Gasto farmacéutico en diabetes mellitus en una región de España según el Clinical Risk Group, 2012 / Pharmaceutical Expenditure for Diabetes Mellitus in a Region of Spain as Clinical Risk Group, 2012 / Despesa com medicamentos em pacientes com diabetes mellitus em uma região da Espanha como o Grupo de Risco Clínico de 2012

Se pretende estimar la multimorbilidad asociada con diabetes mellitus tipo 2 y su relación con el gasto farmacéutico, para lo cual se realizó un estudio de corte transversal durante el año 2012. Se identificó a 350 015 individuos diabéticos, a través de códigos clínicos, usando la Clasificación Internacional de Enfermedades y el software 3M Clinical Risk Groups. Todos los pacientes fueron clasificados en cuatro grupos de morbilidad. El primer grupo corresponde al estadio inicial, el segundo grupo incluye el núcleo de multimorbilidad de pacientes en fases intermedia y avanzada, el tercer grupo incluye pacientes con diabetes y enfermedades malignas, y el último grupo es de pacientes en estado catastrófico, principalmente enfermos renales crónicos. La prevalencia bruta de diabetes fue de 6,7%. El gasto promedio total fue de ¬ 1257,1. La diabetes se caracteriza por una fuerte presencia de otras condiciones crónicas y tiene un gran impacto en el gasto farmacéutico.

Estimations of multimorbidity associated with Type 2 Diabetes Mellitus and its relationship to pharmaceutical expenditure. Cross-sectional study during 2012. 350,015 diabetic individuals, identified through clinical codes using the International Statistical Classification of Diseases and Related Health Problem and the 3M Clinical Risk Groups software. The raw prevalence of diabetes was 6.7%. All patients were stratified into four morbidity groups. The first group corresponds to the initial state; the second group includes the core multimorbidity patients in the intermediate and advanced stages; the third group includes patients with diabetes and malignancies; the last group patients with catastrophic statuses, manly chronic renal patients. The raw prevalence of diabetes was 6.7%. The average total cost was ¬ 1257.1. Diabetes is characterized by a strong presence of other chronic conditions have a great impact on pharmaceutical spending.

As estimativas de vários morbidade associada com diabetes mellitus tipo 2 e sua relação com a despesa farmacêutica, para o qual um estudo transversal foi realizado em 2012. Ele foi identificado em 350 015 indivíduos diabéticos, foram identificados através códigos clínicos, utilizando a Classificação Internacional de Doenças e Risco clínica software Grupos 3M. Todos os pacientes foram classificados em quatro grupos de doença 4. O primeiro grupo corresponde à fase inicial (CRG 1-4); O segundo grupo inclui pacientes multimorbid principais fases intermediárias e avançadas, o terceiro grupo inclui pacientes com diabetes e doenças malignas, eo último grupo de pacientes em estado catastrófico, pacientes renais crónicos, principalmente. A prevalência global de diabetes foi de 6,7%. A despesa média total foi de ¬ 1257,1. Diabetes que se caracteriza por uma forte presença de outras condições crónicas e tieniendo um grande impacto sobre os gastos farmacêutica.

Pharmaceutical cost management in an ambulatory setting using a risk adjustment tool.

BACKGROUND: Pharmaceutical expenditure is undergoing very high growth, and accounts for 30% of overall healthcare expenditure in Spain. In this paper we present a prediction model for primary health care pharmaceutical expenditure based on Clinical Risk Groups (CRG), a system that classifies individuals into mutually exclusive categories and assigns each person to a severity level if s/he has a chronic health condition. This model may be used to draw up budgets and control health spending. METHODS: Descriptive study, cross-sectional. The study used a database of 4,700,000 population, with the following information: age, gender, assigned CRG group, chronic conditions and pharmaceutical expenditure. The predictive model for pharmaceutical expenditure was developed using CRG with 9 core groups and estimated by means of ordinary least squares (OLS). The weights obtained in the regression model were used to establish a case mix system to assign a prospective budget to health districts. RESULTS: The risk adjustment tool proved to have an acceptable level of prediction (R2 ≥ 0.55) to explain pharmaceutical expenditure. Significant differences were observed between the predictive budget using the model developed and real spending in some health districts. For evaluation of pharmaceutical spending of pediatricians, other models have to be established. CONCLUSION: The model is a valid tool to implement rational measures of cost containment in pharmaceutical expenditure, though it requires specific weights to adjust and forecast budgets.

Predictability of pharmaceutical spending in primary health services using Clinical Risk Groups.

BACKGROUND: Risk adjustment instruments applied to existing electronic health records and administrative datasets may contribute to monitoring the correct prescribing of medicines. OBJECTIVE: We aim to test the suitability of the model based on the CRG system and obtain specific adjusted weights for determined health states through a predictive model of pharmaceutical expenditure in primary health care. METHODS: A database of 261,054 population in one health district of an Eastern region of Spain was used. The predictive power of two models was compared. The first model (ATC-model) used nine dummy variables: sex and 8 groups from 1 to 8 or more chronic conditions while in the second model (CRG-model) we include sex and 8 dummy variables for health core statuses 2-9. RESULTS: The two models achieved similar levels of explanation. However, the CRG system offers higher clinical significance and higher operational utility in a real context, as it offers richer and more updated information on patients. CONCLUSIONS: The potential of the CRG model developed compared to ATC codes lies in its capacity to stratify the population according to specific chronic conditions of the patients, allowing us to know the degree of severity of a patient or group of patients, predict their pharmaceutical cost and establish specific programmes for their treatment.

[A standardized amount indicator by equivalent patient to control outpatient pharmaceutical expenditure, Spain]. / Desarrollo del indicador Población Estandarizada Equivalente para el control del gasto farmacéutico ambulatorio.

BACKGROUND: The outpatient pharmaceutical expenditure in developed countries represents a huge percentage of the total health budget, because of that, it is necessary to use tools aimed to control and guarantee an efficient use of these resources. Improving the current construction of the indicator of pharmaceutical expenditure in order to have a more adjusted tool of pharmaceutical expenditure control. METHODS: We introduce the concept of "equivalent patient" in the standardization of outpatient pharmaceutical expenditure, considering in its design several socio demographic variables in order to supersede the previous model which just considered the "Co-payment status" for adjusting the outpatient pharmaceutical expenditure. We considered variables as age, sex, co-payment status and nationality to elaborate the concept of equivalent patient. RESULTS: By applying the standardization method we obtained 160 groups of consumption with weights from 0,10 to 4,39 equivalent patients. CONCLUSIONS: We obtained a tool capable of improving the construction of Pharmaceutical Expenditure Indicators, which are essential for the design of measures aimed to stimulate the rational use of drugs. In a micro level of analysis, the new indicator is useful to establish economic incentives aimed to encourage good performance from physicians in the prescription field.

Desarrollo del indicador población estandarizada equivalente para el control del gasto farmacéutico ambulatorio / A standardized amount indicator by equivalent patient to control outpatient pharmaceutical expenditure, Spain

Fundamentos: El gasto farmacéutico representa un elevado porcentaje del gasto sanitario total en la mayoría de los países desarrollados, por lo que es importante utilizar herramientas que permitan hacer un uso eficiente. El objetivo del presente trabajo es construir un indicador de gasto farmacéutico estandarizado con el fin de disponer de una herramienta objetiva de evaluación y control del gasto más precisa que el indicador utilizado hasta el momento en la Comunitat Valenciana. Métodos: Para la construcción de este indicador se introdujo el concepto de "paciente equivalente" en la estandarización de la población, lo que permitió discriminar pacientes con perfiles de consumo diferentes. Dicha estandarización tiene en cuenta una serie de variables sociodemográficas que ofrecen una estandarización de los pacientes más ajustada que la que ofrecía el modelo utilizado hasta 2011, sustituido ahora por este nuevo indicador: el anterior indicador de importe estandarizado solo consideraba como característica diferenciadora del gasto la condición de farmacia (prestación farmaceútica sin o con aportación del 40%). Las variables consideradas en el nuevo proceso de estandarización fueron, la edad, el género, la condición de prestación farmaceútica y la cobertura internacional. Resultados: Después de aplicar el método de estandarización de la población se obtuvieron 160 grupos de pacientes con consumos diferentes a los que se les adjudicó unos pesos de 0,10 a 4,39 pacientes equivalentes. Conclusiones: El indicador obtenido permite comparar poblaciones homogéneas a través del proceso de su estandarización, lo que facilita la evaluación y control del gasto farmacéutico ambulatorio considerando los patrones de consumo de cada estructura poblacional. El indicador se puede aplicar a cualquier nivel organizativo, desde departamentos de salud a facultativos, por lo que ofrece información necesaria para el establecimiento de incentivos encaminados a promover una prescripción más eficiente(AU)

Background: The outpatient pharmaceutical expenditure in developed countries represents a huge percentage of the total health budget, because of that, it is necessary to use tools aimed to control and guarantee an efficient use of these resources. Improving the current construction of the indicator of pharmaceutical expenditure in order to have a more adjusted tool of pharmaceutical expenditure control. Methods: We introduce the concept of "equivalent patient" in the standardization of outpatient pharmaceutical expenditure, considering in its design several socio demographic variables in order to supersede the previous model which just considered the "Co-payment status" for adjusting the outpatient pharmaceutical expenditure. We considered variables as age, sex, co-payment status and nationality to elaborate the concept of equivalent patient. Results: By applying the standardization method we obtained 160 groups of consumption with weights from 0,10 to 4,39 equivalent patients. Conclusions: We obtained a tool capable of improving the construction of Pharmaceutical Expenditure Indicators, which are essential for the design of measures aimed to stimulate the rational use of drugs. In a micro level of analysis, the new indicator is useful to establish economic incentives aimed to encourage good performance from physicians in the prescription fiel(AU)