Catalan Health Institute ICS

Catalonia, Spain

Catalan Health Institute ICS

Catalonia, Spain
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Pina J.M.,Catalan Health Institute ICS | Clotet L.,Catalan Health Institute ICS | Sala M.R.,Epidemiological Surveillance Unit | Garrido P.,University of Barcelona | And 4 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2013

The purpose of this study was to evaluate the cost-effectiveness of the strategy of controlling the contacts of tuberculosis patients with latent tuberculosis infection by means of treatment with rifampin for 4 months or isoniazid for 9 months. The cost was the sum of the cost of treating latent tuberculosis infection in all contacts plus the cost of treating tuberculosis in whom the disease was not avoided. The effectiveness was expressed as cases avoided. The efficacy adopted was 90 % for rifampin for 4 months and 93 % for isoniazid for 9 months. We carried out a sensitivity analysis for efficacies of rifampin for 4 months of 80 %, 75 %, 69 % and 65 %. Of the 1,002 patients studied, 139 were treated with rifampin for 4 months and 863 were treated with isoniazid for 9 months. The cost-effectiveness was €436,842.83/50 cases avoided with rifampin for 4 months and €692,164.42/40 cases avoided with isoniazid for 9 months. Rifampin for 4 months was dominant. In the sensitivity analysis, rifampin for 4 months was dominant for efficacies of 75 % or greater. The cost-effectiveness analysis favoured the use of rifampin for 4 months when its efficacy was 75 % or greater. © 2012 Springer-Verlag Berlin Heidelberg.


Pina J.M.,Catalan Health Institute ICS | Pina J.M.,Epidemiological Surveillance Unit | Clotet L.,Catalan Health Institute ICS | Clotet L.,Epidemiological Surveillance Unit | And 7 more authors.
Respiratory Medicine | Year: 2013

Objectives: To assess the cost-effectiveness ratio of rifampin for 4 months and isoniazid for 6 months in contacts with latent tuberculosis infection. Methods: The cost was the sum of the cost of treatment with isoniazid for 6 months or with rifampin for 4 months of all contacts plus the cost of treatment of cases of tuberculosis not avoided. The effectiveness was the number of cases of tuberculosis avoided with isoniazid for 6 months or with rifampin for 4 months. When the cost with one schedule was found to be cheaper than the other and a greater number of tuberculosis cases were avoided, this schedule was considered dominant. The efficacy adopted was 90% for rifampin for 4 months and 69% for isoniazid for 6 months. A sensitivity analysis was made for efficacies of rifampin for 4 months of 80%, 69%, 60% and 50%. Results: Of the 1002 patients studied, 863 were treated with isoniazid for 6 months and 139 with rifampin for 4 months The cost-effectiveness ratio with isoniazid for 6 month was 19759.48/avoided case of tuberculosis and 8736.86/avoided case of tuberculosis with rifampin for 4 months. Rifampin for 4 months was dominant. In the sensitivity analysis, rifampin for 4 months was dominant for efficacies from 60%. Conclusions: Rifampin for 4 months was more cost-effective than isoniazid for 6 months. © 2013 Elsevier Ltd. All rights reserved.


Aller M.-B.,Health Policy and Health Services Research Group | Vargas I.,Health Policy and Health Services Research Group | Garcia-Subirats I.,Health Policy and Health Services Research Group | Coderch J.,Grup de Recerca en Serveis Sanitaris i Resultats en Salut GRESSIRES | And 5 more authors.
International Journal of Integrated Care | Year: 2013

Background: The CCAENA questionnaire was developed to assess care continuity across levels from the patients' perspective. The aim is to provide additional evidence on the psychometric properties of the scales of this questionnaire. Methods: Cross-sectional study by means of a survey of a random sample of 1500 patients attended in primary and secondary care in three health care areas of the Catalan health care system. Data were collected in 2010 using the CCAENA questionnaire. To assess psychometric properties, an exploratory factor analysis was performed (construct validity) and the item-rest correlations and Cronbach's alpha were calculated (internal consistency). Spearman correlation coefficients were calculated (multidimensionality) and the ability to discriminate between groups was tested. Results: The factor analysis resulted in 21 items grouped into three factors: patient-primary care provider relationship, patient- secondary care provider relationship and continuity across care levels. Cronbach's alpha indicated good internal consistency (0.97, 0.93, 0.80) and the correlation coefficients indicated that dimensions can be interpreted as separated scales. Scales discriminated patients according to health care area, age and educational level. Conclusion: The CCAENA questionnaire has proved to be a valid and reliable tool for measuring patients' perceptions of continuity. Providers and researchers could apply the questionnaire to identify areas for health care improvement.


Reyes C.,Primary Health Care Center Eap Sardenya Biomedical Resarch Institute Sant Pau Sant Pau | Reyes C.,Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol | Reyes C.,Autonomous University of Barcelona | Garcia-Gil M.,Institute Universitari dInvestigacio en Atencio Primaria Jordi Gol Jordi Gol | And 23 more authors.
Osteoarthritis and Cartilage | Year: 2015

Objective: To determine the association between socio-economic status (SES) and risk of hand, hip or knee osteoarthritis (OA) at a population level. Design: Retrospective ecological study using the System for the Development of Research in Primary Care (SIDIAP) database (primary care anonymized records for >5 million people in Catalonia (Spain)). Urban residents >15 years old (2009-2012) were eligible. Outcomes: Validated area-based SES deprivation index MEDEA (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) was estimated for each area based on census data as well as incident diagnoses (ICD-10 codes) of hand, hip or knee OA (2009-2012). Zero-inflated Poisson models were fitted to study the association between MEDEA quintiles and the outcomes. Results: Compared to the least deprived, the most deprived areas were younger (43.29 (17.59) vs 46.83 (18.49), years (Mean SD), had fewer women (49.1% vs 54.8%), a higher percentage of obese (16.2% vs 8.4%), smokers (16.9% vs 11.9%) and high-risk alcohol consumption subjects (1.5% vs 1.3%). Compared to the least deprived, the most deprived areas had an excess risk of OA: age-sex-adjusted Incidence Rate Ratio (IRR) 1.26 (1.11-1.42) for hand, 1.23 (1.17-1.29) hip, and 1.51 (1.45-1.57) knee. Adjustment for obesity attenuated this association: 1.06 (0.93-1.20), 1.04 (0.99-1.09), and 1.23 (1.19-1.28) respectively. Conclusions: Deprived areas have higher rates OA (hand, hip, knee). Their increased prevalence of obesity accounts for a 50% of the excess risk of knee OA observed. Public health interventions to reduce the prevalence of obesity in this population could reduce health inequalities. © 2015 Osteoarthritis Research Society International.


Reyes C.,Biomedical Research Institute Sant Pau | Reyes C.,Autonomous University of Barcelona | Garcia-Gil M.,Autonomous University of Barcelona | Garcia-Gil M.,Idiap Research Institute | And 18 more authors.
Bone | Year: 2015

To determine the association between socioeconomic deprivation (SES) and hip fracture risk. Methods: Retrospective cohort study using a population-based database (primary care records) of over 5 million people. Eligibility: all living subjects registered during the period 2009-2012 and resident in an urban area. Measures: a validated SES composite index (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) estimated for each area based on census data. Outcome: incident hip fracture rates as coded in medical records using ICD-10 codes. Statistics: zero-inflated Poisson models fitted to study the association between SES quintiles and hip fracture risk, adjusted for age, sex, obesity, smoking and alcohol consumption. Results: Compared to the most deprived, wealthy areas had a higher hip fracture incidence (age- and sex-adjusted incidence 38.57 (37.14-40.00) compared to 34.33 (32.90-35.76) per 10,000 person-years). Similarly, most deprived areas had a crude and age- and sex-adjusted lower risk of hip fracture, RR of 0.71 (0.65-0.78) and RR of 0.90 (0.85-0.95), respectively, compared to wealthiest areas. The association was attenuated and no longer significant after adjustment for obesity: RR 0.96 (0.90-1.01). Further adjustment for smoking and high alcohol consumption did not make a difference. Conclusion: Wealthiest areas have an almost 30% increased risk of hip fracture compared to the most deprived. Differences in age-sex composition and a higher prevalence of obesity in deprived areas could explain this higher risk. © 2014 Elsevier Inc.


Aller M.B.,Health Policy and Health Services Research Group | Vargas I.,Health Policy and Health Services Research Group | Waibel S.,Health Policy and Health Services Research Group | Coderch J.,Grup de Recerca en Serveis Sanitaris i Resultats en Salut GRESSIRES | And 5 more authors.
International Journal for Quality in Health Care | Year: 2013

Objective. To determine the patients' perceived degree of continuity of care between primary and secondary care and to identify contextual and individual factors that influence patients' perceptions of continuity of care. Design. Cross-sectional study by means of a survey of patients attended to in primary and secondary care. Setting. Three health-care areas of the Catalonian public health-care system. Participants. A random sample of 1500 patients. Main Outcome Measures. Relational, informational and managerial continuity of care measured by means of Likert scales, using the CCAENA questionnaire. Results. Overall, 93.8 and 83.8% of patients perceived an ongoing relationship with primary and secondary care physicians, respectively (relational continuity), 71.2% perceived high levels of information transfer (informational continuity) and 90.7% perceived high levels of consistency of care (managerial continuity). Patients from health-care areas where primary and secondary care were managed by a single organization and the elderly tended to perceive higher levels of all three types of continuity. Foreign-born patients were less likely to perceive relational continuity with primary care physicians; those with higher educational levels were less likely to perceive high levels of informational continuity and patients with worse health status were less likely to report high levels of managerial and relational continuity with secondary care physicians. Conclusions. Study results suggest high levels of perceived continuity of care, especially for relational and managerial continuity. The adopted comprehensive approach proves to be useful to properly understand the phenomenon because perceptions and associated factors vary according to the type of continuity. © The Author 2013. Published by Oxford University Press in association with the International Society for Quality in Health Care; All rights reserved.


PubMed | Catalan Health Institute ICS
Type: Comparative Study | Journal: Respiratory medicine | Year: 2013

To assess the cost-effectiveness ratio of rifampin for 4 months and isoniazid for 6 months in contacts with latent tuberculosis infection.The cost was the sum of the cost of treatment with isoniazid for 6 months or with rifampin for 4 months of all contacts plus the cost of treatment of cases of tuberculosis not avoided. The effectiveness was the number of cases of tuberculosis avoided with isoniazid for 6 months or with rifampin for 4 months. When the cost with one schedule was found to be cheaper than the other and a greater number of tuberculosis cases were avoided, this schedule was considered dominant. The efficacy adopted was 90% for rifampin for 4 months and 69% for isoniazid for 6 months. A sensitivity analysis was made for efficacies of rifampin for 4 months of 80%, 69%, 60% and 50%.Of the 1002 patients studied, 863 were treated with isoniazid for 6 months and 139 with rifampin for 4 months The cost-effectiveness ratio with isoniazid for 6 month was 19759.48/avoided case of tuberculosis and 8736.86/avoided case of tuberculosis with rifampin for 4 months. Rifampin for 4 months was dominant. In the sensitivity analysis, rifampin for 4 months was dominant for efficacies from 60%.Rifampin for 4 months was more cost-effective than isoniazid for 6 months.


PubMed | Catalan Health Institute ICS, Grup de Recerca en Serveis Sanitaris i Resultats en Salut GRESSIRES, BSA, Health Policy and Health Services Research Group and Strategic Health Services
Type: | Journal: International journal of integrated care | Year: 2013

The CCAENA questionnaire was developed to assess care continuity across levels from the patients perspective. The aim is to provide additional evidence on the psychometric properties of the scales of this questionnaire.Cross-sectional study by means of a survey of a random sample of 1500 patients attended in primary and secondary care in three health care areas of the Catalan health care system. Data were collected in 2010 using the CCAENA questionnaire. To assess psychometric properties, an exploratory factor analysis was performed (construct validity) and the item-rest correlations and Cronbachs alpha were calculated (internal consistency). Spearman correlation coefficients were calculated (multidimensionality) and the ability to discriminate between groups was tested.The factor analysis resulted in 21 items grouped into three factors: patient-primary care provider relationship, patient-secondary care provider relationship and continuity across care levels. Cronbachs alpha indicated good internal consistency (0.97, 0.93, 0.80) and the correlation coefficients indicated that dimensions can be interpreted as separated scales. Scales discriminated patients according to health care area, age and educational level.The CCAENA questionnaire has proved to be a valid and reliable tool for measuring patients perceptions of continuity. Providers and researchers could apply the questionnaire to identify areas for health care improvement.


PubMed | Catalan Health Institute ICS
Type: Journal Article | Journal: European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology | Year: 2013

The purpose of this study was to evaluate the cost-effectiveness of the strategy of controlling the contacts of tuberculosis patients with latent tuberculosis infection by means of treatment with rifampin for 4 months or isoniazid for 9 months. The cost was the sum of the cost of treating latent tuberculosis infection in all contacts plus the cost of treating tuberculosis in whom the disease was not avoided. The effectiveness was expressed as cases avoided. The efficacy adopted was 90 % for rifampin for 4 months and 93 % for isoniazid for 9 months. We carried out a sensitivity analysis for efficacies of rifampin for 4 months of 80 %, 75 %, 69 % and 65 %. Of the 1,002 patients studied, 139 were treated with rifampin for 4 months and 863 were treated with isoniazid for 9 months. The cost-effectiveness was 436,842.83/50 cases avoided with rifampin for 4 months and 692,164.42/40 cases avoided with isoniazid for 9 months. Rifampin for 4 months was dominant. In the sensitivity analysis, rifampin for 4 months was dominant for efficacies of 75 % or greater. The cost-effectiveness analysis favoured the use of rifampin for 4 months when its efficacy was 75 % or greater.


PubMed | University of Southampton, Catalan Health Institute ICS, Parc Of Salut Mar And Institute Salud Carlos Iii and Autonomous University of Barcelona
Type: Journal Article | Journal: Osteoarthritis and cartilage | Year: 2015

To determine the association between socio-economic status (SES) and risk of hand, hip or knee osteoarthritis (OA) at a population level.Retrospective ecological study using the System for the Development of Research in Primary Care (SIDIAP) database (primary care anonymized records for >5 million people in Catalonia (Spain)). Urban residents >15 years old (2009-2012) were eligible.Validated area-based SES deprivation index MEDEA (proportion of unemployed, temporary workers, manual workers, low educational attainment and low educational attainment among youngsters) was estimated for each area based on census data as well as incident diagnoses (ICD-10 codes) of hand, hip or knee OA (2009-2012). Zero-inflated Poisson models were fitted to study the association between MEDEA quintiles and the outcomes.Compared to the least deprived, the most deprived areas were younger (43.29 (17.59) vs 46.83 (18.49), years (Mean SD), had fewer women (49.1% vs 54.8%), a higher percentage of obese (16.2% vs 8.4%), smokers (16.9% vs 11.9%) and high-risk alcohol consumption subjects (1.5% vs 1.3%). Compared to the least deprived, the most deprived areas had an excess risk of OA: age-sex-adjusted Incidence Rate Ratio (IRR) 1.26 (1.11-1.42) for hand, 1.23 (1.17-1.29) hip, and 1.51 (1.45-1.57) knee. Adjustment for obesity attenuated this association: 1.06 (0.93-1.20), 1.04 (0.99-1.09), and 1.23 (1.19-1.28) respectively.Deprived areas have higher rates OA (hand, hip, knee). Their increased prevalence of obesity accounts for a 50% of the excess risk of knee OA observed. Public health interventions to reduce the prevalence of obesity in this population could reduce health inequalities.

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