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Impacto de la atención ambulatoria del primer nivel de atención en la hospitalización de población asegurada con diabetes mellitus tipo 2
Impact of primary care on hospitalization of type 2 diabetics with equal conditions of health insurance
A.M. Salinas-Martínez
Autor para correspondencia
imssnorteinv@infosel.net.mx

Correspondencia: Morelos 133 Ote. 5° piso. Col. Centro. Monterrey. NL México. CP 64000
, D. Sandoval-Espinosa, G.M. Núñez-Rocha, M.E. Garza-Elizondo, E. Villarreal-Ríos
Unidad de Investigación Epidemiológica y en Servicios de Salud. Instituto Mexicano del Seguro Social. Monterrey. NL México
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar el impacto de atenci&#243;n ambulatoria del primer nivel de atenci&#243;n en la hospitalizaci&#243;n del diab&#233;tico tipo 2 en una poblaci&#243;n con condiciones iguales de aseguramiento&#46;</p> <span class="elsevierStyleSectionTitle">Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio de casos y controles&#46; Los casos son pacientes diab&#233;ticos hospitalizados por enfermedad relacionada con el padecimiento&#44; y los controles son pacientes diab&#233;ticos sin antecedente de hospitalizaci&#243;n en el &#250;ltimo a&#241;o&#46;</p> <span class="elsevierStyleSectionTitle">Emplazamiento</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Centros de atenci&#243;n primaria urbanos&#46;</p> <span class="elsevierStyleSectionTitle">Participantes</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los casos fueron seleccionados consecutivamente en 4 de 5 hospitales generales urbanos &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>123&#41;&#46; Los controles fueron elegidos al azar en la unidad de atenci&#243;n primaria de donde proven&#237;a el caso &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>135&#41;&#46; Se excluy&#243; a las mujeres con diabetes gestacional y a todos los que no contaban con expediente localizable &#40;aproximadamente un 15&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Mediciones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se construy&#243; un &#237;ndice de atenci&#243;n primaria seg&#250;n las recomendaciones de la Asociaci&#243;n de M&#233;dicos Norteamericanos&#44; la Comisi&#243;n Conjunta de Acreditaci&#243;n de Organizaciones de Salud&#44; el Comit&#233; Nacional de Aseguramiento para la Calidad&#44; la Asociaci&#243;n Norteamericana de Diabetes y la Norma Oficial Mexicana&#46; Se consider&#243; que un cumplimiento menor al 60&#37; correspond&#237;a a una atenci&#243;n sub&#243;ptima&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los factores de riesgo para la hospitalizaci&#243;n fueron los siguientes&#58; menos de 2 vistas al m&#233;dico de familia en el &#250;ltimo a&#241;o &#40;OR ajustada&#44; 16&#44;2&#59; IC del 95&#37;&#44; 1&#44;5&#8211;174&#44;2&#41;&#44; valor de glucosa &#40;OR ajustada&#44; 1&#44;006&#59; IC del 95&#37;&#44; 1&#44;002&#8211;1&#44;010&#41; y nivel de conocimientos sobre la enfermedad &#40;OR ajustada&#44; 0&#44;98&#59; IC del 95&#37;&#44; 0&#44;96&#8211;0&#44;99&#41;&#44; adem&#225;s de la pr&#225;ctica de ejercicio y el tiempo de diagn&#243;stico&#46; La atenci&#243;n primaria sub&#243;ptima se registr&#243; en el 65&#44;3&#37; de los casos y el 49&#44;1&#37; de los controles &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;03&#41; e increment&#243; 2&#44;5 veces el riesgo de hospitalizaci&#243;n &#40;IC del 95&#37;&#44; 1&#44;2&#8211;5&#44;0&#59; seudo R<span class="elsevierStyleSup">2</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;279&#59; p &#60; 0&#44;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La evidencia disponible indica que la atenci&#243;n primaria puede ser un factor potencial para reducir la tasa de hospitalizaci&#243;n por diabetes mellitus tipo 2&#46; Los programas de manejo efectivos contribuir&#237;an a evitar hospitalizaciones innecesarias&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To determine the impact of primary care on hospitalization of type 2 diabetics with equal conditions of health insurance&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A case-control study&#46; Case<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>diabetic hospitalized by a disease related condition&#46; Control<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>diabetic without hospitalization during the last 12 months&#46;</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Urban primary care centers&#46;</p> <span class="elsevierStyleSectionTitle">Participants</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Cases were consecutively selected from four out of five urban hospitals &#40;n&#61;123&#41;&#46; Controls were chosen at random from primary care units matched by primary care source &#40;n&#61;135&#41;&#46;Women with gestational diabetes were excluded as well as individuals with missing medical charts &#40;approximately 15&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Measurements</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">A primary care index was constructed with process and outcome indicators recommended by the American Medical Association&#44; the Joint Commission on Accreditation of Healthcare Organizations&#44; the National Committee for Quality Assurance&#44; the American Diabetes Association and the Official Mexican Standards&#46; Compliance to less than 60&#37; of recommendations was considered unsatisfactory primary care&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">The following were hospitalization risk factors&#58; less than 2 visits to family physician during the last year &#40;OR adjusted&#44; 16&#44;2&#59; 95&#37; CI&#44; 1&#44;5&#8211;174&#44;2&#41;&#44; glucose level &#40;OR adjusted&#44; 1&#44;006&#59; 95&#37; CI&#44; 1&#44;002&#8211;1&#44;010&#41; and cognitive level &#40;OR adjusted&#44; 0&#44;98&#59; 95&#37; CI&#44; 0&#44;96&#8211;0&#44;99&#41;&#44; in addition to exercising and year of diagnosis&#46; Sixty-five percent of cases observed unsatisfactory primary care compared with 49&#44;1&#37; of controls &#40;P&#61;0&#44;03&#41;&#46; Unsatisfactory primary care increased 2&#44;5 times the risk of hospitalization &#40;95&#37; CI&#44; 1&#44;2&#8211;5&#44;0&#41; &#40;pseudo R<span class="elsevierStyleSup">2</span>&#61;0&#44;279&#59; P&#60;0&#44;001&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Primary care is a potential factor for reducing hospitalization of type 2 diabetics&#46; Effective primary care programs would contribute to a better disease control and less unnecessary hospitalizations&#46;</p>"
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