Rafael Manzanera

Evaluación de la gestión de los casos de incapacidad temporal por contingencia común de más de 15 días en Cataluña

OBJECTIVES To compare the length of nonwork-related sick leave among cases managed by an insurance company versus those managed by the National Institute of Social Security (NISS). METHODS We performed a retrospective cohort study of 289,686 cases of sick leave lasting for more than 15 days that began in 2005 after certification by a primary care physician in Catalonia, were reported to the Catalonian Institute of Medical Evaluations, and were followed to term. Of the total, 156,676 cases were managed by the NISS. To account for repeat episodes (approximately 25% of the total), the Wang-Chang estimator was used to calculate the median duration and percentiles; comparisons were made using log-logistic regression with shared gamma frailty models, with calculation of time ratios (TR) and their corresponding 95% confidence intervals (95% CI). RESULTS The median duration of sick leave was 43 days for cases managed by the NISS and 39 days for those managed by the insurance company. This difference was statistically significant both for men employed under contract (TR=0.87; 95% CI: 0.85-0.88) and for those who were self-employed (TR=0.78; 95% CI: 0.75-0.80) as well as for women under contract (TR=0.85; 95% CI: 0.84-0.87) and self-employed women (TR=0.84; 95% CI: 0.81-0.88). These differences persisted after adjustment was performed for age and health region. CONCLUSIONS For sick leave lasting more than 15 days, these results confirm that cases managed by an insurance company ended earlier than for those managed by the NISS, both for contract and self-employed workers. Further research is needed to explore the reasons for these differences.

Afrontar los estragos de la heroína: evaluación de diez años de un programa integral en Barcelona

Resumen Introduccion La epidemia de consumo de heroina se inicio en Barcelona, como en el conjunto de Espana, a finales de los anos 70, para alcanzar probablemente su maxima expresion a finales de los 80. En una primera etapa los responsables del problema apreciaron dificultades para llegar a una definicion clara de objetivos, aunque posteriormente se alcanzo un consenso amplio que permitio la formulacion de planes de accion con objetivos explicitos. Este trabajo revisa los efectos de la adopcion de una politica explicita y consensuada hacia las drogodependencias por el Ayuntamiento de Barcelona. Sujetos y metodos Se analiza la oferta y utilizacion de servicios asistenciales y de limitacion de danos, y la evolucion de las complicaciones asociadas al consumo, como son la mortalidad por reaccion adversa aguda, la incidencia de la infeccion por el virus de la inmunodeficiencia humana (VIH) y del sida, y la incidencia de enfermedad tuberculosa a lo largo de 12 anos, entre 1986 y 1997. Se compara la situacion en cuatro momentos a lo largo del periodo. El estudio se restringe a los residentes en la ciudad. Resultados Pese a las lagunas de informacion existentes en los periodos iniciales, se aprecian cambios relevantes. La oferta de tratamiento se modifica de forma clara, con incrementos significativos de los inicios de tratamiento, la tasa de usuarios cubiertos por programas de mantenimiento con metadona, y en la media de jeringas esteriles distribuidas. Mejoran tanto el cumplimiento terapeutico de los usuarios de drogas por via parenteral (UDVP) con tuberculosis como su riesgo de infeccion por el VIH. Respecto a los servicios de urgencia, disminuye su uso asociado a la heroina, por sobredosis, o por sindrome de abstinencia. La tasa de mortalidad por sobredosis disminuye desde el tercer trienio, aunque sin alcanzar diferencias estadisticamente significativas. Discusion Los datos de oferta asistencial, reflejados en los inicios de tratamiento y los diversos servicios de reduccion de riesgos, muestran un claro incremento de la oferta, con un cambio de perfil. Por otra parte, con el desarrollo de esta respuesta asistencial se modifican tanto los indicadores que muestran los estragos de la epidemia de opiaceos en complicaciones infecciosas (casos de tuberculosis y sida en UDVP e infeccion por VIH), como los que reflejan un abordaje asistencial mas integral (mejor cumplimiento terapeutico de los UDVPs con tuberculosis). Se aprecia tambien una menor sobrecarga disfuncional de los dispositivos asistenciales de urgencias. Estos cambios se producen pese a que Barcelona se ve marcada por el predominio de heroina blanca, que favorece la via parenteral.

Heterogeneity and event dependence in the analysis of sickness absence

BackgroundSickness absence (SA) is an important social, economic and public health issue. Identifying and understanding the determinants, whether biological, regulatory or, health services-related, of variability in SA duration is essential for better management of SA. The conditional frailty model (CFM) is useful when repeated SA events occur within the same individual, as it allows simultaneous analysis of event dependence and heterogeneity due to unknown, unmeasured, or unmeasurable factors. However, its use may encounter computational limitations when applied to very large data sets, as may frequently occur in the analysis of SA duration.MethodsTo overcome the computational issue, we propose a Poisson-based conditional frailty model (CFPM) for repeated SA events that accounts for both event dependence and heterogeneity. To demonstrate the usefulness of the model proposed in the SA duration context, we used data from all non-work-related SA episodes that occurred in Catalonia (Spain) in 2007, initiated by either a diagnosis of neoplasm or mental and behavioral disorders.ResultsAs expected, the CFPM results were very similar to those of the CFM for both diagnosis groups. The CPU time for the CFPM was substantially shorter than the CFM.ConclusionsThe CFPM is an suitable alternative to the CFM in survival analysis with recurrent events, especially with large databases.

Evaluation of the management of nonwork-related sick leave lasting more than 15 days in Catalonia (Spain)

OBJECTIVES To compare the length of nonwork-related sick leave among cases managed by an insurance company versus those managed by the National Institute of Social Security (NISS). METHODS We performed a retrospective cohort study of 289,686 cases of sick leave lasting for more than 15 days that began in 2005 after certification by a primary care physician in Catalonia, were reported to the Catalonian Institute of Medical Evaluations, and were followed to term. Of the total, 156,676 cases were managed by the NISS. To account for repeat episodes (approximately 25% of the total), the Wang-Chang estimator was used to calculate the median duration and percentiles; comparisons were made using log-logistic regression with shared gamma frailty models, with calculation of time ratios (TR) and their corresponding 95% confidence intervals (95% CI). RESULTS The median duration of sick leave was 43 days for cases managed by the NISS and 39 days for those managed by the insurance company. This difference was statistically significant both for men employed under contract (TR=0.87; 95% CI: 0.85-0.88) and for those who were self-employed (TR=0.78; 95% CI: 0.75-0.80) as well as for women under contract (TR=0.85; 95% CI: 0.84-0.87) and self-employed women (TR=0.84; 95% CI: 0.81-0.88). These differences persisted after adjustment was performed for age and health region. CONCLUSIONS For sick leave lasting more than 15 days, these results confirm that cases managed by an insurance company ended earlier than for those managed by the NISS, both for contract and self-employed workers. Further research is needed to explore the reasons for these differences.

Design of an integrated management system (IMS) in a government-run medical evaluation organisation

Purpose – The authors present the application of the Lopez-Fresno approach in designing an integrated management system (IMS) for an aviation company to the development of an IMS in a government-run organization responsible for the medical evaluation of work disabilities. The purpose of this paper is to share the design process, with the intention of showing that this approach is applicable to other sectors and proposing generalization and applicability strategies to other smaller government entities. Design/methodology/approach – The study involves two phases. Phase I applies the Lopez-Fresno approach to design a basic IMS-I and ends with a European Foundation for Quality Management (EFQM) evaluation, whose suggestions were taken into consideration for the final design of IMS-II during phase II. The data were obtained from the organizations own functioning. There was a significant degree of personal involvement by the authors, external consultants and members of the management committee in areas ranging...

Distribución de la duración de la incapacidad temporal por contingencia común por diagnóstico médico (Cataluña, 2006-2008)

We present a simple and practical tool that allows the usual distribution of the duration of non-occupational sick leave to be determined by medical diagnosis. A total of 2,646,352 episodes of medically certified sick leave, registered by the Catalan Institute of Medical Evaluations for the period 2006-2008, were followed to closure and were entered into a spreadsheet. Given its asymmetric distribution, the median duration of sick leave was 9 days. Musculoskeletal disorders were the most frequent diagnostic group (22.5%), while neoplasms had the longest median duration (56 days). The most common specific diagnoses were diarrhea-gastroenteritis (8.2%; median: 3 days) and acute rhinopharyngitis (5.2%; median: 4 days). The distribution of the duration of sick leave in a population varies by diagnosis and is asymmetric, with most episodes being much shorter than the mean duration. This finding is important for better clinical and administrative management of sick leave episodes.

Gripe y otras infecciones respiratorias agudas en la población trabajadora. Impacto del brote de gripe A (H1N1)

INTRODUCTION This study aims to asses the impact of influenza and other acute respiratory infectious diseases (ARI) on the Catalan working population between January 2007 and December 2009, including the period of the influenza virus A (H1N1) pandemic in our region. METHODS All certified sickness absence episodes (sick-leave) due to influenza and other ARI amongst the working population of Catalonia, Spain, were analyzed from January 2007 to December 2009. Monthly and weekly incidence was calculated, as well as an influenza sick-leave threshold, in order to identify the epidemic season in the working population. RESULTS Registered annual sick-leave incidence for influenza-like illnesses (ILI) per 100,000 workers was 1,260.6 in 2007, 915.2 in 2008 and 2,377.2 in 2009. Epidemic curves show monthly peaks in January-February each year, plus a second peak in November 2009 corresponding to the influenza virus A (H1N1) pandemic in our region. In 2009 sick-leave incidence for ILI and other ARI was higher in workers from the Health-Social Services sector than in the other workers (p<0.001). CONCLUSION This study contributes to the knowledge on the impact of influenza and other ARI on the general workforce, during a period of time including the outbreak of influenza virus A (H1N1).

Assessment of the magnitude of geographical variations in the duration of non-work-related sickness absence by individual and contextual factors

OBJECTIVE To examine variation in the duration of non-work-related sickness absence (NWRSA) across geographical areas and the degree to which this variation can be explained by individual and/or contextual factors. METHODS All first NWRSA episodes ending in 2007 and 2010 were analyzed. Individual (diagnosis, age, sex) and contextual factors (healthcare resources, socioeconomic factors) were analyzed to assess how much of the geographical variation was explained by these factors. Median NWRSA durations in quartiles were mapped by counties in Catalonia. Multilevel Cox proportional hazard regression models with episodes nested within counties were fitted to quantify the magnitude of this variation. The proportional change in variance (PCV), median hazard ratios (MHR) and interquartile hazard ratios (IHR) were calculated. RESULTS We found a geographical pattern in the duration of NWRSA, with longer duration in northwestern Catalonia. There was a small, but statistically significant, geographical variation in the duration of NWRSA, which mostly decreased after adjustment for individual factors in both women (PCV=34.98%, MHR=1.09, IHR=1.13 in 2007; PCV=34.68%, MHR=1.11, IHR=1.28 in 2010) and men (PCV=39.88%, MHR=1.10, IHR=1.27 in 2007; PCV=45.93%, MHR=1.10, IHR=1.25 in 2010); only in the case of women in 2010 was there a reduction in county-level variance due to contextual covariates (PCV=16.18%, MHR=1.12, IHR=1.32). CONCLUSIONS County-level variation in the duration of NWRSA was small and was explained more by individual than by contextual variables. Knowledge of geographic differences in NWRSA duration is needed to plan specific programs and interventions to minimize these differences.

Distribution of the duration of nonoccupational sick leave by medical diagnosis (Catalonia, Spain, 2006-2008)

We present a simple and practical tool that allows the usual distribution of the duration of non-occupational sick leave to be determined by medical diagnosis. A total of 2,646,352 episodes of medically certified sick leave, registered by the Catalan Institute of Medical Evaluations for the period 2006-2008, were followed to closure and were entered into a spreadsheet. Given its asymmetric distribution, the median duration of sick leave was 9 days. Musculoskeletal disorders were the most frequent diagnostic group (22.5%), while neoplasms had the longest median duration (56 days). The most common specific diagnoses were diarrhea-gastroenteritis (8.2%; median: 3 days) and acute rhinopharyngitis (5.2%; median: 4 days). The distribution of the duration of sick leave in a population varies by diagnosis and is asymmetric, with most episodes being much shorter than the mean duration. This finding is important for better clinical and administrative management of sick leave episodes.

Sistemas de identificación de pacientes en hospitales de Cataluña

Resumen Objetivo Conocer la situacion actual del grado de implantacion de los sistemas de identificacion de los pacientes en los centros hospitalarios de agudos de Cataluna. Metodos Encuesta enviada via electronica y dirigida a la direccion de enfermeria de los hospitales de agudos de Cataluna sobre la utilizacion de sistemas de identificacion de los pacientes, la implantacion en los diferentes servicios hospitalarios y los datos utilizados en el sistema. Resultados De los 75 centros estudiados un 90,7% declaro utilizar algun sistema de identificacion de los pacientes. Solamente el 26,7% de los centros disponian de sistemas de identificacion en todos los servicios de hospitalizacion. Los datos identificativos mas frecuentemente utilizados en el sistema de identificacion fueron: nombre y apellidos del paciente (100%), numero de historia clinica (79,4%), fecha de nacimiento (67,6%) y numero de cama (66,2%). El 77,3% de los centros utilizaban un unico sistema de identificacion de pacientes y el mas frecuente fue el brazalete identificativo (85,3%). El uso del brazalete identificativo solo estaba protocolizado en el 67,2% de los centros y el 50% refirio algun problema con su utilizacion. Conclusiones Hay un buen nivel de implantacion de los sistemas de identificacion de los pacientes en Cataluna; sin embargo, es necesario promover una mayor utilizacion en todos los servicios hospitalarios y potenciar la protocolizacion de su uso, asi como realizar un seguimiento de su cumplimiento.