Variabilidad en el manejo de la bronquitis en el primer nivel de atención público de la Argentina / Variability in the management of bronchiolitis in the public first level of attention in Argentina
Bernztein, Ricardo; Drake, Ignacio; Elordi, Susana.
Arch. argent. pediatr
; 106(3): 205-211, jun. 2008. graf
Artículo
en Español
| BINACIS | ID: bin-123046
La bronquiolitis es un grave problema de salud pública que produce una gran demanda en el primer nivel de atención.Objetivo. Describir la frecuencia de diagnóstico y prescripción de la bronquiolitis en el primer nivel de atención público de la Argentina y estimar las variaciones en la práctica clínica.Material y métodos. Estudio observacional retrospectivo, sobre la base del Programa Remediar con cruce de diagnósticos y prescripciones por provincia.Las fuentes de información secundarias son las recetas del Programa. La población es el universo al que se le prescribe medicamentos provistos por Remediar en 6.000 centros de salud en las 24 provinciasde la Argentina, desde marzo de 2005 hasta febrero de 2006.Resultados. Se valoraron 15 millones de recetas, lafrecuencia del diagnóstico bronquiolitis en los menores de 2 años fue 3,0 por ciento (n = 30.278 lactantes identificados).Los grupos de medicamentos más prescriptos fueron: antibióticos, 48,4 por ciento; broncodilatadores,41,4 por ciento; antipiréticos, 31 por ciento; y corticoesteroides,21,1 por ciento. Según la provincia donde se realiza la consulta, varía 4 veces la probabilidad de diagnóstico de bronquiolitis, como así también la prescripción de salbutamol y antibióticos.Conclusión. Existe variabilidad de la práctica, respecto a la evidencia encontrada en las guías depráctica clínica ¹sobreprescripción de antibióticos ycorticoides¹ y entre las diferentes provincias, locual es posible causa de inequidad en la atención (AU)
Bronchiolitis is a serious public health problem generating a great demand at the primary care level. Objective.To describe the frequency of diagnosis ofand prescription for bronchiolitis at the primary care level in Argentina; and to estimate variability in clinical practice.Materials and methods. Retrospective observational study based on the Remediar Program with cross comparisons of diagnosis and prescriptions by individual provinces. The Program prescriptions are the secondary sources of information. The target population consists of the universe of patients in 6000 centers encompassing 24 Argentine provincesthat were prescribed drugs by Remediar, be tween March of 2005 and February of 2006. Results. Fifteen million prescriptions were reviewed.The diagnosis of bronchiolitis was made with a frequency of 3.0% in the under 2 years of age group (n: 30.278 identified infants). The most frequently prescribed drugs were: antibiotics 48.4%, bronchodilators 41.4%, antipyretics 31% and corticosteroids 21.1%. The probability of diagnosis of bronchiolitismay vary up to four times, as well as the prescription of either salbutamol or antibiotics, depending on the original province where the visit is performed.Conclusions. There exists diagnostic and treatment variability, as compared to guidelines, regarding over prescription of antibiotics and steroidal drugs. There also exists treatment variability between the different provinces. These factors may result in unequal services rendering.(AU)
Bronchiolitis is a serious public health problem generating a great demand at the primary care level. Objective.To describe the frequency of diagnosis ofand prescription for bronchiolitis at the primary care level in Argentina; and to estimate variability in clinical practice.Materials and methods. Retrospective observational study based on the Remediar Program with cross comparisons of diagnosis and prescriptions by individual provinces. The Program prescriptions are the secondary sources of information. The target population consists of the universe of patients in 6000 centers encompassing 24 Argentine provincesthat were prescribed drugs by Remediar, be tween March of 2005 and February of 2006. Results. Fifteen million prescriptions were reviewed.The diagnosis of bronchiolitis was made with a frequency of 3.0% in the under 2 years of age group (n: 30.278 identified infants). The most frequently prescribed drugs were: antibiotics 48.4%, bronchodilators 41.4%, antipyretics 31% and corticosteroids 21.1%. The probability of diagnosis of bronchiolitismay vary up to four times, as well as the prescription of either salbutamol or antibiotics, depending on the original province where the visit is performed.Conclusions. There exists diagnostic and treatment variability, as compared to guidelines, regarding over prescription of antibiotics and steroidal drugs. There also exists treatment variability between the different provinces. These factors may result in unequal services rendering.(AU)
Biblioteca responsable:
AR94.1
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