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Resumen Introduccion Estudio promovido por la Sociedad Castellano-Manchega de Endocrinologia, Nutricion y Diabetes para conocer las caracteristicas de los pacientes atendidos en las consultas externas de Endocrinologia y Nutricion del Servicio de Salud de Castilla-La Mancha y la casuistica de la patologia atendida en dichas consultas. Material y metodos Estudio transversal retrospectivo de la actividad en 2018 de las consultas externas de Endocrinologia y Nutricion de los hospitales publicos de Castilla-La Mancha. Se analizaron todas las visitas del 10% de los dias laborables. Se recogio edad y sexo del paciente, si la consulta era primera o sucesiva, presencial o no presencial y hasta cinco diagnosticos por visita. Resultados Se analizaron 10.709 visitas con una relacion sucesivas/primeras 3,4. La edad de los pacientes fue 52,1 ± 18,2 anos con un 67,1% de mujeres. Diabetes mellitus tipo 2, hipotiroidismo primario, enfermedad nodular tiroidea y obesidad/sobrepeso fueron las patologias mas frecuentemente registradas como primer diagnostico, superando entre las cuatro la mitad del total de visitas. Diabetes mellitus tipo 1, y cancer de tiroides fueron los diagnosticos en los que la relacion sucesivas/primeras fue mayor. Diabetes mellitus tipo 2, obesidad e hipotiroidismo primario supusieron casi la mitad de las primeras visitas. Conclusiones Se atendieron una amplia variedad de patologias, algunas de las cuales estan entre las mas prevalentes en la poblacion general y otras que son poco prevalentes, pero complejas, y dificilmente manejables por otras especialidades. El conocer y analizar estos datos permitira identificar oportunidades de mejora y poner en marcha acciones en este sentido.

Introduction This study was promoted by Sociedad Castellano Manchega de Endocrinologia, Nutricion y Diabetes to ascertain the characteristics of patients seen at the outpatient clinics of endocrinology and nutrition of the Castilla-La Mancha Health Authority and the case mix of diagnoses. Patients and Methods This was a retrospective, cross-sectional study of the activity of the endocrinology and nutrition outpatient clinics of public hospitals of Castile-La Mancha during 2018. All visits made on 10% of the working days were analyzed. Data collected comprised patient age and sex, whether a first or subsequent had been made, and whether this was face-to-face or not, and up to five diagnoses per visit. Results A total of 10,709 visits with a subsequent/first visit ratio of 3.4 were analyzed. Patient age was 52.1?±?18.2 years, and 67.1% were women. Type 2 diabetes mellitus, primary hypothyroidism, thyroid nodular disease, and obesity/overweight were the most common conditions recorded as first diagnosis, accounting for more than half of the total number of visits. Type 1 diabetes mellitus and thyroid cancer were the diagnoses in which the subsequent/first visit ratio was greater. Type 2 diabetes mellitus, obesity, and primary hypothyroidism accounted for almost half of the first visits. Conclusions A wide variety of conditions were seen, some of which are among the most prevalent in the general population, while others are not so prevalent, but are complex and difficult to manage by other specialties. Improved knowledge and analysis of the data should allow for the identification of opportunities for improvement and for the implementation of specific actions.

Resumen Introduccion La actividad de los servicios de Endocrinologia y Nutricion (EYN) incluye la asistencia en planta de pacientes propios o mediante interconsultas. La actividad asistencial en planta del conjunto de servicios de EYN de un sistema publico de salud no ha sido estudiada en nuestro pais. Material y metodos Estudio retrospectivo de la actividad en planta de hospitalizacion durante 2018 de los Servicios de EYN del Servicio Publico de Salud de Castilla-La Mancha para conocer las caracteristicas de los pacientes atendidos, tanto con caracter de interconsulta como ingresados a cargo de los propios servicios, asi como la casuistica de la patologia de dichos pacientes. Se analizaron todos los pacientes ingresados a cargo de EYN y una muestra del 10% de los atendidos como interconsulta. Resultados Se registraron 261 ingresos a cargo de los servicios de EYN del Servicio Publico de Salud de Castilla-La Mancha. El 82,8% tuvieron caracter urgente y el 53,7% fueron por diabetes mellitus tipo 1. Se atendieron 5955 pacientes en regimen de interconsulta, de los cuales se analizo una muestra de 591. El motivo de interconsulta mas frecuente fue la diabetes mellitus/hiperglucemia (28,8%), requiriendo 6,1 ± 6,7 dias por paciente. Sin embargo, las interconsultas para nutricion artificial requirieron mas dias de asistencia por paciente y supusieron un porcentaje mayor del total de dias de interconsulta (60,4%). Conclusiones La actividad en planta de los servicios de EYN del Servicio Publico de Salud de Castilla-La Mancha se basa en la asistencia de pacientes con patologias cronicas de alta prevalencia hospitalaria como la diabetes mellitus/hiperglucemia y, especialmente, la Nutricion Clinica.

Introduction The activity of an Endocrinology and Nutrition (E&N) department consists of inpatient care both by those attached to the department and through consultations with specialists from other departments. The inpatient care activity of all the E&N departments of a public health system has not been studied in Spain. Material and methods This was a retrospective study of hospital ward activity during 2018 of the E&N departments of the Castilla-La Mancha Public Health Service. It was undertaken in order to ascertain the characteristics of the patients attended to, both by those in charge of the E&N departments and through interconsultation with other departments, as well as the case-mix of the pathology of these patients. All patients admitted to E&N and a 10% sample of those treated through interconsultation were analysed. Results 261 admissions were recorded for Castilla-La Mancha Public Health Service E&N departments. 82.8% were urgent and 53.7% were due to type 1 diabetes mellitus. A total of 5955 patients were seen on an interconsultation basis, 591 of whom were analysed. The most frequent reason for interconsultation was diabetes mellitus/hyperglucemia (28.8%), requiring 6.1 ± 6.7 days per patient. However, interconsultations for artificial nutrition required more days of attendance per patient and accounted for a higher percentage of the total number of days of interconsultation (60.4%). Conclusions The inpatient care activity of the E&N departments of Castilla-La Mancha Public Health Service mainly consists of attending to patients with chronic pathologies of high hospital prevalence such as diabetes mellitus/hyperglucemia and, especially, clinical nutrition.

Resumen Introduccion Las herramientas para analizar la casuistica en consultas externas son escasas e insatisfactorias. El objetivo de este trabajo de la Sociedad Castellano Manchega de Endocrinologia, Nutricion y Diabetes (SCAMEND) fue el desarrollo de una herramienta que permita analizar la casuistica de las consultas externas de Endocrinologia y Nutricion teniendo en cuenta la complejidad de la patologia atendida. Material y metodos Se definio el Indice SCAMEND de Complejidad en Consultas Externas de Endocrinologia y Nutricion (ISCCE-EyN) mediante metodo Delphi con dos rondas entre especialistas en Endocrinologia y Nutricion, comparando la complejidad de cada patologia con la de una revision de hipotiroidismo primario. Resultados Las primeras visitas fueron consideradas mas complejas que las visitas sucesivas. La patologia tiroidea no neoplasica y el sobrepeso/obesidad sin complicaciones fueron consideradas las patologias menos complejas, mientras que las metabolopatias, los sindromes de neoplasias endocrinas multiples y el carcinoma suprarrenal fueron consideradas las mas complejas. El grado de consenso fue elevado en la mayoria de las patologias analizadas. Conclusiones Presentamos una herramienta que permite analizar la casuistica de las consultas externas de Endocrinologia y Nutricion teniendo en cuenta la complejidad inherente a la patologia del paciente atendido. Esta herramienta puede servir para realizar comparaciones entre centros, para asignar mejores recursos dentro de un determinado servicio o para la autoevaluacion.

Introduction The tools for analyzing the case-mix in outpatient care are scarce and unsatisfactory. The objective of this work by the Sociedad Castellano Manchega de Endocrinologia, Nutricion y Diabetes (SCAMEND) was the development of a tool that allows to analyze the the case-mix in outpatient care in Endocrinology and Nutrition considering the complexity of the patient disease. Material and methods The SCAMEND index of complexity in outpatient care in Endocrinology and Nutrition (ISCCE-EyN) was defined using the Delphi method with two rounds between endocrinologists, comparing the complexity of each consult with that of a review visit of primary hypothyroidism. Results The first visits were considered more complex than the successive visits. Non-neoplastic thyroid pathology and uncomplicated overweight/obesity were considered the least complex diseases, while metabolopathies, multiple endocrine neoplasm syndromes and adrenal carcinoma were considered the most complex. The degree of consensus was high in most of the diseases analyzed. Conclusions We present a tool that allows to analyze the case-mix in outpatient care in Endocrinology and Nutrition considering the inherent complexity of the disease of the patient attended. This tool can be used to make comparisons between centres, to better allocate resources within a given service or for self-evaluation.

The tools for analyzing the case-mix in outpatient clinics are scarce few and unsatisfactory. The objective of this study conducted by Sociedad Castellano Manchega de Endocrinología, Nutrición y Diabetes (SCAMEND) was to develop a tool that allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, considering bearing in mind the complexity of the conditions seen.Using the Delphi method, the SCAMEND index of complexity in outpatient endocrinology and nutrition clinics (ISCCE-EyN) was developed by endocrinologists in two rounds, comparing the complexity of each condition being compared with that of a review visit of primary hypothyroidism.The first visits were considered more complex than the subsequent visits. Non-neoplastic thyroid disease and uncomplicated overweight/obesity were considered as the least complex diseases, while metabolic diseases, multiple endocrine neoplasia syndromes, and adrenal carcinoma were considered as the most complex. The degree of agreement was high in most of the diseases analyzed.This tool allows for analyzing the case-mix in outpatient endocrinology and nutrition clinics, based on the inherent complexity of the disease of the patient is reported. This tool may be used for comparisons between centers, to better allocate resources within a given service, or for self-evaluation.

The activity of an Endocrinology and Nutrition (EN) department consists of inpatient care both by those attached to the department and through consultations with specialists from other departments. The inpatient care activity of all the EN departments of a public health system has not been studied in Spain.This was a retrospective study of hospital ward activity during 2018 of the EN departments of the Castilla-La Mancha Public Health Service. It was undertaken in order to ascertain the characteristics of the patients attended to, both by those in charge of the EN departments and through interconsultation with other departments, as well as the case-mix of the pathology of these patients. All patients admitted to EN and a 10% sample of those treated through interconsultation were analysed.261 admissions were recorded for Castilla-La Mancha Public Health Service EN departments. 82.8% were urgent and 53.7% were due to type 1 diabetes mellitus. A total of 5955 patients were seen on an interconsultation basis, 591 of whom were analysed. The most frequent reason for interconsultation was diabetes mellitus/hyperglucemia (28.8%), requiring 6.1±6.7 days per patient. However, interconsultations for artificial nutrition required more days of attendance per patient and accounted for a higher percentage of the total number of days of interconsultation (60.4%).The inpatient care activity of the EN departments of Castilla-La Mancha Public Health Service mainly consists of attending to patients with chronic pathologies of high hospital prevalence such as diabetes mellitus/hyperglucemia and, especially, clinical nutrition.

This study was promoted by Sociedad Castellano-Manchega de Endocrinología, Nutrición y Diabetes to ascertain the characteristics of patients seen at the outpatient clinics of endocrinology and nutrition of the Castilla-La Mancha Health Authority and the case mix of diagnoses.This was a retrospective, cross-sectional study of the activity of the endocrinology and nutrition outpatient clinics of public hospitals of Castile-La Mancha during 2018. All visits made on 10% of the working days were analyzed. Data collected comprised patient age and sex, whether a first or subsequent had been made, and whether this was face-to-face or not, and up to five diagnoses per visit.A total of 10,709 visits with a subsequent/first visit ratio of 3.4 were analyzed. Patient age was 52.1 ± 18.2 years, and 67.1% were women. Type 2 diabetes mellitus, primary hypothyroidism, thyroid nodular disease, and obesity/overweight were the most common conditions recorded as first diagnosis, accounting for more than half of the total number of visits. Type 1 diabetes mellitus and thyroid cancer were the diagnoses in which the subsequent/first visit ratio was greater. Type 2 diabetes mellitus, obesity, and primary hypothyroidism accounted for almost half of the first visits.A wide variety of conditions were seen, some of which are among the most prevalent in the general population, while others are not so prevalent, but are complex and difficult to manage by other specialties. Improved knowledge and analysis of the data should allow for the identification of opportunities for improvement and for the implementation of specific actions.