Anàlisi de les necessitats de recursos sanitaris en els pacients amb ictus a Barcelona.

Abstract

The economic, sociocultural and health development of a country allows for the improvement of the population’s living conditions, which reverberates in the welfare and in the population longevity. This situation leads to a change in the type of morbidity with predominance in chronic diseases, such as those of the cardiovascular system. Stroke belongs to this category and it is the leading cause of death in spanish women, and the third main cause in men (2010)._x000D_ We have an aged population with predominance of chronic diseases and we have the possibility of realizing preventive and curative therapies of pathologies such as the stroke. It is important to analyse of the health needs in patients affected by stroke. This is the main objective of this study, focusing on patients affected by stroke in Barcelona._x000D_ We conducted an observational study on a Barcelona population, from the year 2000 to 2011 and also conducted future predictions for the years 2015 and 2020. We analyzed the codes corresponding to patients who are affected by stroke, using the database of the Minimal Basic Set of Information from general hospitals and health-social centres (SC). We studied the evolution of the hospitalization of stroke according to sex, age, average occupancy, typology of stroke and discharge destination. To calculate the denominator of the incident hospitalization rates we used two registers: Census (2000-2002) and Central Registry of Inhabitants from 2003-2011. The Mortality Heath Department Register was used to study the changes in deaths during the study period and we used the Institut d'Estadística of Catalonia register for the estimate of the population._x000D_ We analysed the tendency of morbidity and mortality rates with lineal regression and correlation models. We included several models of Poisson's regression to estimate the tendency of hospitalization rate in the folowing 5 and 10 years. Also, the destination of the patients discharged: the home residence or SC (dependency), in function of the demographic changes estimated._x000D_ The obtained results show a significant increase in the stroke hospitalization incidence rate, with an increasing demand for general hospitals. It leads to an increase in the needs for beds in 14% (7-25%) and 77% (40-115%), (2015 and 2020). Also, the home residence as a destination of the patients discharged will increase, while SC as a destination will decrease; then we anticipate a decrease in the need for beds by 6,9 % and 15,5 % for the years 2015 and 2020 in these SC. This analysis was complemented with the evaluation of the sanitary cost that of 15.773.062 € (general and social hospitalizations and ambulatory activity in SC) and the estimation for the next years, with an increase of 12,6% (8,3-18,6%) for 2015 and of 72% (45-98%) for 2020, basically for the expense of general hospitals._x000D_ The results were considered plausible with the information published in the literature, especially because of the positive responses of the patients after the application of the new therapies in the early phase of the disease. However, it is important to remember that the long-term projections (2020) present a wide IC, which could result in certain vagueness in the obtained results._x000D_ To have information about the needs and resources is a fundamental tool for managers and sanitary planners, and has to allow designing strategic plans according to scientific methodology. To reflect the changes of health and social-health needs is important, and can facilitate that the patients with stroke will be able to have an efficient, equitable and good quality care in general hospitals and in SC. In this way, a sanitary integral assistance that helps to improve the health state of the affected patients can be guarantee.

Date of Award	28 Oct 2013
Original language	Catalan
Supervisor	Josep Vaqué Rafart (Director)