Usefulness of the daily defined dose method to estimate trends in the consumption, costs and prevalence of the use of home enteral nutrition.

BACKGROUND & AIMS: To analyse the trends in consumption and costs of home enteral nutrition (HEN) products in Andalusia (Spain) and estimate the prevalence of HEN from 2000 to 2007. METHODS: Using the defined daily dose (DDD) method, we assigned a DDD to each type of diet, grouped as whole diets, supplements, modules and thickeners. The number of cases/10(6) inhabitants/day (CID) was calculated. RESULTS: The number of persons receiving HEN rose notably, from 66.4 CID in 2000 to 1315.4 in 2007. The number of persons with home enteral tube feeding has remained stable since 2003, at around 220 CID. HEN with oral nutritional supplements (ONS) increased exponentially, with a prevalence of 910 CID in 2007. The prevalence of HEN in 2007 was similar to that of other European countries. The costs associated with HEN rose from 1.3 million euros in 2000 to over 37 million euros in 2007, due to the progressive increase in the number of persons being prescribed HEN, especially ONS, and the incorporation of more expensive organ-specific formulas. CONCLUSIONS: DDD is useful to indirectly estimate the prevalence of HEN and evaluate long-term trends in the prescription and costs of various HEN products.

Impacto de una vía clínica para pacientes intervenidos con resección transuretral en próstata y vejiga / Impact of a clinical pathway in cases of transurethral resection of the prostate and bladder

Objetivo. Conocer, desde una triple perspectiva, clínica, económica y centrada en el paciente, la efectividad de una vía clínica. Método. Para ello, se diseñó un estudio experimental, en el que participaron 122 pacientes intervenidos de hiperplasia benigna de próstata o carcinoma vesical mediante resección transuretral (RTU), divididos en 2 grupos, experimental y control. La aleatorización se realizó sobre los listados de espera y, al ser hospitalizados, se controló que el ingreso no se produjera en la misma habitación que otro paciente incluido en distinto grupo, para mantener el simple ciego. Resultados. La comparación de ambos grupos detectó diferencias respecto a los días de estancia (desviación estándar [DE]): 3,59 (1,54) frente a 2,92 (1,18), p = 0,008. Los pacientes del grupo control, en promedio, estaban 0,67 días de más hospitalizados (intervalo de confianza [IC] del 95%, 0,18-1,17) que los del grupo al que se le aplicó la vía clínica. No se detectaron diferencias estadísticamente significativas en cuanto a presentación de complicaciones (el 3,6 frente al 1,8%; p = 0,55), ni en la satisfacción (el 90,9 frente al 94,5%; p = 0,46). Conclusiones. Las vías clínicas producen una reducción de la estancia, si bien el mecanismo por el que lo hacen efectivo no está claro

Objective. To determine the effectiveness of a clinical pathway from a triple perspective: clinical, economic, and patient-centered. Methods. We designed an experimental study. A total of 122 patients undergoing surgery for benign prostatic hyperplasia or cancer of the bladder through transurethral resection were divided into 2 groups: experimental and control. Patients on the waiting list for surgery were randomized to one of the two groups. To guarantee simple blinding, admitted patients were not assigned to the same ward as another patient in the other group. Results. Comparison of the two groups revealed differences in the length of hospital stay (SD): 3.66 (1.42) versus 2.98 (1.42), p = 0.015. On average, length of hospital stay was 0.68 days (95% CI, 0.13-1.21) longer in the control group than in patients in whom the clinical pathway was applied. No significant differences were detected in the complication rate (3.6% versus 1.8%, p = 0.55) or in patient satisfaction (94.5% versus 90.9%, P = 0.46). Conclusions. Clinical pathways reduce the length of hospital stay, although the mechanism through which this reduction is achieved is not entirely clear