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ObjetivosEstimar el coste y conocer el manejo de una crisis asmática en atención primaria.DiseñoEstudio observacional, prospectivo.EmplazamientoDiez consultas de 9 centros de atención primaria de 5 provincias (Asturias, Barcelona, Cádiz, Madrid y Valencia).ParticipantesDiez médicos de familia que incluyeron, secuencialmente, a 133 pacientes con una crisis de asma.Mediciones principalesSe calcularon los costes directos e indirectos que supone una crisis de asma. El episodio se trató como habitualmente venía haciéndolo cada médico, sin que la intervención estuviera previamente definida en el protocolo del estudio.ResultadosSe observaron un 43,6% de crisis leves, un 43,6% de crisis moderadas y un 12,8% de crisis graves. El 17,2% de estas últimas ocurrieron en pacientes con asma intermitente. Cuanto más grave era la crisis, menor era el tratamiento preventivo anterior a ella. El coste medio de una crisis asmática fue de 166,7 € (intervalo de confianza [IC] del 95%, 146,5-192,3), el 80% (132,4 €; IC del 95%, 122,7-143,8) debido a costes directos y el 20% (34,3 €, (IC del 95%, 17- 56,2) a costes indirectos. La opción más económica de manejo de una crisis fue «cambiar el tratamiento, realizar una prueba diagnóstica y 2 visitas médicas».ConclusionesEl coste medio de una crisis asmática tratada en atención primaria fue de 166,7 € (IC del 95%, 146,5-192,3), el 80% debido a costes directos y el 20% a costes indirectos.AbstractObjectivesTo estimate the cost and characterize the management of asthma attacks in primary care.DesignProspective, observational study of 1 year’s duration.Setting10 physician’s offices at 9 primary care centers located in 5 provinces (Asturias, Barcelona, Cadiz, Madrid, and Valencia) of Spain.Participants10 family physicians who saw 133 consecutive patients with an asthma attack.MethodProspective, observational study; no intervention was used. Direct and indirect costs arising from asthma attacks were calculated. Episodes were treated according to the physicians’ habitually used procedures; the study protocol did not specify any predetermined intervention.ResultsThe attacks were classified as mild in 43.6% of the cases, moderately severe in 43.6%, and severe in 12.8%. Of all severe attacks, 17.2% occurred in patients with intermittent asthma. The more severe the attack, the less preventive treatment patients had received previously. The mean cost of asthma attacks was €166.7 (95% CI, 146.5-192.3); 80% (€132.4) (95% CI, 122.7-143.8) were direct costs and 20% (€34.3) (95% CI, 17-56.2) were indirect costs. The most economical management option was to change treatment, perform diagnostic tests and have the patient attend 2 follow-up appointments with the physician.ConclusionsMean cost of each asthma attack treated in primary care was €166.7 (95% CI, 146.5-192.3), of which 80% were direct costs and 20% indirect costs. |
