[Improve of efficiency of patients management admitted in an Intermediate Respiratory Care Unit by means of an integrated delivery of health care]. / Mejora en la eficiencia del manejo del paciente ingresado en una unidad de cuidados respiratorios intermedios tras la introducción de un proceso asistencial integrado.

INTRODUCTION: Patients admitted to Intermediate Respiratory Care Units are common sharpeners. We describe their overall improvement by the introduction of an Integrated Care Process. METHODS: We conducted an observational descriptive study based on an Intermediate Respiratory Care Unit during 2015-2017. We considered 2 groups: those in-patients during 2016-2017, who took profit from the Integrated Care Process (group A), and those other ones admitted before 2015 when the Integrated Care Process didn't exist yet (group B). We collected sociodemographic variables, clinical ones, those related to care process and economic index. We described them according their type and distribution. RESULTS: The readmission rate within B was 23.65% vs 10.20% within A. These last ones had a mean length of hospital stay of 7.19 days (0.12-14.08), a rate reduction of face-to-face specialized consultations of 45.8% and 28.8% at Emergency Department admissions when compared to B. Prior to the introduction of the Integrated Care Process, 64.9% would have been admitted to the Intensive Care Unit (according to Global Diagnostics Group). We saved 735.1 days of stay at the Intensive Care Unit and therefore over 135,118.204 and 214,649 euros. CONCLUSION: The Integrated Care Process for severe respiratory patients allows a direct and safe relationship with them at home through the Primary Care Teams, so we can save readmissions at hospital, face-to-face consultations at the Emergency Departments and Specialized Consultations and we save money.

Drug Cost Avoidance in Prostate Cancer Clinical Trials.

OBJECTIVES: Economic impact of prostate cancer is increasing in relation to its increased incidence and increased patient survival. Clinical trials are essential to evaluate the efficacy and safety of new treatments but may also result in economic benefits by avoiding the cost of the drug. Our objective is to determine the avoided cost in investigational drugs in clinical trials of prostate cancer conducted in a period of 18 years in a tertiary center. MATERIAL AND METHODS: We carried out an observational of prevalence study with retrospective collected data of clinical trials involving currently marketed drugs and cost avoidance during the study period (1996-2013) was calculated. RESULTS: We include in this review five clinical trials on prostate cancer that met selection criteria of 18 performed. All of them were phase III, multicenter, international and with current marketed drugs. 136 patients were included. Total cost avoidance of 696,002€ and an average cost avoidance by clinical trial of 139,200€ were obtained. Average cost avoidance per patient was 5,118€. CONCLUSION: Cost avoidance in investigational drugs is a tangible benefit of clinical trials, whose realization is a source of economic benefits for the hospital, not only by directly generated by each trial. Clinical trials are an exceptional framework for progress in clinical research and real savings for the health system.