CARACTERIZACIÓN CLÍNICA DE LOS PACIENTES CON DIABETES MELLITUS DEL REGISTRO ESTATAL DE DIABETES EN UN ESTADO DE MÉXICO / CLINICAL CHARACTERIZATION OF PATIENTS WITH DIABETES MELLITUS FROM THE STATE REGISTER OF DIABETES IN A STATE OF MEXICO

Introducción: La diabetes mellitus representa un reto para los sistemas de salud debido a la complejidad de la atención, la calidad y el acceso a tratamientos. Objetivo: Describir las características clínicas de los pacientes con diabetes mellitus del registro estatal de diabetes del Estado de Hidalgo en México de los años 2007 a 2012. Material y Métodos: Estudio transversal descriptivo del Registro Estatal de Diabetes (RED) durante 2007 al 2012. Se realizó descripción estadística simple para caracterizar a la población del estudio, proporciones y razones para variables cualitativas y para variables cuantitativas medidas de tendencia central y de dispersión (media, mediana, moda, desviación estándar y varianza). Para el análisis de las variables continuas se hizo la prueba de t de Student. Resultados: Se identificaron 10.198 pacientes del RED, el 66,4% fueron mujeres y el 33,52% hombres. La media de edad fue 52,2 ±12,8 años. Respecto a la glucosa en ayuno, la media fue de 239,1±95,3 mg/dl; la media de glucosa postprandial 293,6±122,7 mg/dl y la de glucosa casual 247,9±102,3 mg/dl. Las actividades del RED incluyeron a 5.795 personas que fueron detectadas en ese momento, lo que corresponde al 56,8%. De las cuales, 11,9% manifestó tener visión borrosa, 48,5% poliuria, 4,7% infecciones, 44,07% polidipsia, 13,19% polifagia, 26,9% pérdida de peso y 35,2% fatiga. Al comparar las que estaban en tratamiento con las que ingresaban no encontramos diferencias estadísticas. Mientras que las que se encontraban en tratamiento, quienes mencionaron solo tener dieta fueron el 33,5%, metformina 72,58%, sulfonilureas 62,9%, acarbosa 3,59%, insulina 9,4%, rosiglitazona 0,66%. Discusión: El RED tiene estándares de control glicémico bajo. Se sugiere la elaboración de indicadores internos para que estos les permitan realizar la toma de decisiones desde el interior de la unidad y ofrecer una mejor calidad de atención, el cumplimiento y oportunidad.

Introduction: Diabetes mellitus is a challenge for health systems due to the complexity of care, and the quality and access to treatment. Objective: To describe the clinical characteristics of patients in the Diabetes Mellitus State Register in the state of Hidalgo in Mexico from 2007 to 2012. Methods: Cross-sectional descriptive study of the Diabetes State Register (DSR) between 2007 and 2012. Simple statistics description to characterize the studied population, proportions and reasons for qualitative variables and for quantitative measures of central tendency and continuous and dispersion variables (media, median, mode, deviation, standard and variance) were carried out. The t student test was used for the analysis of continuous variables. Results: 10,198 patients from the Diabetes State Register were identified; 66.4% were women and 33.52% men. The mean age was 52.2±12.8. Regarding fasting glucose, the mean was 239.1±95.3 mg/dl; the post-prandial glucose mean was 293.6±122.7 mg/dl and casual glucose was 247.9±102.3 mg/dl. The DSR activities included 5,795 people that were detected at that time which correspond to 56.8% from which 11.9% reported having blurred vision, polyuria 48.5%, infections 4.7%, polydipsia 44.07%, polyphagia 13.19%, weight loss 26.9% and fatigue 35.2%. When comparing people under treatment with those admitted, no statistical difference was found While those who were under treatment, who mentioned only having diet were 33.5%, metformin72.58%, sulfonylureas 62.9%, acarbose 3.59%, insulin 9.4%, and rosiglitazone 0.66%. Discussion: The Diabetes State Register has low glycemic control standards. Development of internal indicators is suggested to allow medical staff to make decisions from inside the unit and provide a better quality of care, compliance and opportunity.

Empleo de la Tarjeta Amarilla y el Formato NOM220 para las notificaciones de sospechas de reacciones adversas a medicamentos / Use of Yellow Card and of NOM220 Format for reporting of suspected adverse drug reactions

Introducción: la notificación de reacciones adversas a medicamentos es una obligación a nivel mundial. Aunque se han establecido muchas metodologías para esta acción, en la actualidad existen problemas. Objetivo: determinar la frecuencia de sospecha de reacciones adversas a la administración de medicamentos en pacientes y comparar la accesibilidad del llenado del formato de la NOM220 de la Secretaría de Salud y la Tarjeta Amarilla propuesta por la Organización Mundial de la Salud. Métodos: estudio transversal y observacional. Participaron 50 médicos responsables de las clínicas de diabetes del Estado de Hidalgo. Inicialmente, los médicos fueron capacitados para identificar las sospechas de reacciones adversas a la administración de medicamentos en los pacientes atendidos. Se realizó un diseño cruzado, en el que el 50 por ciento de los médicos utilizaron por tres meses el formato de la NOM220 y 50 por ciento la Tarjeta Amarilla. Después intercambiaron formatos y los utilizaron durante los tres meses siguientes. Al cabo de este periodo, respondieron un cuestionario para determinar la utilidad, claridad, tiempo de llenado y practicidad de ambos formatos. Se realizó estadística descriptiva y análisis bivariado para determinar los factores asociados a las sospecha de reacciones adversas a medicamentos, con el software SPSS (versión 17). Resultados: se registraron 46 sospechas de reacciones adversas a medicamentos en 46 pacientes con el formato de la NOM220 y 78 sospechas de reacciones adversas a medicamentos con la Tarjeta Amarilla en 78 pacientes. Todas las sospechas de reacciones adversas a la administración de medicamentos fueron tipo A. Los médicos recomiendan la utilización de la Tarjeta Amarilla, consideran claro el formato, sencillo, legible, fácil de llenar, entendible y accesible (p< 0,05). Conclusiones: los resultados permiten proponer la Tarjeta Amarilla como una alternativa más accesible para la notificación de sospechas de reacciones adversas a medicamentos, o se hagan adecuaciones al formato de la NOM220(AU)

Introduction: the reporting of adverse drug reactions is a global obligation. Although many methods have been implemented, there are still problems at present. Objective: to determine the frequency of suspected adverse reactions in patients and to compare the access to filling out the NOM220 formats of the Secretaría de Salud and the Yellow Card suggested by the World Health Organization. Methods: a cross-sectional and observational study was made. Fifty physicians responsible for the diabetes clinics in the state of Hidalgo participated in the study. First, the physicians were trained to identify the suspected adverse drug reactions in their patients. A crossover design was created where 50 percent of physicians used the NOM220 format and 50 percent the Yellow Card. Three months later, they exchanged the formats and used them during the following three months. After this period, questionnaire was administered to determine the usefulness, clarity, filling out time and convenience of the formats. Descriptive statistics and bivariate analyses were applied to determine the factors associated with the suspected adverse drug reactions with SPSS software (version 17). Results: a total of 46 suspected adverse reactions were registered in 46 patients using NOM220 format and 78 with the Yellow Card in 78 patients. All the suspected adverse reactions were type A. The physicians recommended the use of Yellow Card since they considered that it is practical, simple, readable, understandable, accessible and requires less time to fill it out (p< 0.05). Conclusions: the results allow selecting the Yellow Card as the most accessible choice for reporting suspected drug adverse reactions; additionally, they suggest that adjustments should be also made in the NOM220 format(AU)

[Effective coverage to manage domestic violence against women in Mexican municipalities: limits of metrics]. / Cobertura efectiva del manejo de la violencia contra mujeres en municipios Mexicanos: límites de la métrica.

The study estimated the effective coverage of health services in primary care for the management of domestic violence against women in three municipalities in Mexico. We estimated the prevalence and severity of violence using a validated scale, and the effective coverage proposed by Shengelia and partners with any modifications. Quality care was considered when there was a suggestion to report it to authorities. The use and quality of care was low in the three municipalities analyzed, used most frequently when there was sexual or physical violence. Effective coverage was 29.41%, 16.67% and zero in Guachochi, Jojutla and Tizimín, respectively. The effective coverage indicator had difficulties in measuring events and responses that were not based on biomedical models. Findings suggest that the indicator can be improved by incorporating other dimensions of quality.

Cobertura efectiva del manejo de la violencia contra mujeres en municipios Mexicanos: límites de la métrica / Cobertura efetiva da gestão da violência contra as mulheres nos municípios mexicanos: os limites métricos / Effective coverage to manage domestic violence against women in mexican municipalities: limits of metrics

El estudio estimó la cobertura efectiva de los servicios en salud de primer nivel de atención para el manejo de la violencia doméstica contra la mujer en tres municipios mexicanos. Se estimó la prevalencia y severidad de la violencia usando una escala validada, y la cobertura efectiva con la propuesta de Shengelia y colaboradores, con modificaciones. Se consideró atención con calidad cuando hubo sugerencia de hacer la denuncia a las autoridades. La utilización y calidad de la atención fue baja en los tres municipios analizados, siendo más frecuente la utilización cuando hubo violencia sexual o física. La cobertura efectiva en Guachochi, Jojutla y Tizimín fue de 29.41%, 16.67% y cero, respectivamente. El indicador de cobertura efectiva tiene dificultades para medir eventos y respuestas no se fundamentan en modelos biomédicos. Los hallazgos sugieren que el indicador puede ser mejorado al incorporar otras dimensiones de la calidad.

O estudo estimou a cobertura eficaz dos serviços da atenção primaria em saúde na gestão da violência doméstica contra as mulheres em três cidades mexicanas. Estimou-se a prevalência e a gravidade da violência doméstica por meio de uma escala validada enquanto a cobertura eficaz foi obtida por meio da proposta de Shengelia e colaboradores, com algumas alterações. O atendimento foi considerado de qualidade quando houve a sugestão de fazer a denúncia às autoridades. O uso dos serviços e a qualidade do atendimento foram baixos nos três municípios analisados, sendo mais frequente a utilização do serviço quando houve violência sexual ou física. A cobertura efetiva em Guachochi, Jojutla e Tizimin foi de 29,41%, 16,67% e zero, respectivamente. O índice de cobertura eficaz apresentou dificuldade em medir desfechos reais e respostas não baseadas em modelos biomédicos. Os resultados sugerem que o indicador pode ser melhorado pela incorporação de outras dimensões da qualidade do atendimento.

The study estimated the effective coverage of health services in primary care for the management of domestic violence against women in three municipalities in Mexico. We estimated the prevalence and severity of violence using a validated scale, and the effective coverage proposed by Shengelia and partners with any modifications. Quality care was considered when there was a suggestion to report it to authorities. The use and quality of care was low in the three municipalities analyzed, used most frequently when there was sexual or physical violence. Effective coverage was 29.41%, 16.67% and zero in Guachochi, Jojutla and Tizimín, respectively. The effective coverage indicator had difficulties in measuring events and responses that were not based on biomedical models. Findings suggest that the indicator can be improved by incorporating other dimensions of quality.

Evaluation of a diabetes care program using the effective coverage framework.

OBJECTIVE: To measure the effective coverage of a program to control type 2 diabetes. DESIGN: Observational study combining multiple SETTING: Hidalgo state, Mexico. PARTICIPANTS: Adults without social security health benefits and patients with a diagnosis of diabetes participating in the program. MAIN OUTCOME MEASURES: Detection of diabetes; glucose, cholesterol, triglyceride and blood pressure control; education; diabetic retinopathy, diabetic foot and nephropathy prevention. RESULTS: Only 7.1% of individuals with diabetes participated in the control program. Fasting glucose and HbA1c values were available for 95.6 and 35.6 of patients, respectively. There were measurements of total cholesterol (52.1%), triglyceride (50.6%) and blood pressure (99.6%). Educative activities were realized for 64.8% of patients. The most important gaps were related with detection of illness, low-density lipoprotein cholesterol control, glucose control with HbA1c and nephropathy prevention. Effective coverage of these medical actions was 6.22, 5.07, 5.01 and 0.34%, respectively. CONCLUSIONS: The greatest challenge to overcome is the detection of individuals with illness because a large number of individuals with type 2 diabetes do not use health services and the health system does not systematically search them out. Medical actions that require resources that must be paid for by patients tend to be used less and to be of lower quality. The use of effective coverage to measure the performance of diabetes care program provides practical information to improve health services.