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1.
BMJ Open ; 9(5): e027909, 2019 May 22.
Artículo en Inglés | MEDLINE | ID: mdl-31122996

RESUMEN

OBJECTIVES: To analyse the trends of amenable mortality rates (AMRs) in children over the period 2001-2015. DESIGN: Time trend analysis. SETTING: Thirty-four member countries of the Organisation for Economic Co-operation and Development (OECD). PARTICIPANTS: Midyear estimates of the resident population aged ≤14 years. PRIMARY AND SECONDARY OUTCOME MEASURES: Using data from the WHO Mortality Database and Nolte and McKee's list, AMRs were calculated as the annual number of deaths over the population/100 000 inhabitants. The rates were stratified by age groups (<1, 1-4, 5-9 and 10-14 years). All data were summarised by presenting the average rates for the years 2001/2005, 2006/2010 and 2011/2015. RESULTS: There was a significant decline in children's AMRs in the <1 year group in all 34 OECD countries from 2001/2005 to 2006/2010 (332.78 to 295.17/100 000; %Δ -11.30%; 95% CI -18.75% to -3.85%) and from 2006/2010 to 2011/2015 (295.17 to 240.22/100 000; %Δ -18.62%; 95% CI -26.53% to -10.70%) and a slow decline in the other age classes. The only cause of death that was significantly reduced was conditions originating in the early neonatal period for the <1 year group. The age-specific distribution of causes of death did not vary significantly over the study period. CONCLUSIONS: The low decline in amenable mortality rates for children aged ≥1 year, the large variation in amenable mortality rates across countries and the insufficient success in reducing mortality from all causes suggest that the heath system should increase its efforts to enhance child survival. Promoting models of comanagement between primary care and subspecialty services, encouraging high-quality healthcare and knowledge, financing universal access to healthcare and adopting best practice guidelines might help reduce amenable child mortality.

2.
Artículo en Inglés | MEDLINE | ID: mdl-30832264

RESUMEN

This study aims to estimate the economic costs of sickness absenteeism of health care workers in a large Italian teaching hospital during the seasonal flu periods. A retrospective observational study was performed. The excess data of hospital's sickness absenteeism during three seasonal influenza periods (2010/2011; 2011/2012; 2012/2013) came from a previous study. The cost of sickness absenteeism was calculated for six job categories: medical doctor, technical executive (i.e., pharmacists); nurses and allied health professionals (i.e., radiographer), other executives (i.e., engineer), non-medical support staff, and administrative staff, and for four age ranges: <39, 40⁻49, 50⁻59, and >59 years. An average of 5401 employees working each year were under study. There were over 11,100 working days/year lost associated with an influenza period in Italy, the costs associated were approximately 1.7 million euros, and the average work loss was valued at € 327/person. The major shares of cost appeared related to nurses and allied health professionals (45% of total costs). The highest costs for working days lost were reported in the 40⁻49 age range, accounting for 37% of total costs. Due to the substantial economic burden of sickness absenteeism, there are clear benefits to be gained from the effective prevention of the influenza.


Asunto(s)
Absentismo , Costo de Enfermedad , Brotes de Enfermedades/economía , Gripe Humana/economía , Gripe Humana/epidemiología , Estaciones del Año , Adulto , Femenino , Personal de Salud , Hospitales de Enseñanza , Humanos , Italia/epidemiología , Masculino , Estudios Retrospectivos
3.
Artículo en Inglés | MEDLINE | ID: mdl-30909553

RESUMEN

In Italy, the Italian National Anti-Corruption Authority (Autorità Nazionale Anti-corruzione-ANAC) has developed a questionnaire to assess the organizational well-being of employees within public agencies. The study aimed to explore the relationship among variables in the ANAC questionnaire: Several job resources (lack of discrimination, fairness, career and professional development, job autonomy, and organizational goals' sharing) and outcomes of well-being at work, such as health and safety at work and sense of belonging. The research was carried out among workers in an Italian hospital in Northwest Italy (N = 1170), through an online self-report questionnaire. Data were grouped into two job categories: Clinical staff (N = 939) and non-clinical staff (N = 231). The hypothesized model was tested across the two groups through multi-group structural equation modeling. Results showed that health and safety at work and sense of belonging had significant positive relationships with the other variables; some differences emerged between the determinants of the two outcomes and among groups. The study aims to identify some reflections and suggestions regarding the assessment of well-being in the health care sector; implications for practice are identified to promote organizational well-being and health in organizations.


Asunto(s)
Hospitales de Enseñanza/estadística & datos numéricos , Satisfacción en el Trabajo , Adulto , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Autoinforme , Adulto Joven
4.
BMC Public Health ; 18(1): 1236, 2018 Nov 06.
Artículo en Inglés | MEDLINE | ID: mdl-30400786

RESUMEN

BACKGROUND: The aim was to analyse participation trajectories in organised breast and cervical cancer screening programmes and the association between socioeconomic variables and participation. METHODS: A pooled, cross-sectional, time series analysis was used to evaluate secondary data from 17 European countries in 2004-2014. RESULTS: The results show that the mammographic screening trend decreases after an initial increase (coefficient for the linear term = 0.40; p = 0.210; 95% CI = - 0.25, 1.06; coefficient for the quadratic term = - 0.07; p = 0.027; 95% CI = - 0.14, - 0.01), while the cervical screening trend is essentially stable (coefficient for the linear term = 0.39, p = 0.312, 95% CI = - 0.42, 1.20; coefficient for the quadratic term = 0.02, p = 0.689, 95% CI = - 0.07, 0.10). There is a significant difference among the country-specific slopes for breast and cervical cancer screening (SD = 16.7, p < 0.001; SD = 14.4, p < 0.001, respectively). No association is found between participation rate and educational level, income, type of employment, unemployment and preventive expenditure. However, participation in cervical cancer screening is significantly associated with a higher proportion of younger women (≤ 49 years) and a higher Gini index (that is, higher income inequality). CONCLUSIONS: In conclusion three messages: organized cancer screening programmes may reduce the socioeconomic inequalities in younger people's use of preventive services over time; socioeconomic variables are not related to participation rates; these rates do not reach a level of stability in several countries. Therefore, without effective recruitment strategies and tailored organizations, screening participation may not achieve additional gains.

5.
Artículo en Inglés | MEDLINE | ID: mdl-30395208

RESUMEN

Objective: To analyse the trajectories of hip-fracture surgery rates within 2 days of admission to the hospital and the ratios of procedures initiated within the same day (Day 0) and the following day (Days 0-1) to procedures performed on the 2nd day. To study the association between socioeconomic, health input variables and early surgery. Design: A pooled, cross-sectional, time-series analysis was used to evaluate secondary data from 15 European countries, during 2000-13. Results: The rate of patients aged ≥65 years that were operated on within 2 days of hip-fracture has changed over time with an EU average annual increase of 0.42% (95% CI = 0.25, 0.59; P < 0.001) and with a significant linear trend. Multiple slopes from all the countries compete with this result. In contrast, the ratios of procedures initiated within the same day (Day 0) and the following day (Days 0-1) compared to procedures performed on the 2nd day are constant. No association was found between the rate of patients treated within 2 days of admission and demographic structure, health expenditure, health resources. However, the rate of patients treated within 2 days of admission is significantly associated with surgical volumes. Conclusions: As the early surgery rate is growing, policy makers should be encouraged to undertake further policies to support the quality of care, and the providers should be driven to improve their organizational effectiveness by taking actions aimed at acting on specific organizational and logistical causes that represent a barrier to early surgery.

6.
Mult Scler Relat Disord ; 24: 107-112, 2018 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-29982106

RESUMEN

BACKGROUND: Knowledge concerning the predictors of social security benefits and the proportion of Multiple Sclerosis (MS) patients receiving these benefits is very limited. OBJECTIVE: To estimate the likelihood of receiving social security benefits for Italian MS patients. METHODS: From September 2014 to November 2015, we interviewed MS outpatients from two Italian MS clinics to collect information regarding their personal data, clinical and working history, and access to social security benefits. We performed both univariate and multivariable analyses to evaluate the predictors for receiving social security benefits. RESULTS: We interviewed 297 patients, with a mean age of 49.5 (±â€¯10.7) years; 71.4% were females. About 73% of patients had a relapsing-remitting (RR) course and the median EDSS score was 2.5 (IQR 1.5-6). About 75% of MS patients received a full exemption from co-payments, while the proportions of people who enjoyed each of the other social security benefits were lower, ranging from 8.8% (car adaptation) to 32% (disable badge). At multivariable analysis, the probability of obtaining each of the benefits was significantly associated with the EDSS score: walking aids (OR 3.9), care allowance (OR 3.6), disabled badge (OR 2.4), exemption from co-payment (OR 1.6) and allowed off work permit (OR 1.7). Only the probability of obtaining an allowed off work permit was also influenced by comorbidities (OR 2.9) and a higher education (OR 2.2). CONCLUSION: Except for full exemption from co-payments, the proportions of MS patients who enjoyed social security benefits seem to be limited in our study sample. The EDSS score is the strongest predictor of the probability of receiving all the benefits. Only a small proportion of patients received care allowance and working permits, probably because such benefits are only granted to people with a high level of disability. On the other hand, the low proportion of patients who enjoyed fiscal benefits for home and car adaptations could have been influenced by the way such benefits are granted in our country.


Asunto(s)
Esclerosis Múltiple/economía , Esclerosis Múltiple/epidemiología , Seguridad Social , Adulto , Anciano , Conducción de Automóvil , Estudios Transversales , Evaluación de la Discapacidad , Personas con Discapacidad , Empleo , Femenino , Gastos en Salud , Humanos , Italia , Masculino , Persona de Mediana Edad , Dispositivos de Autoayuda/economía
7.
PLoS One ; 13(6): e0199436, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29933377

RESUMEN

BACKGROUND: This study analyzes the trajectories of antibiotic consumption using different indicators of patients' socioeconomic status, category and age-group of physicians. METHODS: This study uses a pooled, cross-sectional, time series analysis. The data focus on 22 European countries from 2000 to 2014 and were obtained from the European Center for Disease and Control, Organization for Economic Co-operation and Development, Eurostat and Global Economic Monitor. RESULTS: There are large variations in community and hospital use of antibiotics in European countries, and the consumption of antibiotics has remained stable over the years. This applies to the community (b = 0.07, p = 0.267, 95% -0.06, 0.19, b-squared <0.01, p = 0.813, 95% = -0.01, 0.02) as well as the hospital sector (b = -0.02; p = 0.450; CI 95% = -0.06, 0.03; b-squared <0.01; p = 0.396; CI95% = > -0.01, <0.01). Some socioeconomic variables, such as level of education, income, Gini index and unemployment, are not related to the rate of antibiotic use. The age-group of physicians and general practitioners is associated with the use of antibiotics in the hospital. An increase in the proportion of young doctors (<45 years old) leads to a significant increase in antibiotics consumption, and as the percentage of generalist practitioners increases, there use of antibiotics in hospitals decreases by 0.04 DDD/1000 inhabitants. CONCLUSIONS: Understanding that age-groups and categories (general/specialist practitioners) of physicians may predict antibiotic consumption is potentially useful in defining more effective health care policies to reduce the inappropriate antibiotic use while promoting rational use.

8.
PLoS One ; 13(2): e0192620, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29489834

RESUMEN

OBJECTIVES: To analyze trajectories of cataract surgery rates and to confirm the switch between inpatient cases and day surgery or outpatient cases. DESIGN: Pooled, cross-sectional, time series analysis. METHODS: Data on 20 European countries from 2004 to 2014 retrieved from the OECD. RESULTS: The number of cataract surgery cases per 100,000 population has increased since 2004 (b = 31.1, p < 0.001, 95% CI = 26.7, 35.6). A reversal of the inpatient cases and same-day cases was found: the first ones decreased (b = -14.7, p < 0.001, 95% CI = -17.7, -11.8) while day surgery and outpatient cases increased (b = 37.5, p < 0.001, 95% CI = 31.6, 43.4, and b = 8.3, p = 0.001, 95% CI = 3.6, 13.1, respectively). Since 2004, the ratio of day surgery and outpatient cases to inpatient cases has grown significantly (b = 3.3, p < 0.001, 95% CI = 2.5, 4.0), reaching a share of 31.7 in 2014. However, this slope of 3.3 was not constant and slowed over the years: from 4.5 per year during the first five years to 1.9 in the second five. No association was found between cataract surgery rate and two regressors: elderly people, and health care expenditure per capita. CONCLUSION: EU countries have preserved cataract surgery, and this preservation is probably affected by the switch from inpatient to same-day surgery, thanks to the decrease in the cost and equivalent clinical outcomes. However, the slope of the switch slowed over time. Consequently, health care systems must support this process of change especially through reforms in financial and organizational fields.


Asunto(s)
Extracción de Catarata , Estudios Transversales , Unión Europea , Humanos
9.
PLoS One ; 13(1): e0191028, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29329310

RESUMEN

PURPOSE: Medication discrepancies are defined as unexplained differences among regimens across different sites of care. The problem of medication discrepancies that occur during the entire care pathway from hospital admission to a local care setting discharge (namely all types of settings dedicated to formal care other than hospitals) has received little attention in the medical literature. The present study aims to (1) determine the prevalence of medication discrepancies that occur during the entire care pathway from hospital admission to local care setting discharge, (2) describe the discrepancy and medication type, and (3) identify potential risk factors for experiencing medication discrepancies in patient care transitions. Evidence from an integrated health care system, such as the Italian one, may explain results from other studies in different healthcare systems. METHODS: A retrospective longitudinal cohort study of patients admitted from July 2015 to July 2016 to the Giovanni Bosco Hospital serving Turin, Italy and its surrounding territory was performed. Discrepancies were recorded at the following four care transitions: T1: Hospital admission; T2: Hospital discharge; T3: Admission into local care settings; T4: Discharge from local care settings. All evaluations were based on documented regimens and were performed by a team (doctor, nurse and pharmacists). RESULTS: Of 366 included patients, 25.68% had at least one discrepancy. The most frequent type of discrepancy was from medication omission (N = 74; 71.15%). Only discharge from a long-stay care setting (T4) was significantly associated with the onset of discrepancies (p = 0.045). When considering a lack of adequate documentation, not as missing data but as a discrepancy, 43.72% of patients had at least one discrepancy. CONCLUSIONS: This study suggests that an integrated health care system, such as Italian system, may influence the prevalence of discrepancies, thus highlighting the need for structured multidisciplinary and, if possible, computerized medication reconciliation to prevent medication discrepancies and improve the quality of medical documentation.


Asunto(s)
Continuidad de la Atención al Paciente , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Italia , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
10.
BMC Health Serv Res ; 17(1): 735, 2017 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-29141632

RESUMEN

BACKGROUND: Some studies have analyzed the association of health care systems variables, such as health service resources or expenditures, with amenable mortality, but the association of types of health care systems with the decline of amenable mortality has yet to be studied. The present study examines whether specific health care system types are associated with different time trend declines in amenable mortality from 2000 to 2014 in 22 European OECD countries. METHODS: A time trend analysis was performed. Using Nolte and McKee's list, age-standardized amenable mortality rates (SDRs) were calculated as the annual number of deaths over the population aged 0-74 years per 100,000 inhabitants. We classified health care systems according to a deductively generated classification by Böhm. This classification identifies three dimensions that are not entirely independent of each other but follow a clear order: the regulation dimension is first, followed by the financing dimension and finally service provision. We performed a hierarchical semi-log polynomial regression analysis on the annual SDRs to determine whether specific health care systems were associated with different SDR trajectories over time. RESULTS: The results showed a clear decline in SDRs in all 22 health care systems between 2000 and 2014 although at different annual changes (slopes). Regression analysis showed that there was a significant difference among the slopes according to provision dimension. Health care systems with a private provision exhibited a slowdown in the decline of amenable mortality over time. It therefore seems that ownership is the most relevant dimension in determining a different pattern of decline in mortality. CONCLUSIONS: All countries experienced decreases in amenable mortality between 2000 and 2014; this decline seems to be partially a reflection of health care systems, especially when affected by the provision dimension. If the private ownership is maintained or promoted by health systems, these findings might be considered when thinking about regulation policies to control factors that might influence health care performance.


Asunto(s)
Prestación de Atención de Salud , Accesibilidad a los Servicios de Salud/normas , Disparidades en Atención de Salud/estadística & datos numéricos , Calidad de la Atención de Salud/normas , Adulto , Anciano , Causas de Muerte/tendencias , Niño , Prestación de Atención de Salud/normas , Europa (Continente) , Femenino , Programas de Gobierno , Recursos en Salud , Humanos , Masculino , Modelos Teóricos , Propiedad , Estándares de Referencia
11.
Eur J Public Health ; 27(6): 948-954, 2017 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-29048472

RESUMEN

Background: This study aims to confirm whether an increase in the number of elderly people and a worsening in the auto-evaluation of the general health state and in the limitation of daily activities result in increases in the offered services (beds in residential LTC facilities), in the social and healthcare expenditure and, consequently, in the percentage of LTC users. Methods: This study used a pooled, cross-sectional, time series design focusing on 28 European countries from 2004 to 2015. The indicators considered are: population aged 65 years and older; self-perceived health (bad and very bad) and long-standing limitations in usual activities; social protection benefits (cash and kind); LTC beds in institutions; LTC recipients at home and in institutions; healthcare expenditures and were obtained from the Organization for Economic Co-operation and Development and Eurostat. Results: The proportion of elderly people increased, and conversely, the percentage of subjects who had a self-perceived bad or very bad health decreased. Moreover, there was an orientation to reduce the share of elderly people who received LTC services and to focus on the most serious cases. Finally, the combination of formal care at home and in institutions resulted in most Member States shifting from institutional care to home care services. Conclusions: Demographic, societal, health changes could considerably affect LTC needs and services, resulting in higher LTC related costs. Thus, knowledge of LTC expenditures and the demand for services could be useful for healthcare decision makers.


Asunto(s)
Unión Europea/estadística & datos numéricos , Cuidados a Largo Plazo/estadística & datos numéricos , Actividades Cotidianas , Factores de Edad , Anciano/estadística & datos numéricos , Estudios Transversales , Unión Europea/economía , Femenino , Gastos en Salud/estadística & datos numéricos , Estado de Salud , Humanos , Cuidados a Largo Plazo/economía , Masculino
12.
PLoS One ; 12(8): e0182510, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28793335

RESUMEN

OBJECTIVES: To analyze absenteeism among healthcare workers (HCWs) at a large Italian hospital and to estimate the increase in absenteeism that occurred during seasonal flu periods. DESIGN: Retrospective observational study. METHODS: The absenteeism data were divided into three "epidemic periods," starting at week 42 of one year and terminating at week 17 of the following year (2010-2011, 2011-2012, 2012-2013), and three "non-epidemic periods," defined as week 18 to week 41 and used as baseline data. The excess of the absenteeism occurring among HCWs during periods of epidemic influenza in comparison with baseline was estimated. All data, obtained from Hospital's databases, were collected for each of the following six job categories: medical doctors, technical executives (i.e., pharmacists), nurses and allied health professionals (i.e., radiographers), other executives (i.e., engineers), nonmedical support staff, and administrative staff. The HCWs were classified by: in and no-contact; vaccinated and unvaccinated. RESULTS: 5,544, 5,369, and 5,291 workers in three years were studied. The average duration of absenteeism during the epidemic periods increased among all employees by +2.07 days/person (from 2.99 to 5.06), and the relative increase ranged from 64-94% among the different job categories. Workers not in contact with patients experienced a slightly greater increase in absenteeism (+2.28 days/person, from 2.73 to 5.01) than did employees in contact with patients (+2.04, from 3.04 to 5.08). The vaccination rate among HCWs was below 3%, however the higher excess of absenteeism rate among unvaccinated in comparison with vaccinated workers was observed during the epidemic periods (2.09 vs 1.45 days/person). CONCLUSION: The influenza-related absenteeism during epidemic periods was quantified as totaling more than 11,000 days/year at the Italian hospital studied. This result confirms the economic impact of sick leave on healthcare systems and stresses on the necessity of encouraging HCWs to be immunized against influenza.


Asunto(s)
Absentismo , Personal de Salud/estadística & datos numéricos , Gripe Humana/epidemiología , Adulto , Epidemias/estadística & datos numéricos , Femenino , Humanos , Vacunas contra la Influenza/uso terapéutico , Italia/epidemiología , Masculino , Persona de Mediana Edad , Estaciones del Año
13.
Health Serv Res ; 52(5): 1908-1927, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-27704525

RESUMEN

OBJECTIVE: To update amenable mortality in 32 OECD countries at 2013 (or last available year), to describe the time trends during 2000-2013, and to evaluate the association of these trends with various geographic areas. DATA SOURCES: Secondary data from 32 countries during 2000-2013, gathered from the World Health Organization Mortality Database. STUDY DESIGN: Time trend analysis. DATA COLLECTION: Using Nolte and McKee's list, age-standardized amenable mortality rates (SDRs) were calculated as the annual number of deaths over the population aged 0-74 years per 100,000 inhabitants. We performed a mixed-effects polynomial regression analysis on the annual SDRs to determine whether specific geographic areas were associated with different SDR trajectories over time. PRINCIPAL FINDINGS: The OECD average annual decrease was 3.6/100,000 (p < .001), but slowed over time (coefficient for the quadratic term = 0.11, p < .001). Eastern and Atlantic European countries had the steepest decline (-6.1 and -4.7, respectively), while Latin American countries had the lowest slope (-1.7). The OECD average annual decline during the 14-year period was -0.5 (p < .001) for cancers and -2.5 (p < .001) for cardiovascular diseases, with significant differences among countries. CONCLUSION: Declining trend of amenable SDRs was continuing to 2013 but with steepness change compared with previous periods and with a slowdown.


Asunto(s)
Países Desarrollados/estadística & datos numéricos , Mortalidad/tendencias , Adolescente , Adulto , Anciano , Causas de Muerte , Niño , Preescolar , Femenino , Salud Global , Accesibilidad a los Servicios de Salud , Disparidades en Atención de Salud , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Calidad de la Atención de Salud , Adulto Joven
14.
Ig Sanita Pubbl ; 72(4): 303-319, 2016 Jul-Ago.
Artículo en Italiano | MEDLINE | ID: mdl-27783604

RESUMEN

To ensure the safety of surgical procedures, a local health authority in Turin (Piedmont Region, Italy) adopted an operating room chart as a standard procedure that contextualizes the Ministerial surgical checklist and fills the surgical safety requirements of the regional health authority. Three characteristics make the adopted operating room chart especially useful and innovative: (i) it is completed by surgical nurses; (ii) it is completed during the surgical procedure itself; (iii) the greater number and type of checks required in addition to those specified in the ministerial checklist.


Asunto(s)
Lista de Verificación/normas , Quirófanos/normas , Seguridad del Paciente , Procedimientos Quirúrgicos Operativos/normas , Lista de Verificación/legislación & jurisprudencia , Humanos , Italia , Seguridad del Paciente/legislación & jurisprudencia , Procedimientos Quirúrgicos Operativos/legislación & jurisprudencia
15.
Cardiovasc Revasc Med ; 17(1): 5-9, 2016 Jan-Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26616274

RESUMEN

BACKGROUND: In the last years, new techniques, drugs and devices have been introduced in the current practice of primary angioplasty (PPCI) and validated by pivotal studies The objective of our study was to evaluate if these studies have led to significant changes on the current practice of primary PCI in our center. METHODS: From March 2003 to December 2013 1980 patients with ST-segment elevation myocardial infarction underwent PPCI within 12-hours of onset of symptoms. We considered 2 periods of our activity: from 2003 to 2009 (P1) with 1078 patients and from 2010 to 2013 (P2) with 902 patients, and compared them in terms of pharmacological and arterial access strategies and of devices utilization. RESULTS: In P2 there was a significant increase of radial access (34.1% vs. 1.5, p<0.001), as well as of the use of bivalirudin (22.7% vs. 0.5%, p<0.001) and of new antiplatelet drugs (prasugrel or ticagrelor) (18.3% vs. 0%, p<0.001) whereas the use of GP IIb-IIIa and of intraaortic balloon pump significantly decreased (from 82.3% to 52%, p<0.001 and from 17% to 7.5%, p<0.001 respectively). In the P2 there was a significant increase of the procedural efficacy (97.2% vs. 95.1%, p=0.01) that persisted after the logistic regression adjustment (OR 2.09, CI 95%, 1.04-4.21). CONCLUSIONS: Our study shows that in the last years, in a high-PCI center, after the publication of pivotal randomized trial and nationwide registries, there were significant changes in the PPCI current practice that could have had an impact on procedural efficacy.


Asunto(s)
Síndrome Coronario Agudo/terapia , Angioplastia/métodos , Angioplastia/estadística & datos numéricos , Anciano , Antitrombinas/uso terapéutico , Femenino , Hirudinas , Humanos , Italia , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Proteínas Recombinantes/uso terapéutico , Sistema de Registros , Resultado del Tratamiento
16.
Int J Technol Assess Health Care ; 30(3): 273-81, 2014 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25100174

RESUMEN

OBJECTIVES: The study question was whether dual-energy X-ray absorptiometry (DXA) alone is more cost-effective for identifying postmenopausal women with osteoporosis than a two-step procedure with quantitative ultrasound sonography (QUS) plus DXA. To answer this question, a systematic review was performed. METHODS: Electronic databases (PubMed, INAHTA, Health Evidence Network, NIHR, the Health Technology Assessment program, the NHS Economic Evaluation Database, Research Papers in Economics, Web of Science, Scopus, and EconLit) were searched for cost-effectiveness publications. Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Quality assessment of economic evaluations was undertaken using the Drummond checklist. RESULTS: Seven journal articles and four reports were reviewed. The cost per true positive case diagnosed by DXA was found to be higher than that for diagnosis by QUS+DXA in two articles. In one article it was found to be lower. In three studies, the results were not conclusive. These articles were characterized by the differences in the types of devices, parameters and thresholds on the QUS and DXA tests and the unit costs of the DXA and QUS tests as well as by variability in the sensitivity and specificity of the techniques and the prevalence of osteoporosis. CONCLUSIONS: The publications reviewed did not provide clear-cut evidence for drawing conclusions about which screening test may be more cost-effective for identifying postmenopausal women with osteoporosis.


Asunto(s)
Absorciometría de Fotón/economía , Osteoporosis Posmenopáusica/diagnóstico por imagen , Ultrasonografía/economía , Análisis Costo-Beneficio , Medicina Basada en la Evidencia , Femenino , Humanos
17.
G Ital Cardiol (Rome) ; 15(4): 233-9, 2014 Apr.
Artículo en Italiano | MEDLINE | ID: mdl-24873812

RESUMEN

BACKGROUND: Percutaneous coronary interventions (PCI) are widespread procedures in the Italian Healthcare System, but concerns are raised about their economic sustainability. In the last decade, public hospitals have outsourced the PCI services (building and maintaining the technological instruments and the personnel) "buying" them from private companies (Buy) rather than building and maintaining them through public expenditure (Make). The aim of this study was to compare the economic and clinical impact of these two management solutions (Buy and Make) in two community hospitals located in the Turin metropolitan area (Italy). METHODS: We conducted: 1) a quantitative assessment in order to compare differences in the economic impact between Buy and Make for providing PCI; 2) a qualitative assessment comparing the clinical characteristics of two inpatient populations undergoing PCI and then analyzing the efficacy of the procedure in-hospital and at 6-month follow-up. RESULTS: Between January and June 2010, a total of 332 patients underwent PCI at the "degli Infermi" Hospital in Rivoli and 340 at the "Maria Vittoria" Hospital in Turin (Italy). There were no significant differences between the two populations neither about the clinical characteristics nor in procedural efficacy (either immediate or at follow-up). For 600 units of diagnostic-therapeutic pathway, the net present value at a discount rate of 3.5% of the Make project is higher than that of the Buy by €278.402,25, and is therefore the less convenient of the two solutions. The Buy solution is still the more convenient of the two at volumes <700 units. CONCLUSIONS: Our findings show that the Buy solution, if tailored to the specific local needs, provides access to sophisticated technology without making worse quality of services and may save capital expenditure below 700 PCI/years.


Asunto(s)
Cateterismo Cardíaco/economía , Hospitales Comunitarios/economía , Servicios Externos/economía , Intervención Coronaria Percutánea/economía , Anciano , Gastos de Capital , Cateterismo Cardíaco/instrumentación , Enfermedad Coronaria/diagnóstico , Enfermedad Coronaria/economía , Enfermedad Coronaria/epidemiología , Enfermedad Coronaria/terapia , Ahorro de Costo , Femenino , Cardiopatías/mortalidad , Mortalidad Hospitalaria , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Intervención Coronaria Percutánea/instrumentación , Personal de Hospital/economía , Evaluación de Programas y Proyectos de Salud , Accidente Cerebrovascular/epidemiología , Tecnología de Alto Costo/economía , Factores de Tiempo , Resultado del Tratamiento
18.
Int Ophthalmol ; 34(2): 217-23, 2014 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-24014147

RESUMEN

Small-gauge vitreoretinal techniques have been shown to be safe and effective in the management of a wide spectrum of vitreoretinal diseases. However, the costs of the new technologies may represent a critical issue for national health systems. The aim of the study is to plan a Health Technology Assessment (HTA) by performing a comparative analysis between the 23- and 25-gauge techniques in the management of macular diseases (epiretinal membranes, macular holes, vitreo-macular traction syndrome). In this prospective study, 45-80-year-old patients undergoing vitrectomy surgery for macular disease were enrolled at the Torino Eye Hospital. In the HTA model we assessed the safety, clinical effectiveness, and cost and financial evaluation of 23-gauge compared with 25-gauge vitrectomies. Fifty patients entered the study; 14 patients underwent 23-gauge vitrectomy and 36 underwent 25-gauge vitrectomy. There was no statistically significant difference in post-operative visual acuity at 1 year between the two groups. No cases of retinal detachment or endophtalmitis were registered at 1-year follow-up. The 23-gauge technique was slightly more expensive than the 25-gauge: the total surgical costs were EUR1217.70 versus EUR1164.84 (p = 0.351). We provide a financial comparison between new vitreoretinal procedures recently introduced in the market and reimbursed by the Italian National Health System and we also stimulate a critical debate about the expensive technocratic model of medicine.


Asunto(s)
Membrana Epirretinal/cirugía , Desprendimiento de Retina/cirugía , Perforaciones de la Retina/cirugía , Técnicas de Sutura , Evaluación de la Tecnología Biomédica/métodos , Vitrectomía/métodos , Anciano , Anciano de 80 o más Años , Femenino , Costos de la Atención en Salud , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado (Atención de Salud) , Complicaciones Posoperatorias , Estudios Prospectivos , Agudeza Visual , Vitrectomía/economía
19.
Ig Sanita Pubbl ; 70(6): 563-80, 2014 Nov-Dec.
Artículo en Italiano | MEDLINE | ID: mdl-25715893

RESUMEN

Evaluating the quality of organization of nursing activities is essential to improve hospital care delivery. The aim of this pilot study was to develop and test a tool for measuring this aspect of quality of care. A working group developed an assessment instrument by identifying thirteen items to be evaluated and their relevant criteria, indicators, standards and methods of evaluation. The instrument was tested in eight wards of the S. Giovanni Bosco Hospital in Turin (Italy) and, on the basis of assessment results, the working group designed interventions for improvement. The assessment instrument tested was found to be user -friendly and shown to be an effective tool for evaluating the organizational quality of care in a standardized and repeatable manner, and for highlighting areas of concern and identifying possible solutions for improvement.

20.
BMC Infect Dis ; 13: 470, 2013 Oct 09.
Artículo en Inglés | MEDLINE | ID: mdl-24106891

RESUMEN

BACKGROUND: In Italy the prevalence of genital warts in women (15-64 years) is approximately 0.6% with an incidence of 0.4% per year. Treatments for GW are usually long, with moderate success and high costs. The aim of the study was to evaluate the diagnostic-therapeutic pathway, duration and setting of treatment, costs of episodes of condyloma in a population attending a regional STI clinic in Piedmont. METHODS: This was a retrospective observational study conducted using medical records of outpatients who first visited the STI Clinic of San Lazzaro Dermatological Hospital in 2008. The patients' medical histories were analysed for episodes that occurred and were cleared in 18 months following the initial visit. Data on screening methods for STIs, type of diagnosis for condyloma, treatment type, treatment setting, and anatomic lesion site were obtained from medical records. The costs were calculated for each episode. RESULTS: A total of 450 episodes were analysed (297 men,153 women). The most frequently affected anatomic site was the genital area (74%) in both genders. With regard to treatment setting, 78.44% of patients received outpatient treatment at the STI clinic, 4% were treated at home, and 0.22% were hospitalised; 11.11% were treated in multiple settings. The mean number of treatments per episode was 2.03; although many patients received only 1 treatment (n = 207, 46%), exspecially cryotherapy or diathermy coagulation (64.73% versus 28.02% of episodes, respectively). The mean episode duration was 80.74 days. The mean cost (in 2011 euros) for an episode was €158.46 ± 257.77; the mean costs were €79.13 ± 57.40 for diagnosis and €79.33 ± 233.60 for treatment. The mean cost for treatment in a STI-Clinic setting was €111.39 ± 76.72, that for home treatment was €160.88 ± 95.69, and that for hospital care was €2825.94. CONCLUSIONS: The treatment of and associated costs for genital warts are significant. Several factors affect the cost, and internal STI clinic protocols, such as the 6 month window used to consider a recurrence or new diagnosis, create bias. Nonetheless, our findings how costs similar to those reported in the international literature and should be considered when deciding on which HPV vaccination programs should be provided by the public health system.


Asunto(s)
Condiloma Acuminado/economía , Condiloma Acuminado/terapia , Costos de la Atención en Salud , Adolescente , Adulto , Femenino , Humanos , Italia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Adulto Joven
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