Initial opioid prescription characteristics and risk of opioid misuse, poisoning and dependence: retrospective cohort study.

OBJECTIVE: To identify individual and initial prescription-related factors associated with an increased risk for opioid-related misuse, poisoning and dependence (MPD) in patients with non-cancer pain. METHODS: Cohort study linking several databases covering 5 million inhabitants of the region of Valencia, Spain, including all adults initiating prescription opioids in the period 2012-2018. To ascertain the association between the characteristics of the initial prescription choice and the risk of opioid MPD, we used shared frailty Cox regression models. We additionally considered death as a competing risk in sensitivity analyses. RESULTS: 958 019 patients initiated opioid prescription from 2012 to 2018, of which 0.13% experienced MPD. Most patients were prescribed tramadol as initial opioid (76.7%) followed by codeine (16.3%), long-acting opioids (6.7%), short-acting opioids (0.2%) and ultrafast opioids (0.1%). Initiation with ultrafast (HR 7.2; 95% CI 4.1 to 12.6), short-acting (HR 4.8; 95% CI 2.3 to 10.2) and long-acting opioids (HR 1.5; 95% CI 1.2 to 1.9) were associated with a higher risk of MPD when compared with tramadol. Initial prescriptions covering 4-7 days (HR 1.3; 95% CI 1.0 to 1.8), 8-14 days (HR 1.4; 95% CI 1.0 to 1.9), 15-30 days (HR 1.7; 95% CI 1.2 to 2.3) and more than one a month (HR 1.8; 95% CI 1.3 to 2.5) were associated with more MPD risk than initial prescriptions for 1-3 days. Treatments with >120 daily morphine milligram equivalents (MME) increased MPD risk (vs <50 MME, HR 1.6; 95% CI 1.1 to 2.2). Main individual factors associated with increased risk of MPD risk were male sex (HR 2.4; 95% CI 2.1 to 2.7), younger age (when compared with patients aged 18-44 years, patients aged 45-64 years, HR 0.4; 95% CI 0.4 to 0.5; patients aged 65-74 years, HR 0.4; 95% CI 0.3 to 0.5 and patients aged 75 years old and over, HR 0.7; 95% CI 0.6 to 0.8), lack of economic resources (2.1; 95% CI 1.8 to 2.5) and registered misuse of alcohol (2.9; 95% CI 2.4 to 3.5). Sensitivity analyses yielded overall comparable results. CONCLUSIONS: Our study identifies riskier patterns of opioid prescription initiation for non-cancer indications, as well as patient subgroups with higher risk of misuse, poisoning and dependence.

Tratamiento de la desnutrición relacionada con la enfermedad: situación de la regulación en el Sistema Nacional de Salud. Un estudio exploratorio mediante grupos focales / Treatment of disease-related malnutrition: status of regulation in the Spanish National Health System. An exploratory study through focus groups

ANTECEDENTES Y OBJETIVOS: la normativa que regula la inclusión de alimentos para usos médicos especiales (ADUME) entre las prestaciones del Sistema Nacional de Salud (SNS) fue elaborada hace unos 15 años, si bien la nutrición enteral domiciliaria (NED) se comenzó a regular en 1998. La evolución de las características técnicas de los ADUME justifica un análisis de la actual normativa y la consideración de posibles modificaciones que permitan la incorporación de avances tecnológicos. MATERIAL Y MÉTODOS: reuniones estructuradas siguiendo la metodología del grupo focal, con expertos en su mayoría médicos (91 %), mujeres (55 %) y especialistas hospitalarios en disciplinas relacionadas con la nutrición (73 %) de 8 hospitales y 6 comunidades autónomas. Previamente, los participantes recibieron 4 documentos resumen de diferentes aspectos técnicos de la regulación sobre ADUME en España. Se transcribió de forma anonimizada el audio de las reuniones y se codificó su contenido en 9 códigos: 1) problemática y regulación; 2) beneficios clínicos y evidencia de eficacia o efectividad; 3) indicaciones clínicas; 4) contexto internacional y comparaciones con otros países; 5) impacto presupuestario; 6) coste-efectividad; 7) riesgos y motivos para mantener la regulación actual; 8) propuestas de avance, factibilidad y aspectos que dificultan la implementación; y 9) otros temas. RESULTADOS: los grupos señalaron la necesidad de modificar aspectos regulatorios relacionados con la exclusión de financiación de las fórmulas de densidad calórica superior a 2,1 kcal/ml, la exclusión de la financiación de los ADUME obtenidos total o parcialmente a partir de alimentos ordinarios, la preferencia por la alimentación por sonda y la exclusividad de la financiación de fórmulas completas para los ADUME que se empleen por vía oral como complemento de una ingesta insuficiente. CONCLUSIONES: sobre la base del desarrollo tecnológico y la aplicación clínica de los ADUME en los últimos años, el SNS debería actualizar la regulación de la financiación de estos productos. La mayor parte de estos cambios no implican incremento del gasto si se mantienen las condiciones actuales en cuanto a indicaciones y precios máximos

BACKGROUND AND OBJECTIVES: the legislation currently regulating the inclusion of Food for Special Medical Purposes (FSMP) among the benefits of the National Health System (SNS) was made approximately 15 years ago. The evolution of the technical characteristics of the FSMP justifies an analysis of the current regulation and the consideration of possible regulatory modifications that would allow the incorporation of the progress achieved. MATERIAL AND METHODS: four successive focus groups of experts, mostly doctors (91%), hospital specialists in disciplines related to nutrition (73%), from 8 different hospitals and 6 autonomous communities. Previously, 4 documents summarizing different technical aspects of the regulation on FSMP in Spain were sent to the participants. The audio of the meetings was transcribed anonymously and its content was codified. RESULTS: the contents of the focus groups were grouped into 9 codes: 1) problems and regulation; 2) clinical benefits and evidence of efficacy or effectiveness; 3) clinical indications; 4) international context and comparisons with other countries; 5) budgetary impact; 6) cost-effectiveness; 7) risks and reasons for maintaining current regulation; 8) proposals for progress, feasibility and aspects that make implementation difficult; and 9) other issues. CONCLUSIONS: based on the technological development and clinical application of the FSMP carried out in recent years, an update of the regulation of these products can be proposed for financing by the National Health System in Spain. Most of these changes do not imply an increase in expenditure if current conditions regarding indications and maximum prices are maintained

[Treatment of disease-related malnutrition: status of regulation in the Spanish National Health System. An exploratory study through focus groups]. / Tratamiento de la desnutrición relacionada con la enfermedad: situación de la regulación en el Sistema Nacional de Salud. Un estudio exploratorio mediante grupos focales.

INTRODUCTION: Background: the legislation currently regulating the inclusion of Food for Special Medical Purposes (FSMP) among the benefits of the National Health System (SNS) was made approximately 15 years ago. The evolution of the technical characteristics of the FSMP justifies an analysis of the current regulation and the consideration of possible regulatory modifications that would allow the incorporation of the progress achieved. Material and methods: four successive focus groups of experts, mostly doctors (91%), hospital specialists in disciplines related to nutrition (73%), from 8 different hospitals and 6 autonomous communities. Previously, 4 documents summarizing different technical aspects of the regulation on FSMP in Spain were sent to the participants. The audio of the meetings was transcribed anonymously and its content was codified. Results: the contents of the focus groups were grouped into 9 codes: 1) problems and regulation; 2) clinical benefits and evidence of efficacy or effectiveness; 3) clinical indications; 4) international context and comparisons with other countries; 5) budgetary impact; 6) cost-effectiveness; 7) risks and reasons for maintaining current regulation; 8) proposals for progress, feasibility and aspects that make implementation difficult; and 9) other issues. Conclusions: based on the technological development and clinical application of the FSMP carried out in recent years, an update of the regulation of these products can be proposed for financing by the National Health System in Spain. Most of these changes do not imply an increase in expenditure if current conditions regarding indications and maximum prices are maintained.

INTRODUCCIÓN: Antecedentes: la normativa que regula la inclusión de alimentos para usos médicos especiales (ADUME) entre las prestaciones del Sistema Nacional de Salud (SNS) fue elaborada hace unos 15 años, si bien la nutrición enteral domiciliaria se comenzó a regular en 1998. La evolución de las características técnicas de los ADUME justifica un análisis de la actual normativa y la consideración de posibles modificaciones que permitan la incorporación de avances tecnológicos. Material y métodos: reuniones estructuradas siguiendo la metodología del grupo focal, con expertos en su mayoría médicos (91 %), mujeres (55 %) y especialistas hospitalarios en disciplinas relacionadas con la nutrición (73 %) de 8 hospitales y 6 comunidades autónomas. Previamente, los participantes recibieron 4 documentos resumen de diferentes aspectos técnicos de la regulación sobre ADUME en España. Se transcribió de forma anonimizada el audio de las reuniones y se codificó su contenido en 9 códigos: 1) problemática y regulación; 2) beneficios clínicos y evidencia de eficacia o efectividad; 3) indicaciones clínicas; 4) contexto internacional y comparaciones con otros países; 5) impacto presupuestario; 6) coste-efectividad; 7) riesgos y motivos para mantener la regulación actual; 8) propuestas de avance, factibilidad y aspectos que dificultan la implementación; y 9) otros temas. Resultados: los grupos señalaron la necesidad de modificar aspectos regulatorios relacionados con la exclusión de financiación de las fórmulas de densidad calórica superior a 2,1 kcal/ml, exclusión de la financiación de los ADUME obtenidos total o parcialmente a partir de alimentos ordinarios, preferencia por la alimentación por sonda y exclusividad de la financiación de fórmulas completas para los ADUME que se empleen por vía oral como complemento de una ingesta insuficiente. Conclusiones: sobre la base del desarrollo tecnológico y la aplicación clínica de los ADUME en los últimos años, el SNS debería actualizar la regulación de la financiación de estos productos. La mayor parte de estos cambios no implican incremento del gasto si se mantienen las condiciones actuales en cuanto a indicaciones y precios máximos.

[Prevalence and associated factors in self-monitoring of blood glucose in noninsulin-treated type 2 diabetes patients in the Valencia Community, Spain]. / Prevalencia y factores asociados de la automonitorización glucémica en pacientes diabéticos tipo 2 no tratados con insulina en la Comunidad Valenciana.

BACKGROUND: Self-monitoring of blood glucose (SMBG) in noninsulin-treated type 2 diabetes patients (T2DM) is a controversial topic. We aimed to describe the SMBG prevalence in noninsulin-treated (NIT) T2DM patients in the Valencia Community (VC) and to analyze factors associated with their use. METHOD: Cross-sectional study with 573 NIT-T2DM patients from 83 primary care surgeries. Electronic medical records and patient interview were used. We examine associations among patient, doctors and organizational characteristics, and the SMBG indication. RESULTS: 289 (50.4%) of the 573 NIT-T2DM patients used SMBG. In the multivariable analysis SMBG use was associated with age (OR:2.3 for 65-84 and 6.0 for <65 years vs 85+ years old)) the length from diagnosis (OR:2.2 for 10-15 years vs 0-5 years), the number of OAAs prescribed (OR:2.5, 4.1 and 5.7 for 1, 2 or 3+ OAAs vs no treatment with OAAs) and type (with more SMBG prescribed in patients with sulfonylureas and glitazones), glycated haemoglobin figures (OR: 1.9 y 1.6 for 7-8 and >8, vs <7), sedentary behaviour (OR:1.6), obesity (OR:1.5), and housewife status, and chronic respiratory disease antecedents (OR:0.5). After controlling these factors, SMBG use was also associated with the length of doctor's professional practice and some healthcare departments. CONCLUSIONS: In the Valencia Community the SMBG use in noninsulin-treated T2DM patients is strongly associated with clinic patient' characteristics, but some non-clinical factors explain part of the variance in their utilization.

Use of monoclonal antibodies for metastatic colorectal cancer in the Andalusian public health system.

BACKGROUND: The place of monoclonal antibodies in metastatic colorectal cancer has not been clearly defined. OBJECTIVE: To determine the treatment pattern of monoclonal antibodies in colorectal cancer patients in the Andalusian Public Healthcare System. METHOD: Data were collected from all patients treated with these drugs from July 2009 to December 2010 from pharmacy programs and medical records. RESULTS: Three hundred patients were included, of whom 227 received the antibody at the forefront. The proportion of patients who received bevacizumab in the first line is greater than that of cetuximab (62.1 vs. 37.5 % respectively) and similar in the second line and subsequent (47.8 vs. 53.8 % and 48.5 vs. 46.2 % respectively). XELOXbevacizumab was the most frequently prescribed scheme (35.3 %) followed by FOLFOX-monoclonal antibody schemes, regardless that this was bevacizumab or cetuximab (22.5 %). The median progression free survival (PFS) was 11.7 months for patients receiving cetuximab, 9.6 months for patients receiving bevacizumab and 8.2 months for those who received no monoclonal antibody in the first line. CONCLUSION: Bevacizumab was the antibody of choice in first line, showing utilization rates similar to cetuximab in second line and subsequent. The median PFS in our study is related to the PFS of the major clinical trials.

Shared component modelling as an alternative to assess geographical variations in medical practice: gender inequalities in hospital admissions for chronic diseases.

BACKGROUND: Small area analysis is the most prevalent methodological approach in the study of unwarranted and systematic variation in medical practice at geographical level. Several of its limitations drive researchers to use disease mapping methods -deemed as a valuable alternative. This work aims at exploring these techniques using - as a case of study- the gender differences in rates of hospitalization in elderly patients with chronic diseases. METHODS: Design and study setting: An empirical study of 538,358 hospitalizations affecting individuals aged over 75, who were admitted due to a chronic condition in 2006, were used to compare Small Area Analysis (SAVA), the Besag-York-Mollie (BYM) modelling and the Shared Component Modelling (SCM). Main endpoint: Gender spatial variation was measured, as follows: SAVA estimated gender-specific utilization ratio; BYM estimated the fraction of variance attributable to spatial correlation in each gender; and, SCM estimated the fraction of variance shared by the two genders, and those specific for each one. RESULTS: Hospitalization rates due to chronic diseases in the elderly were higher in men (median per area 21.4 per 100 inhabitants, interquartile range: 17.6 to 25.0) than in women (median per area 13.7 per 100, interquartile range: 10.8 to 16.6). Whereas Utilization Ratios showed a similar geographical pattern of variation in both genders, BYM found a high fraction of variation attributable to spatial correlation in both men (71%, CI95%: 50 to 94) and women (62%, CI95%: 45 to 77). In turn, SCM showed that the geographical admission pattern was mainly shared, with just 6% (CI95%: 4 to 8) of variation specific to the women component. CONCLUSIONS: Whereas SAVA and BYM focused on the magnitude of variation and on allocating where variability cannot be due to chance, SCM signalled discrepant areas where latent factors would differently affect men and women.

Income level and regional policies, underlying factors associated with unwarranted variations in conservative breast cancer surgery in Spain.

BACKGROUND: Geographical variations in medical practice are expected to be small when the evidence about the effectiveness and safety of a particular technology is abundant. This would be the case of the prescription of conservative surgery in breast cancer patients. In these cases, when variation is larger than expected by need, socioeconomic factors have been argued as an explanation. OBJECTIVES: Using an ecologic design, our study aims at describing the variability in the use of surgical conservative versus non-conservative treatment. Additionally, it seeks to establish whether the socioeconomic status of the healthcare area influences the use of one or the other technique. METHODS: 81,868 mastectomies performed between 2002 and 2006 in 180 healthcare areas were studied. Standardized utilization rates of breast cancer conservative (CS) and non-conservative (NCS) procedures were estimated as well as the variation among areas, using small area statistics. Concentration curves and dominance tests were estimated to determine the impact of income and instruction levels in the healthcare area on surgery rates. Multilevel analyses were performed to determine the influence of regional policies. RESULTS: Variation in the use of CS was massive (4-fold factor between the highest and the lowest rate) and larger than in the case of NCS (2-fold), whichever the age group. Healthcare areas with higher economic and instruction levels showed highest rates of CS, regardless of the age group, while areas with lower economic and educational levels yielded higher rates of NCS interventions. Living in a particular Autonomous Community (AC), explained a substantial part of the CS residual variance (up to a 60.5% in women 50 to 70). CONCLUSION: The place where a woman lives -income level and regional policies- explain the unexpectedly high variation found in utilization rates of conservative breast cancer surgery.

[Risk factors for 4-year mortality in older adults. Toledo Study]. / Factores de riesgo de mortalidad a los 4 años en personas mayores. Estudio Toledo.

INTRODUCTION: multiple factors contribute to mortality in older adults. Measures of physical and cognitive function are strong predictors of mortality, but the extent to which function, health-related quality of life and other factors contribute independently to mortality risk is not known. MATERIAL AND METHODS: we performed a prospective study of a representative sample of people aged 65 years and older (n=3,214) followed-up for 4 years. Individuals from the sample were interviewed to obtain information about sociodemographic characteristics, comorbidity, functional status, health-related quality of life, and healthcare utilization. The main outcome measure was 4-year mortality. To assess the independent impact of each risk factor on mortality, several multivariate survival models were built using the Cox proportional hazard model. RESULTS: in the 4 years of monitoring, 478 people died (14.9%). The variables independently associated with mortality risk were age 75 years or older (HR = 1.93), male gender (HR = 1.73), heart disease (HR = 1.32), chronic respiratory disease (HR = 1.78), activities of daily living disability (HR = 1.55), instrumental activities of daily living disability (HR = 2.19), cognitive impairment (HR = 1.39), poor health-related quality of life (HR = 1.85) and hospital admission in the year prior to the interview (HR = 1.51). CONCLUSIONS: objective measures of physical and cognitive function are independent predictors of 4-year mortality in the elderly. Poor health-related quality of life is associated with mortality. The magnitude of this association is comparable to that of other well-know predictors of mortality. Instruments to measure health-related quality of life can be useful to evaluate health requirements in the elderly.

Factores de riesgo de mortalidad a los 4 años en personas mayores. Estudio Toledo / Risk factors for 4-year mortality in older adults. Toledo Study

Introducción: múltiples factores contribuyen a la incidencia de la mortalidad de las personas mayores. Las medidas de función física y cognitiva son potentes predictores de mortalidad, pero el grado en que la función, la calidad de vida relacionada con la salud u otros factores contribuyen de forma independiente en la mortalidad es poco conocido. Material y métodos: estudio prospectivo de una muestra representativa de mayores de 65 años (N = 3.214) seguidos durante 4 años. Mediante entrevista personal se obtuvo información de la muestra sobre variables sociodemográficas, comorbilidad, función, calidad de vida relacionada con la salud y utilización de servicios sanitarios. Medida de resultados: mortalidad a los 4 años. Con el objetivo de analizar el impacto de cada variable en la mortalidad se construyeron varios modelos multivariantes utilizando el análisis de riesgo proporcional de Cox. Resultados: en el tiempo de seguimiento fallecieron 478 individuos (14,9%). Se asociaron de forma independiente a un mayor riesgo de muerte: edad Ž 75 años (hazard ratio [HR] = 1,93), sexo varón (HR = 1,73), enfermedad cardíaca (HR = 1,32), enfermedad respiratoria crónica (HR = 1,78), dependencia en las actividades básicas de la vida diaria (ABVD) (HR = 1,55), dependencia en las actividades instrumentales de la vida diaria (AIVD) (HR = 2,19), deterioro cognitivo (HR = 1,39), mala calidad de vida (HR = 1,85) y haber presentado ingresos hospitalarios en el año previo (HR = 1,51). Conclusiones: las medidas de función física y cognitiva son factores independientes de muerte a los 4 años en personas mayores. Una peor calidad de vida se asocia a una mayor mortalidad. La magnitud de esta asociación es comparable con la que ofrecen otros predictores conocidos de mortalidad. Los instrumentos para medir la calidad de vida relacionada con la salud pueden usarse para una valoración de las necesidades en salud de las personas mayores

Introduction: multiple factors contribute to mortality in older adults. Measures of physical and cognitive function are strong predictors of mortality, but the extent to which function, health-related quality of life and other factors contribute independently to mortality risk is not known. Material and methods: we performed a prospective study of a representative sample of people aged 65 years and older (n=3,214) followed-up for 4 years. Individuals from the sample were interviewed to obtain information about sociodemographic characteristics, comorbidity, functional status, health-related quality of life, and healthcare utilization. The main outcome measure was 4-year mortality. To assess the independent impact of each risk factor on mortality, several multivariate survival models were built using the Cox proportional hazard model. Results: in the 4 years of monitoring, 478 people died (14.9%). The variables independently associated with mortality risk were age 75 years or older (HR = 1.93), male gender (HR = 1.73), heart disease (HR = 1.32), chronic respiratory disease (HR = 1.78), activities of daily living disability (HR = 1.55), instrumental activities of daily living disability (HR = 2.19), cognitive impairment (HR = 1.39), poor health-related quality of life (HR = 1.85) and hospital admission in the year prior to the interview (HR = 1.51). Conclusions: objective measures of physical and cognitive function are independent predictors of 4-year mortality in the elderly. Poor health-related quality of life is associated with mortality. The magnitude of this association is comparable to that of other well-know predictors of mortality. Instruments to measure health-related quality of life can be useful to evaluate health requirements in the elderly (AU)

Patterns of electroconvulsive therapy use in Spain.

OBJECTIVE: To describe the utilization, geographical variations and adaptation of ECT in the Spanish context. METHOD: A cross-sectional study, involving a questionnaire delivered to all hospitals with a Psychiatry Unit (PU) in Spain included in the National Hospitals Catalogue (N = 233). A descriptive analysis was made of the answers to the different questions, using an adequate denominator in each case: all PUs (n = 233), those units that prescribe and apply ECT (n = 174), or only those that apply the technology (n = 108). RESULTS: All PUs completed the questionnaire. Fifty-nine units (25.3%) neither prescribed nor applied ECT, while 108 (46.4%) prescribed and applied the technology, and 66 PUs (28.3%) only prescribed ECT. Those units with training responsibilities for psychiatry residents or pregraduate students, and those with a larger number of beds, were more inclined to apply ECT. The estimated ECT applied in the preceding 12 months totaled 2435 with an annual rate per 10,000 inhabitants of 0.61, and a range per Spanish Autonomous Community of 0.28-16.59. CONCLUSIONS: We now know a reliable rate and characteristics of the use of ECT in Spain, and the attitudes and opinion of PUs Spanish psychiatrists about it. We found a very important variability in ECT application rates among Autonomous Communities.

Evaluación de la calidad mediante los sistemas de información sociosanitarios: un reto posible / Evaluation of the quality through systems of information: a possible challenge

La utilización de sistemas de información se contempla cada vez más como un elemento necesario tanto en la planificación, la financiación y el control del acceso a la atención sanitaria, como en la gestión de servicios, la determinación de niveles de dotación de personal y la evaluación de la calidad asistencial, en el sector de atención a enfermos crónicos y geriátricos. El Resident Assessment Instrument es uno de los sistemas de información sociosanitarios más desarrollado, validado y usado internacionalmente. La comparación de la prevalencia de determinados indicadores de calidad entre centros y a nivel regional, estatal e internacional, es uno de los usos potenciales. A pesar de lo reciente del sistema, sus primeras aplicaciones parecen alcanzar un elevado grado de aceptación entre los profesionales asistenciales. Es por ello que consideramos que tanto la experiencia norteamericana como sus aplicaciones internacionales, constituyen un excelente patrón de referencia de demostrada calidad y utilidad. En el contexto español la iniciativa más desarrollada es la de la administración sanitaria catalana, donde es obligatoria la cumplimentación periódica de un conjunto mínimo de datos para la planificación del volumen de servicios y el seguimiento de la distribución de servicios asistenciales y de la calidad asistencial. Las aproximaciones a partir de las bases de datos son útiles para identificar y detectar problemas que requieren un estudio posterior mediante otros estudios específicos. De aquí la necesidad, en nuestro entrono, de continuar mejorando la calidad de los datos, las metodologías de análisis de la evaluación del comportamiento de estos sistemas (AU)

Estado de salud de las personas ancianas y hospitalización en servicios geriátricos, médicos y quirúrgicos. Estudio poblacional en Toledo / Senior citizen health conditions and hospitilization on geriatric, general and surgical floors. A population study conducted in Toledo

Fundamento: El estado de salud y algunas características clínicas configuran un grupo de ancianos que necesitan más cuidados, que podrían beneficiarse de asistencia geriátrica especializada, aunque no existe consenso para identificar estos pacientes. El objetivo de este trabajo es describir el perfil de los pacientes mayores de 64 años ingresados en una unidad geriátrica y compararlo con los mayores de esta edad ingresados en los servicios médicos y quirúrgicos. Método: Durante 18 meses se siguió una cohorte representativa de la población mayor de 64 años del Partido Judicial de Toledo (n=3214), para identificar los ingresos y estancias hospitalarias en los hospitales públicos del área sanitaria. Las variables sobre estado de salud, se recogieron por entrevista personal, y los ingresos y sus características según datos del servicio de admisiones hospitalario. Resultados: Ingresaron 410 personas (12,8 por ciento), en geriatría 168 pacientes (30,7 por ciento), en servicios médicos 204 (37,3 por ciento) y en servicios quirúrgicos 174 (32,0 por ciento). En geriatría la edad media fue significativamente mayor (77,4 años), sin diferencias en la estancia media (12,8 días;IC95 por ciento:10,6-14,0), fallecieron 44 pacientes (8,1 por ciento), ingresados en geriatría 26 (59,1 por ciento). En los servicios quirúrgicos ingresaron más mujeres, pacientes más jóvenes y con déficit leve de visión y audición; en geriatría, respecto a servicios médicos, más pacientes mayores de 80 años, viviendo en residencias, sin pareja, dependencia funcional moderada-severa, deterioro cognitivo, depresión, mala calidad de vida y escasos recursos sociales. Conclusiones: No se observaron diferencias en el estado de salud entre los mayores de 64 años ingresados en servicios no quirúrgicos y quirúrgicos. En geriatría, respecto a los otros grupos de servicios, los pacientes tuvieron una edad media más elevada, peor estado de salud, mayor mortalidad y estancia media similar (AU)