Allergy medical care network: A new model of care for specialties

array:22 ["pii" => "S0301054613002887" "issn" => "03010546" "doi" => "10.1016/j.aller.2013.09.015" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "577" "copyright" => "SEICAP" "copyrightAnyo" => "2013" "documento" => "article" "subdocumento" => "fla" "cita" => "Allergol Immunopathol (Madr). 2015;43:48-56" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 692 "formatos" => array:3 [ "EPUB" => 8 "HTML" => 486 "PDF" => 198 ] ] "itemSiguiente" => array:17 [ "pii" => "S0301054613002875" "issn" => "03010546" "doi" => "10.1016/j.aller.2013.09.014" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "576" "copyright" => "SEICAP" "documento" => "article" "subdocumento" => "fla" "cita" => "Allergol Immunopathol (Madr). 2015;43:57-61" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 638 "formatos" => array:3 [ "EPUB" => 7 "HTML" => 430 "PDF" => 201 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Bronchial hyperreactivity in children with antibody deficiencies" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "57" "paginaFinal" => "61" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Celal Özcan, Ay¿e Metin, Mustafa Erkoço¿lu, Can Naci Kocabas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Celal" "apellidos" => "Özcan" ] 1 => array:2 [ "nombre" => "Ay¿e" "apellidos" => "Metin" ] 2 => array:2 [ "nombre" => "Mustafa" "apellidos" => "Erkoço¿lu" ] 3 => array:2 [ "nombre" => "Can Naci" "apellidos" => "Kocabas" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054613002875?idApp=UINPBA00004N" "url" => "/03010546/0000004300000001/v1_201501250943/S0301054613002875/v1_201501250943/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "S0301054614000251" "issn" => "03010546" "doi" => "10.1016/j.aller.2013.10.005" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "589" "copyright" => "SEICAP" "documento" => "article" "subdocumento" => "fla" "cita" => "Allergol Immunopathol (Madr). 2015;43:42-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 1014 "formatos" => array:3 [ "EPUB" => 10 "HTML" => 753 "PDF" => 251 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Nasal endoscopic findings and nasal symptoms in patients with asthma: A clinical study from a rhinological perspective" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "42" "paginaFinal" => "47" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1322 "Ancho" => 1653 "Tamanyo" => 69557 ] ] "descripcion" => array:1 [ "en" => "Correlation between the nasal endoscopic score and the duration of asthma in the patients with different grade of asthma (¿=0.278 and P<0.05, Spearman rank test)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Feng, Q. He, Y. Fan, J. Mi, L. Guo, H. Hong, H. Li" "autores" => array:7 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Feng" ] 1 => array:2 [ "nombre" => "Q." "apellidos" => "He" ] 2 => array:2 [ "nombre" => "Y." "apellidos" => "Fan" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Mi" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Guo" ] 5 => array:2 [ "nombre" => "H." "apellidos" => "Hong" ] 6 => array:2 [ "nombre" => "H." "apellidos" => "Li" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054614000251?idApp=UINPBA00004N" "url" => "/03010546/0000004300000001/v1_201501250943/S0301054614000251/v1_201501250943/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Allergy medical care network: A new model of care for specialties" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "48" "paginaFinal" => "56" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "L. Ferré-Ybarz, R. Salinas Argente, S. Nevot Falcó, C. Gómez Galán, J. Franquesa Rabat, J. Trapé Pujol, P. Oliveras Alsina, M. Pons Serra, X. Corbella Virós" "autores" => array:9 [ 0 => array:4 [ "nombre" => "L." "apellidos" => "Ferré-Ybarz" "email" => array:1 [ 0 => "lferre@althaia.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "R." "apellidos" => "Salinas Argente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "Nevot Falcó" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "C." "apellidos" => "Gómez Galán" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Franquesa Rabat" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 5 => array:3 [ "nombre" => "J." "apellidos" => "Trapé Pujol" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 6 => array:3 [ "nombre" => "P." "apellidos" => "Oliveras Alsina" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 7 => array:3 [ "nombre" => "M." "apellidos" => "Pons Serra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 8 => array:3 [ "nombre" => "X." "apellidos" => "Corbella Virós" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0030" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Allergy Service, Althaia, Xarxa Assistencial Universitària de Manresa, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Managing Director Banc de Sang i Teixits Catalunya Central i Vallès Occidental, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Biological Diagnosis Department, Althaia, Xarxa Assistencial Universitària de Manresa, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Management Control Unit, Althaia, Xarxa Assistencial Universitària de Manresa, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Specialized Care Director, Althaia, Xarxa Assistencial Universitària de Manresa, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] 5 => array:3 [ "entidad" => "Management Hospital Universitari Bellvitge, Territorial Management ICS Metropolitana Sud, Spain" "etiqueta" => "f" "identificador" => "aff0030" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1994 "Ancho" => 1965 "Tamanyo" => 191291 ] ] "descripcion" => array:1 [ "en" => "First visits and successive visits made to the allergy department in the period 2005–2010 and the evolution of resolution capability." ] ] ] "textoCompleto" => "IntroductionThe Althaia Foundation is a healthcare referral network for 188,000 inhabitants of regions of Central Catalonia. It has a number of centres: Hospital Sant Joan de Deu (HSJD/public medicine), Centre Hospitalari (CH/public medicine), Clinic Sant Josep (CSJ/private and sports medicine), CESAM (Mental Health) and two primary care centres. In the 2005 health care model, allergists were located in HSJD, and patients had to travel to receive their treatment.The primary objective of the study is to analyse the value of measures designed and subsequently implemented under the strategic plan (SP) for service 2005–2010, which are:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•To validate whether the measures applied in the SP are appropriate. To assess the impact of the implementation of the SP.</li><li class="elsevierStyleListItem" id="lsti0010">•To compare our care model with other allergy departments in the same setting (benchmarking).</li><li class="elsevierStyleListItem" id="lsti0015">•To improve the department's performance by adapting the most appropriate cost possible: Profitability and Productivity.</li><li class="elsevierStyleListItem" id="lsti0020">•To maintain and/or improve the quality standard.</li><li class="elsevierStyleListItem" id="lsti0025">•Adaptation to all new demands for care in our referral area and to proposals and objectives established by the health authorities.</li><li class="elsevierStyleListItem" id="lsti0030">•Strengthening the department's organisational model. Implementation of the organisational model in medical visits, day hospital (DH) and hospitalisation.</li><li class="elsevierStyleListItem" id="lsti0035">•Promote coordination with primary care (PC).</li></ul>In this study it was important to assess the environment and adjust performance accordingly before study initiation:<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0040">•gradual increase in demand for allergy care;</li><li class="elsevierStyleListItem" id="lsti0045">•difficulty in finding professionals;</li><li class="elsevierStyleListItem" id="lsti0050">•inability to minimise the prevalence of allergic disease; and</li><li class="elsevierStyleListItem" id="lsti0055">•need to respond to demand, without cost overruns, optimising existing resources (human and financial) with quality practices.</li></ul>Thus it was necessary to:<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0060">•Analyse the allergy department situation in 2005.</li><li class="elsevierStyleListItem" id="lsti0065">•Define reliable/appropriate indicators enabling a comparative analysis between the situation in 2005 and the following years.</li><li class="elsevierStyleListItem" id="lsti0070">•Establish a specific SP.</li></ul>Material and methodsDescriptive, retrospective study that assessed the operation of the Althaia Foundation allergy department.In order to provide data to allow performing the assessment of measures resulting from SP, analysis time was partitioned into two distinct periods (before processing the SP and after the application of corrective measures, whose origin was the SP itself).In the first period (2005), an analysis of service performance was conducted.<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0075">1.External analysis: Social/demographic setting, Political/economic/technological setting.</li><li class="elsevierStyleListItem" id="lsti0080">2.Internal analysis: Architectural resources, Human resources, Activities conducted, Work flows, Quality control.</li></ul>Subsequently:<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0085">-Identification of problems/threats and proposal of improvement strategies.</li><li class="elsevierStyleListItem" id="lsti0090">-Benchmarking.</li><li class="elsevierStyleListItem" id="lsti0095">-Design and implementation of SP (2005–2010).</li></ul>The development of an SP according to traditional methodology was made based on data obtained from various sources: population of the record of the Statistical Institute of Catalonia (Idescat), economic information of Althaia's Management Control Unit, hospital activity and functional plan from allergy department's own activity logs and Management Control Unit, and analytic data of Althaia's Department of Biological Diagnosis.Finally indicators were designed to enable a comparison before and after the application of the SP:<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0100">•Waiting time for first visit.</li><li class="elsevierStyleListItem" id="lsti0105">•Number of first visits (FV).</li><li class="elsevierStyleListItem" id="lsti0110">•Number of successive visits (SV).</li><li class="elsevierStyleListItem" id="lsti0115">•FV/SV ratio.</li><li class="elsevierStyleListItem" id="lsti0120">•Number of DH.</li><li class="elsevierStyleListItem" id="lsti0125">•Index specific IgE determinations/patient.</li><li class="elsevierStyleListItem" id="lsti0130">•Expenditure per pathology (case-mix groups).</li><li class="elsevierStyleListItem" id="lsti0135">•Allergist/no. inhabitants ratio.</li></ul>ResultsResults and indicators 2005In 2005 the HSJD of Manresa was the only centre in Central Catalonia with an allergy department. In 2005 private alternative medical care was very limited and was provided by allergists unrelated to HSJD. In the Pla de Salut de Catalunya during this period there was no clear specification for the speciality of allergology.Some of the tests included in the portfolio of services cannot be performed immediately and are scheduled on different days (patch tests, drug studies, etc.). Depending on the patients’ pathology they were divided into four case-mix groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the activity data in 2005.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>Summary of strategic plan 2005–2010The initial situation analysis allowed to describe the strengths and weaknesses of the department as well as the threats and opportunities (SWOT matrix), basis of the SP:<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0140">•Strengths: 1. Institutional positioning (Althaia Foundation). Willingness to work in network and to be a reference in the territory. 2. Head of service: visionary and credible. 3. Allergy service: reference in Central Catalonia. 4. Participation in cooperative research projects. 5. Teaching: participation in courses, publications, request allergy MIR accreditation. 6. Service depends on the Department of Pediatrics.</li><li class="elsevierStyleListItem" id="lsti0145">•Weaknesses: 1. Unstable staff. 2. Inadequate resources human/activity to develop. 3. Lack of control on waiting list. Poor communication with primary care. 4. Absence of own computer activity logs. 5. Absence of internal/external action protocols agreed upon according to each pathology. 6. Location of day hospital.7. Need for improvements in diagnostic techniques and treatments. 8. Excessive waiting time for specific paediatric studies.</li><li class="elsevierStyleListItem" id="lsti0150">•Opportunities: 1. Population pyramid 2. Increasing immigration. 3. Complete management of the waiting list. 4 Allergological needs not covered in other territories. 5. Small number of allergists. 6. Lack of activity in private paediatric allergology. 7. Expansion of the Hospital.</li><li class="elsevierStyleListItem" id="lsti0155">•Threats: 1. Regressive population pyramid 2. Increased immigration. 3. Lack of control of waiting list. 4. External competitors: area Metropolitana, Berga Hospital. 5. Internal competitors: pulmonology, otolaryngology, dermatology. 6. Few Allergists. 7. Vagueness in the Pla de Salut.</li></ul>As a consequence of the SP, specific measures were implemented which resulted in improved system performance, patient care and improvements in the department itself.<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0160">1.Increase in the territory for which the Althaia Foundation provides care through movement of the allergist to other centres (Igualada, Andorra, CSJ) and creation of a networking system.</li><li class="elsevierStyleListItem" id="lsti0165">2.To provide private medical care in paediatric allergology, as part of this network.</li><li class="elsevierStyleListItem" id="lsti0170">3.To establish a pilot programme to reduce the waiting list:<ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0175">•Development and implementation of specific referral protocols.</li><li class="elsevierStyleListItem" id="lsti0180">•Conducting initial visits screening in PC.</li><li class="elsevierStyleListItem" id="lsti0185">•To improve communication with PC: regular meetings, specific e-mail account.</li><li class="elsevierStyleListItem" id="lsti0190">•To obtain DH nursing support.</li><li class="elsevierStyleListItem" id="lsti0195">•To reorganise the scheduling of paediatric allergy DH.</li></ul></li><li class="elsevierStyleListItem" id="lsti0200">4.Innovation/improvement in diagnosis and treatment. Improvement in quality of care.<ul class="elsevierStyleList" id="lis0050"><li class="elsevierStyleListItem" id="lsti0205">•Establishment of determination of exhaled nitric oxide technique and bronchial challenge tests.</li><li class="elsevierStyleListItem" id="lsti0210">•Diagnosis using recombinant allergens.</li><li class="elsevierStyleListItem" id="lsti0215">•Application of cluster patterns in immunotherapy.</li><li class="elsevierStyleListItem" id="lsti0220">•Desensitisation treatments for food and drugs.</li></ul></li><li class="elsevierStyleListItem" id="lsti0225">5.To perform weekly clinical sessions with the whole team.</li><li class="elsevierStyleListItem" id="lsti0230">6.Increase allergist hours to develop all these changes.</li></ul>Results 2010<ul class="elsevierStyleList" id="lis0055"><li class="elsevierStyleListItem" id="lsti0235">1.In 2010 the Althaia Foundation allergy department expanded its territory for providing medical care: Hospital de Igualada (Consorci Sanitari Anoia) and Hospital Nostra Senyora de Meritxell (Andorra). Private medical care activity was begun in the CSJ.</li><li class="elsevierStyleListItem" id="lsti0240">2.Increase in allergist hours and work areas available.</li><li class="elsevierStyleListItem" id="lsti0245">3.Creation of an allergy network for Central Catalonia.</li><li class="elsevierStyleListItem" id="lsti0250">4.Implementation of the pilot scheme to reduce the waiting list has reduced the time to first hospital visit by several months (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The plan was carried out for 10 months. The allergist performed visits and tests (prick/spirometry) in PC centres without nursing assistance. The maximum waiting time was 30 days, the patient avoided travelling to the hospital, the level of absenteeism was lower than in the hospital (3.4% vs. 29.5% hospital), the degree of patient satisfaction was high and the relationship with primary care physicians improved (developing agreed-upon referral protocols and creation of a specific e-mail account).<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>The number of first visits increased mainly due to the increase in the total number of hours dedicated to medical care and, to a lesser extent, by the addition of a nurse in the DH that has allowed the attending physician to conduct his/her activities while monitoring challenge tests (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Thus in 2010, there were a total of 3018 first visits and 7359 successive visits (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).<elsevierMultimedia ident="fig0005"></elsevierMultimedia>If the activity in Igualada and Andorra is included, the 1st/2nd visit ratio is significantly reduced from 2.87 in 2005 to 2.44 in 2010 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There is also a clear increase in day hospital visits.</li><li class="elsevierStyleListItem" id="lsti0255">5.An estimate was made of the expense of an allergy study. An exact economic analysis cannot be performed because there are no computerised records of activity in 2005. Patients were classified into four case-mix groups and a complete cost approximation was performed according to usual study protocols (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 3</a>). Cost per visit or examination was calculated based on the time spent by the professional. Calculation of analytical determination costs was made by multiplying the average cost per allergen by the average number of allergens requested per patient.<elsevierMultimedia ident="tbl0015"></elsevierMultimedia></li></ul>It should be kept in mind as potential biases that a patient could have multiple reasons for the consultation, and therefore belong to several groups at once. In addition, some patients do not complete the study and there is no accounting of consumables used in the examination.<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows a comparison of the costs before and after the application of the SP.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionIn recent years, the population in our country has been increasing due to longer life expectancy and migration.<a class="elsevierStyleCrossRef" href="#bib0015">3</a> The WHO has warned about the health impact of the progressive ageing of the population, estimating that overall spending on health care will increase by 41% between 2000 and 2050.<a class="elsevierStyleCrossRef" href="#bib0020">4</a>In recent decades there is an increase in the prevalence of allergic diseases and consequently an increased demand for allergy care.<a class="elsevierStyleCrossRefs" href="#bib0025">5,6</a> This fact is clearly related to the characteristics of the occidental lifestyle, which encompasses factors such as dietary habits, exposure to allergens, environmental pollution and ease of access to health care, among others.<a class="elsevierStyleCrossRefs" href="#bib0035">7,8</a> The increase in the immigrant population, mostly young and with children, has led to increased respiratory disease and longer life expectancy, resulting in more studies on skin drug-related pathologies. Increased demand forces us to rethink the current care model more focused on hospital care, aiming for another model based on a coordinated network of services that provide continuity between levels of care.In the work presented PC participation has been positive and has helped establish a basis for collaboration with PC.<a class="elsevierStyleCrossRefs" href="#bib0005">1,2</a>In our setting, the increased territory for which allergy care is provided through the creation of strategic alliances (under the SP)<a class="elsevierStyleCrossRef" href="#bib0045">9</a> has diversified the allergy study as awareness profiles obviously vary depending on the geographical area. According to WHO an allergist is required for every 50,000 inhabitants.<a class="elsevierStyleCrossRef" href="#bib0050">10</a>After application of the SP the Althaia Foundation allergy department strengthened its role as a referral allergy service in Central Catalonia. The increase in physician hours (97h/week in 2005 to 122h in 2010) and the addition of two professionals to the team has enhanced the care activity. The allergist/inhabitants ratio in our current coverage area (383,082 inhabitants) is still far from WHO recommendations (1:50,000 population); 7.67 allergists are still needed. Even with these data the current relationship of an allergist for every 63,847 inhabitants is better than the Catalan average in 2010 (1/140,000 inhabitants).This reorganisation into a healthcare network reinforces teamwork and prevents the existence of one-person services that otherwise might exist in Igualada and Andorra. The number of patient journeys was reduced. Reducing indirect socioeconomic costs (time lost from work by patients) justifies the time spent in allergist travel (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). There are studies that refer to improving the accessibility of the patient which evaluate the minimum values of distance travelled and time spent on journeys of users from their place of residence to the nearest health service based on private road transport. No studies have been found on accessibility to health centres that have allergy care nor are there studies about work conducted in allergy speciality medical care networks.<a class="elsevierStyleCrossRefs" href="#bib0055">11,12</a><elsevierMultimedia ident="tbl0025"></elsevierMultimedia>The lack of specialists in allergology in Igualada, Andorra and CSJ would have affected 1236 first visits (40.95% of total). If we analyse the data including first visits, successive and DH, in 2010 there were a total of 3115 visits in Igualada and Andorra in which the patient did not have to travel, which represents 26.63% of total visits during this period (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).In recent years there have been different models for managing patients with chronic diseases such as the Chronic Care Model of Wagner, Expanded Chronic Care Model, the WHO Framework for Innovative Care of Chronic Diseases, among others. They emphasise the importance of prevention and health promotion, the need to optimise resources and formulation of health policy.<a class="elsevierStyleCrossRef" href="#bib0065">13</a>Another model of interest is the stratification of patients according to their level based on the Kaiser Permanent pyramid (KP). The KP model identifies three levels of intervention according to the degree of complexity of the case in order to optimise human resources and organisation of care while avoiding unnecessary costs. Patients who are at the top of the pyramid represent 3–5% of cases, are the most complex and consume the highest proportion of resources.<a class="elsevierStyleCrossRefs" href="#bib0070">14–16</a>The Pla de Salut (Healthcare Plan) of the Catalan Government presented in December 2012 included protocols in allergic disease and referral criteria from primary care to specialised care consistent with the actions taken under the SP presented in this paper.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>The working model of a network of centres (hospital care, primary care, private care) applied in this project is novel in Catalan allergology and to date there was no allergy department to implement this type of care. This model, which was implemented within the Althaia Foundation in other medical specialities, could also be valid for other specialities and may be the network of choice to provide future benefits for both the patient and the healthcare system.<a class="elsevierStyleCrossRefs" href="#bib0090">18,19</a>Recently, the Department of Health of the Catalan Government through the Department of Regulation and Health Resource Planning included in its care framework a possible alternative to the current model, which is very similar to that created in our service after application of the SP.<a class="elsevierStyleCrossRef" href="#bib0085">17</a>The reduction in the waiting list is relevant data of this study. In 2005 a pilot project was initiated in which the allergist moved to primary care so as to perform screening visits, reducing hospital referrals by 39.1%, with low absenteeism visits (3.4%) and a high rate of satisfaction among users. Avoiding patient travels and reduction in waiting time for the first visit were the aspects most valued by patients. In a study published by Negro et al. in 2004 on the degree of the failure of scheduled visits, after implementation of an improvement plan there was a 15.72% improvement.<a class="elsevierStyleCrossRefs" href="#bib0100">20–22</a> The selection of these visits was made after evaluating referrals differentiating patient groups according to severity/complexity establishing complexity groups based on the KP care model. This work has enabled the development of specific referral criteria for allergic pathologies in consensus with PC and the creation of a specific email account to improve communication between the two levels of care.<a class="elsevierStyleCrossRef" href="#bib0115">23</a>Increasing care activity leads to an increase in costs, which is offset, among other factors, by a higher rate of resolution in the study of patients with the objective of significant reduction in the 1st/2nd visit ratio. The improvement in the 1st/2nd visit ratio (2.87 in 2005, 2.44 in 2010) can be explained primarily by the screening done in the first few visits based on stratification by complexity; in this way less complex pathologies can be controlled in PC and specialised hospital care can focus on patients with more complex or difficult to manage conditions.<a class="elsevierStyleCrossRefs" href="#bib0070">14,15</a> Time of diagnostic resolution was reduced and the complexity of the patients treated in hospitals increased.The cost analysis per pathology shows that the drug allergy group is the group that generates more spending, so this brought up the need for a more detailed analysis, which will be the subject of another publication. One limitation of the analysis by case-mix groups is that not all patients are subjected to the same number of tests and the same patient may have several pathologies.<a class="elsevierStyleCrossRefs" href="#bib0120">24–27</a>The increase in the total number of visits implies an increase in the number of additional examinations conducted and the full costs (<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2–4</a>). The department's performance analysis has highlighted the need for computerised records since the data of the tests performed by nurses in 2005 were recorded manually. For this reason analysis of the real increase in the number of tests may not be accurate. It must be kept in mind that in screening visits for the waiting list reduction plan it is the doctor himself who makes the prick test or spirometry and these tests were not recorded in the registers. At the economic level we must mention the savings of not having to provide nursing support for conducting such tests in these patients.The reduction in the number of rhinomanometries (RMM) performed in the study period is because in 2005 the allergy department performed, in addition to its own RMMs, those requested by the otolaryngologists (ENT) from PC.The number of determinations of specific IgE (CAP) also increased substantially due to increasing care activity. Not included in the results of this work were CAPs performed at Igualada hospital or Andorra. It must be taken into account that the total number includes those determinations requested by pulmonology, PC and paediatrics. This bias is found in the 2005 data as well as 2010 but it is assumed since the largest volume of determinations comes from the allergy department.<a class="elsevierStyleCrossRef" href="#bib0005">1</a>In 2005 there were 5170 specific IgE determinations representing 3.4 CAPs/first visit. In 2010 there was an increase in this ratio to 4.27 from CAPs/first visit. Probably this increase in the proportion of requests per patient is due to an increase in the variety of allergens on the market (e.g. recombinant allergens), as well as greater complexity of the patients studied. In many cases it involves the existence of polysensitisations and therefore a greater number of determinations per patient.The increase is due primarily to determinations for airborne allergens due to the incorporation of recombinant pollen allergens and increased respiratory disease prevalence. Secondly, there is an increased number of requests for food specific IgE, explained among other reasons, by plant food allergy found in many patients (cross-reactivity).<a class="elsevierStyleCrossRefs" href="#bib0140">28,29</a>Importantly, although there were more studies of allergies to drugs in 2010 than in 2005, there was a slight decrease in CAP determinations for drugs. There is probably a better selection of patients studied although this is discussed in more detail in another publication.Diagnosis by recombinant allergens is more sensitive but less cheap than that done with the natural allergen (average price of natural allergen determination is 5.31 Euros, vs. 10.63 Euros for recombinant), so currently only the most prevalent allergens in the area study are included in the routine study.The observed increase in the number of patients treated in day hospitals is not only quantitative but also has increased the complexity and risk of testing.In 2005, the waiting list for a challenge test in children DH was longer than 10 months. After application of the SP the waiting list is down to four months. Of the 873 DH sessions in 2005, 214 correspond to challenge tests in adults (24.5%) and 133 in children (15.23%). In 2010, a total of 924 DH sessions were performed (of which 227 adults (24.5%) and 225 in children (24.35%)).The number of treatments with allergen-specific immunotherapy to aeroallergens increased by 19.99% (2005: 2173 standard+48 clusters; 2010: 2563 standard+102 clusters). The largest increase was in the number of administrations in cluster pattern (+112.5%), which must always be performed in DH or in an immunotherapy unit. Administration in cluster or rush patterns leads directly to a reduction in the total number of doses administered to the patient, reducing the number of reactions and the number of visits by the patient, with the consequent savings that this represents at all levels.<a class="elsevierStyleCrossRefs" href="#bib0150">30,31</a>With these changes the allergy department currently has a greater number of patients with highly complex diseases (severe asthma, multiple food allergy, etc.) that require a greater number of studies and more complex treatment.Other improvements after application of SP were: monoclonal drug therapy, desensitisation, exhaled nitric oxide levels and modelling of comprehensive specific informed consent in the computerised medical record.After analysing the results following application of the SP the model of allergy care used so far would have to be reconsidered and opt for a new organisational model based on risk stratification of patients and on the system of networking between centres and levels of care.ConclusionsApplying a SP in the allergology department has allowed to:<ul class="elsevierStyleList" id="lis0060"><li class="elsevierStyleListItem" id="lsti0260">1.Create a healthcare network in allergy, a new care model in Catalonia, matching available resources to the growing demand, rationalising expenditure and improving the quality of care.</li><li class="elsevierStyleListItem" id="lsti0265">2.Improve the quality of care, increase the diversity of services and expand the territory for which the service is provided (strategic alliances).</li><li class="elsevierStyleListItem" id="lsti0270">3.Implement specific referral criteria for each pathology as agreed upon with PC, reducing waiting lists and avoiding unnecessary studies. Another work will deal with specific analysis of diagnostic yield of drug allergy studies.</li><li class="elsevierStyleListItem" id="lsti0275">4.Adjust the pathology treated in hospital to what is really necessary due to its complexity and improve the diagnostic resolution time.</li><li class="elsevierStyleListItem" id="lsti0280">5.Obtain an increase in absolute costs secondary to increased activity is justified by the expansion of the territory, the number of patients seen, the improvement in diagnostic resolution and reducing indirect socioeconomic costs. So even though overall spending increases, spending per patient successfully treated is reduced.</li></ul>Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments were performed on human or animals for this investigation.Patient's data protectionThe authors declare that no patient data appear in this article.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflict of interestThere is no conflict of interest with regard to the article." "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:2 [ "identificador" => "xres414322" "titulo" => array:4 [ 0 => "Abstract" 1 => "Material and methods" 2 => "Results" 3 => "Conclusions" ] ] 1 => array:2 [ "identificador" => "xpalclavsec389963" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 4 => array:3 [ "identificador" => "sec0015" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Results and indicators 2005" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Summary of strategic plan 2005–2010" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "Results 2010" ] ] ] 5 => array:2 [ "identificador" => "sec0035" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "sec0040" "titulo" => "Conclusions" ] 7 => array:3 [ "identificador" => "sec0045" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0050" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0055" "titulo" => "Patient's data protection" ] 2 => array:2 [ "identificador" => "sec0060" "titulo" => "Right to privacy and informed consent" ] ] ] 8 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interest" ] 9 => array:2 [ "identificador" => "xack123034" "titulo" => "Acknowledgment" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-07-15" "fechaAceptado" => "2013-09-04" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec389963" "palabras" => array:5 [ 0 => "Allergology" 1 => "Care network" 2 => "Cost" 3 => "Management" 4 => "Strategic plan" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "In 2005 the Althaia Foundation Allergy Department performed its daily activity in the Hospital Sant Joan de Deu of Manresa. Given the increasing demand for allergy care, the department's performance was analysed and a strategic plan (SP) for 2005–2010 was designed.The main objective of the study was to assess the impact of the application of the SP on the department's operations and organisational level in terms of profitability, productivity and quality of care. Material and methodsDescriptive, retrospective study which evaluated the operation of the allergy department. The baseline situation was analysed and the SP was designed. Indicators were set to perform a comparative analysis after application of the SP. ResultsThe indicators showed an increase in medical care activity (first visits, 34%; successive visits, 29%; day hospital treatments, 51%), high rates of resolution, reduced waiting lists. Economic analysis indicated an increase in direct costs justified by increased activity and territory attended. Cost optimisation was explained by improved patient accessibility, minimised absenteeism in the workplace and improved cost per visit. ConclusionsAfter application of the SP a networking system was established for the allergy speciality that has expanded the territory for which it provides care, increased total activity and the ability to resolve patients, optimised human resources, improved quality of care and streamlined medical costs." ] ] "multimedia" => array:6 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1994 "Ancho" => 1965 "Tamanyo" => 191291 ] ] "descripcion" => array:1 [ "en" => "First visits and successive visits made to the allergy department in the period 2005–2010 and the evolution of resolution capability." ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Groups \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CIE 10 CODE \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Group 1(respiratory allergy) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Rhinitis: J30, J30.0, J30.1, J30.2, J30.3, J30.4Asthma: J45, J45.0, J45.1, J45.8, J45.9Conjunctivitis: H10, H10.1, H10.3, H10.4, H10.5, H10.8, H10.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Group 2(food allergy) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Anaphylactic shock due to adverse reactions to food: T 78.0, T78.1, T78.2, T78.3, T78.4Allergic urticaria: L50.0Laryngeal oedema: J38.4Nausea and vomiting: R11.Itching: L29.Dermatitis due to ingestion of food: L27.2Dysphagia: R13.Unspecified intestinal malabsorption: K90.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Group 3 (allergy to drugs) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Dermatitis: L27, L27.0, L27.1Itching: L29Anaphylactic shock unspecified: T78.2Angioneurotic oedema: T78.3Urticaria: L50Phototoxic drug response: L56.0Photoallergic drug response: L56.1Anaphylactic shock due to adverse effects of drug or correct medicine appropriately administered: T88.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="middle">Group 4(skin pathology) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Atopic dermatitis: L20, L20.0, L20.8, L20.9Contact allergic dermatitis: L23Unspecified contact dermatitis: L25Other dermatitis: L30.8, L30.9Urticaria: L50, L50.0, L50.1, L50.2, L50.3, L50.4, L50.5, L50.6, L50.8, L50.9, L56.3Erythema multiforme: L51Polymorphic light eruption: L56.4Oedema: T78.3, R60, R60.0, R60.1, R60.9, J38.4Itching: L29Mastocytosis: Q 82.2Unspecified allergy: T78.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab646910.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Division by pathologies according to code CIE 1." ] ] 2 => array:7 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "NC: not calculable." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2005 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2010 \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variation \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Annual hours allergist in Manresa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4233h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6345h \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+2112h (+ 49.89%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Allergy waiting list adults \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">420 days (14m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">180 days (6m) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−240 days (8 months) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Allergy paediatric waiting list \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">6m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−90 days (3 months) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">First visits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1519 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2037 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+518 (+34%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Second visits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4355 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5620 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+1265 (+29.05%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Resolution index (1st/2nd visit) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2.76<a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No. prick test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1989<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2025<a class="elsevierStyleCrossRef" href="#tblfn0010">**</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NC \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No. epicutaneous tests \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">234<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">105 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NC \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No. lung function studies \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2613<a class="elsevierStyleCrossRef" href="#tblfn0015">***</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3243 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NC \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No. rhinomanometries \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">81 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−60 (−74.07%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No. day hospital sessions \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">873 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">924 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+51 (+5.84%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No. conventional immunotherapy treatments administered \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2173 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2563 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+390 (+17.95%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total specific IgE performed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5170 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8705 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+3535 (+68.3%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">-foods \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1611 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2647 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+1036 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">-inhalants \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2743 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5250 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+2507 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">-drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">391 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">348 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">−43 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">-other allergens \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">425 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">460 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">+35 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " colspan="4" align="left" valign="top"></td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">No. informed consents signed \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Not recorded \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100% \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NC \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab646912.png" ] ] ] "notaPie" => array:3 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "Corrected per activity in Igualada and Andorra would be 2.44." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "**" "nota" => "Pricks made by the physician in screening visits not recorded." ] 2 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "***" "nota" => "Record not computerised." ] ] ] "descripcion" => array:1 [ "en" => "Comparative analysis years 2005–2010 (activity in Manresa)." ] ] 3 => array:7 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:2 [ "leyenda" => "Cost per physician/hour (2010): 50.64 Euros, nursing cost/hour: 27.11 Euros.* Mean CAP cost 2005: 6.81 Euros, mean CAP cost 2010: 7.57 Euros. PFR: lung function tests, RMM: rhinomanometry." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1st visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prick tests \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PFR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Blood tests \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Day hospital \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RMM \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Epicutaneous \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost/patient (2005) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost/patient (2010) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Group 1 (respiratory pathology) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.5h×cost per physician hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.33h×cost per nursing hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.17h×cost per nursing hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.4 CAPs x cost per CAP2010: 4.27 CAP X price CAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1.75h×cost per nursing hour (only in 10% patients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.25×cost per physician hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.42Euros (not including RMM)114,72Euros (including RMM) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83.74 Euros not including RMM131.18Euros(including RMM) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Group 2 (food pathology) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.5h×cost per physician hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.33h×cost per nursing hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.4 CAPs×cost per CAP2010: 4.27 CAP×cost per CAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2h×cost per physician hour+5h×cost per nursing hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.25h×cost per physician hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">264.69Euros \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">300.66 Euros \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Group 3(drug allergies) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.5h×cost per physician hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.33h×cost per nursing hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.4 CAPs×cost per CAP2010: 4.27 CAP×cost per CAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">(2h×cost per physician hour+5h×cost per nursing hourx 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.25h×cost per physician hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">454.04 Euros \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">522.19 Euros \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Group 4 (Skin pathology \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.5h×cost per physician hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.33h×cost per nursing hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3.4 CAPs×cost per CAP2010: 4.27 CAP×cost per CAP \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.5h×cost per physician hour \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.25×50.49 Euros \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77.53 Euros \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92.69 Euros \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab646911.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Approximate full costs per patient for consultation." ] ] 4 => array:7 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2005 (1519 first visits)</th><th class="td" title="table-head " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2010 (3018 first visits in Manresa, Igualada and Andorra)</th></tr><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of patients \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost per patient (Euros) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost (Euros) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of patients (increase) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost per patient (Euros) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost (Euros) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Group 1 (respiratory pathology) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">881 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">69.42 (90% patients)114.72 (10% patients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">65,145.42 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1962 (+122%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">83.74 (90% patients)131.18(10% patients) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">173,605.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Group 2(food pathology) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">379 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">264.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">100,317.51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">905 (+138%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">300.66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">272,097.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Group 3(allergy to drugs) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">212 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">454.04 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">96,256.48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">482 (+127%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">522.19 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">251,695.58 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Group 4(Skin pathology) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">273 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">77.53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21,165.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">513 (+87.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">92.69 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47,549.97 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">282,885.1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">744,948.45 Euros \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Difference \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " colspan="6" align="center" valign="top">+462,063.35 Euros</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab646909.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Comparative costs according to pathologies between 2005 and 2010." ] ] 5 => array:7 [ "identificador" => "tbl0025" "etiqueta" => "Table 5" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Region of origin \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Region of destination \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time going (min) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Distance going (km) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time going+return (min) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Distance going+return (km) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Igualada \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Manresa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">30min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Igualada \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Barcelona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">49min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63.6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1h 38min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">127.2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Andorra la Vella \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Manresa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1h 56min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">137.7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3h 52min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">275.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Andorra la Vella \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Barcelona \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2h 27min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">186.8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4h 54min \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">393.6 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab646908.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Distance and time involved in travelling from Igualada and Andorra." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio preliminar del desplazamiento del alergólogo a Atención Primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Ferré-Ybarz" 1 => "R. Tella Ruz" 2 => "S. Ranea Arroyo" 3 => "R. Guspí Bori" 4 => "S. Nevot Falcó" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Alergol Inmunol Clin" "fecha" => "2005" "volumen" => "290" "paginaInicial" => "224" "paginaFinal" => "229" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Al·lergologia a l’atenció primària" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Ferré-Ybarz" 1 => "R. Tella" 2 => "S. Ranea" 3 => "R. Guspí" 4 => "S. Nevot" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediatr Catalana" "fecha" => "2006" "volumen" => "66" "paginaInicial" => "180" "paginaFinal" => "184" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Idescat: Banc d’estadístiques de municipis i comarques. Indicadors demogràfics. Barcelona, Generalitat de Catalunya. Available from: <a href="http://www.idescat.net/">http://www.idescat.net/</a>" ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Bull Wordl Health Organ" "fecha" => "2012" "volumen" => "90" "paginaInicial" => "162" "paginaFinal" => "163" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "Alergológica. Factores epidemiológicos, clínicos y sociodemográficos de las enfermedades alérgicas en España en 2005" "serieFecha" => "2005" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalencia de alergia en la población adulta española" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Gaig" 1 => "D. Muñoz-Lejarazu" 2 => "R. Lleonart" 3 => "J.L. García-Abujeta" 4 => "T. Caballero" 5 => "A. Rodriguez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Alergol Inmunol Clin" "fecha" => "2004" "volumen" => "19" "paginaInicial" => "68" "paginaFinal" => "78" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The most common phenotypes of sensitization to inhalant allergens in childhood" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K. Storm Van's Gravensande" 1 => "M. Moseler" 2 => "J. Kuehr" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Exp allergy" "fecha" => "1997" "volumen" => "27" "paginaInicial" => "646" "paginaFinal" => "652" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9208185" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sensitization patterns to food and inhalant allergens in childhood: a comparision of non-sensitized, monosensitized and polysensitized children" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.B. de Jong" 1 => "L.D. Dikkeschei" 2 => "P.L. Brand" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Pediat Allergy Immunol" "fecha" => "2011" "volumen" => "22" "paginaInicial" => "166" "paginaFinal" => "171" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Aplicación de un modelo de gestión empresarial en un servicio cebtral hospitalario public. Experiencia de cinco años" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Salinas Argente" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2001" "editorial" => "Universitat Autónoma de Bellaterra" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "El papel del especialista en Alergología en el siglo XXI" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Chivato Pérez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Alergol Inmunol" "fecha" => "2004" "volumen" => "19" "paginaInicial" => "131" "paginaFinal" => "132" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mapa Sanitario: una vision dinámica de la planificación de servicios en Cataluña" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M.L. de la Puente" 1 => "J. Fusté" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2008" "volumen" => "131" "numero" => "supl 4" "paginaInicial" => "3" "paginaFinal" => "8" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilización de servicios de salud y flujos asistenciales" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "D. Frigola" 1 => "C. Illa" 2 => "J.M. Elorza" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2008" "volumen" => "131" "numero" => "Supl 4" "paginaInicial" => "23" "paginaFinal" => "30" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management models" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Bengoa" 1 => "F. Martos" 2 => "R. Nuño" 3 => "S. Kreindler" 4 => "T. Novak" 5 => "R. Pinilla" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:2 [ "titulo" => "When people live with multiple chronic diseases: a collaborative approach to an emerging global challenge" "serieFecha" => "2010" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Buenas prácticas en gestión sanitaria: el caso Kaiser Permanente" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Nuño" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Adm Sanit" "fecha" => "2007" "volumen" => "5" "paginaInicial" => "283" "paginaFinal" => "292" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lessons for the NHS from Kaiser Permanente" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Schapiro" 1 => "S. Smith" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1136/bmj.327.7420.895" "Revista" => array:4 [ "tituloSerie" => "BMJ" "fecha" => "2003" "volumen" => "327" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14563744" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Methods for predicting risk of emergency hospitalization" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Goodwin" 1 => "N. Curry" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:3 [ "titulo" => "8th Annual Conference" "conferencia" => "Gothenburg" "serieFecha" => "2008" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Pla de Salut 2011–2015: Les guies, els protocols dabordatge de la patologia al·lèrgica i els criteris de derivació en l’atenció primària. Generalitat de Catalunya, novembre de 2012. Depósito legal: B. 33685-2012" ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "2012" "editorial" => "Departament de Salut. Direcció General de Regulació, Planificació i Recursos Sanitaris. Primera edició" "editorialLocalizacion" => "Barcelona" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Grupo de investigadores proyecto RECENT. Redes centinela sanitarias en España. Consenso para una guía de principios y métodos" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.T. Vega Alonso" 1 => "O. Zurriaga Llorens" 2 => "A. Galmés Truyols" 3 => "J.E. Lozano Alonso" 4 => "L. Paisán Maestro" 5 => "M. Gil Costa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gac Sanit" "fecha" => "2006" "volumen" => "20" "paginaInicial" => "496" "paginaFinal" => "502" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17198629" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La transformación de una red hospitalaria pública: el Institut Català de la Salut" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.D. González Cuyàs" 1 => "M. Figuerola Batista" 2 => "Gabaldà Azofra J." 3 => "Gràcia Escoriza R." 4 => "de Haro Martín L." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "edicion" => "5a" "titulo" => "Gestión Hospitalaria" "fecha" => "2011" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Alianzas estratégicas y empresa multifactorial. Gestión y Evaluación de Costes Sanitarios, vol 11, monográfico 1" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. de Rosa Torner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:1 [ "fecha" => "2010" ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluación de los resultados obtenidos en el incumplimiento de citas concertadas en pacientes de una consulta de alergología, al año de la implantación de un ciclo de mejora" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Negro Álvarez" 1 => "R. Félix Toledo" 2 => "M. Guerrero Fernández" 3 => "F.J. Campuzano López" 4 => "T. Bernal Fernández" 5 => "F. Pellicer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ultramic.2007.03.006" "Revista" => array:6 [ "tituloSerie" => "Gestión Hospitalaria" "fecha" => "2004" "volumen" => "15" "paginaInicial" => "13" "paginaFinal" => "21" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17517476" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Incumplimiento de citas concertadas en los pacientes de una consulta de alergología tras el Segundo año de implantación de un ciclo de mejora" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.M. Negro Álvarez" 1 => "F.J. Campuzano López" 2 => "F. Pellicer Orenes" 3 => "T. Bernal Fernández" 4 => "M.D. Martos Calahorro" 5 => "R. Martínez López" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Alergol Inmunol Clin" "fecha" => "2004" "volumen" => "19" "paginaInicial" => "195" "paginaFinal" => "204" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "How should continuity of care in primary health care be assessed?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Salisbury" 1 => "F. Sampson" 2 => "M. Ridd" 3 => "A. Montgomery" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Br J Gen Pract" "fecha" => "2009" "volumen" => "9" "paginaInicial" => "134" "paginaFinal" => "141" ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Los costes directos de un paciente asistido en la consulta externa de alergología de un hospital universitario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.M. Negro-Alvarez" 1 => "T. Murcia Alemán" 2 => "C. Aparicio García" 3 => "J. Hernández García" 4 => "R. Ferrándiz Gomis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Alergol Inmunol Clin" "fecha" => "2005" "volumen" => "20" "paginaInicial" => "4" "paginaFinal" => "9" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gestión por procesos en Alergología" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "J.M. Negro Álvarez" 1 => "J.C. Miralles López" 2 => "J.L. Jiménez Molina" 3 => "M. 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Carrillo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Aten Primaria" "fecha" => "1996" "volumen" => "17" "paginaInicial" => "74" "paginaFinal" => "83" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Codificación y comunicación en alergia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.M. 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"vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03010546/0000004300000001/v1_201501250943/S0301054613002887/v1_201501250943/en/main.assets" "Apartado" => array:4 [ "identificador" => "5554" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03010546/0000004300000001/v1_201501250943/S0301054613002887/v1_201501250943/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0301054613002887?idApp=UINPBA00004N"]

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Original Article

L. Ferré-Ybarza,

Corresponding author

lferre@althaia.cat

Corresponding author.

, R. Salinas Argenteb, S. Nevot Falcóa, C. Gómez Galána, J. Franquesa Rabatc, J. Trapé Pujolc, P. Oliveras Alsinad, M. Pons Serrae, X. Corbella Virósf

a Allergy Service, Althaia, Xarxa Assistencial Universitària de Manresa, Spain

b Managing Director Banc de Sang i Teixits Catalunya Central i Vallès Occidental, Spain

c Biological Diagnosis Department, Althaia, Xarxa Assistencial Universitària de Manresa, Spain

d Management Control Unit, Althaia, Xarxa Assistencial Universitària de Manresa, Spain

e Specialized Care Director, Althaia, Xarxa Assistencial Universitària de Manresa, Spain

f Management Hospital Universitari Bellvitge, Territorial Management ICS Metropolitana Sud, Spain

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In the 2005 health care model, allergists were located in HSJD, and patients had to travel to receive their treatment.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The primary objective of the study is to analyse the value of measures designed and subsequently implemented under the strategic plan (SP) for service 2005&#8211;2010, which are:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0015" class="elsevierStylePara elsevierViewall">To validate whether the measures applied in the SP are appropriate. To assess the impact of the implementation of the SP.</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0020" class="elsevierStylePara elsevierViewall">To compare our care model with other allergy departments in the same setting (benchmarking).</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0025" class="elsevierStylePara elsevierViewall">To improve the department&#39;s performance by adapting the most appropriate cost possible: Profitability and Productivity.</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0030" class="elsevierStylePara elsevierViewall">To maintain and/or improve the quality standard.</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0035" class="elsevierStylePara elsevierViewall">Adaptation to all new demands for care in our referral area and to proposals and objectives established by the health authorities.</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0040" class="elsevierStylePara elsevierViewall">Strengthening the department&#39;s organisational model. Implementation of the organisational model in medical visits, day hospital (DH) and hospitalisation.</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Promote coordination with primary care (PC).</p></li></ul></p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">In this study it was important to assess the environment and adjust performance accordingly before study initiation:</span><ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">gradual increase in demand for allergy care;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">difficulty in finding professionals;</p></li><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0065" class="elsevierStylePara elsevierViewall">inability to minimise the prevalence of allergic disease; and</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0070" class="elsevierStylePara elsevierViewall">need to respond to demand, without cost overruns, optimising existing resources (human and financial) with quality practices.</p></li></ul></p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Thus it was necessary to:</span><ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">Analyse the allergy department situation in 2005.</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">Define reliable/appropriate indicators enabling a comparative analysis between the situation in 2005 and the following years.</p></li><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0090" class="elsevierStylePara elsevierViewall">Establish a specific SP.</p></li></ul></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Material and methods</span><p id="par0095" class="elsevierStylePara elsevierViewall">Descriptive, retrospective study that assessed the operation of the Althaia Foundation allergy department.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In order to provide data to allow performing the assessment of measures resulting from SP, analysis time was partitioned into two distinct periods (before processing the SP and after the application of corrective measures, whose origin was the SP itself).</p><p id="par0105" class="elsevierStylePara elsevierViewall">In the first period (2005), an analysis of service performance was conducted.<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">1.</span><p id="par0110" class="elsevierStylePara elsevierViewall">External analysis: Social/demographic setting, Political/economic/technological setting.</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">2.</span><p id="par0115" class="elsevierStylePara elsevierViewall">Internal analysis: Architectural resources, Human resources, Activities conducted, Work flows, Quality control.</p></li></ul></p><p id="par0120" class="elsevierStylePara elsevierViewall">Subsequently:<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">-</span><p id="par0125" class="elsevierStylePara elsevierViewall">Identification of problems/threats and proposal of improvement strategies.</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">-</span><p id="par0130" class="elsevierStylePara elsevierViewall">Benchmarking.</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">-</span><p id="par0135" class="elsevierStylePara elsevierViewall">Design and implementation of SP (2005&#8211;2010).</p></li></ul></p><p id="par0140" class="elsevierStylePara elsevierViewall">The development of an SP according to traditional methodology was made based on data obtained from various sources: population of the record of the Statistical Institute of Catalonia (Idescat), economic information of Althaia&#39;s Management Control Unit, hospital activity and functional plan from allergy department&#39;s own activity logs and Management Control Unit, and analytic data of Althaia&#39;s Department of Biological Diagnosis.</p><p id="par0145" class="elsevierStylePara elsevierViewall">Finally indicators were designed to enable a comparison before and after the application of the SP:<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">Waiting time for first visit.</p></li><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">&#8226;</span><p id="par0155" class="elsevierStylePara elsevierViewall">Number of first visits (FV).</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">Number of successive visits (SV).</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">&#8226;</span><p id="par0165" class="elsevierStylePara elsevierViewall">FV/SV ratio.</p></li><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">&#8226;</span><p id="par0170" class="elsevierStylePara elsevierViewall">Number of DH.</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall">Index specific IgE determinations/patient.</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">&#8226;</span><p id="par0180" class="elsevierStylePara elsevierViewall">Expenditure per pathology (case-mix groups).</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">&#8226;</span><p id="par0185" class="elsevierStylePara elsevierViewall">Allergist/no. inhabitants ratio.</p></li></ul></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results and indicators 2005</span><p id="par0190" class="elsevierStylePara elsevierViewall">In 2005 the HSJD of Manresa was the only centre in Central Catalonia with an allergy department. In 2005 private alternative medical care was very limited and was provided by allergists unrelated to HSJD. In the <span class="elsevierStyleItalic">Pla de Salut de Catalunya</span> during this period there was no clear specification for the speciality of allergology.</p><p id="par0195" class="elsevierStylePara elsevierViewall">Some of the tests included in the portfolio of services cannot be performed immediately and are scheduled on different days (patch tests, drug studies, etc.). Depending on the patients&#8217; pathology they were divided into four case-mix groups (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the activity data in 2005.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Summary of strategic plan 2005&#8211;2010</span><p id="par0200" class="elsevierStylePara elsevierViewall">The initial situation analysis allowed to describe the strengths and weaknesses of the department as well as the threats and opportunities (SWOT matrix), basis of the SP:<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">&#8226;</span><p id="par0205" class="elsevierStylePara elsevierViewall">Strengths: 1. Institutional positioning (Althaia Foundation). Willingness to work in network and to be a reference in the territory. 2. Head of service: visionary and credible. 3. Allergy service: reference in Central Catalonia. 4. Participation in cooperative research projects. 5. Teaching: participation in courses, publications, request allergy MIR accreditation. 6. Service depends on the Department of Pediatrics.</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">&#8226;</span><p id="par0210" class="elsevierStylePara elsevierViewall">Weaknesses: 1. Unstable staff. 2. Inadequate resources human/activity to develop. 3. Lack of control on waiting list. Poor communication with primary care. 4. Absence of own computer activity logs. 5. Absence of internal/external action protocols agreed upon according to each pathology. 6. Location of day hospital.7. Need for improvements in diagnostic techniques and treatments. 8. Excessive waiting time for specific paediatric studies.</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">&#8226;</span><p id="par0215" class="elsevierStylePara elsevierViewall">Opportunities: 1. Population pyramid 2. Increasing immigration. 3. Complete management of the waiting list. 4 Allergological needs not covered in other territories. 5. Small number of allergists. 6. Lack of activity in private paediatric allergology. 7. Expansion of the Hospital.</p></li><li class="elsevierStyleListItem" id="lsti0155"><span class="elsevierStyleLabel">&#8226;</span><p id="par0220" class="elsevierStylePara elsevierViewall">Threats: 1. Regressive population pyramid 2. Increased immigration. 3. Lack of control of waiting list. 4. External competitors: area Metropolitana, Berga Hospital. 5. Internal competitors: pulmonology, otolaryngology, dermatology. 6. Few Allergists. 7. Vagueness in the Pla de Salut.</p></li></ul></p><p id="par0225" class="elsevierStylePara elsevierViewall">As a consequence of the SP, specific measures were implemented which resulted in improved system performance, patient care and improvements in the department itself.<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0160"><span class="elsevierStyleLabel">1.</span><p id="par0230" class="elsevierStylePara elsevierViewall">Increase in the territory for which the Althaia Foundation provides care through movement of the allergist to other centres (Igualada, Andorra, CSJ) and creation of a networking system.</p></li><li class="elsevierStyleListItem" id="lsti0165"><span class="elsevierStyleLabel">2.</span><p id="par0235" class="elsevierStylePara elsevierViewall">To provide private medical care in paediatric allergology, as part of this network.</p></li><li class="elsevierStyleListItem" id="lsti0170"><span class="elsevierStyleLabel">3.</span><p id="par0240" class="elsevierStylePara elsevierViewall">To establish a pilot programme to reduce the waiting list:<ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0175"><span class="elsevierStyleLabel">&#8226;</span><p id="par0245" class="elsevierStylePara elsevierViewall">Development and implementation of specific referral protocols.</p></li><li class="elsevierStyleListItem" id="lsti0180"><span class="elsevierStyleLabel">&#8226;</span><p id="par0250" class="elsevierStylePara elsevierViewall">Conducting initial visits screening in PC.</p></li><li class="elsevierStyleListItem" id="lsti0185"><span class="elsevierStyleLabel">&#8226;</span><p id="par0255" class="elsevierStylePara elsevierViewall">To improve communication with PC: regular meetings, specific e-mail account.</p></li><li class="elsevierStyleListItem" id="lsti0190"><span class="elsevierStyleLabel">&#8226;</span><p id="par0260" class="elsevierStylePara elsevierViewall">To obtain DH nursing support.</p></li><li class="elsevierStyleListItem" id="lsti0195"><span class="elsevierStyleLabel">&#8226;</span><p id="par0265" class="elsevierStylePara elsevierViewall">To reorganise the scheduling of paediatric allergy DH.</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0200"><span class="elsevierStyleLabel">4.</span><p id="par0270" class="elsevierStylePara elsevierViewall">Innovation/improvement in diagnosis and treatment. Improvement in quality of care.<ul class="elsevierStyleList" id="lis0050"><li class="elsevierStyleListItem" id="lsti0205"><span class="elsevierStyleLabel">&#8226;</span><p id="par0275" class="elsevierStylePara elsevierViewall">Establishment of determination of exhaled nitric oxide technique and bronchial challenge tests.</p></li><li class="elsevierStyleListItem" id="lsti0210"><span class="elsevierStyleLabel">&#8226;</span><p id="par0280" class="elsevierStylePara elsevierViewall">Diagnosis using recombinant allergens.</p></li><li class="elsevierStyleListItem" id="lsti0215"><span class="elsevierStyleLabel">&#8226;</span><p id="par0285" class="elsevierStylePara elsevierViewall">Application of cluster patterns in immunotherapy.</p></li><li class="elsevierStyleListItem" id="lsti0220"><span class="elsevierStyleLabel">&#8226;</span><p id="par0290" class="elsevierStylePara elsevierViewall">Desensitisation treatments for food and drugs.</p></li></ul></p></li><li class="elsevierStyleListItem" id="lsti0225"><span class="elsevierStyleLabel">5.</span><p id="par0295" class="elsevierStylePara elsevierViewall">To perform weekly clinical sessions with the whole team.</p></li><li class="elsevierStyleListItem" id="lsti0230"><span class="elsevierStyleLabel">6.</span><p id="par0300" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Increase allergist hours</span> to develop all these changes.</p></li></ul></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results 2010</span><p id="par0305" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="lis0055"><li class="elsevierStyleListItem" id="lsti0235"><span class="elsevierStyleLabel">1.</span><p id="par0310" class="elsevierStylePara elsevierViewall">In 2010 the Althaia Foundation allergy department expanded its territory for providing medical care: Hospital de Igualada (Consorci Sanitari Anoia) and Hospital Nostra Senyora de Meritxell (Andorra). Private medical care activity was begun in the CSJ.</p></li><li class="elsevierStyleListItem" id="lsti0240"><span class="elsevierStyleLabel">2.</span><p id="par0315" class="elsevierStylePara elsevierViewall">Increase in allergist hours and work areas available.</p></li><li class="elsevierStyleListItem" id="lsti0245"><span class="elsevierStyleLabel">3.</span><p id="par0320" class="elsevierStylePara elsevierViewall">Creation of an allergy network for Central Catalonia.</p></li><li class="elsevierStyleListItem" id="lsti0250"><span class="elsevierStyleLabel">4.</span><p id="par0325" class="elsevierStylePara elsevierViewall">Implementation of the pilot scheme to reduce the waiting list has reduced the time to first hospital visit by several months (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). The plan was carried out for 10 months. The allergist performed visits and tests (prick/spirometry) in PC centres without nursing assistance. The maximum waiting time was 30 days, the patient avoided travelling to the hospital, the level of absenteeism was lower than in the hospital (3.4% vs. 29.5% hospital), the degree of patient satisfaction was high and the relationship with primary care physicians improved (developing agreed-upon referral protocols and creation of a specific e-mail account).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0330" class="elsevierStylePara elsevierViewall">The number of first visits increased mainly due to the increase in the total number of hours dedicated to medical care and, to a lesser extent, by the addition of a nurse in the DH that has allowed the attending physician to conduct his/her activities while monitoring challenge tests (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). Thus in 2010, there were a total of 3018 first visits and 7359 successive visits (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0335" class="elsevierStylePara elsevierViewall">If the activity in Igualada and Andorra is included, the 1st/2nd visit ratio is significantly reduced from <span class="elsevierStyleBold">2.87</span> in 2005 to <span class="elsevierStyleBold">2.44</span> in 2010 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). There is also a clear increase in day hospital visits.</p></li><li class="elsevierStyleListItem" id="lsti0255"><span class="elsevierStyleLabel">5.</span><p id="par0340" class="elsevierStylePara elsevierViewall">An estimate was made of the expense of an allergy study. An exact economic analysis cannot be performed because there are no computerised records of activity in 2005. Patients were classified into four case-mix groups and a complete cost approximation was performed according to usual study protocols (<a class="elsevierStyleCrossRefs" href="#tbl0005">Tables 1 and 3</a>). Cost per visit or examination was calculated based on the time spent by the professional. Calculation of analytical determination costs was made by multiplying the average cost per allergen by the average number of allergens requested per patient.</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></li></ul></p><p id="par0345" class="elsevierStylePara elsevierViewall">It should be kept in mind as potential biases that a patient could have multiple reasons for the consultation, and therefore belong to several groups at once. In addition, some patients do not complete the study and there is no accounting of consumables used in the examination.</p><p id="par0350" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows a comparison of the costs before and after the application of the SP.</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discussion</span><p id="par0355" class="elsevierStylePara elsevierViewall">In recent years, the population in our country has been increasing due to longer life expectancy and migration.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The WHO has warned about the health impact of the progressive ageing of the population, estimating that overall spending on health care will increase by 41% between 2000 and 2050.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0360" class="elsevierStylePara elsevierViewall">In recent decades there is an increase in the prevalence of allergic diseases and consequently an increased demand for allergy care.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> This fact is clearly related to the characteristics of the occidental lifestyle, which encompasses factors such as dietary habits, exposure to allergens, environmental pollution and ease of access to health care, among others.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a> The increase in the immigrant population, mostly young and with children, has led to increased respiratory disease and longer life expectancy, resulting in more studies on skin drug-related pathologies. Increased demand forces us to rethink the current care model more focused on hospital care, aiming for another model based on a coordinated network of services that provide continuity between levels of care.</p><p id="par0365" class="elsevierStylePara elsevierViewall">In the work presented PC participation has been positive and has helped establish a basis for collaboration with PC.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0370" class="elsevierStylePara elsevierViewall">In our setting, the increased territory for which allergy care is provided through the creation of strategic alliances (under the SP)<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> has diversified the allergy study as awareness profiles obviously vary depending on the geographical area. According to WHO an allergist is required for every 50,000 inhabitants.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0375" class="elsevierStylePara elsevierViewall">After application of the SP the Althaia Foundation allergy department strengthened its role as a referral allergy service in Central Catalonia. The increase in physician hours (97<span class="elsevierStyleHsp" style=""></span>h/week in 2005 to 122<span class="elsevierStyleHsp" style=""></span>h in 2010) and the addition of two professionals to the team has enhanced the care activity. The allergist/inhabitants ratio in our current coverage area (383,082 inhabitants) is still far from WHO recommendations (1:50,000 population); 7.67 allergists are still needed. Even with these data the current relationship of an allergist for every 63,847 inhabitants is better than the Catalan average in 2010 (1/140,000 inhabitants).</p><p id="par0380" class="elsevierStylePara elsevierViewall">This reorganisation into a healthcare network reinforces teamwork and prevents the existence of one-person services that otherwise might exist in Igualada and Andorra. The number of patient journeys was reduced. Reducing indirect socioeconomic costs (time lost from work by patients) justifies the time spent in allergist travel (<a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>). There are studies that refer to improving the accessibility of the patient which evaluate the minimum values of distance travelled and time spent on journeys of users from their place of residence to the nearest health service based on private road transport. No studies have been found on accessibility to health centres that have allergy care nor are there studies about work conducted in allergy speciality medical care networks.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11,12</span></a></p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia><p id="par0385" class="elsevierStylePara elsevierViewall">The lack of specialists in allergology in Igualada, Andorra and CSJ would have affected 1236 first visits (40.95% of total). If we analyse the data including first visits, successive and DH, in 2010 there were a total of 3115 visits in Igualada and Andorra in which the patient did not have to travel, which represents 26.63% of total visits during this period (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><p id="par0390" class="elsevierStylePara elsevierViewall">In recent years there have been different models for managing patients with chronic diseases such as the Chronic Care Model of Wagner, Expanded Chronic Care Model, the WHO Framework for Innovative Care of Chronic Diseases, among others. They emphasise the importance of prevention and health promotion, the need to optimise resources and formulation of health policy.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0395" class="elsevierStylePara elsevierViewall">Another model of interest is the stratification of patients according to their level based on the Kaiser Permanent pyramid (KP). The KP model identifies three levels of intervention according to the degree of complexity of the case in order to optimise human resources and organisation of care while avoiding unnecessary costs. Patients who are at the top of the pyramid represent 3&#8211;5% of cases, are the most complex and consume the highest proportion of resources.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#8211;16</span></a></p><p id="par0400" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Pla de Salut</span> (Healthcare Plan) of the Catalan Government presented in December 2012 included protocols in allergic disease and referral criteria from primary care to specialised care consistent with the actions taken under the SP presented in this paper.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0405" class="elsevierStylePara elsevierViewall">The working model of a network of centres (hospital care, primary care, private care) applied in this project is novel in Catalan allergology and to date there was no allergy department to implement this type of care. This model, which was implemented within the Althaia Foundation in other medical specialities, could also be valid for other specialities and may be the network of choice to provide future benefits for both the patient and the healthcare system.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,19</span></a></p><p id="par0410" class="elsevierStylePara elsevierViewall">Recently, the Department of Health of the Catalan Government through the Department of Regulation and Health Resource Planning included in its care framework a possible alternative to the current model, which is very similar to that created in our service after application of the SP.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0415" class="elsevierStylePara elsevierViewall">The reduction in the waiting list is relevant data of this study. In 2005 a pilot project was initiated in which the allergist moved to primary care so as to perform screening visits, reducing hospital referrals by 39.1%, with low absenteeism visits (3.4%) and a high rate of satisfaction among users. Avoiding patient travels and reduction in waiting time for the first visit were the aspects most valued by patients. In a study published by Negro et al. in 2004 on the degree of the failure of scheduled visits, after implementation of an improvement plan there was a 15.72% improvement.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#8211;22</span></a> The selection of these visits was made after evaluating referrals differentiating patient groups according to severity/complexity establishing complexity groups based on the KP care model. This work has enabled the development of specific referral criteria for allergic pathologies in consensus with PC and the creation of a specific email account to improve communication between the two levels of care.<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0420" class="elsevierStylePara elsevierViewall">Increasing care activity leads to an increase in costs, which is offset, among other factors, by a higher rate of resolution in the study of patients with the objective of significant reduction in the 1st/2nd visit ratio. The improvement in the 1st/2nd visit ratio (<span class="elsevierStyleBold">2.87</span> in 2005, <span class="elsevierStyleBold">2.44</span> in 2010) can be explained primarily by the screening done in the first few visits based on stratification by complexity; in this way less complex pathologies can be controlled in PC and specialised hospital care can focus on patients with more complex or difficult to manage conditions.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14,15</span></a> Time of diagnostic resolution was reduced and the complexity of the patients treated in hospitals increased.</p><p id="par0425" class="elsevierStylePara elsevierViewall">The cost analysis per pathology shows that the drug allergy group is the group that generates more spending, so this brought up the need for a more detailed analysis, which will be the subject of another publication. One limitation of the analysis by case-mix groups is that not all patients are subjected to the same number of tests and the same patient may have several pathologies.<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#8211;27</span></a></p><p id="par0430" class="elsevierStylePara elsevierViewall">The increase in the total number of visits implies an increase in the number of additional examinations conducted and the full costs (<a class="elsevierStyleCrossRefs" href="#tbl0010">Tables 2&#8211;4</a>). The department&#39;s performance analysis has highlighted the need for computerised records since the data of the tests performed by nurses in 2005 were recorded manually. For this reason analysis of the real increase in the number of tests may not be accurate. It must be kept in mind that in screening visits for the waiting list reduction plan it is the doctor himself who makes the prick test or spirometry and these tests were not recorded in the registers. At the economic level we must mention the savings of not having to provide nursing support for conducting such tests in these patients.</p><p id="par0435" class="elsevierStylePara elsevierViewall">The reduction in the number of rhinomanometries (RMM) performed in the study period is because in 2005 the allergy department performed, in addition to its own RMMs, those requested by the otolaryngologists (ENT) from PC.</p><p id="par0440" class="elsevierStylePara elsevierViewall">The number of determinations of specific IgE (CAP) also increased substantially due to increasing care activity. Not included in the results of this work were CAPs performed at Igualada hospital or Andorra. It must be taken into account that the total number includes those determinations requested by pulmonology, PC and paediatrics. This bias is found in the 2005 data as well as 2010 but it is assumed since the largest volume of determinations comes from the allergy department.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0445" class="elsevierStylePara elsevierViewall">In 2005 there were 5170 specific IgE determinations representing 3.4 CAPs/first visit. In 2010 there was an increase in this ratio to 4.27 from CAPs/first visit. Probably this increase in the proportion of requests per patient is due to an increase in the variety of allergens on the market (e.g. recombinant allergens), as well as greater complexity of the patients studied. In many cases it involves the existence of polysensitisations and therefore a greater number of determinations per patient.</p><p id="par0450" class="elsevierStylePara elsevierViewall">The increase is due primarily to determinations for airborne allergens due to the incorporation of recombinant pollen allergens and increased respiratory disease prevalence. Secondly, there is an increased number of requests for food specific IgE, explained among other reasons, by plant food allergy found in many patients (cross-reactivity).<a class="elsevierStyleCrossRefs" href="#bib0140"><span class="elsevierStyleSup">28,29</span></a></p><p id="par0455" class="elsevierStylePara elsevierViewall">Importantly, although there were more studies of allergies to drugs in 2010 than in 2005, there was a slight decrease in CAP determinations for drugs. There is probably a better selection of patients studied although this is discussed in more detail in another publication.</p><p id="par0460" class="elsevierStylePara elsevierViewall">Diagnosis by recombinant allergens is more sensitive but less cheap than that done with the natural allergen (average price of natural allergen determination is 5.31 Euros, vs. 10.63 Euros for recombinant), so currently only the most prevalent allergens in the area study are included in the routine study.</p><p id="par0465" class="elsevierStylePara elsevierViewall">The observed increase in the number of patients treated in day hospitals is not only quantitative but also has increased the complexity and risk of testing.</p><p id="par0470" class="elsevierStylePara elsevierViewall">In 2005, the waiting list for a challenge test in children DH was longer than 10 months. After application of the SP the waiting list is down to four months. Of the 873 DH sessions in 2005, 214 correspond to challenge tests in adults (24.5%) and 133 in children (15.23%). In 2010, a total of 924 DH sessions were performed (of which 227 adults (24.5%) and 225 in children (24.35%)).</p><p id="par0475" class="elsevierStylePara elsevierViewall">The number of treatments with allergen-specific immunotherapy to aeroallergens increased by 19.99% (2005: 2173 standard<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>48 clusters; 2010: 2563 standard<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>102 clusters). The largest increase was in the number of administrations in cluster pattern (+112.5%), which must always be performed in DH or in an immunotherapy unit. Administration in cluster or rush patterns leads directly to a reduction in the total number of doses administered to the patient, reducing the number of reactions and the number of visits by the patient, with the consequent savings that this represents at all levels.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30,31</span></a></p><p id="par0480" class="elsevierStylePara elsevierViewall">With these changes the allergy department currently has a greater number of patients with highly complex diseases (severe asthma, multiple food allergy, etc.) that require a greater number of studies and more complex treatment.</p><p id="par0485" class="elsevierStylePara elsevierViewall">Other improvements after application of SP were: monoclonal drug therapy, desensitisation, exhaled nitric oxide levels and modelling of comprehensive specific informed consent in the computerised medical record.</p><p id="par0490" class="elsevierStylePara elsevierViewall">After analysing the results following application of the SP the model of allergy care used so far would have to be reconsidered and opt for a new organisational model based on risk stratification of patients and on the system of networking between centres and levels of care.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusions</span><p id="par0495" class="elsevierStylePara elsevierViewall">Applying a SP in the allergology department has allowed to:<ul class="elsevierStyleList" id="lis0060"><li class="elsevierStyleListItem" id="lsti0260"><span class="elsevierStyleLabel">1.</span><p id="par0500" class="elsevierStylePara elsevierViewall">Create a healthcare network in allergy, a new care model in Catalonia, matching available resources to the growing demand, rationalising expenditure and improving the quality of care.</p></li><li class="elsevierStyleListItem" id="lsti0265"><span class="elsevierStyleLabel">2.</span><p id="par0505" class="elsevierStylePara elsevierViewall">Improve the quality of care, increase the diversity of services and expand the territory for which the service is provided (strategic alliances).</p></li><li class="elsevierStyleListItem" id="lsti0270"><span class="elsevierStyleLabel">3.</span><p id="par0510" class="elsevierStylePara elsevierViewall">Implement specific referral criteria for each pathology as agreed upon with PC, reducing waiting lists and avoiding unnecessary studies. Another work will deal with specific analysis of diagnostic yield of drug allergy studies.</p></li><li class="elsevierStyleListItem" id="lsti0275"><span class="elsevierStyleLabel">4.</span><p id="par0515" class="elsevierStylePara elsevierViewall">Adjust the pathology treated in hospital to what is really necessary due to its complexity and improve the diagnostic resolution time.</p></li><li class="elsevierStyleListItem" id="lsti0280"><span class="elsevierStyleLabel">5.</span><p id="par0520" class="elsevierStylePara elsevierViewall">Obtain an increase in absolute costs secondary to increased activity is justified by the expansion of the territory, the number of patients seen, the improvement in diagnostic resolution and reducing indirect socioeconomic costs. So even though overall spending increases, spending per patient successfully treated is reduced.</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Ethical disclosures</span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Protection of human and animal subjects</span><p id="par0525" class="elsevierStylePara elsevierViewall">The authors declare that no experiments were performed on human or animals for this investigation.</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patient&#39;s data protection</span><p id="par0530" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Right to privacy and informed consent</span><p id="par0535" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article.</p></span></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflict of interest</span><p id="par0540" class="elsevierStylePara elsevierViewall">There is no conflict of interest with regard to the article.</p></span></span>"
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        "resumen" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">In 2005 the Althaia Foundation Allergy Department performed its daily activity in the Hospital Sant Joan de Deu of Manresa. Given the increasing demand for allergy care, the department&#39;s performance was analysed and a strategic plan (SP) for 2005&#8211;2010 was designed.</p><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">The main objective of the study was to assess the impact of the application of the SP on the department&#39;s operations and organisational level in terms of profitability, productivity and quality of care.</p> <span class="elsevierStyleSectionTitle" id="sect0010">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Descriptive, retrospective study which evaluated the operation of the allergy department. The baseline situation was analysed and the SP was designed. Indicators were set to perform a comparative analysis after application of the SP.</p> <span class="elsevierStyleSectionTitle" id="sect0015">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The indicators showed an increase in medical care activity (first visits, 34%; successive visits, 29%; day hospital treatments, 51%), high rates of resolution, reduced waiting lists. Economic analysis indicated an increase in direct costs justified by increased activity and territory attended. Cost optimisation was explained by improved patient accessibility, minimised absenteeism in the workplace and improved cost per visit.</p> <span class="elsevierStyleSectionTitle" id="sect0020">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">After application of the SP a networking system was established for the allergy speciality that has expanded the territory for which it provides care, increased total activity and the ability to resolve patients, optimised human resources, improved quality of care and streamlined medical costs.</p>"
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          "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">First visits and successive visits made to the allergy department in the period 2005&#8211;2010 and the evolution of resolution capability.</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Groups&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">CIE 10 CODE&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Group 1(respiratory allergy)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Rhinitis: J30, J30.0, J30.1, J30.2, J30.3, J30.4Asthma: J45, J45.0, J45.1, J45.8, J45.9Conjunctivitis: H10, H10.1, H10.3, H10.4, H10.5, H10.8, H10.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Group 2(food allergy)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Anaphylactic shock due to adverse reactions to food: T 78.0, T78.1, T78.2, T78.3, T78.4Allergic urticaria: L50.0Laryngeal oedema: J38.4Nausea and vomiting: R11.Itching: L29.Dermatitis due to ingestion of food: L27.2Dysphagia: R13.Unspecified intestinal malabsorption: K90.9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Group 3 (allergy to drugs)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Dermatitis: L27, L27.0, L27.1Itching: L29Anaphylactic shock unspecified: T78.2Angioneurotic oedema: T78.3Urticaria: L50Phototoxic drug response: L56.0Photoallergic drug response: L56.1Anaphylactic shock due to adverse effects of drug or correct medicine appropriately administered: T88.6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="middle">Group 4(skin pathology)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Atopic dermatitis: L20, L20.0, L20.8, L20.9Contact allergic dermatitis: L23Unspecified contact dermatitis: L25Other dermatitis: L30.8, L30.9Urticaria: L50, L50.0, L50.1, L50.2, L50.3, L50.4, L50.5, L50.6, L50.8, L50.9, L56.3Erythema multiforme: L51Polymorphic light eruption: L56.4Oedema: T78.3, R60, R60.0, R60.1, R60.9, J38.4Itching: L29Mastocytosis: Q 82.2Unspecified allergy: T78.4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "leyenda" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">NC: not calculable.</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variation&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Annual hours allergist in Manresa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4233<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6345<span class="elsevierStyleHsp" style=""></span>h&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">+2112<span class="elsevierStyleHsp" style=""></span>h (+ 49.89%)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Allergy waiting list adults</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">420 days (14<span class="elsevierStyleHsp" style=""></span>m)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">180 days (6<span class="elsevierStyleHsp" style=""></span>m)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;240 days (8 months)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Allergy paediatric waiting list</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;90 days (3 months)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">First visits</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1519&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2037&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">+518 (+34%)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Second visits</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4355&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5620&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">+1265 (+29.05%)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Resolution index (1st/2nd visit)</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2.87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2.76<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">*</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">No. prick test</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1989<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">***</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">2025</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">**</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">NC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">No. epicutaneous tests</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">234<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">***</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">105</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">NC</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">No. lung function studies</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2613<a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">***</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3243&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">No. rhinomanometries</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;60 (&#8722;74.07%)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">No. day hospital sessions</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">873&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">924&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">+51 (+5.84%)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">No. conventional immunotherapy treatments administered</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2173&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2563&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">+390 (+17.95%)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">Total specific IgE performed</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8705&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">+3535 (+68.3%)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>-<span class="elsevierStyleHsp" style=""></span>foods&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1611&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2647&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">+1036&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>-<span class="elsevierStyleHsp" style=""></span>inhalants&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2743&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5250&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">+2507&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>-<span class="elsevierStyleHsp" style=""></span>drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">391&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">348&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">&#8722;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>-<span class="elsevierStyleHsp" style=""></span>other allergens&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">425&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">460&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">+35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="4" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">No. informed consents signed</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Not recorded&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100%&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">NC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab646912.png"
              ]
            ]
          ]
          "notaPie" => array:3 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "<span class="elsevierStyleBold">*</span>"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Corrected per activity in Igualada and Andorra would be 2.44.</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "**"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Pricks made by the physician in screening visits not recorded.</p>"
            ]
            2 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "***"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Record not computerised.</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Comparative analysis years 2005&#8211;2010 (activity in Manresa).</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cost per physician/hour (2010): 50.64 Euros, nursing cost/hour: 27.11 Euros.* Mean CAP cost 2005: 6.81 Euros, mean CAP cost 2010: 7.57 Euros. PFR: lung function tests, RMM: rhinomanometry.</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1st visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Prick tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">PFR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Blood tests&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Day hospital&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">RMM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Epicutaneous&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Visit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost/patient (2005)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost/patient (2010)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Group 1 (respiratory pathology)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.5<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per physician hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.33<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per nursing hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.17<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per nursing hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3.4 CAPs x cost per CAP<span class="elsevierStyleItalic">2010: 4.27 CAP X price CAP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1.75<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per nursing hour (only in 10% patients)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.25<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per physician hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69.42Euros (not including RMM)114,72Euros (including RMM)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">83.74 Euros not including RMM</span>131.18Euros<span class="elsevierStyleItalic">(including RMM)</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Group 2 (food pathology)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.5<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per physician hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.33<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per nursing hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3.4 CAPs<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per CAP<span class="elsevierStyleItalic">2010: 4.27 CAP</span><span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">cost per CAP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per physician hour+5<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per nursing hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.25<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per physician hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">264.69Euros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">300.66 Euros</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Group 3(drug allergies)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.5<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per physician hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.33<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per nursing hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3.4 CAPs<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per CAP<span class="elsevierStyleItalic">2010: 4.27 CAP</span><span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">cost per CAP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">(2<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per physician hour<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>5<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per nursing hourx 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.25<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per physician hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">454.04 Euros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">522.19 Euros</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Group 4 (Skin pathology&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.5<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per physician hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.33<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per nursing hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3.4 CAPs<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per CAP<span class="elsevierStyleItalic">2010: 4.27 CAP</span><span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">cost per CAP</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.5<span class="elsevierStyleHsp" style=""></span>h<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>cost per physician hour&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0.25<span class="elsevierStyleHsp" style=""></span>&times;<span class="elsevierStyleHsp" style=""></span>50.49 Euros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77.53 Euros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top"><span class="elsevierStyleItalic">92.69 Euros</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab646911.png"
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        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Approximate full costs per patient for consultation.</p>"
        ]
      ]
      4 => array:7 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2005 (1519 first visits)</th><th class="td" title="table-head  " colspan="3" align="center" valign="top" scope="col" style="border-bottom: 2px solid black">2010 (3018 first visits in Manresa, Igualada and Andorra)</th></tr><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of patients&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost per patient (Euros)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost (Euros)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">No. of patients (increase)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost per patient (Euros)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Cost (Euros)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Group 1 (respiratory pathology)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">881&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">69.42 (90% patients)114.72 (10% patients)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">65,145.42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1962 (<span class="elsevierStyleBold">+122%</span>)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">83.74 (90% patients)131.18(10% patients)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">173,605.6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Group 2(food pathology)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">379&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">264.69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">100,317.51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">905 (<span class="elsevierStyleBold">+138%</span>)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">300.66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">272,097.3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Group 3(allergy to drugs)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">212&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">454.04&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">96,256.48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">482 (<span class="elsevierStyleBold">+127%</span>)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">522.19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">251,695.58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Group 4(Skin pathology)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">273&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">77.53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21,165.69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">513 (<span class="elsevierStyleBold">+87.9%</span>)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">92.69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47,549.97&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">282,885.1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">744,948.45 Euros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Difference&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " colspan="6" align="center" valign="top">+462,063.35 Euros</td></tr></tbody></table>
                  """
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Comparative costs according to pathologies between 2005 and 2010.</p>"
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        "identificador" => "tbl0025"
        "etiqueta" => "Table 5"
        "tipo" => "MULTIMEDIATABLA"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Region of origin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Region of destination&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time going (min)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Distance going (km)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time going<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>return (min)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Distance going<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>return (km)&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Igualada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Manresa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27.7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">60<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">55.4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Igualada&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Barcelona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">63.6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>h 38<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">127.2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Andorra la Vella&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Manresa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1<span class="elsevierStyleHsp" style=""></span>h 56<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">137.7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3<span class="elsevierStyleHsp" style=""></span>h 52<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">275.4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " align="left" valign="top">Andorra la Vella&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Barcelona&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2<span class="elsevierStyleHsp" style=""></span>h 27<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">186.8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4<span class="elsevierStyleHsp" style=""></span>h 54<span class="elsevierStyleHsp" style=""></span>min&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">393.6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Distance and time involved in travelling from Igualada and Andorra.</p>"
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estudio preliminar del desplazamiento del alerg&oacute;logo a Atenci&oacute;n Primaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L. Ferr&eacute;-Ybarz"
                            1 => "R. Tella Ruz"
                            2 => "S. Ranea Arroyo"
                            3 => "R. Gusp&iacute; Bori"
                            4 => "S. Nevot Falc&oacute;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Alergol Inmunol Clin"
                        "fecha" => "2005"
                        "volumen" => "290"
                        "paginaInicial" => "224"
                        "paginaFinal" => "229"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Al&middot;lergologia a l&#8217;atenci&oacute; prim&agrave;ria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "L. Ferr&eacute;-Ybarz"
                            1 => "R. Tella"
                            2 => "S. Ranea"
                            3 => "R. Gusp&iacute;"
                            4 => "S. Nevot"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediatr Catalana"
                        "fecha" => "2006"
                        "volumen" => "66"
                        "paginaInicial" => "180"
                        "paginaFinal" => "184"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Idescat: Banc d&#8217;estadístiques de municipis i comarques. Indicadors demogràfics. Barcelona, Generalitat de Catalunya. Available from: <a href="http://www.idescat.net/">http://www.idescat.net/</a>"
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:1 [
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Bull Wordl Health Organ"
                        "fecha" => "2012"
                        "volumen" => "90"
                        "paginaInicial" => "162"
                        "paginaFinal" => "163"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:1 [
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:2 [
                        "titulo" => "Alergol&oacute;gica. Factores epidemiol&oacute;gicos, cl&iacute;nicos y sociodemogr&aacute;ficos de las enfermedades al&eacute;rgicas en Espa&ntilde;a en 2005"
                        "serieFecha" => "2005"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalencia de alergia en la poblaci&oacute;n adulta espa&ntilde;ola"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P. Gaig"
                            1 => "D. Mu&ntilde;oz-Lejarazu"
                            2 => "R. Lleonart"
                            3 => "J.L. Garc&iacute;a-Abujeta"
                            4 => "T. Caballero"
                            5 => "A. Rodriguez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Alergol Inmunol Clin"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "68"
                        "paginaFinal" => "78"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The most common phenotypes of sensitization to inhalant allergens in childhood"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K. Storm Van&#39;s Gravensande"
                            1 => "M. Moseler"
                            2 => "J. Kuehr"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Exp allergy"
                        "fecha" => "1997"
                        "volumen" => "27"
                        "paginaInicial" => "646"
                        "paginaFinal" => "652"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9208185"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sensitization patterns to food and inhalant allergens in childhood: a comparision of non-sensitized, monosensitized and polysensitized children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A.B. de Jong"
                            1 => "L.D. Dikkeschei"
                            2 => "P.L. Brand"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Pediat Allergy Immunol"
                        "fecha" => "2011"
                        "volumen" => "22"
                        "paginaInicial" => "166"
                        "paginaFinal" => "171"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Aplicaci&oacute;n de un modelo de gesti&oacute;n empresarial en un servicio cebtral hospitalario public. Experiencia de cinco a&ntilde;os"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R. Salinas Argente"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:2 [
                        "fecha" => "2001"
                        "editorial" => "Universitat Autónoma de Bellaterra"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "El papel del especialista en Alergolog&iacute;a en el siglo XXI"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T. Chivato P&eacute;rez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Alergol Inmunol"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "131"
                        "paginaFinal" => "132"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mapa Sanitario: una vision din&aacute;mica de la planificaci&oacute;n de servicios en Catalu&ntilde;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M.L. de la Puente"
                            1 => "J. Fust&eacute;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Clin (Barc)"
                        "fecha" => "2008"
                        "volumen" => "131"
                        "numero" => "supl 4"
                        "paginaInicial" => "3"
                        "paginaFinal" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utilizaci&oacute;n de servicios de salud y flujos asistenciales"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D. Frigola"
                            1 => "C. Illa"
                            2 => "J.M. Elorza"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Clin (Barc)"
                        "fecha" => "2008"
                        "volumen" => "131"
                        "numero" => "Supl 4"
                        "paginaInicial" => "23"
                        "paginaFinal" => "30"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management models"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "R. Bengoa"
                            1 => "F. Martos"
                            2 => "R. Nu&ntilde;o"
                            3 => "S. Kreindler"
                            4 => "T. Novak"
                            5 => "R. Pinilla"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:2 [
                        "titulo" => "When people live with multiple chronic diseases: a collaborative approach to an emerging global challenge"
                        "serieFecha" => "2010"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Buenas pr&aacute;cticas en gesti&oacute;n sanitaria: el caso Kaiser Permanente"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R. Nu&ntilde;o"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Adm Sanit"
                        "fecha" => "2007"
                        "volumen" => "5"
                        "paginaInicial" => "283"
                        "paginaFinal" => "292"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lessons for the NHS from Kaiser Permanente"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J. Schapiro"
                            1 => "S. Smith"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1136/bmj.327.7420.895"
                      "Revista" => array:4 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2003"
                        "volumen" => "327"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14563744"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Methods for predicting risk of emergency hospitalization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N. Goodwin"
                            1 => "N. Curry"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:3 [
                        "titulo" => "8th Annual Conference"
                        "conferencia" => "Gothenburg"
                        "serieFecha" => "2008"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "titulo" => "Pla de Salut 2011&#8211;2015: Les guies, els protocols dabordatge de la patologia al&middot;l&egrave;rgica i els criteris de derivaci&oacute; en l&#8217;atenci&oacute; prim&agrave;ria. Generalitat de Catalunya, novembre de 2012. Dep&oacute;sito legal: B. 33685-2012"
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2012"
                        "editorial" => "Departament de Salut. Direcció General de Regulació, Planificació i Recursos Sanitaris. Primera edició"
                        "editorialLocalizacion" => "Barcelona"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Grupo de investigadores proyecto RECENT. Redes centinela sanitarias en Espa&ntilde;a. Consenso para una gu&iacute;a de principios y m&eacute;todos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A.T. Vega Alonso"
                            1 => "O. Zurriaga Llorens"
                            2 => "A. Galm&eacute;s Truyols"
                            3 => "J.E. Lozano Alonso"
                            4 => "L. Pais&aacute;n Maestro"
                            5 => "M. Gil Costa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Gac Sanit"
                        "fecha" => "2006"
                        "volumen" => "20"
                        "paginaInicial" => "496"
                        "paginaFinal" => "502"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17198629"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "La transformaci&oacute;n de una red hospitalaria p&uacute;blica: el Institut Catal&agrave; de la Salut"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M.D. Gonz&aacute;lez Cuy&agrave;s"
                            1 => "M. Figuerola Batista"
                            2 => "Gabald&agrave; Azofra J."
                            3 => "Gr&agrave;cia Escoriza R."
                            4 => "de Haro Mart&iacute;n L."
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "edicion" => "5<span class="elsevierStyleSup">a</span>"
                        "titulo" => "Gesti&oacute;n Hospitalaria"
                        "fecha" => "2011"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Alianzas estrat&eacute;gicas y empresa multifactorial. Gesti&oacute;n y Evaluaci&oacute;n de Costes Sanitarios, vol 11, monogr&aacute;fico 1"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A. de Rosa Torner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:1 [
                        "fecha" => "2010"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluaci&oacute;n de los resultados obtenidos en el incumplimiento de citas concertadas en pacientes de una consulta de alergolog&iacute;a, al a&ntilde;o de la implantaci&oacute;n de un ciclo de mejora"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J.M. Negro &Aacute;lvarez"
                            1 => "R. F&eacute;lix Toledo"
                            2 => "M. Guerrero Fern&aacute;ndez"
                            3 => "F.J. Campuzano L&oacute;pez"
                            4 => "T. Bernal Fern&aacute;ndez"
                            5 => "F. Pellicer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.ultramic.2007.03.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Gesti&oacute;n Hospitalaria"
                        "fecha" => "2004"
                        "volumen" => "15"
                        "paginaInicial" => "13"
                        "paginaFinal" => "21"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17517476"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incumplimiento de citas concertadas en los pacientes de una consulta de alergolog&iacute;a tras el Segundo a&ntilde;o de implantaci&oacute;n de un ciclo de mejora"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J.M. Negro &Aacute;lvarez"
                            1 => "F.J. Campuzano L&oacute;pez"
                            2 => "F. Pellicer Orenes"
                            3 => "T. Bernal Fern&aacute;ndez"
                            4 => "M.D. Martos Calahorro"
                            5 => "R. Mart&iacute;nez L&oacute;pez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Alergol Inmunol Clin"
                        "fecha" => "2004"
                        "volumen" => "19"
                        "paginaInicial" => "195"
                        "paginaFinal" => "204"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "How should continuity of care in primary health care be assessed?"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C. Salisbury"
                            1 => "F. Sampson"
                            2 => "M. Ridd"
                            3 => "A. Montgomery"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Br J Gen Pract"
                        "fecha" => "2009"
                        "volumen" => "9"
                        "paginaInicial" => "134"
                        "paginaFinal" => "141"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Los costes directos de un paciente asistido en la consulta externa de alergolog&iacute;a de un hospital universitario"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J.M. Negro-Alvarez"
                            1 => "T. Murcia Alem&aacute;n"
                            2 => "C. Aparicio Garc&iacute;a"
                            3 => "J. Hern&aacute;ndez Garc&iacute;a"
                            4 => "R. Ferr&aacute;ndiz Gomis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Alergol Inmunol Clin"
                        "fecha" => "2005"
                        "volumen" => "20"
                        "paginaInicial" => "4"
                        "paginaFinal" => "9"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gesti&oacute;n por procesos en Alergolog&iacute;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "J.M. Negro &Aacute;lvarez"
                            1 => "J.C. Miralles L&oacute;pez"
                            2 => "J.L. Jim&eacute;nez Molina"
                            3 => "M. Guerrero Fern&aacute;ndez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Alergol Inmunol Clin"
                        "fecha" => "2001"
                        "volumen" => "16"
                        "paginaInicial" => "356"
                        "paginaFinal" => "360"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sistemas de clasificaci&oacute;n en grupos de iso-consumo (case-mix) en atenci&oacute;n ambulatoria. Perspectivas para nuestra atenci&oacute;n primaria"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "B. Bolibar"
                            1 => "A. Prados"
                            2 => "J. Gerv&aacute;s"
                            3 => "S. Juncosa"
                            4 => "E. Carrillo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Aten Primaria"
                        "fecha" => "1996"
                        "volumen" => "17"
                        "paginaInicial" => "74"
                        "paginaFinal" => "83"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Codificaci&oacute;n y comunicaci&oacute;n en alergia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J.M. Bartolom&eacute; &Aacute;lvarez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Alergol Inmunol Clin"
                        "fecha" => "2002"
                        "volumen" => "17"
                        "paginaInicial" => "123"
                        "paginaFinal" => "127"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pollen and plant food profiling allergens show equivalent IgE reactivity"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S. Sirvent"
                            1 => "L. Tordesillas"
                            2 => "M. Villalba"
                            3 => "A. D&iacute;az-Perales"
                            4 => "J. Cuesta-Herranz"
                            5 => "G. Salcedo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Ann Allergy Asthmma immunol"
                        "fecha" => "2011"
                        "volumen" => "106"
                        "paginaInicial" => "429"
                        "paginaFinal" => "435"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The role of lipid transfer proteins in allergic diseases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M. Egger"
                            1 => "M. Hauser"
                            2 => "A. Mari"
                            3 => "F. Ferreira"
                            4 => "G. Gadermaier"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s11882-010-0128-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "Curr Allergy Asthma Rep"
                        "fecha" => "2010"
                        "volumen" => "10"
                        "paginaInicial" => "326"
                        "paginaFinal" => "335"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20582490"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gesti&oacute;n T&eacute;cnica de una Unidad de Inmunoterapia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M. Lluch P&eacute;rez"
                            1 => "N. Rubira"
                            2 => "P. Amat"
                            3 => "F. de la Torre"
                            4 => "A. Malet"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Alergol Inmunol Clin"
                        "fecha" => "2002"
                        "volumen" => "17"
                        "paginaInicial" => "143"
                        "paginaFinal" => "146"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Safety to two cluster schedules for subcutaneous immunotherapy in allergic rhinitis or asthma patients sensitized to inhalant allergens"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O. Pfaar"
                            1 => "L. Klimek"
                            2 => "I. Fischer"
                            3 => "J. Sieber"
                            4 => "S. Amoroso"
                            5 => "C. Moreno Aguilar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1159/000210436"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int Arch Allergy Immunol"
                        "fecha" => "2009"
                        "volumen" => "150"
                        "paginaInicial" => "102"
                        "paginaFinal" => "108"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19339808"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
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Article information

ISSN: 03010546
Original language: English

DOI:10.1016/j.aller.2013.09.015

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	3	0	3
2024 October	20	2	22
2024 September	20	12	32
2024 August	8	2	10
2024 July	17	6	23
2024 June	8	2	10
2024 May	7	7	14
2024 April	13	3	16
2024 March	12	6	18
2024 February	12	4	16
2024 January	20	6	26
2023 December	15	9	24
2023 November	13	9	22
2023 October	21	12	33
2023 September	27	6	33
2023 August	19	4	23
2023 July	16	5	21
2023 June	13	3	16
2023 May	27	6	33
2023 April	27	4	31
2023 March	32	4	36
2023 February	15	0	15
2023 January	12	8	20
2022 December	14	7	21
2022 November	13	10	23
2022 October	22	4	26
2022 September	16	16	32
2022 August	21	6	27
2022 July	13	9	22
2022 June	20	6	26
2022 May	13	9	22
2022 April	15	16	31
2022 March	8	9	17
2022 February	9	5	14
2022 January	20	9	29
2021 December	11	11	22
2021 November	10	6	16
2021 October	15	10	25
2021 September	9	13	22
2021 August	12	9	21
2021 July	8	15	23
2021 June	13	11	24
2021 May	15	12	27
2021 April	34	15	49
2021 March	13	7	20
2021 February	14	12	26
2021 January	12	7	19
2020 December	1	0	1
2020 November	0	1	1
2020 October	1	0	1
2020 September	0	1	1
2020 August	0	1	1
2020 July	0	2	2
2020 June	0	1	1
2020 May	0	2	2
2020 February	0	1	1
2020 January	0	1	1
2019 December	0	6	6
2019 November	0	1	1
2019 September	0	1	1
2019 July	0	3	3
2019 May	0	11	11
2018 February	7	1	8
2018 January	14	0	14
2017 December	6	0	6
2017 November	15	1	16
2017 October	16	8	24
2017 September	7	3	10
2017 August	20	1	21
2017 July	13	1	14
2017 June	19	7	26
2017 May	29	4	33
2017 April	30	5	35
2017 March	36	21	57
2017 February	22	11	33
2017 January	9	6	15
2016 December	15	5	20
2016 November	24	2	26
2016 October	44	8	52
2016 September	23	10	33
2016 August	15	5	20
2016 July	12	1	13
2016 June	20	8	28
2016 May	19	7	26
2016 April	13	18	31
2016 March	15	9	24
2016 February	16	12	28
2016 January	22	7	29
2015 November	1	0	1
2015 October	0	1	1
2015 April	0	4	4
2015 March	0	2	2
2015 February	4	6	10

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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Allergologia et Immunopathologia is no longer published on Elsevier since the 2021 year.Transferred to Codon Publications

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