Analysis of the implementation of an innovative IT solution to improve waiting times, communication with primary care and efficiency in Rheumatology.

OBJECTIVE: To describe in detail an innovative program based on telemedicine for semi-automated prioritization of referrals from Primary Care (PC) to Rheumatology, for reproducibility purposes, and to present the results of the implementation study. METHODS: The context and situation were carefully analyzed, paying attention to all processes in place, referral numbers, waiting times, and number of complementary tests prior to discharge from Rheumatology. The composition of the team, aims, users, scope, and implementation phases were defined. Eight process indicators were established and measured before and 32 months after the program implementation. RESULTS: The program, which includes IT circuits, algorithms based on response to specific guideline-based checklists, e-consultation, and appointments based on priority, was fully implemented in our health area after a pilot study in two PC centers. After implementation, 6185 rheumatology referrals showed an e-consultation response delay of 8.95 days, and to first face-to-face visit (after e-consultation) of 12.6 (previous delay before program implementation was 83.1 days). Resolution by e-consultation reached 20% (1195 patients did not need seeing the rheumatologist to have the problem solved), and 1369 patients (32%) were discharged after the first visit. The overall resolution rate was 44.0% (2564 discharges/5830 e-consultations). From a random sample of 100 visits, only 10% of patients needed additional complementary tests to make a diagnosis and decision by Rheumatology (20.9% decrease from previous period). CONCLUSION: A careful analysis of the situation and processes, with implementation of simple IT circuits, allows for the improvement of the efficiency and resolution of problems in Rheumatology.

Incidencia de la fractura de cadera osteoporótica en Galicia en relación con la dispensación de medicamentos con indicación en su prevención y tratamiento / Incidence of hip fractures due to osteoporosis in relation to the precription of drugs for their prevention and treatment in Galicia, Spain

ObjetivoAnalizar la evolución de la incidencia de fractura de cadera en la Comunidad Autónoma de Galicia en relación con la tendencia evolutiva en la dispensación de medicamentos con evidencia en la prevención y/o tratamiento de la fractura de cadera osteoporótica.DiseñoEstudio observacional descriptivo ecológico.EmplazamientoRed pública sanitaria de toda la Comunidad Autónoma de Galicia durante 5 años, del 1 de enero de 2004 al 31 de diciembre de 2008.ParticipantesPacientes mayores de 44 años ingresados por fractura de cadera osteoporótica. Medicamentos dispensados con evidencia en prevención y/o tratamiento de fractura de cadera osteoporótica. Exclusión: fracturas abiertas, prescripción hospitalaria, privada o mutuas.Mediciones principalesIncidencia (número de casos nuevos de fractura acontecidos en un año), tasa de incidencia (incidencia/100.000 habitantes), tasa de dispensación (número envases dispensados en un año por 100.000 habitantes) y razón de tasas (RT, cociente entre la tasa año último y año primero). Se calcularon tasas anuales estandarizadas según método directo.ResultadosSe identificaron 12.137 ingresos por fractura de cadera (2.792 hombres y 9.345 mujeres). Fracturas subcapitales: tasas de incidencia media (TIM)=86,14,IC95%[61,85–110,42]; RT=1,22,IC95%[0,82–1,63] (hombres) y TIM=180,88,IC95%[124,74–237,02]; RT=1,08,IC95%[0,73–1,43] (mujeres). Fracturas trocantéreas: TIM=56,30,IC95%[39,18–73,42]; RT=1,04,IC95%[0,75–1,34] (hombres) y TIM=136,51,IC95%[90,23–182,78]; RT=1,12,IC95%[0,89–1,35] (mujeres). Fracturas subtrocantéreas: TIM=8,92,IC95%[6,52–11,32]; RT=1,26,IC95%[0,05–2,46] (hombres) y TIM=22,91,IC95%[15,24–30,58]; RT=1,08,IC95%[0,57–1,58] (mujeres). RT fracturas totales=1,07,IC95%[0,92–1,23] (hombres) y 0,99,IC95%[0,83–1,17] (mujeres). Dispensación de medicamentos (2008–2004): RT alendronato=1,30; RT risedronato=1,92; RT ranelato de estroncio=10,38(AU)

ConclusiónEn 5 años, se ha multiplicado la dispensación de medicamentos en la sanidad pública para la prevención y tratamiento de la fractura de cadera manteniéndose constante la incidencia de esta(AU)

ObjectiveTo analyse the evolution in the incidence of hip fractures in our autonomous community in relationship to the trend in the prescription of medicines for the prevention and/or treatment of osteoporotic hip fracture.DesignDescriptive observational ecological study.SettingPublic health network in the whole autonomous community over five years, from 1st January 2004 to 31st December 2008.ParticipantsPatients over 44 years old admitted with osteoporotic hip fracture. Medicines dispensed at a pharmacy which are indicated for the prevention of osteoporotic hip fractures (alendronate, risedronate and strontium ranelate). Exclusion: Open fractures, hospital or private or prescriptions.MeasurementsIncidence (number of new cases of hip fractures occurring in a year), Incidence rate (incidence per 100,000 inhabitants), Dispersion rate (number of packets dispensed per year per 100,000 inhabitants) and Hazard ratio (HR, ratio between the rate of last year and first). Annual rates were calculated standardised by the direct method.ResultsWe identified 12,137 hospital admissions for fractured hip (2,792 men and 9,345 women). Sub-capital fractures: Mean Incidence Rate (MIR)=86.14,95%CI[61.85–110.42]; HR=1.22, 95%CI[0.82–1.63] (men) and MIR=180.88,95%CI[124.74–237.02]; HR=1.08,95%CI[0.73–1.43] (women). Trochanteric fractures: MIR=56.30,95%CI[39.18–73.42], HR=1.04,95%CI[0.75–1.34] (men) and MIR=136.51,95%CI[90.23–182.78]; HR=1.12,95%CI[0.89–1.35] (women). Subtrochanteric fractures: MIR=8.92,95%CI[6.52–11.32]; HR=1.26,95%CI[0.05–2.46] (men) and MIR=22.91,95%CI[15.24–30.58]; HR=1.08,95%CI[0.57–1.58] (women). Total HR fractures=1.07, 95%CI[0.92–1.23] (men) and 0.99,95%CI[0.83–1.17] (women). Drug dispensing (2008–2004): HR alendronate=1.30; HR risedronate=1.92; HR strontium ranelate=10.38(AU)

ConclusionOver five years the dispensing of drugs by the public health service has multiplied for the prevention and treatment of hip fractures while the incidence has remained unaltered(AU)

[Incidence of hip fractures due to osteoporosis in relation to the prescription of drugs for their prevention and treatment in Galicia, Spain]. / Incidencia de la fractura de cadera osteoporótica en Galicia en relación con la dispensación de medicamentos con indicación en su prevención y tratamiento.

OBJECTIVE: To analyse the evolution in the incidence of hip fractures in our autonomous community in relationship to the trend in the prescription of medicines for the prevention and/or treatment of osteoporotic hip fracture. DESIGN: Descriptive observational ecological study. SETTING: Public health network in the whole autonomous community over five years, from 1st January 2004 to 31st December 2008. PARTICIPANTS: Patients over 44 years old admitted with osteoporotic hip fracture. Medicines dispensed at a pharmacy which are indicated for the prevention of osteoporotic hip fractures (alendronate, risedronate and strontium ranelate). Exclusion: Open fractures, hospital or private or prescriptions. MEASUREMENTS: Incidence (number of new cases of hip fractures occurring in a year), Incidence rate (incidence per 100,000 inhabitants), Dispersion rate (number of packets dispensed per year per 100,000 inhabitants) and Hazard ratio (HR, ratio between the rate of last year and first). Annual rates were calculated standardised by the direct method. RESULTS: We identified 12,137 hospital admissions for fractured hip (2,792 men and 9,345 women). Sub-capital fractures: Mean Incidence Rate (MIR)=86.14,95%CI[61.85-110.42]; HR=1.22, 95%CI[0.82-1.63] (men) and MIR=180.88,95%CI[124.74-237.02]; HR=1.08,95%CI[0.73-1.43] (women). Trochanteric fractures: MIR=56.30,95%CI[39.18-73.42], HR=1.04,95%CI[0.75-1.34] (men) and MIR=136.51,95%CI[90.23-182.78]; HR=1.12,95%CI[0.89-1.35] (women). Subtrochanteric fractures: MIR=8.92,95%CI[6.52-11.32]; HR=1.26,95%CI[0.05-2.46] (men) and MIR=22.91,95%CI[15.24-30.58]; HR=1.08,95%CI[0.57-1.58] (women). Total HR fractures=1.07, 95%CI[0.92-1.23] (men) and 0.99,95%CI[0.83-1.17] (women). Drug dispensing (2008-2004): HR alendronate=1.30; HR risedronate=1.92; HR strontium ranelate=10.38. CONCLUSION: Over five years the dispensing of drugs by the public health service has multiplied for the prevention and treatment of hip fractures while the incidence has remained unaltered.