Gaceta Sanitaria (Aug 2007)
Costes y patrón de uso de servicios en pacientes que demandan atención por problemas mentales en asistencia primaria Patterns of health services use and costs in patients with mental disorders in primary care
Abstract
Objetivos: Determinar el patrón de uso de servicios y costes en pacientes que demandan atención por problemas mentales (PM) en asistencia primaria en situación de práctica clínica habitual. Métodos: Estudio retrospectivo. Se incluyeron pacientes mayores de 15 años, con al menos una demanda de atención por PM, atendidos por 5 equipos de atención primaria durante el año 2004. Se formó un grupo comparativo con el resto de pacientes sin PM. Las variables fueron: edad, sexo, casuística/comorbilidad, utilización de recursos sanitarios y costes ambulatorios correspondientes (medicamentos, procedimientos diagnósticos y visitas). Se empleó el análisis de regresión logística múltiple y modelos de ANCOVA. Resultados: Se incluyeron 64.072 pacientes, de los cuales 11.128 presentaron algún PM (17,4%; intervalo de confianza [IC] del 95%, 16,7-18,1). Los pacientes que demandaron atención por PM presentaron un mayor número de problemas de salud (6,7 frente a 4,7; p Objectives: To determine the pattern of services use and costs of patients requiring care for mental disorders (MD) in primary care in the context of routine clinical practice. Methods: We performed a retrospective study of patients older than 15 consulting primary care at least once for MD, attended by 5 primary care teams in 2004. A comparative group was formed with the remaining outpatients without MD. The main measurements were age, gender, case-mix/comorbidity and health resource utilization and corresponding outpatient costs (drugs, diagnostic tests and visits). Multiple logistic regression analysis and ANCOVA models were applied. Results: A total of 64,072 patients were assessed, of which 11,128 had some type of MD (17.4%; 95% CI, 16.7-18.1). Patients consulting for MD had a greater number of health problems (6.7 vs. 4.7; p < 0.0001) and higher resource consumption, mainly all-type medical visits/patient/year (10.7 vs. 7.2; p < 0.0001). The mean annual cost per patient was higher for patients with MD (851.5 vs. 519.2 euros; p < 0.0001), and this difference remained significant after adjusting by age, sex and comorbidities, with a differential cost of euros 72.7 (95% CI, 59.2-85.9). All components of outpatient management costs were significantly higher in the MD group. Conclusions: Outpatients seeking care for some type of MD had a high number of comorbidities and showed greater annual cost per patient in the primary care setting.
