76,2% de los pacientes que siguieron un tratamiento de segunda línea, al 37,7% todavía se les administró un análogo de platino y/o fluoropirimidina. Durante el período de seguimiento, el 50% de los pacientes progresó y el 32,8% tenía enfermedad estable. La terapia de apoyo consistió principalmente en visitas ambulatorias después de la última línea de quimioterapia (16,8%), radioterapia paliativa (16,8%) y cirugía (30,7%). Se observaron diferencias significativas entre los costos de los hospitales públicos y privado. CONCLUSIONES: Comprender los patrones de tratamiento en pacientes con cáncer gástrico localmente avanzado o metastásico puede ayudar a abordar las necesidades médicas no satisfechas para un mejor manejo del paciente y la mejora de sus resultados clínicos en Argentina.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Gastrectomía/métodos , Neoplasias Gástricas/epidemiología , Adulto , Anciano , Argentina , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Costos de Hospital/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Estudios Retrospectivos , Neoplasias Gástricas/patología , Neoplasias Gástricas/terapiaRESUMEN
Aims: To assess patient and disease characteristics, treatment patterns, and associated costs in patients with advanced or metastatic gastric cancer (A/MGC) in Colombia, in both the public and private hospitals. Materials and methods: A total of 145 patients who had received first-line chemotherapy treatment (platinum analog and/or a fluoropyrimidine) and were followed for at least 3 months after the last administration of a first-line cytotoxic agent were eligible for inclusion. Case-report forms were elaborated based on the patients' medical records from three Colombian hospitals. Estimates of treatment costs were calculated using unit costs from the participating hospitals. Results: Of the 145 patients, more than half (64.83%) were male, 79.56% were diagnosed with metastatic stage IV disease (mean age = 58.14 years). Prior to MGC diagnosis, 31.71% of the patients being operated on received a total gastrectomy; 66.9% of the patients received a doublet therapy, of which 5-fluorouracil (5-FU) in combination with cisplatin was the standard treatment (14%), followed by combination with leucovorin (12%). Only around 10% of the patients responded to first-line treatment. Out of 41.38% of the patients who received a second-line treatment, 71.67% were still administered a platinum analog and/or fluoropyrimidine. During the follow-up period, 52% of the patients progressed and 20% achieved stable disease. Best supportive care mostly consisted of outpatient visits after last line-therapy (72.41%), palliative radiotherapy (18.6%), and surgery (37.2%). Limitations and conclusions: Gastric cancer is one of the main causes of cancer-related death in Colombia, as most of the patients are diagnosed at an advanced stage, when prognosis is poor. Treatment patterns are highly heterogeneous. Second-line treatments were mostly initiated with paclitaxel, capecitabine, irinotecan, or cisplatin.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Hospitales Privados/estadística & datos numéricos , Hospitales Públicos/estadística & datos numéricos , Neoplasias Gástricas/tratamiento farmacológico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/economía , Colombia , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Estadificación de Neoplasias , Cuidados Paliativos/economía , Cuidados Paliativos/estadística & datos numéricos , Pronóstico , Estudios Retrospectivos , Neoplasias Gástricas/patología , Neoplasias Gástricas/terapiaRESUMEN
Background: Cervical Cancer (CC) is an important public health problem worldwide. In 2015, CC was the sixth leading cause of death for women aged 30-59 years in Mexico. Despite the importance of having high-quality and accurate estimates of CC treatment costs that can be used to effectively evaluate the impact of preventive programs, there is scarce information on this topic in Mexico. Objective: To estimate the treatment costs by stage diagnosis in patients with CC at a Mexican Social Security Institute (IMSS) oncology hospital in Mexico City. Methods: An observational retrospective study of the resources used to treat 346 women with CC was conducted. Medical charts were reviewed and relevant resource use information was extracted using a data collection instrument that was created based on treatment guidelines. Data were classified into nine cost categories to estimate the total cost per patient. Results: The mean age of patients in the study sample was 54.3 years (range: 41-67), and the average body mass index (BMI) was >26 kg/m2. Among the participants, 37% were smokers, 39% had diabetes, and 56% had hypertension. The medical cost for stages I-IV ranged from $4,738 to $6,058 USD, with an estimated average cost of $5,114 USD. Conclusion: Total treatment costs per patient are high, especially since they were estimated considering only 7.5 months of treatment. This is the first study to estimate the annual cost to treat CC in Mexico and to additionally document the resource pattern use, cost by stage of cancer, and the distribution by cost categories.
Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Oncología Médica/economía , Seguridad Social/economía , Neoplasias del Cuello Uterino/economía , Femenino , Hospitales/estadística & datos numéricos , Humanos , México , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJETIVO Describir las características clínicas, los patrones de tratamiento y los costos asociados en pacientes con cáncer gástrico localmente avanzado o metastásico en Argentina, en los sectores público y privado. MÉTODOS Una cohorte histórica de pacientes que recibieron tratamiento de quimioterapia de primera línea (análogo de platino y/o una fluoropirimidina) y fueron seguidos durante al menos tres meses después de la última administración de un agente citotóxico de primera línea fueron elegibles. Se extrajeron los datos a través de un cuestionario estructurado a partir de los registros médicos de cuatro hospitales argentinos. Las estimaciones de los costos de tratamiento también se calcularon utilizando los costos unitarios de los hospitales participantes. RESULTADOS Entre los 101 pacientes, más de tres cuartas partes (79,2%) eran hombres, 41,6% fueron diagnosticados con enfermedad metastásica en estadio IV, la edad media fue de 57,7 años y el 27,7% tenían antecedentes de tabaquismo. Antes del diagnóstico de cáncer gástrico metastásico, el 42,4% de los pacientes habían recibido gastrectomía total. El 97% de los pacientes recibió una terapia doble o triplete, de los cuales el tratamiento más frecuente fue la epirubicina en combinación con oxaliplatino y capecitabina (38%), seguida de capecitabina + oxaliplatino (29%). Alrededor del 36% de los pacientes respondieron al tratamiento de primera línea (respuesta completa y parcial). Del 76,2% de los pacientes que siguieron un tratamiento de segunda línea, al 37,7% todavía se les administró un análogo de platino y/o fluoropirimidina. Durante el período de seguimiento, el 50% de los pacientes progresó y el 32,8% tenía enfermedad estable. La terapia de apoyo consistió principalmente en visitas ambulatorias después de la última línea de quimioterapia (16,8%), radioterapia paliativa (16,8%) y cirugía (30,7%). Se observaron diferencias significativas entre los costos de los hospitales públicos y privado. CONCLUSIONES Comprender los patrones de tratamiento en pacientes con cáncer gástrico localmente avanzado o metastásico puede ayudar a abordar las necesidades médicas no satisfechas para un mejor manejo del paciente y la mejora de sus resultados clínicos en Argentina.
AIM To assess patient and disease characteristics, treatment patterns and associated costs in patients with locally advanced or metastatic gastric cancer in Argentina, in the public and private sectors. METHODS A historic cohort of patients who had received first-line chemotherapy treatment (platinum analog and/or a fluoropyrimidine) and were followed-up for at least three months after the last administration of a first-line cytotoxic agent were eligible. Case-report forms were prepared based on medical records from four Argentinian hospitals. Estimates of treatment costs were also calculated using the unit costs of the participating hospitals. RESULTS Of 101 patients, more than three quarters (79.2%) were male, 41.6% were diagnosed with metastatic stage IV disease (mean age, 57.7years), and 27.7 % had a smoking history. Before locally advanced or metastatic gastric cancer diagnosis, 42.4% of the patients had received total gastrectomy. Ninety-seven percent of the patients received a doublet or triplet therapy, of which epirubicin in combination with oxaliplatin and capecitabine was the most common treatment (38%), followed by capecitabine plus oxaliplatin (29%). Around 36% of the patients responded to first-line treatment (complete and partial response). Out of the 76.2% of the patients who followed a second-line treatment, 37.7% were still administered a platinum analog and/or fluoropyrimidine. During the reported follow-up period, 50% of the patients progressed, and 32.8% had stable disease. The best supportive care consisted mostly of outpatient visits after last-line therapy (16.8%), palliative radiotherapy (16.8%), and surgery (30.7%). We observed significant differences between public and private hospital costs. CONCLUSIONS Understanding treatment patterns in patients with locally advanced or metastatic gastric cancer may help address unmet medical needs for better patient management and improvement of their clinical outcome in Argentina.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Neoplasias Gástricas/epidemiología , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Gastrectomía/métodos , Argentina , Neoplasias Gástricas/patología , Neoplasias Gástricas/terapia , Estudios Retrospectivos , Estudios de Cohortes , Estudios de Seguimiento , Costos de Hospital/estadística & datos numéricos , Metástasis de la Neoplasia , Estadificación de NeoplasiasRESUMEN
This work assessed the effectiveness and net operational costs of a strategic selective treatment for controlling ectoparasites (Rhipicephalus microplus, as well as Dermatobia hominis and Cochliomyia hominivorax larvae) and hemoparasites (Anaplasma marginale and Babesia spp.) in Holstein Friesian calves. Thirty calves were equally distributed in two groups: ST) strategic selective treatment and CT) conventional treatment. From birth, calves were monitored biweekly until 12 months of age. The CT group was subjected to parasite control according to directions provided by the veterinarian at the Experimental Farm of the Federal University of Lavras (FE/UFLA), whereas parasite control of the ST group followed criteria we had previously established. The ST group experienced fewer changes in physical traits on average and lower globular volume (GV) than the CT group (p 0.05). Approximately 23% of ST calves exhibited external omphalitis, compared with 48% CT calves (p 0.001). Additionally, ST calves were less affected than CT calves (p 0.05) by R. microplus females and D. hominis larvae. Seropositivity rates from the indirect immunofluorescence reaction for A. marginale and B. bovis were similar for both groups (ST: 85.6% and 87.8%, respectively; CT: 83.2% and 83.2%). Additionally, subclinical (asymptomatic infection) anaplasmosis predominated in both groups during the dry period of the year. The daily average weight gains (DWG) were identical among ST (580 g) and CT (570 g), but the effective operational cost (EOC) was 3.7 times greater in ST (R$ 406.58/animal) compared with CT (R$ 110.90/animal). Laboratory exams to monitor the animals represented the largest share of the cost (82.7%) in ST, whereas drug expenses represented the highest costs (49.8%) in CT. Despite having a greater EOC, ST was more efficient at reducing parasite burdens than CT.
Objetivou-se avaliar a eficácia e os custos operacionais efetivos de um tratamento estratégico seletivo no controle de ecto (Rhipicephalus microplus e, larvas de Dermatobia hominis e Cochliomyia hominivorax) e hemoparasitos (Anaplasma marginale e Babesia spp.), em bezerras da raça holandesa, na Fazenda Experimental da Universidade Federal de Lavras (FE-UFLA), MG. Trinta bezerras foram distribuídas igualmente em dois grupos: TE) Tratamento estratégico seletivo e TC) Tratamento convencional. As bezerras foram monitoradas a cada 14 dias desde o nascimento até os 12 meses de idade. O controle de ecto e hemoparasitos, no TC, foi realizado de acordo com a orientação do médico veterinário responsável pela FE-UFLA. No TE, esse controle de parasitos seguiu critérios, previamente, estabelecidos pelos pesquisadores deste estudo. Nas análises estatísticas utilizou-se o pacote estatístico PASW 18.0. As frequências médias de alterações nos parâmetros físicos e no volume globular (VG) foram menores (p 0,05) no TE, em relação ao TC. As bezerras do TE (23%) apresentaram menos (p 0,001) casos de onfalite externa em relação aos animais do TC (48%). Bezerras do TE estavam menos (p 0,05) parasitadas por fêmeas de R. microplus e larvas de D. hominis (berne) que os animais do TC. Na reação de imunofluorescência indireta (RIFI), as soropositividades para A. marginale e B. bovis, foram foram, respectivamente, 85,6% e 87,8% no TE e, 83,2% e 83,2% no TC. Em ambos os tratamentos, predominaram os casos de anaplasmose subclínica (infecção assintomática) no período seco do ano. Os ganhos de peso médios diários (GPD) foram iguais (p>0,05) entre TE (580 g) e TC (570 g). O custo operacional efetivo (COE) foi 3,7 vezes maior no TE (R$ 406,58/animal) em relação ao TC (R$ 110,90/animal).
Asunto(s)
Animales , Bovinos , Bovinos/parasitología , Bovinos/sangre , RhipicephalusRESUMEN
This work assessed the effectiveness and net operational costs of a strategic selective treatment for controlling ectoparasites (Rhipicephalus microplus, as well as Dermatobia hominis and Cochliomyia hominivorax larvae) and hemoparasites (Anaplasma marginale and Babesia spp.) in Holstein Friesian calves. Thirty calves were equally distributed in two groups: ST) strategic selective treatment and CT) conventional treatment. From birth, calves were monitored biweekly until 12 months of age. The CT group was subjected to parasite control according to directions provided by the veterinarian at the Experimental Farm of the Federal University of Lavras (FE/UFLA), whereas parasite control of the ST group followed criteria we had previously established. The ST group experienced fewer changes in physical traits on average and lower globular volume (GV) than the CT group (p 0.05). Approximately 23% of ST calves exhibited external omphalitis, compared with 48% CT calves (p 0.001). Additionally, ST calves were less affected than CT calves (p 0.05) by R. microplus females and D. hominis larvae. Seropositivity rates from the indirect immunofluorescence reaction for A. marginale and B. bovis were similar for both groups (ST: 85.6% and 87.8%, respectively; CT: 83.2% and 83.2%). Additionally, subclinical (asymptomatic infection) anaplasmosis predominated in both groups during the dry period of the year. The daily average weight gains (DWG) were identical among ST (580 g) and CT (570 g), but the effective operational cost (EOC) was 3.7 times greater in ST (R$ 406.58/animal) compared with CT (R$ 110.90/animal). Laboratory exams to monitor the animals represented the largest share of the cost (82.7%) in ST, whereas drug expenses represented the highest costs (49.8%) in CT. Despite having a greater EOC, ST was more efficient at reducing parasite burdens than CT.(AU)
Objetivou-se avaliar a eficácia e os custos operacionais efetivos de um tratamento estratégico seletivo no controle de ecto (Rhipicephalus microplus e, larvas de Dermatobia hominis e Cochliomyia hominivorax) e hemoparasitos (Anaplasma marginale e Babesia spp.), em bezerras da raça holandesa, na Fazenda Experimental da Universidade Federal de Lavras (FE-UFLA), MG. Trinta bezerras foram distribuídas igualmente em dois grupos: TE) Tratamento estratégico seletivo e TC) Tratamento convencional. As bezerras foram monitoradas a cada 14 dias desde o nascimento até os 12 meses de idade. O controle de ecto e hemoparasitos, no TC, foi realizado de acordo com a orientação do médico veterinário responsável pela FE-UFLA. No TE, esse controle de parasitos seguiu critérios, previamente, estabelecidos pelos pesquisadores deste estudo. Nas análises estatísticas utilizou-se o pacote estatístico PASW 18.0. As frequências médias de alterações nos parâmetros físicos e no volume globular (VG) foram menores (p 0,05) no TE, em relação ao TC. As bezerras do TE (23%) apresentaram menos (p 0,001) casos de onfalite externa em relação aos animais do TC (48%). Bezerras do TE estavam menos (p 0,05) parasitadas por fêmeas de R. microplus e larvas de D. hominis (berne) que os animais do TC. Na reação de imunofluorescência indireta (RIFI), as soropositividades para A. marginale e B. bovis, foram foram, respectivamente, 85,6% e 87,8% no TE e, 83,2% e 83,2% no TC. Em ambos os tratamentos, predominaram os casos de anaplasmose subclínica (infecção assintomática) no período seco do ano. Os ganhos de peso médios diários (GPD) foram iguais (p>0,05) entre TE (580 g) e TC (570 g). O custo operacional efetivo (COE) foi 3,7 vezes maior no TE (R$ 406,58/animal) em relação ao TC (R$ 110,90/animal).(AU)
Asunto(s)
Animales , Bovinos , Bovinos/sangre , Bovinos/parasitología , RhipicephalusRESUMEN
AIMS: Test strips for self-monitoring of blood glucose (SMBG) represent in Argentina, around 50 % of diabetes treatment cost; the frequency of their use is closely associated with hyperglycemia treatment. However, the favorable impact of SMBG on attainment of HbA1c goal in different treatment conditions remains controversial. We therefore attempted to estimate the relationship between use of SMBG test strips and degree of attainment of metabolic control in an institution of our social security subsector (SSS) in which provision is fully covered and submitted to a regular audit system. METHODS: Observational retrospective study using information of 657 patients with T2DM (period 2009-2010) from the database of the Diabetes and Other Cardiovascular Risk Factors Program (DICARO) of one institution of our SSS. DICARO provides-with an audit system-100 % coverage for all drugs and keeps records of clinical, metabolic and treatment data from every patient. RESULTS: The average monthly test strips/patient used for SMBG increased as a function of treatment intensification: Monotherapy with oral antidiabetic drugs (OAD) < combined OAD therapy < insulin treatment. In every condition, the number was larger in people with target HbA1c levels. Test strips represented the larger percentage of total prescription cost. CONCLUSIONS: In our population, the type of hyperglycemia treatment was the main driver of test strip use for SMBG; in every condition tested, targeted HbA1c values were associated with greater strip use. Patient education and prescription audit may optimize its use and treatment outcomes.
Asunto(s)
Glucemia/análisis , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/epidemiología , Hemoglobina Glucada/metabolismo , Planificación de Atención al Paciente/estadística & datos numéricos , Adulto , Glucemia/metabolismo , Automonitorización de la Glucosa Sanguínea/normas , Automonitorización de la Glucosa Sanguínea/estadística & datos numéricos , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/complicaciones , Enfermedades Cardiovasculares/epidemiología , Bases de Datos Factuales , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/economía , Femenino , Hemoglobina Glucada/análisis , Humanos , Hiperglucemia/sangre , Hiperglucemia/complicaciones , Hiperglucemia/epidemiología , Hipoglucemiantes/uso terapéutico , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Objetivo: determinar la validez y confiabilidad de la Entrevista de Percepción de Carga del Cuidado de Zarit, versión de 22 ítems en español, con cuidadores familiares de personas con enfermedades crónicas en Colombia. Materiales y métodos: estudio metodológico de corte transversal, con 652 cuidadores familiares de personas con enfermedades crónicas, residentes en las cinco regiones de Colombia, con el fin de establecer la validez de constructo, con un análisis factorial y la confiabilidad a través de la consistencia interna determinando el alfa de Cronbach. Resultado: respecto a la validez de constructo, el estudio reporta a partir de la asociación libre de la rotación Varimax la carga total, y en sus dimensiones que incluyen carga interpersonal, impacto del cuidado, y las competencias y expectativas sobre el cuidado. Las cargas factoriales corresponden a los ítems planteados para medir cada una de las dimensiones propuestas. Conclusión: el instrumento Entrevista de Percepción de Carga del Cuidado de Zarit, versión de 22 ítems en español, es una herramienta de fácil aplicación y comprensión en población colombiana de diferente nivel educativo, socioeconómico y cultural; además, mostró ser válido y confiable para evaluar la carga del cuidado en cuidadores familiares de personas con enfermedad crónica.
Objective: This research was designed to determine the validity and reliability of the Zarit Burden Interview, specifically the 22-item Spanish version, as an instrument to measure the burden of care perceived by family caregivers of patients in Colombia with chronic diseases. Materials and Methods: A cross-sectional study of 652 family caregivers of patients with chronic diseases who reside in five regions of Colombia was conducted to establish construct validity, with a factor analysis and internal consistency reliability measured by determining the Cronbach's alpha value. Result: In terms of construct validity, the study reports the total loading, based on free association of a varimax rotation, and in the dimensions that include interpersonal burden, impact of care, and skills and expectations about care. The factor loadings pertain to the items introduced to measure each of the proposed dimensions. Conclusion: The results showed the 22-item Spanish version of the Zarit Burden Interview is an instrument that can be applied and understood easily in a Colombian population with different educational, socio-economic and cultural levels. It also proved to be valid and reliable for assessing the burden of care perceived by family caregivers of patients with chronic diseases.
Objetivo: determinar a validade e confiabilidade da Entrevista de Percepção de Carga do Cuidado de Zarit, versão de 22 itens em espanhol, com cuidadores familiares de pessoas com doenças crônicas na Colômbia. Materiais e métodos: estudo metodológico de corte transversal, com 652 cuidadores familiares de pessoas com doenças crônicas, residentes nas cinco regiões da Colômbia, para estabelecer a validade de constructo, com uma análise fatorial, e a confiabilidade por meio da consistência interna que determina o alfa de Cronbach. Resultado: a respeito da validade de constructo, o estudo relata, a partir da associação livre da rotação Varimax, a carga total, e em suas dimensões que incluem carga interpessoal, impacto do cuidado, bem como as competências e expectativas sobre o cuidado. As cargas fatoriais correspondem aos itens apresentados para mediar cada uma das dimensões propostas. Conclusão: o instrumento Entrevista de Percepção de Carga do Cuidado de Zarit, versão de 22 itens em espanhol, é uma ferramenta de fácil aplicação e compreensão em população colombiana de diferente nível educativo, socioeconômico e cultural; além disso, mostrou ser válido e confiável para avaliar a carga do cuidado em cuidadores familiares de pessoas com doença crônica.
Asunto(s)
Humanos , Psicometría , Enfermedad Crónica , Cuidadores , Costos de la Atención en Salud , ColombiaRESUMEN
Se realizó un estudio de descripción de costos en el Centro Penitenciario "Mar Verde" de la provincia de Santiago de Cuba, desde enero del 2008 hasta diciembre del 2009, con vistas a calcular los costos directos e indirectos pertinentes para el diagnóstico y tratamiento de pacientes infectados por sífilis, para lo cual se compararon los resultados antes y después de efectuar una intervención educativa en la población de penados, por un grupo de promotores seleccionados y preparados en la prevención de infecciones de transmisión sexual. El impacto de la intervención se midió por medio de la disminución del número de afectados con sífilis. Finalmente, después de la actividad educativa, la incidencia de la enfermedad decreció en una tasa de 1,1 por cada 100 habitantes y los costos del tratamiento antiinfeccioso de los reclusos disminuyeron en $ 1 344,48, para obtener un beneficio económico de 1 513,04 pesos cubanos.
A study of costs description was carried out in "Mar Verde" Prison in Santiago de Cuba, from January, 2008 to December, 2009, with the objective of calculating the direct and indirect pertinent costs for the diagnosis and treatment of patients infected by syphilis, for which the results were compared before and after developing an educational intervention in the prisoners population, by a group of selected and prepared promoters in the prevention of sexual transmission infections. The impact of the intervention was measured by means of a decrease in the number the affected prisoners with syphilis. Finally, after the educational activity, the incidence of the disease fell at a rate of 1,1 per 100 inhabitants and the costs of the treatment against infection of the prisoners decreased in $1 344,48, to obtain an economic benefit of 1 513,04 Cuban pesos.
Asunto(s)
Prisioneros , Costos de la Atención en Salud , Prisiones , CubaRESUMEN
OBJECTIVE: Major Depressive Disorder (MDD) is a debilitating condition with a marked social impact. The impact of MDD and Treatment-Resistant Depression (TRD+) within the Brazilian health system is largely unknown. The goal of this study was to compare resource utilization and costs of care for treatment-resistant MDD relative to non-treatment-resistant depression (TRD-). METHODS: We retrospectively analyzed the records of 212 patients who had been diagnosed with MDD according to the ICD-10 criteria. Specific criteria were used to identify patients with TRD+. Resource utilization was estimated, and the consumption of medication was annualized. We obtained information on medical visits, procedures, hospitalizations, emergency department visits and medication use related or not to MDD. RESULTS: The sample consisted of 90 TRD+ and 122 TRD- patients. TRD+ patients used significantly more resources from the psychiatric service, but not from non-psychiatric clinics, compared to TRD- patients. Furthermore, TRD+ patients were significantly more likely to require hospitalizations. Overall, TRD+ patients imposed significantly higher (81.5%) annual costs compared to TRD- patients (R$ 5,520.85; US$ 3,075.34 vs. R$ 3,042.14; US$ 1,694.60). These findings demonstrate the burden of MDD, and especially of TRD+ patients, to the tertiary public health system. Our study should raise awareness of the impact of TRD+ and should be considered by policy makers when implementing public mental health initiatives.
OBJETIVO: O Transtorno Depressivo Maior (TDM) é uma condição debilitante com um forte impacto social. O impacto do TDM e Depressão Resistente ao Tratamento (DRT+) no sistema de saúde brasileiro é praticamente desconhecido. Nosso objetivo é comparar a utilização de recursos e custos dos cuidados para o tratamento de DRT+ em relação ao TDM não resistente (DRT-). MÉTODOS: Foram analisados retrospectivamente os prontuários de 212 pacientes diagnosticados com TDM segundo a CID-10. Critérios específicos foram utilizados para identificar pacientes com DRT+. A utilização dos recursos foi estimada e consumo de medicamentos foram anualizados. Foram obtidas informações sobre consultas, procedimentos, internações, atendimentos no serviço de emergência e uso de medicação relacionada ou não ao TDM. RESULTADOS: A amostra foi composta de 90 pacientes DRT+ e 122 DRT-. Pacientes DRT+ utilizaram significativamente mais recursos do serviço de psiquiatria, mas não em clínicas não psiquiátricas, em relação a DRT-. Eles eram significativamente mais propensos a exigir internações. Pacientes DRT+ apresentaram um custo direto anual significativamente maior (81,5%) do que pacientes com depressão não resistente (R$ 5.520,85; US$ 3.075,34 contra R$ 3.042,14, US$ 1.694,60). Estes resultados demonstram o impacto do TDM, principalmente da DRT+ ao sistema de saúde público terciário. Nosso estudo deve aumentar a sensibilização para o impacto da DRT + e deve ser considerado pelos formuladores de políticas públicas na implementação de iniciativas de saúde mental.
Asunto(s)
Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastorno Depresivo Mayor/economía , Trastorno Depresivo Mayor/terapia , Trastorno Depresivo Resistente al Tratamiento/economía , Costos de la Atención en Salud , Recursos en Salud/economía , Brasil , Costos y Análisis de Costo , Recursos en Salud , Hospitalización/economía , Tiempo de Internación/economía , Estudios RetrospectivosRESUMEN
JUSTIFICATIVA E OBJETIVOS: O aumento progressivo nos recursos diagnósticos tem aumentado a qualidade e a quantidade dos exames de laboratório realizados nas Unidades de Terapia Intensiva (UTI). A influência deste aumento sobre a morbidade e mortalidade não está bem definida. O objetivo deste estudo foi avaliar a freqüência da solicitação de exames na UTI do HU e verificar se houve ou não relação entre a quantidade de exames solicitados e a idade dos pacientes, o seu desfecho e a gravidade das doenças. MÉTODO: Coorte prospectiva, com abordagem quantitativa. Foram analisados os exames dos pacientes internados na UTI, dos meses de julho a dezembro, 2005. Foram coletados dados clínicos e demográficos dos pacientes e quantificados diariamente os exames mais freqüentemente solicitados na UTI. Seqüencialmente a média diária de exames foi calculada para todo o período de internação. Para fins de análise os pacientes foram divididos obedecendo três critérios: faixa etária, desfecho de saída da UTI e gravidade. Para a análise estatística foram utilizados os testes Exato de Fisher, Qui-quadrado e ANOVA. RESULTADOS: Foram admitidos 113 pacientes durante o período de estudo. A taxa média foi de 11,5 exames por dia de internação. Estes valores não apresentaram diferença estatística quando comparados entre os pacientes com idade acima ou abaixo de 60 anos, entre os que sobreviveram e os que foram a óbito e entre aqueles que tiveram taxa de óbito estimada em menos que 50 por cento ou mais que 50 por cento. CONCLUSÕES: Os exames solicitados não guardam correlação clínica e prognóstica com sua solicitação. Não houve estatística significativa quando a taxa diária média de exames foi relacionada à idade do paciente, ao desfecho e à gravidade.
BACKGROUND AND OBJECTIVES: The progressive increasing diagnostic resources had influenced the quality and quantity of laboratory exams. It is not clear if the amount of exams performed influence the morbidity and mortality in the ICU patients. The purpose of this study was to appraise the frequency of the most ordering tests in the ICU of HU-UFSC and to check if there was connection between them and the age, the destiny until the ICU discharge and the estimate severity of their diseases. METHODS: Prospective cohort study with qualitative approach. The blood samples of admitted patients were analyzed, from July to December 2005. Clinical and demographic features were collected and the most frequently blood-samples were quantified per day. In the sequence the daily rate of exams were calculated during all the admission period. The patients were analyzed according to three criterions: age, destiny until the ICU discharge and estimate severity according to APACHE II index. Data were analyzed using Fisher Exact, Chi-square and ANOVA tests. RESULTS: One hundred and thirteen patients were enrolled to this study. The average test-ordering was 11.50 per day. These numbers didn't have statistical difference when they were compared between survivor and non-survivor patients, and between those whose the death estimated tax was bigger or smaller than 50 per cent. CONCLUSIONS: The test-ordering didn't show clinical and prognostic relation to its request. There were no statistic relation between the patient's age, ICU discharge and the estimate severity.