L’appropriatezza clinica e organizzativa nella gestione del paziente iperglicemico ospedalizzato: gestione integrata ospedale/territorio
Paola Saturnino, Maria Barbato, Maria Pia Mannelli, Angela Gallo, Filomena Vecchione
Introduction Diabetes, and its related complications, is a widespread chronic disease in the world and is an onerous health problem. Because of the progressive increase in risk factors such as obesity and aging population, the incidence of this disease is increasing in an epidemic way. Since drugs and biomedical technologies have transformed the disease, once lethal, in a chronic disease, diabetes care needs more health interventions that require more resources.
One of our recent studies performed within AORN “A. Cardarelli” in Naples, showed that, in hospital environment, the choice of the type of insulin to use, must be targeted. Comparisons were made between similar insulins given by small bottle (insulin glulisine and lispro) and that given by pen (insulin aspart), evaluating the safety, satisfaction and inexpensiveness aspects.
Methods In this study the diabetic patients hospitalized in 2016 in the various operating units have been counted, both those with a primary diagnosis of diabetes and those with secondary diagnosis. Then, the number of days of hospitalization per capita was found as well as the average hospitalization. Based on these parameters the economic waste due to any unused insulin pen was calculated and quantified.
Results This in-depth analysis confirms that in areas where we have few days of hospitalization, the pen is uneconomical because it is not completely used (Total waste calculated: € 1,987.34).
Based on these evaluations and our practical experience for the treatment of the diabetic patient, in our hospital, an internal PDTA (Diagnostic Therapeutic Care Path) was prepared and is going to be activated in order to encode the organizational paths, not only to regulate actually prohibited practices as the use of pens in possession of the patient and the delivery of the pen containing residual unused allowances when the patient is discharged but also to ensure the best care and continuity of care.
Key words: diabetes, insulin, device, care of a diabetic patient, PDTA