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1.
Ann Med ; 53(1): 581-586, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-33825598

RESUMO

Although coronavirus disease 2019 (COVID-19) is a pandemic, it has several specificities influencing its outcomes due to the entwinement of several factors, which anthropologists have called "syndemics". Drawing upon Singer and Clair's syndemics model, I focus on synergistic interaction among chronic kidney disease (CKD), diabetes, and COVID-19 in Pakistan. I argue that over 36 million people in Pakistan are standing at a higher risk of contracting COVID-19, developing severe complications, and losing their lives. These two diseases, but several other socio-cultural, economic, and political factors contributing to structured vulnerabilities, would function as confounders. To deal with the critical effects of these syndemics the government needs appropriate policies and their implementation during the pandemic and post-pandemic. To eliminate or at least minimize various vulnerabilities, Pakistan needs drastic changes, especially to overcome (formal) illiteracy, unemployment, poverty, gender difference, and rural and urban difference.


Assuntos
/epidemiologia , Diabetes Mellitus/epidemiologia , Pandemias/prevenção & controle , Insuficiência Renal Crônica/epidemiologia , Sindemia , /prevenção & controle , Mudança Climática/economia , Mudança Climática/estatística & dados numéricos , Fatores de Confusão Epidemiológicos , Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Diabetes Mellitus/economia , Diabetes Mellitus/prevenção & controle , Abastecimento de Alimentos/economia , Abastecimento de Alimentos/estatística & dados numéricos , Letramento em Saúde/economia , Letramento em Saúde/estatística & dados numéricos , Humanos , Paquistão/epidemiologia , Pandemias/economia , Política , Pobreza/economia , Pobreza/estatística & dados numéricos , Insuficiência Renal Crônica/economia , Insuficiência Renal Crônica/prevenção & controle , Desemprego/estatística & dados numéricos
3.
Postgrad Med ; 133(4): 385-387, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33612066

RESUMO

The number of Americans affected by diabetes continues to increase but the number of endocrinologists with specialty training to treat this population has not kept up with demand. Primary care outpatient visits can also not meet the projected diabetes population demands or the needs for other complex diabetes management issues. Treatments for diabetes including both medications and technologies continue to expand and become more complex. In response to these challenges there have been primary care physicians seeking specialized training to become diabetologists. This can fill some of the gaps left by a lack of resources in the U.S. healthcare system.


Assuntos
Diabetes Mellitus/terapia , Educação Médica/organização & administração , Bolsas de Estudo/organização & administração , Atenção Primária à Saúde/organização & administração , Acreditação , Diabetes Mellitus/economia , Bolsas de Estudo/economia , Bolsas de Estudo/normas , Humanos , Atenção Primária à Saúde/economia , Estados Unidos
4.
J Med Internet Res ; 23(1): e20123, 2021 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-33475518

RESUMO

BACKGROUND: The impending scale up of noncommunicable disease screening programs in low- and middle-income countries coupled with limited health resources require that such programs be as accurate as possible at identifying patients at high risk. OBJECTIVE: The aim of this study was to develop machine learning-based risk stratification algorithms for diabetes and hypertension that are tailored for the at-risk population served by community-based screening programs in low-resource settings. METHODS: We trained and tested our models by using data from 2278 patients collected by community health workers through door-to-door and camp-based screenings in the urban slums of Hyderabad, India between July 14, 2015 and April 21, 2018. We determined the best models for predicting short-term (2-month) risk of diabetes and hypertension (a model for diabetes and a model for hypertension) and compared these models to previously developed risk scores from the United States and the United Kingdom by using prediction accuracy as characterized by the area under the receiver operating characteristic curve (AUC) and the number of false negatives. RESULTS: We found that models based on random forest had the highest prediction accuracy for both diseases and were able to outperform the US and UK risk scores in terms of AUC by 35.5% for diabetes (improvement of 0.239 from 0.671 to 0.910) and 13.5% for hypertension (improvement of 0.094 from 0.698 to 0.792). For a fixed screening specificity of 0.9, the random forest model was able to reduce the expected number of false negatives by 620 patients per 1000 screenings for diabetes and 220 patients per 1000 screenings for hypertension. This improvement reduces the cost of incorrect risk stratification by US $1.99 (or 35%) per screening for diabetes and US $1.60 (or 21%) per screening for hypertension. CONCLUSIONS: In the next decade, health systems in many countries are planning to spend significant resources on noncommunicable disease screening programs and our study demonstrates that machine learning models can be leveraged by these programs to effectively utilize limited resources by improving risk stratification.


Assuntos
Diabetes Mellitus/diagnóstico , Hipertensão/diagnóstico , Aprendizado de Máquina/normas , Diabetes Mellitus/economia , Diagnóstico Precoce , Feminino , Humanos , Hipertensão/economia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco
5.
PLoS One ; 16(1): e0245036, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33400703

RESUMO

BACKGROUND: Irrational prescription of drugs can lead to high cost of treatment thus limiting access to essential medicines. We assessed the affordability and appropriateness of prescriptions written for diabetic patients in Eastern Uganda. METHODS: We collected secondary data from the health management information system registers of patients who attended the outpatient medical clinic at Mbale regional referral hospital from January 2019 to December 2019. The average cost of the prescriptions was calculated and adjusted odds ratios for predictors for unaffordability estimated using logistic regression. Computed scores for indicators of rational drug prescription were used to assess the extent of rational prescribing. RESULTS: The median cost per prescription was USD 11.34 (IQR 8.1, 20.2). Majority of the diabetic patients (n = 2462; 94.3%, 95% CI: 93.3-95.1%) could not afford the prescribed drugs. Predictors for unaffordability were if a prescription contained: ≥ 4 medicines (AOR = 12.45; 95% CI: 3.9-39.7); an injectable (AOR = 5.47; 95%CI: 1.47-20.32) and a diagnosis of diabetes mellitus with other comorbidities (AOR = 3.36; 95%CI: 1.95-5.78). Having no antidiabetic drug prescribed was protective for non-affordability (AOR = 0.38; 95%CI: 0.24-0.61). The average number of drugs per prescription was 2.8. The percentage prescription of drugs by generic name and from the essential medicine and health supplies list of Uganda were (6160/7461; 82.6%, 96% CI: 81.7%-83.4%) and (6092/7461; 81.7%, 95% CI: 80.8%-82.5%) respectively against WHO standard of 100%. CONCLUSION: The majority of diabetic patients (94.3%) in Eastern Uganda cannot afford to buy prescribed medicines. The government should therefore ensure that essential medicines are readily accessible in public health facilities.


Assuntos
Custos e Análise de Custo , Diabetes Mellitus/tratamento farmacológico , Medicamentos Essenciais/uso terapêutico , Medicamentos sob Prescrição/uso terapêutico , Estudos Transversais , Diabetes Mellitus/economia , Medicamentos Essenciais/economia , Humanos , Medicamentos sob Prescrição/economia , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Centros de Atenção Terciária , Uganda
6.
PLoS One ; 15(10): e0239844, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33126237

RESUMO

BACKGROUND: This study analyzed factors that affect the financial burden and utilization of medical services of patients with diabetes in a city of China. METHODS: We randomly sampled 10% of the information on the front page of diabetic inpatient medical records in the city from January 2014 to September 2019. Total cost of hospitalization, length of hospitalization and the number of hospitalization were analyzed. Descriptive statistical analysis and multiple linear regression analysis were adopted. RESULTS: Understanding the current financial burden of diabetic patients and the use of medical services, the results show that the direct economic burden of diabetic patients per hospitalization was approximately 8,000 Yuan, and the indirect economic burden was approximately 2,000 Yuan. Age, medical payment methods, admission channels, and medical institution grades are all important factors affecting medical expenses and medical service utilization of diabetic patients. In addition, the inequality of medical service utilization of patients is increased due to different types of medical insurance. CONCLUSIONS: To reduce the economic burden on patients and society, governments should strengthen supervision, the advancement of diagnosis and treatment systems, the service conditions of primary medical institutions, the management of medical services, and the use of medical resources. To create a more impartial medical and health environment where the value of medical staff are truly reflected, financial investments should be attained to improve medical technologies and labor costs.


Assuntos
Efeitos Psicossociais da Doença , Diabetes Mellitus/economia , Utilização de Instalações e Serviços/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Diabetes Mellitus/epidemiologia , Feminino , Disparidades em Assistência à Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
7.
Nihon Koshu Eisei Zasshi ; 67(8): 501-508, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32879236

RESUMO

Objectives Medical expenses for diabetes differ between Japan's 47 prefectures. The medical care expenditure regulation plan aims to reduce regional differences in outpatient medical costs through prevention of severe diabetes, promotion of specific health checkups and specific health guidance, promotion of generic drugs, and proper use of medicines. To achieve this goal, we need to conduct an in-depth analysis of inter-prefecture differences in diabetes care expenses. This study analyzed regional differences in prescription fees for dipeptidyl peptidase-4 (DPP-4) inhibitors and the use of generic sulfonylureas (SUs), glinides, biguanides, α-glucosidase inhibitors (α-GIs), and thiazoline derivatives, using the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Furthermore, we analyzed regional differences in consultancy fees for dialysis prevention.Methods We analyzed the 2nd NDB Open Data Japan website of the Ministry of Health, Labor, and Welfare. Pearson's correlation coefficient (r) was used to evaluate the relationship between the medical costs of diabetes and each factor. The correlation coefficient was analyzed with Student's t-test, and a P-value<0.05 was considered statistically significant.Results Regarding oral hypoglycemic drugs, prefectures with a large number of DPP-4 inhibitors tended to have higher medical costs of diabetes (r=0.40, P=0.0048). Furthermore, such expenses tended to be low in prefectures where the use of generic SU drugs was high (r=-0.43, P=0.0023).Conclusions In conclusion, the results revealed regional differences in the use of DPP-4 inhibitors and generic SU drugs, which may contribute to the regional differences in medical expenses for diabetes. This study suggests that NDB open data are useful for policy making to reduce regional differences in outpatient medical costs of diabetes.


Assuntos
Serviços de Saúde Comunitária/economia , Efeitos Psicossociais da Doença , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/economia , Inibidores Enzimáticos/administração & dosagem , Inibidores Enzimáticos/economia , Custos de Cuidados de Saúde , Hipoglicemiantes/administração & dosagem , Hipoglicemiantes/economia , Compostos de Sulfonilureia/administração & dosagem , Compostos de Sulfonilureia/economia , Análise de Dados , Diabetes Mellitus/prevenção & controle , Dipeptidil Peptidase 4 , Humanos , Japão , Honorários por Prescrição de Medicamentos , Encaminhamento e Consulta/economia
8.
Public Health ; 185: 167-173, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32634608

RESUMO

OBJECTIVE: With the continuing rise in the global incidence of diabetes, the prevention of diabetes and control of associated medical expenses has become a public health issue worldwide. This study aims to identify the medical expenses of patients with diabetes in different regions of China and examine the differences in inpatient medical expenses and the impacts of them on these patients. STUDY DESIGN: This study is a longitudinal analysis of medical expenses for inpatients with diabetes for different years; horizontal analysis of medical expenses among different regions; and literature review. METHODS: Data were derived from China's Medical Insurance Department database. We selected inpatients with diabetes in the eastern, central, and western regions of China for the period 2013-2015 and randomly selected data through systematic sampling. RESULTS: Among the 4150 patients with diabetes considered in this study, the patients' medical expenses were found to differ significantly across regions, years, ages, medical insurance types, medical institution levels, total medical expenses, medical insurance fund payments, and out-of-pocket (OOP) expenses. In addition, there were significant differences in total medical expenses for male and female patients. Furthermore, medical insurance type, patients' age, medical institution level, and year significantly influenced total medical expenses. CONCLUSIONS: Inpatients with diabetes in different regions exhibited significant differences in total medical expenses, medical insurance fund payments, and OOP expenses. China should invest more in chronic disease treatment in its central and western regions, narrow the regional differences in medical expenses, and endeavor to ensure equity in the availability and cost of medical services. Moreover, patients with diabetes must be encouraged to access primary care to reduce their medical expenses.


Assuntos
Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Gastos em Saúde , Pacientes Internados , Adulto , Idoso , China/epidemiologia , Diabetes Mellitus/prevenção & controle , Feminino , Humanos , Incidência , Seguro Saúde , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Literatura de Revisão como Assunto , Adulto Jovem
9.
Diabetes Metab Syndr ; 14(5): 731-732, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32473905

RESUMO

BACKGROUND AND AIMS: Diabetes mellitus (DM) is one of the most critical risk factors for complications and death in COVID-19 patients. The present study aims to highlight challenges in the management of diabetic patients during the COVID-19 outbreak in developing countries. METHODS: We reviewed the literature to obtain information about diabetic care during the Covid-19 crisis. We also seek opinions of clinicians working in undeveloped countries. RESULTS: Current challenges faced by clinicians in the management of diabetic patients in developing countries are as follows: lack of preventive measures, inadequate number of visits, loss of the traditional method of communication with the patient, shortage of medications, impaired routine diabetic care, and absence of telehealth services. CONCLUSIONS: Developing countries are faced with many challenges in diabetes management due to a lack of resources.


Assuntos
Infecções por Coronavirus/epidemiologia , Países em Desenvolvimento , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Pneumonia Viral/epidemiologia , Assistência Ambulatorial/economia , Assistência Ambulatorial/normas , Assistência Ambulatorial/estatística & dados numéricos , Betacoronavirus/fisiologia , Infecções por Coronavirus/complicações , Países em Desenvolvimento/economia , Países em Desenvolvimento/estatística & dados numéricos , Diabetes Mellitus/economia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Incidência , Pandemias , Pneumonia Viral/complicações , Fatores de Risco , Telemedicina/economia , Telemedicina/métodos
10.
Med Care ; 58 Suppl 6 Suppl 1: S4-S13, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32412948

RESUMO

BACKGROUND: High deductible health plans linked to Health Savings Accounts (HSA-HDHPs) must include all care under the deductible except for select preventive services. Some employers and insurers have adopted Preventive Drug Lists (PDLs) that exempt specific classes of medications from deductibles. OBJECTIVE: The objective of this study was to examine the association between shifts to PDL coverage and medication utilization among patients with diabetes in HSA-HDHPs. RESEARCH DESIGN: A natural experiment comparing pre-post changes in monthly and annual outcomes in matched study groups. SUBJECTS: The intervention group included 1744 commercially-insured HSA-HDHP patients with diabetes age 12-64 years switched by employers to PDL coverage; the control group included 3349 propensity-matched HSA-HDHP patients whose employers offered no PDL. MEASURES: Outcomes were out-of-pocket (OOP) costs for medications and the number of pharmacy fills converted to 30-day equivalents. RESULTS: Transition to the PDL was associated with a relative pre-post decrease of $612 (-35%, P<0.001) per member OOP medication expenditures; OOP reductions were higher for key classes of antidiabetic and cardiovascular medicines listed on the PDL; the policy did not affect unlisted classes. The PDL group experienced relative increases in medication use of 6.0 30-day fills per person during the year (+11.2%, P<0.001); the increase was more than twice as large for lower-income (+6.6 fills, +12.6%, P<0.001) than higher-income (+3.0 fills, +5.1%, P=0.024) patients. CONCLUSION: Transition to a PDL which covers important classes of medication to manage diabetes and cardiovascular conditions is associated with substantial annual OOP cost savings for patients with diabetes and increased utilization of important classes of medications, especially for lower-income patients.


Assuntos
Custo Compartilhado de Seguro/métodos , Dedutíveis e Cosseguros , Hipoglicemiantes/economia , Poupança para Cobertura de Despesas Médicas , Pobreza/estatística & dados numéricos , Adolescente , Adulto , Criança , Diabetes Mellitus/economia , Diabetes Mellitus/prevenção & controle , Feminino , Financiamento Pessoal/economia , Financiamento Pessoal/estatística & dados numéricos , Humanos , Hipoglicemiantes/uso terapêutico , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pobreza/economia , Adulto Jovem
11.
Med Care ; 58 Suppl 6 Suppl 1: S14-S21, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32412949

RESUMO

BACKGROUND: Medical, behavioral, and social determinants of health are each associated with high levels of emergency department (ED) visits and hospitalizations. OBJECTIVE: The objective of this study was to evaluate a care coordination program designed to provide combined "whole-person care," integrating medical, behavioral, and social support for high-cost, high-need Medicaid beneficiaries by targeting access barriers and social determinants. RESEARCH DESIGN: Individual-level interrupted time series with a comparator group, using person-month as the unit of analysis. SUBJECTS: A total of 42,214 UnitedHealthcare Medicaid beneficiaries (194,834 person-months) age 21 years or above with diabetes, with Temporary Assistance to Needy Families, Medicaid expansion, Supplemental Security Income without Medicare, or dual Medicaid/Medicare. MEASURES: Our outcome measures were any hospitalizations and any ED visits in a given month. Covariates of interest included an indicator for intervention versus comparator group and indicator and spline variables measuring changes in an outcome's time trend after program enrollment. RESULTS: Overall, 6 of the 8 examined comparisons were not statistically significant. Among Supplemental Security Income beneficiaries, we observed a larger projected decrease in ED visit risk among the intervention sample versus the comparator sample at 12 months postenrollment (difference-in-difference: -6.6%; 95% confidence interval: -11.2%, -2.1%). Among expansion beneficiaries, we observed a greater decrease in hospitalization risk among the intervention sample versus the comparator sample at 12 months postenrollment (difference-in-difference: -5.8%; 95% confidence interval: -11.4%, -0.2%). CONCLUSION: A care coordination program designed to reduce utilization among high-cost, high-need Medicaid beneficiaries was associated with fewer ED visits and hospitalizations for patients with diabetes in selected Medicaid programs but not others.


Assuntos
Diabetes Mellitus/economia , Medicaid/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Diabetes Mellitus/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Medicaid/economia , Medicaid/organização & administração , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
12.
Med Care ; 58 Suppl 6 Suppl 1: S40-S45, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32412952

RESUMO

BACKGROUND/OBJECTIVES: Medicaid beneficiaries with diabetes have complex care needs. The Accountable Care Communities (ACC) Program is a practice-level intervention implemented by UnitedHealthcare to improve care for Medicaid beneficiaries. We examined changes in costs and utilization for Medicaid beneficiaries with diabetes assigned to ACC versus usual care practices. RESEARCH DESIGN: Interrupted time series with concurrent control group analysis, at the person-month level. The ACC was implemented in 14 states, and we selected comparison non-ACC practices from those states to control for state-level variation in Medicaid program. We adjusted the models for age, sex, race/ethnicity, comorbidities, seasonality, and state-by-year fixed effects. We examined the difference between ACC and non-ACC practices in changes in the time trends of expenditures and hospital and emergency room utilization, for the 4 largest categories of Medicaid eligibility [Temporary Assistance to Needy Families, Supplemental Security Income (without Medicare), Expansion, Dual-Eligible]. SUBJECTS/MEASURES: Eligibility and claims data from Medicaid adults with diabetes from 14 states between 2010 and 2016, before and after ACC implementation. RESULTS: Analyses included 1,200,460 person-months from 66,450 Medicaid patients with diabetes. ACC implementation was not associated with significant changes in outcome time trends, relative to comparators, for all Medicaid categories. CONCLUSIONS: Medicaid patients assigned to ACC practices had no changes in cost or utilization over 3 years of follow-up, compared with patients assigned to non-ACC practices. The ACC program may not reduce costs or utilization for Medicaid patients with diabetes.


Assuntos
Organizações de Assistência Responsáveis/estatística & dados numéricos , Diabetes Mellitus/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Organizações de Assistência Responsáveis/economia , Adulto , Idoso , Diabetes Mellitus/terapia , Feminino , Humanos , Masculino , Medicaid/economia , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
13.
Med Care ; 58(8): 681-688, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32265355

RESUMO

OBJECTIVE: The objective of this study was to compare health care utilization and costs among diabetes patients with physician, nurse practitioner (NP), or physician assistant (PA) primary care providers (PCPs). RESEARCH DESIGN AND METHODS: Cohort study using Veterans Affairs (VA) electronic health record data to examine the relationship between PCP type and utilization and costs over 1 year in 368,481 adult, diabetes patients. Relationship between PCP type and utilization and costs in 2013 was examined with extensive adjustment for patient and facility characteristics. Emergency department and outpatient analyses used negative binomial models; hospitalizations used logistic regression. Costs were analyzed using generalized linear models. RESULTS: PCPs were physicians, NPs, and PAs for 74.9% (n=276,009), 18.2% (n=67,120), and 6.9% (n=25,352) of patients respectively. Patients of NPs and PAs have lower odds of inpatient admission [odds ratio for NP vs. physician 0.90, 95% confidence interval (CI)=0.87-0.93; PA vs. physician 0.92, 95% CI=0.87-0.97], and lower emergency department use (0.67 visits on average for physicians, 95% CI=0.65-0.68; 0.60 for NPs, 95% CI=0.58-0.63; 0.59 for PAs, 95% CI=0.56-0.63). This translates into NPs and PAs having ~$500-$700 less health care costs per patient per year (P<0.0001). CONCLUSIONS: Expanded use of NPs and PAs in the PCP role for some patients may be associated with notable cost savings. In our cohort, substituting care patterns and creating similar clinical situations in which they practice, NPs and PAs may have reduced costs of care by up to 150-190 million dollars in 2013.


Assuntos
Diabetes Mellitus/economia , Pessoal de Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Diabetes Mellitus/psicologia , Feminino , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Profissionais de Enfermagem/economia , Profissionais de Enfermagem/normas , Profissionais de Enfermagem/estatística & dados numéricos , Assistentes Médicos/economia , Assistentes Médicos/normas , Assistentes Médicos/estatística & dados numéricos , Médicos/economia , Médicos/normas , Médicos/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Estados Unidos , United States Department of Veterans Affairs/economia , United States Department of Veterans Affairs/organização & administração , United States Department of Veterans Affairs/estatística & dados numéricos
14.
Acta Orthop Traumatol Turc ; 54(2): 127-131, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32254026

RESUMO

OBJECTIVE: The aim of this study was to determine the role of new inflammatory markers, including the platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR), in the prediction of length and cost of hospital stay in patients with infected diabetic foot ulcers (DFUs). METHODS: A total of 78 patients with DFUs who were admitted to our endocrinology clinic between January 2016 and July 2017 were included. Patients were then divided into three groups according to the Wagner DFU classification system: group 1: 18 patients with grade 2 DFU (11 men, 7 women; mean age = 57.5±7 years); group 2: 44 patients with grade 3 DFU (18 men, 26 women; mean age = 59.7±8.7 years); and group 3: 16 patients with grade 4 DFU (10 men, 6 women; mean age = 59.9±11.6 years). Laboratory findings were retrospectively obtained from hospital records; the PLR and NLR were calculated in all groups. Length and cost of hospital stay were recorded. Hospital costs were estimated in Turkish Lira (TL) based on the evaluation of glucose regulation, wound care, and antibiotic treatment. RESULTS: The mean NLR was significantly lower in group 1 (2.8±0.9) than in group 2 (6.0±5.2; p=0.017) and group 3 (6.9±5.3; p=0.011). The mean PLR was significantly lower in group 1 (140.8±42.6) than in group 3 (222.1±95.5; p=0.006). The mean length of stay was 7.9±2.7 days in group 1, 15.0±8.9 days in group 2, and 12.5±8.9 days in group 3. The mean cost was 1,310.8±500 TL in group 1, 2,966.9±2105 TL in group 2, and 3,488.1±3603.1 TL in group 3. Length and cost of stay were both significantly lower in group 1 than in groups 2 and 3 (p=0.011 and p=0.002, respectively). Comparative results showed that the length and cost of hospital stay increased with increasing severity of DFUs. Furthermore, correlation analyses demonstrated no correlation of length of stay with PLR and NLR but an obvious correlation between cost of stay and PLR (r=0.412; p<0.001). Additionally, there was no correlation between cost of stay and NLR (r=0.158, p>0.05). CONCLUSION: The PLR is inflammatory marker that can be measured by an inexpensive and easily accessible test and can aid in the prediction of length and cost of hospital stay in patients with DFUs. LEVEL OF EVIDENCE: Level III, Therapeutic study.


Assuntos
Pé Diabético , Tempo de Internação/economia , Contagem de Leucócitos/métodos , Contagem de Plaquetas/métodos , Biomarcadores/sangue , Diabetes Mellitus/economia , Pé Diabético/sangue , Pé Diabético/economia , Pé Diabético/terapia , Feminino , Humanos , Inflamação/sangue , Tempo de Internação/estatística & dados numéricos , Linfócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Estudos Retrospectivos , Turquia
15.
Horm Metab Res ; 52(3): 149-157, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32215886

RESUMO

The objective of this scoping review was to create an up-to-date descriptive overview of published Disease-Management-Program evaluations conducted within Europe. We also assessed the methodological quality of the evaluation and the comparability of the included studies. The Databases Pub Med via Medline and Embase via Ovid were searched for thematically fitting publications. Out of 649 initial titles and abstracts, 45 full-texts were screened for inclusions. Finally, 21 publications met all inclusion criteria. DMPs from Germany, Austria, Italy, the Netherlands and Great Britain were included. The results are tabulated in the results section and discussed descriptively. Due to the heterogeneity of the included studies and the application of sometimes potentially biased study design comparisons were difficult. A uniform European-wide evaluation strategy and common quality features would be desirable.


Assuntos
Diabetes Mellitus/terapia , Gerenciamento Clínico , Análise Custo-Benefício , Diabetes Mellitus/economia , Europa (Continente) , Humanos
16.
Diabetes Res Clin Pract ; 162: 108072, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32061820

RESUMO

AIMS: Diabetes and its complications have a significant economic impact on individuals and their families, health systems and national economies. METHODS: The direct health expenditure of diabetes was calculated relying on the following inputs: diagnosed and undiagnosed diabetes prevalence estimates, United Nations population estimates, World Health Organization health expenditure per capita and ratios of health expenditure for people with diabetes compared to people without diabetes. RESULTS: The estimated global direct health expenditure on diabetes in 2019 is USD 760 billion and is expected to grow to a projected USD 825 billion by 2030 and USD 845 billion by 2045. There is a wide variation in annual health expenditures on diabetes. The United States of America has the highest estimated expenditure with USD 294.6 billion, followed by China and Brazil, with USD 109.0 billion and USD 52.3 billion, respectively. The age group with the largest annual diabetes-related health expenditure is 60-69 years with USD 177.7 billion, followed by 50-59 years, and 70-79 years with USD 173.0 billion and USD 171.5 billion, respectively. Slightly higher diabetes-related health expenditure is seen in women than in men (USD 382.6 billion vs. USD 377.6 billion, respectively). The same difference is expected to be present in 2030 and 2045. CONCLUSIONS: There were large disparities between high-, middle- and low-income countries with total health expenditures in high-income countries being over 300 times those in low-income countries. The ratio for annual direct health expenditure per person between these groups of countries is more than 38-fold.


Assuntos
Diabetes Mellitus/economia , Saúde Global , Gastos em Saúde/normas , Adulto , Idoso , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
Circ Cardiovasc Qual Outcomes ; 13(2): e006139, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32069093

RESUMO

BACKGROUND: The trend of increasing total and out-of-pocket expenditure among patients with diabetes mellitus represents a risk of financial hardship for Americans and a threat to medical and nonmedical needs. We aimed to describe the national scope and associated tradeoffs of financial hardship from medical bills among nonelderly individuals with diabetes mellitus. METHODS AND RESULTS: We used the National Health Interview Survey data from 2013 to 2017, including adults ≤64 years old with a self-reported diagnosis of diabetes mellitus. Among 164 696 surveyed individuals, 8967 adults ≤64 years old reported having diabetes mellitus, representing 13.1 million individuals annually across the United States. The mean age was 51.6 years (SD 10.3), and 49.1% were female. A total of 41.1% were part of families that reported having financial hardship from medical bills, with 15.6% reporting an inability to pay medical bills at all. In multivariate analyses, individuals who lacked insurance, were non-Hispanic black, had low income, or had high-comorbidity burden were at higher odds of being in families with financial hardship from medical bills. When comparing the graded categories of financial hardship, there was a stepwise increase in the prevalence of high financial distress, food insecurity, cost-related nonadherence, and foregone/delayed medical care, reaching 70.5%, 49.4%, 49.5%, and 74% among those unable to pay bills, respectively. Compared with those without diabetes mellitus, individuals with diabetes mellitus had higher odds of financial hardship from medical bills (adjusted odds ratio [aOR], 1.27 [95% CI, 1.18-1.36]) or any of its consequences, including high financial distress (aOR, 1.14 [95% CI, 1.05-1.24]), food insecurity (aOR, 1.27 [95% CI, 1.16-1.40]), cost-related medication nonadherence (aOR, 1.43 [95% CI, 1.30-1.57]), and foregone/delayed medical care (aOR, 1.30 [95% CI, 1.20-1.40]). CONCLUSIONS: Nonelderly patients with diabetes mellitus have a high prevalence of financial hardship from medical bills, with deleterious consequences.


Assuntos
Efeitos Psicossociais da Doença , Diabetes Mellitus/economia , Diabetes Mellitus/terapia , Financiamento Pessoal/economia , Custos de Cuidados de Saúde , Gastos em Saúde , Acesso aos Serviços de Saúde/economia , Adolescente , Adulto , Afro-Americanos , Fatores Etários , Comorbidade , Estudos Transversais , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/etnologia , Feminino , Abastecimento de Alimentos/economia , Pesquisas sobre Serviços de Saúde , Humanos , Renda , Masculino , Pessoas sem Cobertura de Seguro de Saúde , Pessoa de Meia-Idade , Cooperação do Paciente , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
19.
Clín. investig. arterioscler. (Ed. impr.) ; 32(1): 15-26, ene.-feb. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-187003

RESUMO

Introducción: Los objetivos del estudio fueron determinar las tasas de prevalencia brutas y ajustadas por edad y sexo de diabetes mellitus (DM), DM tipo 1 (DM1) y DM tipo 2 (DM2), y comparar la asociación de factores de riesgo cardiovascular, enfermedades cardiovasculares, enfermedad renal crónica y enfermedades metabólicas entre las poblaciones con y sin DM. Métodos: SIMETAP-DM es un estudio observacional transversal realizado en atención primaria, con una muestra aleatoria de base poblacional de 10.579 adultos. Tasa de respuesta: 66%. Los diagnósticos de DM, DM1 y DM2 se basaron en criterios clínicos y bioquímicos y/o en la comprobación de estos diagnósticos en las historias clínicas. Se determinaron las prevalencias brutas y ajustadas por edad y sexo (estandarizadas con la población española). Resultados: Las prevalencias brutas de DM1, DM2 y DM fueron del 0,87% (intervalo de confianza al 95% [IC 95%]: 0,67-1,13), el 14,7% (IC 95%: 13,9-15,6) y el 15,6% (IC 95%: 14,7-16,5), respectivamente. Las prevalencias ajustadas por edad y sexo de DM1, DM2 y DM fueron del 1,0% (1,3% para hombres y 0,7% para mujeres), el 11,5% (13,6% para hombres y 9,7% para mujeres) y el 12,5% (14,9% para hombres y 10,5% para mujeres), respectivamente. La prevalencia de DM en la población ≥ 70 años era el doble (30,3% [IC 95%: 28,0-32,7]) que en la población entre 40 y 69 años (15,3% [IC 95%: 14,1-16,5%]). La hipertensión arterial, la enfermedad arterial periférica, el índice cintura-talla aumentado, la albuminuria, la enfermedad coronaria, la dislipidemia aterogénica y la hipercolesterolemia se asociaban con la DM. Conclusiones: En el ámbito de la atención primaria española, las prevalencias ajustadas por edad de DM1, DM2 y DM en la población adulta fueron del 1,0, el 11,5 y el 12,5%, respectivamente. Un tercio de la población mayor de 70 años padecía DM


Introduction: The aims of this study were to determine the age- and sex-adjusted prevalence rates of DM, type-1 DM (T1DM), and type-2 DM (T2DM), and to compare the relationship with cardiovascular risk factors, cardiovascular diseases, chronic kidney disease, and metabolic diseases between populations with and without DM. Methods: SIMETAP-DM is a cross-sectional observational study conducted in a Primary Care setting with a random population-based sample of 10,579 adults. Response rate: 66%. The diagnoses of DM, T1DM and T2DM were based on clinical and biochemical criteria and/or the checking of these diagnoses in the medical records. The crude and age- and sex-adjusted (standardised for Spanish population) prevalence rates were calculated. Results: The crude prevalence rates of T1DM, T2DM, and DM were 0.87% (95% confidence interval [95% CI]: 0.67-1.13), 14.7% (95% CI: 13.9-15.6), and 15.6% (95% CI: 14.7-16.5), respectively. The age- and sex-adjusted prevalence rates of T1DM, T2DM, and DM were 1.0% (1.3% for men and 0.7% for women), 11.5% (13.6% for men and 9.7% for women), and 12.5% (14.9% for men and 10.5% for women), respectively. The prevalence of DM in the population ≥ 70 years was double (30.3% [95% CI: 28.0-32.7]) that of the population between 40 and 69 years (15.3% [95% CI: 14.1-16.5]). Hypertension, peripheral arterial disease, increased waist-to-height ratio, albuminuria, coronary heart disease, atherogenic dyslipidaemia and hypercholesterolaemia were associated with DM. Conclusions: In a Spanish primary care setting, the age-adjusted prevalences of T1DM, T2DM and DM in the adult population were 1.0, 11.5, and 12.5%, respectively. One-third (33%) of the population over 70 years had DM


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Diabetes Mellitus/epidemiologia , Atenção Primária à Saúde , Fatores de Risco , Doenças Cardiovasculares/complicações , Espanha/epidemiologia , Doenças Cardiovasculares/epidemiologia , Doenças Metabólicas/epidemiologia , Nefropatias/epidemiologia , Estudos Transversais , Hipertensão/complicações , Diabetes Mellitus/economia , Diabetes Mellitus/classificação , Razão de Chances , Análise Multivariada
20.
BMC Public Health ; 20(1): 24, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914972

RESUMO

BACKGROUND: Increasing medicines availability and affordability is a key goal of Brazilian health policies. "Farmácia Popular" (FP) Program is one of the government's key strategies to achieve this goal. Under FP, antihypertension (HTN) and antiglycemic (DM) medicines have been provided at subsidized prices in private retail settings since 2006, and free of charge since 2011. We aim to assess the impact of sequential changes in FP benefits on patient affordability and government expenditures for HTN and DM treatment under the FP, and examine their implications for public financing mechanisms and program sustainability. METHODS: Longitudinal, retrospective study using interrupted time series to analyze: HTN and DM treatment coverage; total and per capita expenditure; percentage paid by MoH; and patient cost sharing. Analyzes were conducted in the dispensing database of the FP program (from 2006 to 2012). RESULTS: FP has increased its coverage over time; by December 2012 FP covered on average 13% of DM and 11.5% of HTN utilization, a growth of over 600 and 1500%, respectively. The overall cost per treatment to the MoH declined from R$36.43 (R$ = reais, the Brazilian currency) to 18.74 for HTN and from R$33.07to R$15.05 for DM over the period analyzed, representing a reduction in per capita cost greater than 50%. The amount paid by patients for the medicines covered increased over time until 2011, but then declined to zero. We estimate that to treat all patients in need for HTN and DM in 2012 under FP, the Government would need to expend 97% of the total medicines budget. CONCLUSIONS: FP rapidly increased its coverage in terms of both program reach and proportion of cost subsidized during the period analyzed. Costs of individual HTN and DM treatments in FP were reduced after 2011 for both patients (free) and government (better negotiated prices). However, overall FP expenditures by MoH increased due to markedly increased utilization. The FP is sustainable as a complementary policy but cannot feasibly substitute for the distribution of medicines by the SUS.


Assuntos
Custos e Análise de Custo/estatística & dados numéricos , Diabetes Mellitus/economia , Diabetes Mellitus/terapia , Financiamento Governamental/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Hipertensão/economia , Hipertensão/terapia , Adulto , Idoso , Brasil , Custo Compartilhado de Seguro/estatística & dados numéricos , Feminino , Programas Governamentais , Humanos , Análise de Séries Temporais Interrompida , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos
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