Angélica Castro-Ríos

Costos de la atención médica atribuibles al consumo de tabaco en el Instituto Mexicano del Seguro Social

OBJETIVO: Cuantificar el efecto de las enfermedades atribuibles al consumo de tabaco, en terminos epidemiologicos (morbilidad) y economicos (costos de atencion medica), en el Instituto Mexicano del Seguro Social (IMSS) a escala nacional. MATERIAL Y METODOS: Los costos de la atencion medica se estimaron desde la perspectiva del proveedor y se empleo la metodologia del costeo de enfermedad. A partir de una muestra de pacientes (n= 1 596) atendidos en las unidades medicas se establecio la frecuencia de utilizacion de servicios en los tres niveles de atencion. Para cada enfermedad se consideraron costos promedio por paciente y costos totales de enfermedad, los cuales se mensuraron en pesos mexicanos de 2004. Se calculo la fraccion atribuible al consumo de tabaco para cada enfermedad, misma que se uso para atribuir los costos al tabaco. RESULTADOS: Los costos totales anuales de atencion medica nacional corresponden a 7 114 millones para el infarto agudo del miocardio, 3 424 millones para la enfermedad vascular cerebral, 1 469 millones para la enfermedad pulmonar obstructiva cronica y 102 millones para el cancer pulmonar. El costo total anual para el IMSS por estas cuatro enfermedades asciende a 12 100 millones de pesos. Los costos atribuibles al consumo de tabaco corresponden a 7 100 millones de pesos, lo cual equivale a 4.3% del gasto de operacion de la institucion en el ano 2004. CONCLUSIONES: Estos resultados confirman el elevado costo de la atencion medica de las enfermedades atribuibles al consumo de tabaco en el IMSS y generan informacion de primera mano necesaria para impulsar las medidas de prevencion en esa institucion y reforzar las politicas de control del tabaquismo ya aplicadas en Mexico.

Socioeconomic factors associated with drug consumption in prison population in Mexico

BackgroundConsumption of illegal drugs is a public health problem in Mexico, and the prison population is a vulnerable group with higher rates of prevalence than in the general population. The objective of this study was to determine the main socioeconomic variables associated with drug consumption in the prison population.MethodsUtilizing data from the Second Incarcerated Population Survey carried out by the Centre of Research and Teaching of Economics (CIDE) in Mexico, a logistic model in two stages was developed. The first stage analyzed the determinants of habitual drug consumption by prisoners (prior to admittance into prisons), while the second stage of the model addressed drug consumption within prisons.ResultsPrevalence of drug consumption previous to incarceration was 28.5%, although once people were imprisoned this figure dropped to 7.4%. The characteristics that most heavily influenced against the possibility of habitual drug consumption prior to admittance to prison were: preparatory school or higher, being employed and having children; while the variables associated negatively were: male gender, childhood home shared with adults who consumed illegal drugs; abandoning childhood home; and having previous prison sentences. Once in prison, the negative conditions in there are associated with drug consumption.ConclusionsWork and study during incarceration, in addition to being instruments for rehabilitation, seem to exert an important positive association against drug consumption. However, this correlation seems to be minimized in the face of negative conditions of the penal institution; thus, public policies are necessary to improve the prisoners environment.

Potential Savings In Mexico From Screening And Prevention For Early Diabetes And Hypertension

This study analyzes the potential economic benefits of identifying and treating patients with so-called prediabetes and prehypertension through the Mexican prevention program known by its Spanish acronym PREVENIMSS. The results show that for each US dollar invested in prevention,

Effectiveness of a medical education intervention to treat hypertension in primary care.

84-

Evaluación de un programa de educación médica continua para la atención primaria en la prescripción de hipoglucémicos

323 would be saved over a twenty-year period. For this and other reasons, providing preventive care for prediabetes and prehypertension patients is better than the current routine care model, in which care is provided in most cases when the disease has progressed substantially. Yet data show that screening and preventive care services are still not being used widely enough in Mexico, are provided too late, or are not sufficiently targeted to the most at-risk individuals. Investing in preventive care for patients with prediabetes and prehypertension is cost saving.

Triggering factors of primary care costs in the years following type 2 diabetes diagnosis in Mexico.

BACKGROUND AND OBJECTIVES In Mexico, hypertension is among the top five causes for visits to primary care clinics; its complications are among the main causes of emergency and hospital care. The present study reports the effectiveness of a continuing medical education (CME) intervention to improve appropriate care for hypertension, on blood pressure control of hypertensive patients in primary care clinics. METHODS A secondary data analysis was carried out using data of hypertensive patients treated by family doctors who participated in the CME intervention. The evaluation was designed as a pre-/post-intervention study with control group in six primary care clinics. The effect of the CME intervention was analysed using multiple logistic regression modelling in which the dependent variable was uncontrolled blood pressure in the post-intervention patient measurement. RESULTS After the CME intervention, the net reduction of uncontrolled blood pressure between stages in the intervention group was 10.3%. The model results were that being treated by a family doctor who participated in the CME intervention reduced by 53% the probability of lack of control of blood pressure; receiving dietary recommendations reduced 57% the probability of uncontrolled blood pressure. Having uncontrolled blood pressure at the baseline stage increased the probability of lack of control in 166%, and per each unit of increase in body mass index the lack of control increased 7%. CONCLUSIONS CME intervention improved the medical decision-making process to manage hypertension, thus increasing the probability of hypertensive patients to have blood pressure under control.

Direct Medical Costs for Partial Refractory Epilepsy in Mexico

OBJECTIVE To evaluate the impact of a continuing medical education program on family doctors to improve prescription of hypoglycemic drugs. MATERIAL AND METHODS An observational study was conducted with two groups of comparison (with-without program) and before-after periods. The unit of analysis was the visit. The period of evaluation comprised six months before and six after implementing the program. The outcome variable was the appropriateness of prescription that was based upon two criteria: appropriate selection and proper indication of the drug. Logistic regression models and the double differences technique were used to analyze the information. Models were adjusted by independent variables related with the patient, the visit and the PCC, the more relevant ones were: sex, obesity, conditions other than diabetes, number of visits in the analyzed period, number of drugs prescribed, size of the PCC and period. RESULTS the program increases 0.6% the probability of appropriate prescription and 11% the probability of appropriate choice of the hypoglycemic drug in obese patients.OBJETIVO: Evaluar el efecto en la prescripcion de hipoglucemicos de un programa de educacion medica continua en unidades de medicina familiar (UMF). MATERIAL Y METODOS: Se realizo un estudio observacional que comparo dos grupos (con y sin programa) con dos cortes transversales (antes y despues). La unidad de analisis fue la consulta. El periodo de analisis comprendio seis meses anteriores y seis posteriores a la institucion del programa. La principal variable de resultado fue la prescripcion adecuada, evaluada mediante dos criterios: eleccion e indicacion correctas. El analisis incluyo modelos de regresion logistica, se aplico la tecnica de dobles diferencias y se ajusto por variables relativas al paciente, la consulta y la UMF; las mas relevantes fueron sexo, obesidad, otras afecciones, numero de consultas, numero de medicamentos, tamano de la clinica, grupo y etapa. RESULTADOS: Se obtuvo un incremento atribuible al programa de 0.6% en la probabilidad de prescripcion adecuada y de 11% en la eleccion correcta en pacientes obesos.

Direct medical costs of neonatal respiratory distress syndrome in two specialized public hospitals in Mexico

BACKGROUND AND AIMS Diabetes represents a high epidemiological and economic burden worldwide. The cost of diabetes care increases slowly during early years, but it accelerates once chronic complications set in. There is evidence that adequate control may delay the onset of complications. Management of diabetes falls almost exclusively into primary care services until chronic complications appear. Therefore, primary care is strategic for reducing the expedited growth of costs. The objective of this study was to identify predictors of primary care costs in patients without complications in the years following diabetes diagnosis. METHODS Direct medical costs for primary care were determined from the perspective of public health services provider. Information was obtained from medical records of 764 patients. Microcosting and average cost techniques were combined. A generalized linear regression model was developed including characteristics of patients and facilities. Primary health care costs for different patient profiles were estimated. RESULTS The mean annual primary care cost was USD

Necesidades de atención social a la salud de los niños y adolescentes con VIH-SIDA: perspectivas del Hospital Infantil de México Federico Gómez

465.1. Gender was the most important predictor followed by weight status, insulin use, respiratoty infections, glycemic control and dyslipidemia. A gap in costs was observed between genders; women make greater use of resources (42.1% on average). Such differences are reduced with obesity (18.1%), overweight (22.8%), respiratory infection (20.8%) and age >80 years (26.8%). Improving glycemic control shows increasing costs but at decreasing rates. CONCLUSIONS Modifiable factors (glycemic control, weight status and comorbidities) drive primary care costs the first 10 years. Those factors had a larger effect in costs for males than in for females.