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Resumen: Objetivo: Evaluar el grado en que los sucesos adversos (SA) ligados a la asistencia sanitaria alcanzan al paciente y su severidad. Analizar los factores contribuyentes a la aparición de SA, la relación con el daño provocado y el grado de evitabilidad. Diseño: Estudio descriptivo retrospectivo. Emplazamiento: Servicio de Atención Primaria de Porriño desde enero de 2014 a abril de 2016. Participantes y/o contexto: Se incluyeron notificaciones de SA en el Sistema de Notificación y Aprendizaje para Seguridad del Paciente (SiNASP). Método: Variables de medida: incidente adverso (IA) si no alcanzó al paciente o no produjo daño, evento adverso (EA) si llegó al paciente con daño. Grado de daño clasificado como mínimo, menor, moderado, crítico y catastrófico. Evitabilidad registrada como escasa evidencia de ser evitable, 50% evitable y sólida evidencia de ser evitable. Análisis de datos: porcentajes y test de chi-cuadrado para variables cualitativas; p

ResumenObjetivoEvaluar la evolución del consumo de fármacos antiulcerosos en relación a la tendencia evolutiva de la hospitalización por hemorragia digestiva alta (HDA).DiseñoEstudio observacional retrospectivo ecológico.EmplazamientoRed pública Sistema Nacional de Salud (SNS) durante 9 años, desde el 1 de enero de 2000 hasta el 31 de diciembre de 2008.ParticipantesCriterios inclusión: pacientes con 15 años o más ingresados por HDA, divididos en 4 grupos etarios: 15-44, 45-64, 65-74 y ≥75años. Medicamentos facturados con cargo al SNS del subgrupo A02B. Criterios exclusión: prescripción hospitalaria o MUFACE-ISFAS-MUGEJU.Mediciones principalesIncidencia (número nuevos casos acontecidos en un año), tasa incidencia (incidencia/100.000 habitantes) de HDA, tasa consumo (DHD, dosis por habitante/día) y razón de tasas (RT, cociente entre tasas último/primer año). Fuente de datos: Ministerio de Sanidad.ResultadosSe identificaron 110.150 ingresos por HDA (61,17% hombres, 38,83% mujeres). Valores para IC95%. HDA: Tasa incidencia media total (TIM)= 34,45 [32,70; 36,20]; RT=0,83. Hombres: TIM=43,07 [40,41; 45,72]; RT=0,80 y mujeres: TIM=25,20 [25,18; 27,23]; RT=0,88. RT HDA por grupos de edad en hombres: 15-44años=0,64; 45-64años=0,74; 65-74años=0,74 y >74años=0,85. Mujeres: 15-44años=0,82; 45-64=0,71; 65-74años=0,73 y >74años=0,89. En cuanto al incremento de las DHD de los distintos grupos de antiulcerosos durante el periodo de estudio: DHD2008/DHD2000 IBP=4,43; DHD2008/DHD2000 para el total de medicamentos=3,01.ConclusionesSe detecta un elevado incremento del consumo de fármacos antiulcerosos sin que tenga relación con la tendencia evolutiva de los ingresos por HDA.AbstractObjectiveTo analyse trends in the incidence of hospitalisation due to upper gastrointestinal bleeding (UGB) and the relationship with the prescribing of anti-ulcer agents.DesignRetrospective observational ecological study.SettingSpanish National Health System (NHS) for the nine years between 1st January 2000 and 31st December 2008.ParticipantsInclusion criteria: Patients aged 15 or over hospitalised due to UGB were divided into four age groups: 15-44, 45-64, 65-74 and ≥75 years old. Drugs, A02B subgroup, prescribed under the NHS. Exclusion criteria: Prescription of medicines in hospital or public-employee insurance companies.MeasurementsIncidence (number of new cases of UGB occurring in one year), Incidence rate (incidence per 100,000 inhabitants), Dispersion rate (number of packets dispensed per year per 100,000 inhabitants), and Hazard ratio (HR, ratio between the rate of the last year over the first year. Annual rates were calculated by the standardised direct method). Data source: Ministry of Health.ResultsWe identified 110,150 hospital admissions due to UGB (61.17% male, 38.83% female). Values for 95% UGB: Total Mean Incidence Rate (MIR)=34.45 [32.70, 36.20], HR=0.83. Males: MIR=43.07 [40.41, 45.72], HR=0.80 and females: MIR=25.20 [25.18, 27.23], HR=0.88. HR HDA by age group in males: 15-44 years=0.64; 45-64 years=0.74, 65-74years=0.74 and >74years=0.85. Females: 15-44 years=0.82, 45-64years=0.71, 65-74 years=0.3 and >74years=0.89. Drug dispensing (2000-2008): HR proton pump inhibitors=4.43; HR all anti-ulcer agents=3.01.ConclusionsOver nine years the dispensing of anti-ulcer agents by the Spanish National Health System has multiplied without having regard to the evolutionary trend of hospitalisation due to UGB.

ResumenObjetivoAnalizar la evolución de la incidencia de fractura de cadera en la Comunidad Autónoma de Galicia en relación con la tendencia evolutiva en la dispensación de medicamentos con evidencia en la prevención y/o tratamiento de la fractura de cadera osteoporótica.DiseñoEstudio observacional descriptivo ecológico.EmplazamientoRed pública sanitaria de toda la Comunidad Autónoma de Galicia durante 5 años, del 1 de enero de 2004 al 31 de diciembre de 2008.ParticipantesPacientes mayores de 44 años ingresados por fractura de cadera osteoporótica. Medicamentos dispensados con evidencia en prevención y/o tratamiento de fractura de cadera osteoporótica. Exclusión: fracturas abiertas, prescripción hospitalaria, privada o mutuas.Mediciones principalesIncidencia (número de casos nuevos de fractura acontecidos en un año), tasa de incidencia (incidencia/100.000 habitantes), tasa de dispensación (número envases dispensados en un año por 100.000 habitantes) y razón de tasas (RT, cociente entre la tasa año último y año primero). Se calcularon tasas anuales estandarizadas según método directo.ResultadosSe identificaron 12.137 ingresos por fractura de cadera (2.792 hombres y 9.345 mujeres). Fracturas subcapitales: tasas de incidencia media (TIM)=86,14,IC95%[61,85–110,42]; RT=1,22,IC95%[0,82–1,63] (hombres) y TIM=180,88,IC95%[124,74–237,02]; RT=1,08,IC95%[0,73–1,43] (mujeres). Fracturas trocantéreas: TIM=56,30,IC95%[39,18–73,42]; RT=1,04,IC95%[0,75–1,34] (hombres) y TIM=136,51,IC95%[90,23–182,78]; RT=1,12,IC95%[0,89–1,35] (mujeres). Fracturas subtrocantéreas: TIM=8,92,IC95%[6,52–11,32]; RT=1,26,IC95%[0,05–2,46] (hombres) y TIM=22,91,IC95%[15,24–30,58]; RT=1,08,IC95%[0,57–1,58] (mujeres). RT fracturas totales=1,07,IC95%[0,92–1,23] (hombres) y 0,99,IC95%[0,83–1,17] (mujeres). Dispensación de medicamentos (2008–2004): RT alendronato=1,30; RT risedronato=1,92; RT ranelato de estroncio=10,38.ConclusiónEn 5 años, se ha multiplicado la dispensación de medicamentos en la sanidad pública para la prevención y tratamiento de la fractura de cadera manteniéndose constante la incidencia de esta.AbstractObjectiveTo analyse the evolution in the incidence of hip fractures in our autonomous community in relationship to the trend in the prescription of medicines for the prevention and/or treatment of osteoporotic hip fracture.DesignDescriptive observational ecological study.SettingPublic health network in the whole autonomous community over five years, from 1st January 2004 to 31st December 2008.ParticipantsPatients over 44 years old admitted with osteoporotic hip fracture. Medicines dispensed at a pharmacy which are indicated for the prevention of osteoporotic hip fractures (alendronate, risedronate and strontium ranelate). Exclusion: Open fractures, hospital or private or prescriptions.MeasurementsIncidence (number of new cases of hip fractures occurring in a year), Incidence rate (incidence per 100,000 inhabitants), Dispersion rate (number of packets dispensed per year per 100,000 inhabitants) and Hazard ratio (HR, ratio between the rate of last year and first). Annual rates were calculated standardised by the direct method.ResultsWe identified 12,137 hospital admissions for fractured hip (2,792 men and 9,345 women). Sub-capital fractures: Mean Incidence Rate (MIR)=86.14,95%CI[61.85–110.42]; HR=1.22, 95%CI[0.82–1.63] (men) and MIR=180.88,95%CI[124.74–237.02]; HR=1.08,95%CI[0.73–1.43] (women). Trochanteric fractures: MIR=56.30,95%CI[39.18–73.42], HR=1.04,95%CI[0.75–1.34] (men) and MIR=136.51,95%CI[90.23–182.78]; HR=1.12,95%CI[0.89–1.35] (women). Subtrochanteric fractures: MIR=8.92,95%CI[6.52–11.32]; HR=1.26,95%CI[0.05–2.46] (men) and MIR=22.91,95%CI[15.24–30.58]; HR=1.08,95%CI[0.57–1.58] (women). Total HR fractures=1.07, 95%CI[0.92–1.23] (men) and 0.99,95%CI[0.83–1.17] (women). Drug dispensing (2008–2004): HR alendronate=1.30; HR risedronate=1.92; HR strontium ranelate=10.38.ConclusionOver five years the dispensing of drugs by the public health service has multiplied for the prevention and treatment of hip fractures while the incidence has remained unaltered.

OBJECTIVE: To analyse trends in the incidence of hospitalisation due to upper gastrointestinal bleeding (UGB) and the relationship with the prescribing of anti-ulcer agents. DESIGN: Retrospective observational ecological study. SETTING: Spanish National Health System (NHS) for the nine years between 1st January 2000 and 31st December 2008. PARTICIPANTS: Inclusion criteria: Patients aged 15 or over hospitalised due to UGB were divided into four age groups: 15-44, 45-64, 65-74 and ≥75 years old. Drugs, A02B subgroup, prescribed under the NHS. Exclusion criteria: Prescription of medicines in hospital or public-employee insurance companies. MEASUREMENTS: Incidence (number of new cases of UGB occurring in one year), Incidence rate (incidence per 100,000 inhabitants), Dispersion rate (number of packets dispensed per year per 100,000 inhabitants), and Hazard ratio (HR, ratio between the rate of the last year over the first year. Annual rates were calculated by the standardised direct method). Data source: Ministry of Health. RESULTS: We identified 110,150 hospital admissions due to UGB (61.17% male, 38.83% female). Values for 95% UGB: Total Mean Incidence Rate (MIR) = 34.45 [32.70, 36.20], HR = 0.83. Males: MIR = 43.07 [40.41, 45.72], HR = 0.80 and females: MIR = 25.20 [25.18, 27.23], HR = 0.88. HR HDA by age group in males: 15-44 years = 0.64; 45-64 years = 0.74, 65-74 years = 0.74 and >74 years = 0.85. Females: 15-44 years = 0.82, 45-64 years = 0.71, 65-74 years = 0.3 and >74 years = 0.89. Drug dispensing (2000-2008): HR proton pump inhibitors = 4.43; HR all anti-ulcer agents = 3.01. CONCLUSIONS: Over nine years the dispensing of anti-ulcer agents by the Spanish National Health System has multiplied without having regard to the evolutionary trend of hospitalisation due to UGB.

OBJECTIVE: To analyse the evolution in the incidence of hip fractures in our autonomous community in relationship to the trend in the prescription of medicines for the prevention and/or treatment of osteoporotic hip fracture. DESIGN: Descriptive observational ecological study. SETTING: Public health network in the whole autonomous community over five years, from 1st January 2004 to 31st December 2008. PARTICIPANTS: Patients over 44 years old admitted with osteoporotic hip fracture. Medicines dispensed at a pharmacy which are indicated for the prevention of osteoporotic hip fractures (alendronate, risedronate and strontium ranelate). Exclusion: Open fractures, hospital or private or prescriptions. MEASUREMENTS: Incidence (number of new cases of hip fractures occurring in a year), Incidence rate (incidence per 100,000 inhabitants), Dispersion rate (number of packets dispensed per year per 100,000 inhabitants) and Hazard ratio (HR, ratio between the rate of last year and first). Annual rates were calculated standardised by the direct method. RESULTS: We identified 12,137 hospital admissions for fractured hip (2,792 men and 9,345 women). Sub-capital fractures: Mean Incidence Rate (MIR)=86.14,95%CI[61.85–110.42]; HR=1.22, 95%CI[0.82–1.63] (men) and MIR=180.88,95%CI[124.74–237.02]; HR=1.08,95%CI[0.73–1.43] (women). Trochanteric fractures: MIR=56.30,95%CI[39.18–73.42], HR=1.04,95%CI[0.75–1.34] (men) and MIR=136.51,95%CI[90.23–182.78]; HR=1.12,95%CI[0.89–1.35] (women). Subtrochanteric fractures: MIR=8.92,95%CI[6.52–11.32]; HR=1.26,95%CI[0.05–2.46] (men) and MIR=22.91,95%CI[15.24–30.58]; HR=1.08,95%CI[0.57–1.58] (women). Total HR fractures=1.07, 95%CI[0.92–1.23] (men) and 0.99,95%CI[0.83–1.17] (women). Drug dispensing (2008–2004): HR alendronate=1.30; HR risedronate=1.92; HR strontium ranelate=10.38. CONCLUSION: Over five years the dispensing of drugs by the public health service has multiplied for the prevention and treatment of hip fractures while the incidence has remained unaltered.