[Budget impact analysis of the treatment of chronic hepatitis C in a hospital]. / Análisis de impacto presupuestario en el tratamiento de la hepatitis por virus C en un hospital.

OBJECTIVE: To perform a budget impact analysis (BIA) of the treatment with pegylated interferon (pegIFN), alfa-2a or alfa-2b, plus ribavirin in patients with chronic hepatitis C (CHC). METHOD: An interactive model has been designed from the inputs obtained from hospital databases. Prices for pegIFN and RIB have been taken from the hospitals considering their respective discounts. Only pharmacological costs (euros 2005 values) for the options have been considered. Both strategies have been considered as therapeutic equivalents. RESULTS: The number of patients with CHC evaluated in the model has been of 117, with an average age of 42 years and an average weight of 75 kg. The genotypes of the patients were: G1/4, 85% and; G2/3, 15%. Discontinuation of the treatment at week 12 took place in 26% of the patients. The average duration of treatment has been of 37 weeks. Total cost of the 117 evaluated patients ranged between 942,632-952,109 and 861,646-880,751 euros for the treatment with pegIFN alfa-2a + RIB and pegIFN alfa-2b + RIB, respectively. CONCLUSIONS: BIA models can be useful for the inclusion or reassessment of drugs in formularies. In this case, the treatment with pegIFN alfa-2b + RIB (in comparison with pegIFN alfa-2a + RIB) is an efficient strategy although it depends on acquisition prices, and so, it would be rarely useful in other centres. In our hospital it would produce a budgetary saving that would range from 71,358 to 80,986 euros, which would represent a 7.5-8.6% of the total cost of the pharmacological treatment of the CHC.

Análisis de impacto presupuestario en el tratamiento de la hepatitis por virus C en un hospital / No disponible

Objetivo: Realizar un análisis de impacto presupuestario (AIP)del tratamiento con interferón pegilado (pegIFN), alfa-2a o alfa-2b, más ribavirina (RIB) en pacientes naïve con hepatitis crónicaC (HCC).Método: Se ha diseñado un modelo interactivo a partir de lasvariables obtenidas de bases de datos hospitalarias. Los precios depegIFN y RIB han sido los abonados por el hospital con sus respectivosdescuentos. Sólo se han considerado los costes farmacológicosasociados a las opciones (en euros 2005). Ambas estrategiasse han considerado equivalentes terapéuticos.Resultados: El número de pacientes con HCC evaluados enel modelo ha sido de 117, con una edad media de 42 años y unpeso promedio de 75 kg. Los genotipos de los pacientes y su distribuciónfueron: G1/4, 85% y G2/3, 15%. Se produjo discontinuacióndel tratamiento a las 12 semanas en el 26% de lospacientes. El tiempo promedio del tratamiento ha sido de 37semanas. El coste total de los 117 pacientes evaluados oscilaentre 942.632-952.109 y 861.646-880.751 euros para el tratamientocon pegIFN alfa-2a + RIB y con pegIFN alfa-2b + RIB,respectivamente.Conclusiones: Los modelos de AIP pueden ser útiles para lainclusión o reevaluación de medicamentos en las guías farmacoterapéuticas.En este hospital, el tratamiento con pegIFN alfa-2b +RIB (en comparación con pegIFN alfa-2a + RIB) es una estrategiaeficiente aunque muy sensible a los precios de adquisición por loque es difícilmente extrapolable a otros entornos. En nuestro hospitalproduciría un ahorro presupuestario entre 71.358 a 80.986euros, lo que representaría un 7,5-8,6% del coste total del tratamientofarmacológico de la HCC

Objective: To perform a budget impact analysis (BIA) of thetreatment with pegylated interferon (pegIFN), alfa-2a or alfa-2b,plus ribavirin in patients with chronic hepatitis C (CHC).Method: An interactive model has been designed from theinputs obtained from hospital databases. Prices for pegIFN andRIB have been taken from the hospitals considering their respectivediscounts. Only pharmacological costs (euros 2005 values) forthe options have been considered. Both strategies have been consideredas therapeutic equivalents.Results: The number of patients with CHC evaluated in themodel has been of 117, with an average age of 42 years and anaverage weight of 75 kg. The genotypes of the patients were:G1/4, 85% and; G2/3, 15%. Discontinuation of the treatment atweek 12 took place in 26% of the patients. The average durationof treatment has been of 37 weeks. Total cost of the 117 evaluatedpatients ranged between 942,632-952,109 and 861,646-880,751 euros for the treatment with pegIFN alfa-2a + RIB andpegIFN alfa-2b + RIB, respectively.Conclusions: BIA models can be useful for the inclusion orreassessment of drugs in formularies. In this case, the treatmentwith pegIFN alfa-2b + RIB (in comparison with pegIFN alfa-2a +RIB) is an efficient strategy although it depends on acquisitionprices, and so, it would be rarely useful in other centres. In ourhospital it would produce a budgetary saving that would rangefrom 71,358 to 80,986 euros, which would represent a 7,5-8,6%of the total cost of the pharmacological treatment of the CHC

[Assessing an automated dispensation system in the emergency department of a level III-hospital]. / Evaluación de un sistema automático de dispensación en el Servicio de Urgencias de un hospital de tercer nivel.

OBJECTIVE: The objective of this work was to describe and to assess an automated drug dispensing system in the emergency department of a level-III hospital. MATERIALS AND METHODS: Sequential implementation of PyxisA(R) commenced in July 2001 in a number of Emergency areas. The addition of a Medanalistâ system speeds up the evaluation of generated information. Analysed variables were classified as: a) logistic: workload distribution; b) financial: cost per emergency patient attended; c) number of pharmaceutical procedures. Statistical descriptors were analysed using the SPSS 10.0 software. RESULTS: 1. Logistic: increased workload in PD and decreased Emergency staff calls. 2. Financial: Consumption in the emergency department was reduced by 12% in 2001. In addition, the number of applications for drugs not included within the hospital formulary decreased. CONCLUSION: The main benefit of this system is the information it provides on drug use. However, the fact that this projectâs implementation increased workload in our department, and that a definitive set-up would require a pharmacy assistant staff member should be considered. Regarding this memberâs work, at least a half-day commitment during implementation stages would be needed to direct this change in mentality. Once the system is set up, time is needed to review and monitor previous day activities, and to analyse generated information monthly.

[Identification of quality problems in the clinical information to hospital emergency department patients]. / Identificación de problemas de calidad en la información clínica a usuarios de un servicio de Urgencias hospitalario.

OBJECTIVES: To evaluate the comprehension level of the information provided to patients and relatives attending an emergency department and to know their satisfaction degree. METHODS: A cross-sectional descriptive study was designed. The selection of study patients was made by means of a simple randomized sampling and the total of patients was 213. At discharge, these patients and their relatives answered a written, anonymous questionnaire. To evaluate the comprehension of the information provided, the questionnaire responses were checked against the clinical records. RESULTS: The self-identification of the health care providers, information on the estimated length of stay at the ED, the explanation of complementary tests and their results significantly determined the satisfaction score on the provided information, which for the patients was 6.3 on a 10-point scale. The percentages of patients who were knowledgeable of the performed tests, diagnosis, and administered treatment were 61.5%, 50.7%, and 35.2%, respectively. Understanding the diagnosis and the administered treatment differed according to age (p < 0.001) and the assimilation of the information on recommendations at patients's discharge differed according to the education level (p < 0.05). CONCLUSIONS: The self-identification of health care personnel would allow for a better bi-directional information flow. Given the socio-cultural characteristics of our population, the information provided should be clear and concise. The transmission of information to most emergency department users would be best achieved with previous information of the workflow at the emergency department in the form of booklets at the entrance, and also establishing protocols for the informed consent on different diagnostic and treatment techniques inherent to emergency care.

Identificación de problemas de calidad en la información clínica a usuarios de un servicio de Urgencias hospitalario / Identification of quality problems in the clinical information to hospital emergency department patients

Objetivos. Valorar el nivel de asimilación de la información facilitada a los pacientes y familiares en el servicio de Urgencias y conocer el grado de satisfacción. Métodos. Se diseñó un estudio descriptivo transversal. La selección de los sujetos a estudio se realizó mediante un muestreo aleatorio simple, obteniéndose una muestra de 213 pacientes. En el momento del alta estos pacientes con sus acompañantes contestaron una encuesta escrita y anónima. Para valorar la comprensión de la información se contrastaron las respuestas del cuestionario con la historia clínica. Resultados. La presentación del médico, la información sobre el tiempo de estancia aproximado en Urgencias, la explicación de las pruebas complementarias a realizar y de los resultados de las mismas determinó significativamente la puntuación de satisfacción sobre la información ofrecida, que para los pacientes fue de 6,3 puntos sobre 10. El porcentaje de pacientes que tenía conocimiento puntual de las pruebas realizadas fue del 61,5 por ciento, del diagnóstico el 50,7 por ciento y del tratamiento administrado el 35,2 por ciento. La comprensión del diagnóstico y del tratamiento administrado fue diferente según la edad (p < 0,001), y la asimilación de la información sobre las recomendaciones al alta fue diferente según el nivel de estudios (p < 0,05).Conclusiones. La identificación del personal sanitario permitiría un mejor flujo bidireccional de la información. Dadas las características socioculturales de nuestro medio, la información debe ser clara y concisa. Para que la información se transmitiera a la mayoría de los usuarios del servicio de Urgencias sería útil la información previa sobre el funcionamiento del servicio en forma de folletos en la entrada y establecer protocolos para el consentimiento informado sobre diversas técnicas diagnósticas y de tratamiento propias de la Medicina de urgencias (AU)

Elaboración y puesta en marcha del programa de calidad del hospital / Elaboration and start up of the Hospital’s quality program

No disponible

[Human fascioliasis with atypical severe presentation. Treatment with triclabendazole]. / Fascioliasis humana con presentación atípica y grave. Tratamiento con triclabendazol.

BACKGROUND: Fascioliasis is a zoonosis mainly involving sheep but which occasionally may be found in man as an accidental host. It is acquired by the consumption of herbs (watercress, wild endive, and dandelion) contaminated with metacercarias. The adult phase is established in the biliary tree. Most of the human infections are asymptomatic or with unspecific self limited abdominal symptoms making diagnosis difficult. METHODS: A case of human fascioliasis is of note because of two aspects: a) the infrequent, severe life threatening form of presentation: recurrent subcapsular hepatic hematomas, and b) favorable evolution of the patient on treatment with triclabendazol (to date its use is not approved in humans). RESULTS: Resistance to treatment with praziquantel was observed at a dosis of 75 mg/day for 2 days, being repeated 15 days later with no response. The patient was posteriorly treated with 10 mg/kg of a single dosis of triclabendazol following approval as "compassive use" with a favorable clinical response. CONCLUSIONS: This unusual disease requires a high index of suspicion to achieve diagnosis. Treatment with triclabendazol should be studied as a possible treatment of choice given is efficacy, absence of adverse effects and comfortable dosage.