¿Participan los pacientes crónicos en su plan de tratamiento?: resultados de la encuesta nacional de salud, Chile, ENS 2016-2017 / Do chronic patients participate in decision-making about their treatment plans? Results of a national health survey, Chile, ENS 2016-2017

Introducción: el apoyo al automanejo, la participación y retroalimentación son centrales en la implementación de una atención centrada en el usuario en el marco del modelo de cuidados crónicos. Esto ha demostrado mejorar diversos resultados sanitarios. Objetivo: estimar el grado de participación de los pacientes hipertensos y diabéticos, en las decisiones sobre su plan de tratamiento en población adulta chilena. Métodos: análisis secundario de la Encuesta Nacional de Salud (ENS) 2016-2017, muestra aleatoria estratificada de hogares, multietápica por conglomerados, representativa de la población adulta chilena. Se incluyó población mayor de 15 años hipertensa o diabética bajo tratamiento. Se describen las prevalencias expandidas de la variable percepción de participación en la toma de decisio-nes sobre plan terapéutico en escala Likert de 5 niveles, según edad, sexo, zona urbana/rural y nivel educacional. Se utilizó regresión logística y OR ajustados. Resultados: el 72,3% de los diabéticos y el 71,9% de los hipertensos, refieren "nunca" haber sido consultados al preparar su plan de tratamiento. En la población hipertensa, existe una percepción de participación significativamente más baja en mujeres que en hombres (OR ajustado por edad = 0,5 (IC 95% de 0,3-0,8) no se observaron diferencias estadísticamente significativas según edad, ruralidad ni nivel educacional. Conclusiones: la población hipertensa y diabética percibe bajos niveles de participación en el diseño de su plan terapéutico y los resultados sugieren inequidad de género en hipertensos. Este estudio permitirá evaluar futuras políticas y modificaciones al modelo de cuidados crónicos en el sistema de salud chileno.

Introduction: Self-management support, activation, participation, and feedback are core elements in chronic care models. Patients' participation in decision-making has been shown to improve health outcomes. Objective: To estimate the degree of participation of hypertensive and diabetic patients in decisions about their treatment plan in the general Chilean adult population. Methods: Secon-dary analysis of the "Encuesta Nacional de Salud (National Health Survey) (ENS) 2016-2017" multistage random stratified sample of households representative of the Chilean adult population. Hypertensive or diabetic populations older than 15 years of age that were under treatment were included. The weighted prevalence of the variable "perception of participation in decision making about their treatment plan" was described on a Likert scale of 5 levels, according to age, sex, urban/rural area, and educational level. We used logistic regression and adjusted OR. Results 72.3.5% of diabetic and 71.9% of hypertensive patients say they have "never" been asked their opinion about their treatment plan. In the hypertensive population, women perceived less participation than men (OR adjust by age =0.5 [IC 95% de 0.3-0.8]), with no significant differences observed by age, rurality, or educational level. Conclusions: Hypertensive and diabetic populations perceive low levels of participation in the design of their therapeutic plan, results also suggest gender inequity. This study contributes essential insights for the reformulation of Chilean chronic care models and may stand as a baseline to evaluate the implementation of future health policy.

Health and economic effects on patients with type 2 diabetes mellitus in the long run: predictions for the Chilean population.

BACKGROUND: Diabetes is associated to a high financial and disease burden, explaining a large proportion of expenditure of the health system in one year. The purpose of this study was to estimate long-term costs and health outcomes of recently diagnosed patients with type 2 diabetes in Chile. METHODS: Cost and consequence study based on mathematical discrete event simulation (DES) model. We modelled expected costs (USD) and quality-adjusted life-years (QALYs) from diagnosis to death (or the age of 95) of a hypothetical cohort of 100,000 incident cases, simulated based on the Chilean National Health Survey 2018. The incidence of twelve complications was estimated assuming the hazard functions provided by the United Kingdom Prospective Diabetes Study. We explore heterogeneity across patients based on their baseline risk covariates and their impact on costs and QALYs. RESULTS: The expected cost and QALY of a recently diagnosed type 2 diabetes patient in Chile were USD 8660 and 12.44 QALYs. Both costs and QALYs were independently determined by baseline risk and the patient's life expectancy from the diagnosis. Length of life since diagnosis showed the major impact on costs (5.2% increase for every additional year). Myocardial infarction was the most frequent complication (47.4%) and the most frequent cause of death. CONCLUSION: Diabetes type 2 determines a significant expenditure of the health system and substantial health losses. Although the control of cardiovascular risk factors and the metabolic control of the disease, both have an important impact on costs and outcomes, the main impact is achieved by postponing the age of onset of the disease.

[Inappropriate medication use among Chilean older people]. / Uso inapropiado de medicamentos en adultos mayores: resultados de la Encuesta Nacional de Salud 2010.

BACKGROUND: Inappropriate medication use in older people is an important source of adverse events and complications. AIM: To determine the frequency of inappropriate medication use in the general population. MATERIAL AND METHODS: As part of the 2010 Chilean National Health Survey, 1,048 persons aged 65 years or more were interviewed about medication use. The information obtained was analyzed using standardized Beer’s criteria, adapted for the Chilean population, to define inappropriate medication use. A logistic regression model was performed to define risk factors for inappropriate medication use. RESULTS: Ten percent of subjects had a high risk of inappropriate medication use. The most common medications used were chlorphenamine, amitriptyline, diazepam, chlorpromazine, chlordiazepoxide and piroxicam. The risk factors detected were female gender, polypharmacy and a bad health self-perception. CONCLUSIONS: Inappropriate medication use is common among Chilean older people and should be discouraged.

Uso inapropiado de medicamentos en adultos mayores: resultados de la Encuesta Nacional de Salud 2010 / Inappropriate medication use among Chilean older people

Background: Inappropriate medication use in older people is an important source of adverse events and complications. Aim: To determine the frequency of inappropriate medication use in the general population. Material and Methods: As part of the 2010 Chilean National Health Survey, 1,048 persons aged 65 years or more were interviewed about medication use. The information obtained was analyzed using standardized Beer’s criteria, adapted for the Chilean population, to define inappropriate medication use. A logistic regression model was performed to define risk factors for inappropriate medication use. Results: Ten percent of subjects had a high risk of inappropriate medication use. The most common medications used were chlorphenamine, amitriptyline, diazepam, chlorpromazine, chlordiazepoxide and piroxicam. The risk factors detected were female gender, polypharmacy and a bad health self-perception. Conclusions: Inappropriate medication use is common among Chilean older people and should be discouraged.

Study protocol for the Maule Cohort (MAUCO) of chronic diseases, Chile 2014-2024.

BACKGROUND: Maule Cohort (MAUCO), a Chilean cohort study, seeks to analyze the natural history of chronic diseases in the agricultural county of Molina (40,000 inhabitants) in the Maule Region, Chile. Molina´s population is of particular interest because in the last few decades it changed from being undernourished to suffering excess caloric intake, and it currently has the highest national rates of cardiovascular diseases, stomach cancer and gallbladder cancer. Between 2009 and 2011 Molina´s poverty rate dropped from 24.1 % to 13.5 % (national average 20.4 %); in this period the county went from insufficient to almost complete basic sanitation. Despite these advances, chemical pollutants in the food and air are increasing. Thus, in Molina risk factors typical of both under-developed and developed countries coexist, generating a unique profile associated with inflammation, oxidative stress and chronic diseases. METHODS/DESIGN: MAUCO is the core project of the recently established Advanced Center for Chronic Diseases (ACCDiS), Universidad de Chile & Pontificia Universidad Católica de Chile. In this study, we are enrolling and following 10,000 adults aged 38 to 74 years over 10 years. All eligible Molina residents will be enrolled. Participants were identified through a household census. Consenting individuals answer an epidemiological survey exploring risk factors (psycho-social, pesticides, diet, alcohol, and physical activity), medical history and physical and cognitive conditions; provide fasting blood, urine, and saliva samples; receive an electrocardiogram, abdominal ultrasound and bio-impedance test; and take a hand-grip strength test. These subjects will be re-interviewed after 2, 5 and 7 years. Active surveillance of health events is in place throughout the regional healthcare system. The MAUCO Bio-Bank will store 30 to 50 aliquots per subject using an NIH/NCI biorepository system for secure and anonymous linkage of samples with data. DISCUSSION: MAUCO´s results will help design public health interventions tailored to agricultural populations in Latin America.