Efectividad y eficiencia de una consulta externa monográfica de asma corticodependiente

Abstract

To evaluate the efficacy and efficiency of a specialist outpatient clinic for corticosteroid-dependent asthmatics. The clinic was supervised by the respiratory medicine service of a reference hospital. The first 20 consecutive patients (mean age 58.1+/- 9.5 years; 14 women, 6 men) treated at a specialist outpatient clinic for corticosteroid-dependent asthmatics were studied, with prospective follow-up of 12.33 +/- 4.6 months. The following variables were examined: a) forced spirometry (FS), b)corticosteroid doses, c) number and cost (NC) of visits to the outpatient clinic, d) NC of FS, e) NC of emergency room visits, f) NC of hospitalizations, g)cumulative cost of health care generated by these patients within the National Health Service of Catalonia (NHSC). The results were compared with those recorded in each patient's history. Findings were a) improved FEV1 (55.1 +/- 21.6% vs.60.1 +/- 21%, p = 0.02); b) decreased corticosteroid use (21.9 +/- 11.2 mg vs. 12.8 +/- 6.0 mg, p < 0.0001);c) statistically significant increase in NC to the outpatient clinic and NC of FS; d) statistically significant decrease in number of visits to emergency services and hospitalizations;e) reduced total cost of health care for these patients borne by the NHSC, which went from 4,400,070 Spanish pesetas to 1,171,157 Spanish pesetas. A hospital deficit of nearly 2,000,000 Spanish pesetas was canceled. Changing the system for delivering health care to these patients has led to improved care (effectiveness) and a noteworthy reduction in cost (efficiency). We conclude that medical specialists should play an important role in reorganizing the present health care system of the NHSC.