Evidencia sobre la externalización de los servicios de diálisis: Una revisión de alcance / Evidence on outsourcing dialysis services: A scoping review

Introducción: La enfermedad renal crónica representa un importante problema de salud, tanto por su elevada incidencia y prevalencia, como por su importante morbimortalidad y coste socioeconómico. Objetivo: Comparar la efectividad y consecuencias económicas de la diálisis concertada frente a la diálisis hospitalaria. Metodología: Revisión de alcance, para lo cual se consultaron diferentes bases de datos, mediante términos controlados y libres. Se incluyeron aquellos artículos que comparasen la diálisis concertada frente a la hospitalaria en términos de efectividad. Igualmente, se incluyeron aquellas publicaciones que comparasen, en el ámbito español, el coste entre ambas modalidades de prestación de servicios y las tarifas de precios públicos de las diferentes Comunidades Autónomas. Resultados: En esta revisión se incluyeron 11 artículos: ocho sobre comparación de la efectividad, todos ellos en EE. UU. y tres sobre costes. Se observó una mayor tasa de hospitalización en aquellos centros concertados, pero no se observaron diferencias en mortalidad. Además, una mayor competencia entre proveedores se asoció a menores tasas de hospitalización. Los estudios de costes revisados muestran que la hemodiálisis hospitalaria es más costosa que en centros concertados, debido a los costes de estructura. Los datos de las tarifas públicas de las diferentes Comunidades Autónomas muestran una amplia heterogeneidad en el pago de los conciertos. Conclusiones: La coexistencia en España de centros públicos y concertados, la variabilidad en la prestación y costes de las técnicas de diálisis y la escasa evidencia sobre la efectividad de la externalización del tratamiento ponen de manifiesto la necesidad de seguir potenciando estrategias que redunden en una mejora de la atención a la enfermedad renal crónica. (AU)

Introduction: Chronic kidney disease represents an important health problem, due to its high incidence and prevalence, as well as its significant morbidity and mortality and socioeconomic cost. Aims: Compare the effectiveness and economic consequences of outsourcing versus hospital dialysis. Method: A scoping review, for which different databases were consulted, using controlled and free terms. Those articles that compared concerted versus in hospital dialysis in terms of effectiveness were included. Likewise, those publications that compared, in the Spanish field, the cost between both modes of service provision and the public price rates of the different Autonomous Communities were included. Results: 11 articles were included in this review: 8 on comparison of effectiveness, all of them in the USA, and 3 on costs. A higher rate of hospitalization was observed in subsidized centers, but no differences in mortality were observed. Additionally, greater competition among providers was associated with lower hospitalization rates. The cost studies reviewed show that hospital hemodialysis is more expensive than in subsidized centers, due to the structural costs. The data of the public rates of the different Autonomous Communities show a wide heterogeneity in the payment of the concerts. Conclusions: The coexistence in Spain of public and subsidized centers, the variability in the provision and costs of dialysis techniques, and the low of evidence on the effectiveness of outsourcing treatment show all the need to continue promoting strategies that result in improvement in the care for chronic kidney disease. (AU)

Effect of an intervention New Medicine Service to improve adherence in the Spanish community pharmacies: a protocol of a pragmatic randomised trial / Eficacia del Servicio de Asistencia en Nuevos Medicamentos para mejorar su adherencia en pacientes con enfermedades crónicas en farmacias comunitarias españolas: protocolo de un ensayo pragmático aleatorizado

Introduction: Non-adherence to medications is one of the challenges health systems faces. Patients with poor adherence to treatment fail to benefit from effective medication, and this is associated with reductions in quality of life, poorer outcomes, increased hospitalisations, deaths, and, consequently, higher healthcare costs. Community pharmacies are shown to be key elements in improving adherence to prescribed medications, optimising patient outcomes and increasing the efficiency of care. Objectives: (1) assess the effectiveness of the New Medicine Service (NMS) intervention delivered by community pharmacists to improve adherence to treatment in patients who have been prescribed a new medicine for a specific chronic condition; and (2) to conduct an economic evaluation of this intervention. Methods: A pragmatic randomized clinical trial at community pharmacy-level (clusters) will be performed. Patients identified in the collaborating community pharmacy as starting treatment for the following conditions, will be invited to join the study: chronic obstructive pulmonary disease, hypertension, diabetes mellitus or on an anticoagulant/antiplatelet agent. The intervention is based on the pharmacist-patient communication, aiming to assess the patient's relationship with his/her new prescription, and identify potential issues, concerns and false beliefs or expectations. Ethics and dissemination: The study protocol has been reviewed and ethics approval obtained from the regional ethics committee. The results from this study will be actively disseminated through manuscript publications and conference presentations. (AU)

Introducción: La falta de adherencia a los medicamentos es uno de los desafíos a los que se enfrentan los sistemas de salud. Los pacientes con mala adherencia al tratamiento no se benefician de la eficacia de la medicación, lo que se asocia con peor calidad de vida, aumento en hospitalizaciones y muertes y, en consecuencia, mayores costes sanitarios. Se ha demostrado que las farmacias comunitarias son elementos clave para mejorar la adherencia a los medicamentos prescritos, optimizar los resultados en pacientes con enfermedades crónicas y aumentar la eficiencia de la atención sanitaria. Objetivos: (1) evaluar la efectividad de la intervención Asistencia a Nuevos Medicamentos (ANM) administrada por farmacéuticos comunitarios para mejorar la adherencia al tratamiento en pacientes a los que se les ha recetado un nuevo medicamento para una enfermedad crónica específica; y (2) realizar una evaluación económica de esta intervención. Métodos: Se realizará un ensayo clínico pragmático aleatorizado a nivel de farmacia comunitaria (clúster). Se invitará a unirse al estudio a los pacientes identificados en la farmacia comunitaria que inicien tratamiento para: enfermedad pulmonar obstructiva crónica, hipertensión arterial, diabetes mellitus o en tratamiento con un anticoagulante/ antiagregante plaquetario. La intervención se basa en la comunicación farmacéutico-paciente, con el objetivo de evaluar la relación del paciente con su nuevo medicamento, e identificar posibles problemas, preocupaciones y falsas creencias-expectativas. Ética y difusión: Se ha obtenido el dictamen favorable del Comité de Ética de la Investigación Biomédica de Andalucía. Los resultados de este estudio se difundirán activamente a través de publicaciones y presentaciones en congresos. (AU)

Evidence on outsourcing dialysis services: a scoping review.

INTRODUCTION: Chronic kidney disease represents an important health problem, due to its high incidence and prevalence, as well as its significant morbidity and mortality and socioeconomic cost. AIMS: compare the effectiveness and economic consequences of outsourcing versus hospital dialysis. METHOD: A scoping review, for which different databases were consulted, using controlled and free terms. Those articles that compared concerted versus in hospital dialysis in terms of effectiveness were included. Likewise, those publications that compared, in the Spanish field, the cost between both modes of service provision and the public price rates of the different Autonomous Communities were included. RESULTS: 11 articles were included in this review: 8 on comparison of effectiveness, all of them in the USA, and 3 on costs. A higher rate of hospitalization was observed in subsidized centers, but no differences in mortality were observed. Additionally, greater competition among providers was associated with lower hospitalization rates. The cost studies reviewed show that hospital hemodialysis is more expensive than in subsidized centers, due to the structural costs. The data of the public rates of the different Autonomous Communities show a wide heterogeneity in the payment of the concerts. CONCLUSIONS: the coexistence in Spain of public and subsidized centers, the variability in the provision and costs of dialysis techniques, and the low of evidence on the effectiveness of outsourcing treatment show all the need to continue promoting strategies that result in improvement in the care for Chronic Kidney Disease.

Evidence for deprescription in primary care through an umbrella review.

BACKGROUND: There is a high prevalence of potentially inappropriate prescriptions in primary care. This is associated with more frequent adverse events, lower quality of life and more frequent visits to hospital accident & emergency departments. The aim of the present study is to summarise available evidence on the effectiveness of deprescription interventions in primary care, and to describe the barriers and enablers of the process from the point of view of patients and healthcare professionals. METHODS: We designed an umbrella review which includes nine systematic reviews. More than 50% of included studies were performed with adults in primary care. Two reviewers independently performed data extraction and analysis. RESULTS: In considering studies of the effectiveness of interventions, it can be observed that the educational component of deprescription procedures is a key factor, whilst procedures tailored towards the patient's situation offer better results. With regards to studies involving healthcare professionals, the main explored areas were the balance between risks and benefits, and the need to improve communication with patients as well as other colleagues involved in patient care. Amongst the identified barriers we found lack of time, inability to access all information, being stuck in a routine, resistance to change and a lack of willingness to question the prescription decisions made by healthcare colleagues. With regards to patients, it is clear that they have worries and doubts. In order to overcome these issues, a good relationship with healthcare professionals and receipt of their support is required during the process. CONCLUSIONS: Optimizing medication through targeted deprescribing is an important part of managing chronic conditions, avoiding adverse effects and improving outcomes. The majority of deprescription interventions in primary care are effective. Good communication between healthcare professionals is a key element for success in the deprescription process.