Article

Evaluación de la calidad de la asistencia al paciente diabético en América Latina

Revista Panamericana de Salud Pública 01/2001;
Source: DOAJ

ABSTRACT Objetivos. Hacer un diagnóstico preliminar de la calidad de la atención que reciben las personas con diabetes (DM) en centros tributarios de la red QUALIDIAB y analizar el potencial de esta información y la importancia de la expansión de la red en América Latina y el Caribe. Métodos. Se analizaron 13 513 registros provenientes de centros de atención del subsector público y privado de salud y de la Seguridad Social de Argentina, Brasil, Chile, Colombia, Paraguay y Uruguay (red QUALIDIAB). Se utilizaron indicadores de la calidad de la atención basados en valores de referencia internacionales, una planilla de registro de parámetros clínicos, bioquímicos y terapéuticos y de la tasa de uso de elementos diagnósticos y terapéuticos, un programa para cargar los datos y otro para su análisis estadístico. Resultados. La diabetes tenía una duración < 5 años en alrededor de la mitad de las personas con DM de tipo 1 (DM1) y de tipo 2 (DM2) registradas. El 24% de las personas con DM1 y el 15 % con DM2 tenían glucemias < 4,4 mmol/L, mientras que el 41% con DM1 y el 57% con DM2 tenían glucemias > 7,7 mmol/L. La frecuencia de la asociación de la DM2 con otros factores de riesgo cardiovascular (FRCV) fue la siguiente: sobrepeso/obesidad, 59%; hipertensión, 60%; colesterol total > 5,5 mmol/L, 53%; colesterol de las lipoproteínas de alta densidad < 1 mmol/L, 32%; triglicéridos > 1,7 mmol/L, 45%; tabaquismo 13%. El 20% de las personas con DM1 tenían un índice de masa corporal < 19 kg/m² que probablemente refleje un deficiente control metabólico e hipoinsulinización. La verificación sistemática de indicadores del control metabólico y la detección de FRCV y de complicaciones crónicas de la DM fueron deficientes en el 3 al 75% de los casos. Según los indicadores de educación terapéutica, solo la mitad o la cuarta parte de los participantes podrían desempeñar un papel activo y eficaz en el control y tratamiento de su DM. El 50% de las personas con DM1 son tratadas con combinación de insulinas (NPH + corriente), administrada en dos inyecciones diarias en el 43% de los casos. El 5 y el 9% de los pacientes reciben, respectivamente, 1 y > 3 inyecciones diarias de insulina. El 13% de las personas con DM2 tratan su enfermedad solo con dieta y el 14% solo con insulina. Entre los pacientes tratados con fármacos, los hipoglucemiantes orales más utilizados como monoterapia fueron las sulfonilureas (33%), seguidas por las biguanidas (9%) y su administración combinada (14%). Menos de la mitad de las personas con diabetes reciben farmacoterapia para tratar los FRCV asociados. La frecuencia de las complicaciones microangiopáticas y macroangiopáticas aumentó con la antigüedad de la enfermedad, verificándose los incrementos máximos en la insuficiencia renal y en las amputaciones (alrededor de 7 veces) y los menores en la neuropatía periférica (2 veces) y los accidentes cerebrovasculares (1,6 veces). Conclusiones. Estos resultados demuestran la necesidad de mejorar la calidad de la atención a los pacientes diabéticos y que QUALIDIAB puede ser el instrumento idóneo para ello en América Latina y el Caribe. La ampliación de la Red QUALIDIAB contribuirá a establecer un diagnóstico más preciso de la calidad de dicha atención en la Región y facilitará la implementación de intervenciones destinadas a optimizarla, mejorando así la calidad de vida de quienes la padecen y disminuyendo simultáneamente el costo socioeconómico de la enfermedad.

Download full-text

Full-text

Available from: Juan José Gagliardino, Jul 30, 2014
0 Followers
 · 
168 Views
    • "Introduction Type 2 diabetes (T2DM) is a serious public health problem worldwide due to its progressively increasing prevalence and the frequent development of its chronic complications, which increase treatment costs and impose a heavy burden for the patient and society [1] [2] [3] [4]. Although it has been clearly established that the development and progression of such chronic complications can be effectively prevented or delayed through tight glycemic and associated cardiovascular risk factor (CVRF) control [5] [6] [7] [8] [9], many people with diabetes worldwide have poor control and Latin America is no exception [10] [11]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Aim To compare the socioeconomic status (SES) of people with type 2 diabetes (T2DM) in Argentina (Córdoba) with and without major chronic complications of diabetes, with that recorded in persons without diabetes matched by age and gender. Methods For this descriptive and analytic case-control study, potential candidates were identified from the electronic records of one institution of the Social Security System of the city of Córdoba. We identified and recruited 387 persons each with T2DM with or without chronic complications and 774 gender- and age-matched persons without T2DM (recruitment rate, 83%). Data were obtained by telephone interviews and supplemented with data from the institution's records. Group comparisons were performed with parametric or non-parametric tests as appropriate. We used ordinary least squares to regress household income and the difference between income and household expenses on diabetes status, age, sex, education and body mass index. Results Persons with T2DM, particularly those with complications, reported fewer years of general education (13.6 ± 4.2 vs. 12.2 ± 4.4 years), a lower percentage of full time jobs (43.0 vs. 26.9%), lower salaries and monthly household income among those with full-time jobs (> 5,000 ARG$: 52.6 vs. 24.5%), and a higher propensity to spend more money than they earned (expenditure/income ratio ≥ 1: 10.2 vs. 16.0%). The percentage of unmarried people was also higher among people with type 2 diabetes (7.0 vs. 10.9%). Conclusion T2DM and the development of its complications are each positively associated with lower SES and greater economic distress in Argentina.
    Diabetes research and clinical practice 05/2014; 104(2). DOI:10.1016/j.diabres.2014.02.010 · 2.54 Impact Factor
  • Source
    • "In Argentina, the Health Ministry provision of economic incentives to entities of the Social Security subsector that include preventive strategies in their care programs for chronic diseases, play also in favor of this concept. This policy would be particularly important in developing countries, where the expected rise in the prevalence of diseases such as type 2 diabetes will imply an increased demand of care both in the short and long term [11] [18]. As with most simulation studies, our own has some limitations , namely 1) we had no direct information on glycemic selfmonitoring performance; and 2) we assumed a linear efficacy relationship between risk factor reduction and HF prevention, despite many authors have shown the appropriateness of using Weibull distributions and accelerated failure time equations to treat these relationships [7] [19] [20]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To estimate the cost-consequence of interventions to prevent hospitalizations for heart failure (HF) in people with type 2 diabetes. In HF events (63) from type 2 diabetes-related hospitalizations (N = 462) recorded in an Argentine hospital (March 2004-April 2005), we verified 1) the presence of one metabolic HF predictor (glycosylated hemoglobin [HbA1c] value) before hospitalization; and 2) in a simulation model, the resources needed for its prevention controlling such predictor during 6 months before and after the event. Sensitivity analysis of HF risk reduction, hospitalization cost, and cost of different treatments to achieve HbA1c 7% or less was performed with a Monte Carlo simulation (10,000 iterations). HF represented 14% of hospitalizations, with a 44% rehospitalization rate for the same cause. Due to the total estimated cost for an HF hospitalization event was $437.31, the prevention attained using our simulated treatment was $2326.51. The number needed to treat to prevent an HF event under any of the proposed alternatives to reduce HbA1c would be 3.57 (95% confidence interval 2.00-16.67). The additional cost of the simulated treatment versus the real one oscillates between $6423.91 and $8455.68. HbA1c control to reduce the number of HF events would be economically beneficial for health care payers.
    Value in Health 07/2011; 14(5 Suppl 1):S20-3. DOI:10.1016/j.jval.2011.05.018 · 2.89 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Validating an instrument for measuring the perceived quality of services received by people using hospitals forming part of the Colombian Ministry of Social Protection's restructuring, redesigning and modernisation programme for health-service providing networks. Sánchez and Echeverri's guidelines for validating health quality measurement scales were followed due to the lack of a valid instrument for doing this in Colombia. Conceptual synthesis led to identifying a structure of constituent indicators, domains and sub-domains regarding the perception of health service quality. A list of reactions (having a scale for categorising the replies) was analysed according to the validity of appearance, construct, criteria and utility as criteria for sensitivity and usefulness. Successive revisions and three rounds of field-trials led to producing PECASUSS, an acronym given to the instrument for measuring users' perception of health service quality (Percepción de Calidad Según Usuarios de Servicios de Salud). The guidelines effectively orientated the validation of the instrument required for measuring the perceived quality of health services received by people using hospitals forming part of the programme.
    Revista de salud publica (Bogota, Colombia) 10(3):443-51. DOI:10.1590/S0124-00642008000300009
Show more