Taller de educación para la salud sobre prevención de osteoporosis en mujeres. Efectividad de una intervenciónenfermera en atención primaria / Workshop on health education on prevention of osteoporosis in women. Effectiveness of an intervention in primary care nurse

Los autocuidados son fundamentales para cualquier persona, sana o enferma, tanto en el tratamiento como en la prevención de enfermedades. Un aumento del nivel de autocuidados es deseable en enfermedades crónicas y de elevada prevalencia como la osteoporosis. El objetivo fue proporcionar conocimientos y promover estilos de vida saludables orientados a mejorar la calidad de vida y el autocuidado en mujeres que reciben educación sanitaria sobre la osteoporosis. El diseño del estudio es de intervención comunitaria, abierto, de un solo centro, prospectivo y de 8 meses de duración, desarrollado en el Centro de Salud de Morarzarzal. La muestra fue de 140 mujeres de edades comprendidas entre 40 y 70 años. Todas las participantes rellenaron un test inicial para evaluar su nivel de conocimientos sobre la osteoporosis y estilos de vida. Efectuamos la valoración de enfermería por patrones funcionales de Salud de Marjory Gordon e identificamos, entre otros, problemas relacionados con el manejo adecuado del régimen terapéutico, su conocimiento y ejecución, estableciendo un diagnóstico enfermero. Con el apoyo de la taxonomía NANDA, la NOC y NIC determinamos los objetivos e intervenciones de enfermería. Las mujeres recibieron 4 sesiones de educación sanitaria grupal sobre menopausia y osteoporosis, dieta equilibrada y adecuada orientada hacia la prevención de la enfermedad, ejercicio físico recomendado, corrección postural y manejo de cargas, hábitos tóxicos y de estilos de vida que afectan a la salud ósea. Tras la intervención educativa, las mujeres volvieron a hacer el test de conocimientos y de estilos de vida. A los 8 meses de finalizar los talleres educativos valoramos los resultados el Plan de Cuidados. El estudio estadístico consistió en comparar los valores de las variables seleccionadas antes y después de la intervención educativa. Las variables cuantitativas se analizaron con test paramétricos (t de Student para datos apareados) y con no paramétricos (test U de Mann Whitney). La potencia escogida para los test fue del 80% y el nivel de significación p<0,05. Al estudiar las diferencias entre los resultados se pretendía averiguar si la intervención educativa grupal y el posterior seguimiento del plan de cuidados en consulta de enfermería fueron efectivos para mejorar los autocuidados y la calidad de vida de las mujeres participantes en el estudio. Obtuvimos los resultados esperados del Plan de Cuidados (AU)

The increase of self-care is crucial for any person, healthy or ill, during his treatment or for preventing any illness. This is applicable to osteoporosis, a chronic illness with a high prevalence. Objective: To increase knowledge and promote healthy life styles to improve live quality and self-care for women receiving health education on osteoporosis. Design: Open community intervention trial, prospective during 8 months, developed in a single center: Moralzarzal Health Center. The sample included 140 women aged between 40 and 70. All participants completed an initial test to assess their level of knowledge about osteoporosis and lifestyles. We performed nursing assessment by Marjory Gordon’s Health functional patterns and we identified, among others, problems related to proper management of therapeutic regimen, its knowledge and its execution, establishing a nursing diagnosis. We determined the goals and nursing interventions with the support of taxonomy NANDA, NOC and NIC. The women received four sessions of group health education about menopause and osteoporosis, balanced and adequate diet oriented to disease prevention, recommended physical activity, postural correction and load management, bad habits and lifestyles that affect bone health. After the educational intervention, the women completed again the test of knowledge and lifestyles, and 8 months after the educational workshops’ end, we valued the Care Plan results. The statistical study was to compare the values of selected variables before and after the educational intervention. Quantitative variables were analyzed using parametric tests (Student t test for paired data) or nonparametric (Mann Whitney U test). The power chosen for the test was 80% and significance level p <0.05. By studying the differences in results we wanted to determine if the educational intervention and subsequent monitoring of the care plan in nursing consultations were effective in improving self-care and quality of life of women participating in the study. We obtained the expected results of the Plan of Care (AU)

[Cost and management of asthma exacerbations in Spanish hospitals (COAX study in hospital services)]. / Coste y manejo de una crisis asmática en el ámbito hospitalario de nuestro medio (estudio COAX en servicios hospitalarios).

OBJECTIVE: The prevalence and associated health cost of asthma have been increasing in developed countries, and 70% of the overall disease cost is due to exacerbations. The primary objective of this study was to determine the hospital cost of an asthma exacerbation in Spain. The secondary objective was to determine what maintenance treatments patients were using to control asthma before the exacerbation and how the exacerbation was treated. The study formed part of a broader study (COAX II), with the same objectives in each of the 8 participating European countries. PATIENTS AND METHODS: Prospective observational study that enrolled 126 patients with an asthma exacerbation treated in the usual way in 6 Spanish hospitals over a 3-month period (from January 1 to March 31, 2000). RESULTS: According to the criteria of the Global Initiative for Asthma, 33.3% of the exacerbations were mild, 38.9% moderate, 26.2% severe, and 1.6% were associated with risk of imminent respiratory arrest. Use of corticosteroids was widespread among patients with moderate and severe asthma, but only 68% of the patients with severe asthma used long-acting beta2 agonists. The mean cost was 1555.70 Euros (95% confidence interval [CI], 1237.60 Euros-1907.00 Euros), of which 93.8% (1460.60 Euros; 95% CI, 1152.50 Euros-1779.40 Euros) was due to direct costs, and 6.2% (95.10 Euros; 95% CI, 35.50 Euros-177.00 Euros) to indirect costs. Cost rose with increasing severity of the exacerbation--292.60 Euros for a mild exacerbation, 1230.50 Euros for a moderate exacerbation, and 3543.10 Euros for a severe exacerbation. CONCLUSIONS: The mean cost was 1555.70 Euros. The costs of moderate and severe exacerbations were 4 and 12 times that of a mild exacerbation, respectively. Long-acting beta2 agonists were less widely used than recommended by the guidelines for treatment of moderate and severe persistent asthma leading to asthma exacerbations.

[Cost and management of asthma attacks treated in primary care (COAX Study)]. / Coste y manejo de las crisis asmáticas atendidas en atención primaria (estudio COAX).

OBJECTIVES: To estimate the cost and characterize the management of asthma attacks in primary care. DESIGN: Prospective, observational study of 1 year's duration. Setting. 10 physician's offices at 9 primary care centers located in 5 provinces (Asturias, Barcelona, Cadiz, Madrid, and Valencia) of Spain. PARTICIPANTS: 10 family physicians who saw 133 consecutive patients with an asthma attack. METHOD: Prospective, observational study; no intervention was used. Direct and indirect costs arising from asthma attacks were calculated. Episodes were treated according to the physicians' habitually used procedures; the study protocol did not specify any predetermined intervention. RESULTS: The attacks were classified as mild in 43.6% of the cases, moderately severe in 43.6%, and severe in 12.8%. Of all severe attacks, 17.2% occurred in patients with intermittent asthma. The more severe the attack, the less preventive treatment patients had received previously. The mean cost of asthma attacks was 166.7 (95% CI, 146.5-192.3); 80% (132.4) (95% CI, 122.7-143.8) were direct costs and 20% (34.3) (95% CI, 17-56.2) were indirect costs. The most economical management option was to change treatment, perform diagnostic tests and have the patient attend 2 follow-up appointments with the physician. CONCLUSIONS: Mean cost of each asthma attack treated in primary care was 166.7 (95% CI, 146.5-192.3), of which 80% were direct costs and 20% indirect costs.

[Effectiveness of a recuperative primary care intervention in patients with chronic obstructive pulmonary disease]. / Efectividad de una intervención rehabilitadora, realizada en atención primaria, en la evolución de los pacientes con EPOC.

OBJECTIVES: The main objective is to assess the effect of a respiratory rehabilitation programme on the quality of life of patients with COPD. Secondary aims are to determine whether the intervention, as against the habitual monitoring, improves tolerance to exercise and pulmonary function, and reduces dyspnoea, the number of crises and hospital admissions due to COPD and the medication used to control the disease. DESIGN: Pragmatic cluster-randomised clinical trial. SETTING: Clinics of 16 PC teams in various health areas of the Community of Madrid. PARTICIPANTS: 476 patients with light-moderate COPD, who sign their informed consent. VARIABLES: Quality of life, number of crises, packages of medicines used to control the disease, unscheduled attendance, pulmonary function, dyspnoea and tolerance to exercise. METHOD: The consultations will be assigned to the control and intervention groups at random. At each clinic there will be a randomised selection from all patients with COPD and in a stable clinical condition. 238 patients are needed in each group, in order to detect a minimum difference of 4 points in quality of life, assuming a standard deviation of 16, 95% confidence level, 80% power and 20% losses. The effect between each factor and the variables evaluated through multivariate analysis will be calculated. DISCUSSION: This research project aims to show that a basic recuperative intervention, which is feasible and primary care-based, can achieve improvements in the quality of life of patients with COPD.

Coste y manejo de las crisis asmáticas atendidas en atención primaria (estudio COAX) / Cost and management of asthma attacks treated in primary care (COAX study)

Objetivos. Estimar el coste y conocer el manejo de una crisis asmática en atención primaria. Diseño. Estudio observacional, prospectivo. Emplazamiento. Diez consultas de 9 centros de atención primaria de 5 provincias (Asturias, Barcelona, Cádiz, Madrid y Valencia). Participantes. Diez médicos de familia que incluyeron, secuencialmente, a 133 pacientes con una crisis de asma. Mediciones principales. Se calcularon los costes directos e indirectos que supone una crisis de asma. El episodio se trató como habitualmente venía haciéndolo cada médico, sin que la intervención estuviera previamente definida en el protocolo del estudio. Resultados. Se observaron un 43,6% de crisis leves, un 43,6% de crisis moderadas y un 12,8% de crisis graves. El 17,2% de estas últimas ocurrieron en pacientes con asma intermitente. Cuanto más grave era la crisis, menor era el tratamiento preventivo anterior a ella. El coste medio de una crisis asmática fue de 166,7 € (intervalo de confianza [IC] del 95%, 146,5-192,3), el 80% (132,4 €; IC del 95%, 122,7-143,8) debido a costes directos y el 20% (34,3 €, (IC del 95%, 17-56,2) a costes indirectos. La opción más económica de manejo de una crisis fue «cambiar el tratamiento, realizar una prueba diagnóstica y 2 visitas médicas». Conclusiones. El coste medio de una crisis asmática tratada en atención primaria fue de 166,7 € (IC del 95%, 146,5-192,3), el 80% debido a costes directos y el 20% a costes indirectos

Objectives. To estimate the cost and characterize the management of asthma attacks in primary care. Design. Prospective, observational study of 1 year's duration. Setting. 10 physician's offices at 9 primary care centers located in 5 provinces (Asturias, Barcelona, Cadiz, Madrid, and Valencia) of Spain. Participants. 10 family physicians who saw 133 consecutive patients with an asthma attack. Method. Prospective, observational study; no intervention was used. Direct and indirect costs arising from asthma attacks were calculated. Episodes were treated according to the physicians' habitually used procedures; the study protocol did not specify any predetermined intervention. Results. The attacks were classified as mild in 43.6% of the cases, moderately severe in 43.6%, and severe in 12.8%. Of all severe attacks, 17.2% occurred in patients with intermittent asthma. The more severe the attack, the less preventive treatment patients had received previously. The mean cost of asthma attacks was €166.7 (95% CI, 146.5-192.3); 80% (€132.4) (95% CI, 122.7-143.8) were direct costs and 20% (€34.3) (95% CI, 17-56.2) were indirect costs. The most economical management option was to change treatment, perform diagnostic tests and have the patient attend 2 follow-up appointments with the physician. Conclusions. Mean cost of each asthma attack treated in primary care was €166.7 (95% CI, 146.5-192.3), of which 80% were direct costs and 20% indirect costs

Efectividad de una intervención rehabilitadora, realizada en atención primaria, en la evolución / How much a recuperative primary care intervention affects the evolution of patients with chronic obstructive pulmonary disease

Objetivos. El objetivo principal es valorar la efectividad de un programa de rehabilitación respiratoria en la calidad de vida de pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Los objetivos secundarios son: determinar si la intervención mejora la tolerancia al ejercicio y la función pulmonar, y disminuye la sensación de disnea, el número de exacerbaciones, los ingresos hospitalarios por EPOC y el consumo de medicación necesario para el adecuado control de la enfermedad frente al seguimiento habitual. Diseño. Ensayo clínico aleatorizado por grupos pragmático. Emplazamiento. Consultas de 16 equipos de atención primaria, repartidos por diferentes áreas sanitarias de la Comunidad de Madrid. Participantes. Se incluirá en el estudio a 476 pacientes con EPOC leve-moderada, que firmarán el consentimiento informado. Variables. Calidad de vida, número de agudizaciones, envases de medicación utilizados para el control, visitas no programadas, función pulmonar, disnea y tolerancia al ejercicio. Método. Se realizará asignación aleatoria de las consultas a cada grupo, control e intervención. En cada consulta se realizará una selección aleatoria del total de pacientes con EPOC, en situación clínica estable. Se precisan 238 pacientes en cada grupo para detectar una diferencia mínima de 4 puntos en la calidad de vida, asumiendo una desviación estándar de 16, un nivel de confianza del 95%, una potencia del 80% y unas pérdidas del 20%. Se estimará el efecto entre el factor de estudio y las variables evaluadas mediante análisis multivariante. Discusión. Este proyecto de investigación pretende demostrar que una intervención rehabilitadora básica, factible e implementada en atención primaria permite alcanzar mejoras en la calidad de vida de los pacientes con EPOC

Objectives. The main objective is to assess the effect of a respiratory rehabilitation programme on the quality of life of patients with COPD. Secondary aims are to determine whether the intervention, as against the habitual monitoring, improves tolerance to exercise and pulmonary function, and reduces dyspnoea, the number of crises and hospital admissions due to COPD and the medication used to control the disease. Design. Pragmatic cluster-randomised clinical trial. Setting. Clinics of 16 PC teams in various health areas of the Community of Madrid. Participants. 476 patients with light-moderate COPD, who sign their informed consent. Variables. Quality of life, number of crises, packages of medicines used to control the disease, unscheduled attendance, pulmonary function, dyspnoea and tolerance to exercise. Method. The consultations will be assigned to the control and intervention groups at random. At each clinic there will be a randomised selection from all patients with COPD and in a stable clinical condition. 238 patients are needed in each group, in order to detect a minimum difference of 4 points in quality of life, assuming a standard deviation of 16, 95% confidence level, 80% power and 20% losses. The effect between each factor and the variables evaluated through multivariate analysis will be calculated. Discussion. This research project aims to show that a basic recuperative intervention, which is feasible and primary care-based, can achieve improvements in the quality of life of patients with COPD

Coste y manejo de una crisis asmática en el ámbito hospitalario de nuestro medio (estudio COAX en servicios hospitalarios) / Cost and management of asthma exacerbations in spanish hospitals (COAX study in hospital services)

Objetivo: La prevalencia y el gasto sanitario originado por el asma están aumentando progresivamente en los países desarrollados. El 70% del coste total está producido por exacerbaciones. El objetivo principal del estudio fue conocer el coste hospitalario de una crisis asmática en nuestro medio. Como objetivo secundario se quiso conocer cuál era el tratamiento de mantenimiento para el control del asma que utilizaban los pacientes antes de la agudización asmática y su tratamiento. El estudio formaba parte de uno más amplio (COAX II) realizado en 8 países europeos que pretendía los mismos objetivos en cada país. Pacientes y métodos: Estudio observacional prospectivo en el que se incluyó a 126 pacientes con crisis asmática tratados de forma habitual en 6 hospitales españoles durante un período de 3 meses (del 1 de enero al 31 de marzo de 2000). Resultados: Siguiendo los criterios de la Global Initiative for Asthma, el 33,3% de las crisis fueron leves, el 38,9% moderadas, el 26,2% graves y el 1,6% con riesgo de parada respiratoria inminente. La utilización de corticoides era generalizada en los pacientes con asma moderada y grave, pero sólo el 68% de los pacientes con asma grave seguían tratamiento con agonistas β2 de larga duración. El coste medio fue de 1.555,7 € (intervalo de confianza [IC] del 95%, 1.237,6-1.907), el 93,8% (1.460,6 €; IC del 95%, 1.152,5-1.779,4) debido a costes directos y el 6,2% (95,1 €; IC del 95%, 35,5-177) a costes indirectos. El coste se incrementaba a medida que la crisis era más grave: 292,6 € para una crisis leve, 1.230,5 € para la crisis moderada y 3.543,1 € para la crisis grave. Conclusiones: El coste medio fue de 1.555,7 €. Los costes de las crisis moderadas y graves eran 4 y 12 veces mayores que los de la leve, respectivamente. Se observó una infrautilización de los β2 de larga duración con respecto a las recomendaciones de las guías en el tratamiento del asma persistente moderada y grave que originaba crisis de asma

Objective: The prevalence and associated health cost of asthma have been increasing in developed countries, and 70% of the overall disease cost is due to exacerbations. The primary objective of this study was to determine the hospital cost of an asthma exacerbation in Spain. The secondary objective was to determine what maintenance treatments patients were using to control asthma before the exacerbation and how the exacerbation was treated. The study formed part of a broader study (COAX II), with the same objectives in each of the 8 participating European countries. Patients and Methods: Prospective observational study that enrolled 126 patients with an asthma exacerbation treated in the usual way in 6 Spanish hospitals over a 3-month period (from January 1 to March 31, 2000). Results: According to the criteria of the Global Initiative for Asthma, 33.3% of the exacerbations were mild, 38.9% moderate, 26.2% severe, and 1.6% were associated with risk of imminent respiratory arrest. Use of corticosteroids was widespread among patients with moderate and severe asthma, but only 68% of the patients with severe asthma used long-acting β2 agonists. The mean cost was €1555.70 (95% confidence interval [CI], €1237.60-€1907.00), of which 93.8% (€1460.60; 95% CI, €1152.50-€1779.40) was due to direct costs, and 6.2% (€95.10; 95% CI, €35.50-€177.00) to indirect costs. Cost rose with increasing severity of the exacerbation­ €292.60 for a mild exacerbation, €1230.50 for a moderate exacerbation, and €3543.10 for a severe exacerbation. Conclusions: The mean cost was s1555.70. The costs of moderate and severe exacerbations were 4 and 12 times that of a mild exacerbation, respectively. Long-acting β2 agonists were less widely used than recommended by the guidelines for treatment of moderate and severe persistent asthma leading to asthma exacerbations

[Prevalence of anti-smoking counseling in a primary care clinic: comparison of patient charts with patient reports]. / Prevalencia del consejo antitabaco en un centro de atención primaria: comparación del registro en la historia clínica con lo referido por el usuario.

OBJECTIVE: To estimate the prevalence of anti-tobacco counseling of smokers. DESIGN: Cross-sectional, descriptive study. SETTING: Primary care center. SUBJECTS: Random sample of 1,228 patients over 14 years of age who visited a doctor or nurse over the year prior to the study. MEASURES: 1) Telephone interview: age, sex, medical history, education, smoking status, number of cigarettes daily, frequency of visits to the doctor, receipt of anti-smoking advice, reason for seeking medical care, the type of professional who saw the patient and the patient's attitude toward the advice. 2) Patient chart: record of advice given. RESULTS: Five hundred sixty-three questionnaires were valid. Smokers made up 37% (95% CI 33%-41%) of the population, with a mean age of 33.37 (18.14 years; 39.1% of men and 36.1% of the women smoked. The prevalence of anti-smoking counseling according to the patient was 62.3% (95% CI: 56-69%). There was little agreement between counseling as reported by the patients and as recorded in the patient's chart (kappa index 0.149, p = 0.01). The mean age of patients advised to quit (34.8 + 10.89 years) was higher than that of those who did not receive advice to quit. Seventy percent of patients who came to the clinic more than 3 times per year reported having been advised to quit, whereas 50% of those who came fewer than 3 times per year were so advised. Among patients who were advised to quit, 78.3% said the advice came when they had come to the clinic about matters related to smoking. According to patients, advice was usually given by a doctor (76.7%). After being advised to quit, 32.55% of the smokers did so, 6.2% of them for longer than 6 months. CONCLUSIONS: The percentage of smokers at our clinic is similar to that in the general population. The prevalence of anti-smoking counseling reported by the user is greater than that reported in other studies, but can clearly be improved. Anti-smoking advice is underreported in our patient charts in comparison with patient reports. The patients who receive advice most often are those who come to the clinic frequently and those who come for smoking-related problems. Physicians are the professionals who most often advise patients on smoking.

Prevalencia del consejo antitabaco en un centro de atención primaria: comparación del registro en la historia clínica con lo referido por el usuario / Prevalence of anti-smoking counseling in a primary care clinic: comparison of patient charts with patient reports

OBJETIVO: Estimar la prevalencia del consejo antitabaco en la población fumadora. DISEÑO: Estudio observacional y transversal. ÁMBITO: Atención primaria. SUJETOS: Muestra aleatoria simple de 1.228 pacientes mayores de 14 años citados en el último año en las consultas de medicina o de enfermería. MEDICIONES: Encuesta telefónica: edad, sexo, antecedentes médicos personales, nivel de estudios, existencia de consumo de tabaco, número de cigarrillos diarios, frecuencia asistencial, recepción de consejo antitabaco, motivo de consulta cuando lo recibió, estamento profesional que lo proporcionó y actitud frente al consejo. Historia clínica: registro del consejo. RESULTADOS: Se obtuvieron 563 encuestas válidas. La población fumadora representa el 37 por ciento (intervalo de confianza [IC] del 95 por ciento, 33-41 por ciento), con una edad media ñ desviación estándar (DE) de 33,37 ñ 18,14 años. El 39,1 por ciento de los varones y el 36,1 por ciento de las mujeres fuman. La prevalencia del consejo antitabaco según el usuario es del 62,3 por ciento (IC del 95 por ciento, 5669 por ciento). Existe poca concordancia entre el consejo referido por el paciente y lo registrado en la historia clínica (índice kappa de 0,149; p = 0,01). La edad media de los pacientes aconsejados (34,8 ñ 10,89 años) fue mayor que la de los que no lo recibieron (30,9 ñ 11,35 años). El 70 por ciento de los pacientes que frecuentan la consulta más de tres veces al año refieren haber recibido consejo (el 50 por ciento de los pacientes cuando acudieron menos de tres veces al año). El 78,3 por ciento de los pacientes que recibieron consejo refiere haberlo recibido cuando consultó por un motivo relacionado con el tabaco. Según el paciente, el estamento que mayoritariamente da el consejo es el médico (76,7 por ciento). La población fumadora que abandona el tabaco después del consejo es del 32,55 por ciento, de ellos sólo un 6,2 por ciento durante más de 6 meses. CONCLUSIONES: La población fumadora de nuestro centro de salud representa un porcentaje similar al de la población general. La prevalencia del consejo antitabaco referida por el usuario es superior al obtenido en otros estudios, pero claramente mejorable. Existe un infrarregistro del consejo antitabaco en nuestras historias clínicas si lo comparamos con lo referido por el usuario. Los fumadores que recibieron más consejo son los más frecuentadores y los que consultaron por un motivo relacionado con el tabaco. Quien mayoritariamente da el consejo es el médico. (AU)

Valoración del componente funcional que subyace al uso reiterado de un servicio de urgencias hospitalario y de sus repercusiones económicas / Psychosocial characteristics of non-organic frequent emergency department users and generated costs

Fundamento: Analizar las características psicosociales de los pacientes con un componente funcional relevante que utilizan reiteradamente nuestro servicio de urgencias hospitalario (SUH) y estimar los costes generados por su atención sanitaria. Métodos: Estudio descriptivo retrospectivo (enero 1996-junio 1997) de los pacientes hiperfrecuentadores (HF) del SUH definidos como 3 ó más visitas/semestre durante al menos dos semestres. Revisando sus historias y realizando una entrevista psiquiátrica identificamos a los HF funcionales (HFF). Posteriormente estimamos el coste generado por los episodios con destino alta durante el primer semestre de 1997. Resultados: De 220 HF identificados 66 fueron considerados HFF. La media de consultas fue 11,3ñ9,4. Clínicos y psiquiatras coincidieron en la existencia de funcionalidad en 40/55 (72,7 porciento). Los diagnósticos más frecuentes fueron: trastorno de personalidad (37,5 porciento) y ansiedad-depresión (35 porciento). Los HF psiquiátricos eran más jóvenes (51,7 vs 62,9 años) y consultaban más veces (17,6 vs 9,9). Las 240 asistencias a HFF en el semestre estudiado causaron un único ingreso. Coste promedio del episodio altado fue 8.682,9ñ6.633,8 ptas. El 25,06 porciento se atribuyó a coste variable. El coste del minuto de permanencia en urgencias se estimó en 19,26 ptas. El coste global de atención a HFF durante el semestre estudiado fue 1.903.775 ptas. (0,36 porciento del coste total). Conclusiones: Los HFF suponen proporcionalmente mayor carga en el SUH que el resto de población. Los pacientes con trastorno mental son más jóvenes y acuden más reiteradamente que el resto de HF al Servicio de Urgencias. Sólo un 25 porciento del coste por consulta se debe a material, tratamiento, pruebas o dietas (AU)

[Evaluation of the functional component underlying the frequent attendance to a hospital emergency service and its economic consequences]. / Valoración del componente funcional que subyace al uso reiterado de un servicio de urgencias hospitalario y de sus repercusiones económicas.

OBJECTIVE: To analyse the psychosocial characteristics of frequent emergency department (ER) users with a relevant non-organic component and estimate the generated costs. METHODS: Retrospective-descriptive study (Jan 1996-Jun 1997) about overusers (OU) defined as > = 3 visits/6 months during at least two 6 months periods, coming to our hospital's emergency department. Reviewing their medical records and making a psychiatric interview we identified Non-organic OU (NOU). Subsequently we estimated the cost generated by discharge visits during the first six months of 1997. RESULTS: Sixty six out of 220 OU were identified as NOU. The mean consultation rate was 11.3 +/- 9.4. Clinician-psychiatrist agreement on non-organicity was 72.7%. The most frequent diagnoses were: personality disorders (37.5%) and depression-anxiety (35%). Psychiatric OU were significantly younger (51.7 vs 62.5 years) and attended more often (17.6 vs. 9.9 times). In six months only one of 240 ER consultation cause admission. The mean cost of each discharge episode was 8682.9 +/- 6633.8 pta (25.06% due to variable costs). The cost per minute of emergency room stay was 19.26 ptas. Overall NOU attention cost during the six month period studied was 1,903,775 ptas (0.36% of overall ER costs). CONCLUSIONS: Compared with the rest of users, NOU entail a higher burden for the ER. Mentally-ill patients are younger and consult more frequently than the rest of OU. Only 25% of the cost per consultation is due to treatments, tests or diets.