Preliminary results of ICF dissemination in primary health care in Mozambique: sharing the Italian experience.

PURPOSE: To present the preliminary results of training courses on the International Classification of Functioning, Disability and Health (ICF) prepared by Italian WHO FIC CC and to report on strategies for ICF dissemination among primary health care (PHC) workers in Mavalane Health Area, Maputo, Mozambique. METHODS: A participant-observer description of ICF principles introduction and development of ICF-CY modified checklists in Mavalane health area according to a person-environment interaction classification (PEIC) tree. RESULTS: The first ICF courses were held at Mavalane hospital and involved 25 health workers and 24 members of the health committee acting in the local area. The courses were prepared having as a framework the theoretical principles of the UN Convention of rights of persons with disabilities and the ICF bio-psychosocial model. The trainers adapted and modified the course materials to increase the applicability of the protocol to the cultural and social reality of Mozambique, eventually applying the person-environment interaction classification (PEIC) tree. CONCLUSIONS: The very first phase of this project indicates that the use of the ICF checklist is feasible also in a crowded and busy environment like some PHC units of a developing country. However, data collection require a simpler and lighter to use data compilation tool. The proposed new checklist, which includes a PEIC tree, makes easier the compilation and the collection of data.

The iatrogenic costs of NSAID therapy: a population study.

OBJECTIVE: To estimate the iatrogenic costs of nonsteroidal antiinflammatory drug (NSAID) treatment from the perspective of the Italian National Health Service. METHODS: We conducted a retrospective cohort study using the primary and secondary care claims data registered in the regional health service database in the Friuli-Venezia Giulia (Italy). The study cohort comprised all persons(265,114) who received at least one prescription for any NSAID between August 1996 and July 1998. The outcomes of interest were the costs of medical interventions for upper gastrointestinal disorders following NSAID treatment (i.e., prescriptions for gastroprotective drugs, hospitalizations, and outpatient diagnostic procedures). RESULTS: The study population received a total of 660,311 NSAID prescriptions for a cost of 6,587,533 Euros (0.53 euro per treatment day). The cost of medical interventions for gastrointestinal events added 58% to the cost of NSAID therapy (0.31 euro per NSAID treatment day, up to 64% directly attributable to NSAID use). The iatrogenic costs were generated by 12.4% of the patients, 77% of whom had a positive history of gastrointestinal disorders and 82% of whom were older than 50 years. Co-prescriptions for gastroprotective drugs accounted for 78.6% of the overall iatrogenic costs. The iatrogenic costs did not differ between cyclooxygenase (COX) nonselective and COX-2 preferential drugs within strata of age and prior history of gastrointestinal disorders, but were significantly higher for the parenteral NSAIDs than the oral or rectal formulations. CONCLUSIONS: In Italy, the iatrogenic costs of NSAID therapy add 58% to the cost of NSAID treatment; most of the cost is generated by co-prescriptions of gastroprotective drugs to elderly NSAID users or patients with a history of gastrointestinal disorders.