Estimación de la prevalencia de demencia a partir del análisis de bases de datos sobre uso de fármacos. La situación en la Comunidad de Madrid (España) / Estimated prevalence of dementia based on analysis of drug databases in the Region of Madrid (Spain)

Introducción: El aumento progresivo de la demencia hace conveniente disponer de métodos rápidos que complementen los estudios poblacionales de prevalencia. Objetivo: Estimar la prevalencia de demencia en la población mayor de 65 años a partir del consumo de anticolinesterásicos y memantina. Métodos: Estudio descriptivo del uso de anticolinesterásicos y/o memantina en 2011 en 2 bases de datos: Farm@drid, con registro de facturación en farmacias de la Comunidad Autónoma de Madrid (CAM) y Base de Investigación Farmacoepidemiológica en Atención Primaria (BIFAP), con registros sobre diagnóstico y prescripción. Se analizó la comparabilidad de resultados sobre utilización de fármacos de ambas bases mediante χ2 de Pearson y razón de prevalencias. La prevalencia de demencia en la CAM se estimó a partir de la dosis por 100 habitantes/día, ajustando el resultado con los datos obtenidos en la BIFAP sobre tratamiento combinado en población general (0,37%) y proporción de pacientes con demencia en tratamiento (41,13%). Resultados: El consumo de anticolinesterásicos y memantina entre la población > 65 años de la CAM fue del 2,08 y el 0,72% respectivamente. Ambas bases muestran resultados con similar uso de estos medicamentos. La prevalencia estimada de demencia en > 65 años en la CAM es del 5,91% (IC del 95%, 5,85-5,95) (52.287 personas), mayor en mujeres (7,16%) que en hombres (4,00%). Conclusiones: La prevalencia estimada de demencia es similar a la encontrada en estudios poblacionales. El análisis del consumo de fármacos específicos para la demencia puede ser una herramienta fiable que actualice periódicamente esta prevalencia sin gran coste, ayudando en la planificación de recursos sociosanitarios

Introduction: The progressive rise in dementia prevalence increases the need for rapid methods that complement population-based prevalence studies. Objective: To estimate the prevalence of dementia in the population aged 65 and older based on use of cholinesterase inhibitors and memantine. Methods: Descriptive study of use and prescription of cholinesterase inhibitors and/or memantine in 2011 according to 2 databases: Farm@drid (pharmacy billing records for the Region of Madrid) and BIFAP (database for pharmacoepidemiology research in primary care, with diagnosis and prescription records). We tested the comparability of drug use results from each database using the chi-square test and prevalence ratios. The prevalence of dementia in Madrid was estimated based on the dose per 100 inhabitants/day, adjusting the result for data obtained from BIFAP on combination treatment in the general population (0.37%) and the percentage of dementia patients undergoing treatment (41.13%). Results: Cholinesterase inhibitors and memantine were taken by 2.08% and 0.72% of Madrid residents aged 65 and older was respectively. Both databases displayed similar results for use of these drugs. The estimated prevalence of dementia in individuals aged 65 and older is 5.91% (95% CI%, 5.85-5.95) (52 287 people), and it is higher in women (7.16%) than in men (4.00%). Conclusions: The estimated prevalence of dementia is similar to that found in population-based studies. Analysing consumption of specific dementia drugs can be a reliable and inexpensive means of updating prevalence data periodically and helping rationalise healthcare resources

Estimated prevalence of dementia based on analysis of drug databases in the Region of Madrid (Spain).

INTRODUCTION: The progressive rise in dementia prevalence increases the need for rapid methods that complement population-based prevalence studies. OBJECTIVE: To estimate the prevalence of dementia in the population aged 65 and older based on use of cholinesterase inhibitors and memantine. METHODS: Descriptive study of use and prescription of cholinesterase inhibitors and/or memantine in 2011 according to 2 databases: Farm@drid (pharmacy billing records for the Region of Madrid) and BIFAP (database for pharmacoepidemiology research in primary care, with diagnosis and prescription records). We tested the comparability of drug use results from each database using the chi-square test and prevalence ratios. The prevalence of dementia in Madrid was estimated based on the dose per 100 inhabitants/day, adjusting the result for data obtained from BIFAP on combination treatment in the general population (0.37%) and the percentage of dementia patients undergoing treatment (41.13%). RESULTS: Cholinesterase inhibitors and memantine were taken by 2.08% and 0.72% of Madrid residents aged 65 and older was respectively. Both databases displayed similar results for use of these drugs. The estimated prevalence of dementia in individuals aged 65 and older is 5.91% (95% CI%, 5.85-5.95) (52 287 people), and it is higher in women (7.16%) than in men (4.00%). CONCLUSIONS: The estimated prevalence of dementia is similar to that found in population-based studies. Analysing consumption of specific dementia drugs can be a reliable and inexpensive means of updating prevalence data periodically and helping rationalise healthcare resources.

Evolución del consumo de fármacos específicos para la demencia en la comunidad autónoma de Madrid durante el periodo 2002-2012 / Consumption trends for specific drugs used to treat dementia in the region of Madrid (Spain) from 2002 to 2012

Introducción: El análisis del consumo de fármacos en grandes grupos poblacionales permite ver tendencias de consumo y comparar diferentes ámbitos. Objetivo: Analizar la tendencia temporal de consumo y costes de fármacos específicos para la demencia en la comunidad autónoma de Madrid (CAM) y comparar por grupos de edad y sexo. Métodos: Estudio descriptivo, seleccionando anticolinesterásicos (N06DA) y memantina (N06DX01) dispensados en la CAM del 2002 al 2012 con cargo al Sistema Nacional de Salud. El consumo se calculó analizando la evolución de las dosis diarias definidas (DDD), con incrementos totales y anuales. El coste se estimó por precio de DDD. Para comparar el consumo por edad y sexo, se calcularon las DDD por 100 habitantes-día. Resultados: Del 2002 al 2012 se multiplicó por 6 el consumo de fármacos para la demencia. El 76,70% de los fármacos consumidos en este periodo fueron anticolinesterásicos y el 23,30% memantina. La evolución del coste estimado se multiplicó por 5,7 en 11 años (por 4 considerando utilización de fármacos genéricos). En 2012, el 2,42% de los mayores de 65 años consumió anticolinesterásicos (2,82% mujeres, 1,83% hombres) y el 0,90% memantina (1,10% mujeres, 0,61% hombres). El consumo aumentó hasta los 86-90 años (5,84% en anticolinesterásicos; 2,33% en memantina), disminuyendo posteriormente. Conclusiones: El consumo de anticolinesterásicos y memantina aumentó progresivamente, sin alcanzar en 2012 cifras equivalentes a la prevalencia poblacional de demencia. Las medidas de contención de gasto farmacéutico pueden frenar el aumento del coste, aunque este volverá a crecer si persiste la misma tendencia temporal de consumo

Introduction: Analysing drug consumption in large population groups lets us observe consumption trends and compare them between different settings. Objective: to analyse the time trends for consumption and costs of specific drugs used to treat dementia in the region of Madrid (Spain) and compare trends by sex and age cohort. Methods: Descriptive study of cholinesterase inhibitors (N06DA) and memantine (N06DX01) dispensed in Madrid between 2002 and 2012 and covered by the Spain's national health system. Consumption was calculated by analysing changes in DDD (defined daily doses) to find total and yearly increases. The cost was estimated based on DDD price. To compare consumption rates by age and sex, we calculated DDD per 100 inhabitants/day. Results: Between 2002 and 2012, consumption of drugs used to treat dementia increased sixfold. During this period, cholinesterase inhibitors accounted for 76.70% of the drugs consumed and memantine, 23.30%. The estimated cost rose by a by a factor of 5.7 over 11 years (or by a factor of 4 taking into account the use of generic drugs). In 2012, 2.42% of the patients aged 65 or over consumed cholinesterase inhibitors (women 2.82%, men 1.83%) and 0.90% consumed memantine (women 1.10%, men 0.61%). Consumption increased in age cohorts up to 86 to 90 (5.84% for cholinesterase inhibitors and 2.33% for memantine) and declined thereafter. Conclusions: Consumption of cholinesterase inhibitors and memantine gradually increased, but consumption in 2012 did not reach levels equivalent to dementia prevalence figures. Pharmaceutical expenditure restraint measures may temporarily slow the cost increase temporarily but if the same trend of consumption persists, costs will rise

Consumption trends for specific drugs used to treat dementia in the region of Madrid (Spain) from 2002 to 2012.

INTRODUCTION: Analysing drug consumption in large population groups lets us observe consumption trends and compare them between different settings. OBJECTIVE: to analyse the time trends for consumption and costs of specific drugs used to treat dementia in the region of Madrid (Spain) and compare trends by sex and age cohort. METHODS: Descriptive study of cholinesterase inhibitors (N06DA) and memantine (N06DX01) dispensed in Madrid between 2002 and 2012 and covered by the Spain's national health system. Consumption was calculated by analysing changes in DDD (defined daily doses) to find total and yearly increases. The cost was estimated based on DDD price. To compare consumption rates by age and sex, we calculated DDD per 100 inhabitants/day. RESULTS: Between 2002 and 2012, consumption of drugs used to treat dementia increased sixfold. During this period, cholinesterase inhibitors accounted for 76.70% of the drugs consumed and memantine, 23.30%. The estimated cost rose by a by a factor of 5.7 over 11 years (or by a factor of 4 taking into account the use of generic drugs). In 2012, 2.42% of the patients aged 65 or over consumed cholinesterase inhibitors (women 2.82%, men 1.83%) and 0.90% consumed memantine (women 1.10%, men 0.61%). Consumption increased in age cohorts up to 86 to 90 (5.84% for cholinesterase inhibitors and 2.33% for memantine) and declined thereafter. CONCLUSIONS: Consumption of cholinesterase inhibitors and memantine gradually increased, but consumption in 2012 did not reach levels equivalent to dementia prevalence figures. Pharmaceutical expenditure restraint measures may temporarily slow the cost increase temporarily but if the same trend of consumption persists, costs will rise.

La evaluación de la organización de un equipo de Atención Primaria a través del modelo European Foundation for Quality Management de Excelencia / Evaluation of the organization of a Primary Care team through the European Foundation for Quality Management excellence model

INTRODUCCIÓN. Las experiencias desarrolladas en el sector sanitario en España, con la aplicación del Modelo European Foundation for Quality Management de Excelencia para la autoevaluación de las diferentes organizaciones, son de gran interés pero parece que están aún lejos su generalización. Las características estructurales de los equipos de Atención Primaria hacen difícil la integración de esta compleja metodología en los mismos. Sin embargo, la filosofía del modelo no debería resultar extraña para evaluar el trabajo desarrollado en cualquier equipo de Atención Primaria que se plantee conseguir y mantener una mejora de sus servicios. En este trabajo se evalúa la organización de un equipo de Atención Primaria aplicando cinco criterios del Modelo European Foundation for Quality Management de excelencia y el proceso para dinamizar la Comisión de Calidad del equipo como grupo de mejora continua. MÉTODOS. Se desarrolla un proceso evaluador estructurado en los siguientes pasos: Formación en Gestión de Calidad Total y Modelo European Foundation for Quality Management; autoevaluación mediante cuestionario adaptado; identificación de puntos fuertes y áreas de mejora; priorización de las mismas; puesta en marcha de equipos de mejora y desarrollo de planes de actuación. Se utilizaron técnicas cualitativas para la búsqueda de consenso cuando fue preciso. RESULTADOS. Se identificaron 45 puntos fuertes y 80 áreas de mejora, de las que fueron seleccionadas 15, principalmente relacionadas con los procesos y las personas. Se abordaron las cinco más prioritarias. CONCLUSIONES. La aplicación del Modelo European Foundation for Quality Management de Excelencia ha resultado una experiencia factible y ha permitido identificar deficiencias e impulsar acciones de mejora de modo más sistemático y estructurado que los sistemas evaluadores rutinarios. El proceso facilitó la puesta en marcha de la Comisión de Calidad

INTRODUCTION. Experiences developed in the health care sector in Spain, with the application of the European Foundation for Quality Management Excellence Model for self-evaluation of the different organizations are of great interest but it seems that they are far from being generalized. The structural characteristics of the Primary Care Teams made it difficult to integrate this complex methodology into it. However, the philosophy of the model should not seem unfamiliar to evaluate the work developed in any Primary Care Team that wants to achieve and maintain an improvement in their services. This work evaluates the organization of a Primary Care Team, applying 5 criteria of the European Foundation for Quality Management Excellence Model and the process to dynamize the Quality Committee of the team as a group of continuous improvement. METHODS. A structured evaluating process is developed in the following steps: Formation of Total Quality Management and European Foundation for Quality Management Model, self-evaluation with adapted questionnaire, identification of strong points and areas of improvement, giving priority to them, initiation of improvement teams and development of action plans. Qualitative techniques for the search of consensus when necessary were used. RESULTS. A total of 45 strong points and 80 areas of improvement were identified. Fifteen of these were selected, mainly related with the processes and persons. The five having the greatest priority were studied. CONCLUSIONS. Application of the European Foundation for Quality Management Excellence Model has been a feasible experience and has made it possible to identify deficiencies and promote improvement actions more systematically and structured than the routine evaluation systems. The process facilitated the initiation of the Quality Committee

¿Cuánto nos cuestan los fármacos desechados? / How much do medicines that are thrown away cost us?

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