The timing of introduction of pharmaceutical innovations in seven European countries

RATIONALE, AIMS AND OBJECTIVES: Differences in the performance of medical care may be due to variation in the introduction and diffusion of medical innovations. The objective of this paper is to compare seven European countries (United Kingdom, the Netherlands, West Germany, France, Spain, Estonia and Sweden) with regard to the year of introduction of six specific pharmaceutical innovations (antiretroviral drugs, cimetidine, tamoxifen, cisplatin, oxalaplatin and cyclosporin) that may have had important population health impacts. METHODS: We collected information on introduction and further diffusion of drugs using searches in the national and international literature, and questionnaires to …

¿Mejora la calidad con la implantación de centros de salud? Una visión desde la hospitalización evitable

Resumen Objetivo Las hospitalizaciones evitables (HE) son un conjunto de diagnosticos en los que una atencion primaria de salud efectiva y adecuada hubiera evitado su ingreso hospitalario. Por tanto, su control sirve como medida del nivel de calidad obtenido en los centros de salud. Pacientes y metodo Se realizo un estudio prospectivo individual de todos los pacientes ingresados (1999-2000) en un hospital procedentes de 2 zonas, una con un modelo tradicional de atencion primaria (consultorio) y otro con un modelo moderno de centro de salud. El periodo de seguimiento fue de 2 anos. A los pacientes que ingresaron se les paso una encuesta. Para el estudio se empleo un listado de codigos de HE …

Sobre los Sistemas Multihospitalarios

Influence of social factors on avoidable mortality: a hospital-based case-control study.

Objective. The effect of socioeconomic factors on avoidable mortality at an individual level is not well known, since most studies showing this association are based on aggregate data. The purpose of this study was to determine socioeconomic differences between those patients who die of avoidable causes and those who do not die. Methods. A matched case-control study was carried out regarding in-hospital avoidable mortality (Holland's medical care indicators) that occurred in a university hospital serving a Spanish-Mediterranean population during a 30-month period. Results. We studied 82 cases of death from avoidable causes and 300 controls matched on medical care indicators and age. The var…

Clinical inertia in diagnosis and treatment of hypertension in primary care: Quantification and associated factors

The objective of the present study was to quantify both diagnostic and therapeutic inertia in hypertension and to identify patient-associated variables.Cross-sectional, multicenter study of 35 424 subjects carried out in 428 health centers and/or primary care clinics in the Valencian Community, Spain, in a preventive activity conducted during 2003 and 2004. Diagnostic inertia was identified when a patient without known hypertension had high blood pressure (BP) but was labeled "normal" by the medical staff, and therapeutic inertia when treatment was not modified for a hypertensive patient on the presence of high BP values. Bivariate and multivariate statistical analyses were performed to ide…

Comparación de las frecuencias de los alelos factor V Leiden (G1691A) y protrombina-G20210A entre pacientes con trombosis venosa profunda y población general mediterránea española

Background: Factor V leiden and the -G20210A variant of prothrombin gene are associated to a higher risk of deep venous thrombosis. Aim: To assess the frequency of factor V Leiden (G1691A) and prothrombin -G20210A alleles in patients with deep venous thrombosis (DVT) and in the general population from Spain. Material and methods: Factor V Leiden (g1691a) and prothrombin-g20210a alleles were genotyped in 493 individuals from the Spanish general populations and in 131 patients with DVT. The presence of DVT was confirmed by phlebography. Allelic frequencies and the DVT risk associated with these variants were estimated. Results: Allelic frequencies for the factor V Leiden (G1691A) allele were …

Innovations in medical care and mortality trends from four circulatory diseases between 1970 and 2005

Background: Governments have identified innovation in pharmaceuticals and medical technology as a priority for health policy. Although the contribution of medical care to health has been studied extensively in clinical settings, much less is known about its contribution to population health. We examine how innovations in the management of four circulatory disorders have influenced trends in cause-specific mortality at the population level. Methods: Based on literature reviews, we selected six medical innovations with proven effectiveness against hypertension, ischaemic heart disease, heart failure and cerebrovascular disease. We combined data on the timing of these innovations and cause-spe…

Are we really seeing the total costs of surgical site infections? A Spanish study.

To identify overall costs generated by surgical site infections (SSI) patients, including indirect costs. A prospective study of case series of patients who have undergone major surgical treatment was undertaken. Patients who suffered SSI were compared with controls (nested case-control design). Centers for Disease Control and Prevention definitions were followed and SSI established. Overall costs and indirect related morbidity/mortality costs were estimated. The study was performed in a general, tertiary hospital (Valencia, Spain) for 4.5 years. Surgical site infections patients were 9.02% of the total people who underwent surgery. Their stays were prolonging by 14 days, and resources were…

Medida del resultado de las intervenciones sanitarias en España: una aproximación mediante el análisis temporal y espacial de la mortalidad evitable entre 1986-2001

Fundamento: Muchos estudios proponen la mortalidad evitable (ME) como indicador para monitorizar los servicios de salud aunque su generalización está limitada por el gran número de listas de causas utilizadas. El objetivo es analizar la evolución temporal del período 1986-2001 y la distribución geográfica de la mortalidad evitable utilizando una lista de causas consensuada. Métodos: Se analiza la mortalidad evitable global (ME) y agrupada en causas ISAS (intervenciones de los servicios sanitarios) y causas IPSI (políticas intersectoriales). Se analiza la evolución temporal ajustando una recta de regresión de Poisson o un modelo de regresión de Joinpoint, según el caso, y se estima el porcen…