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Access Barriers and Factors Associated With Incurring Out-of-Pocket Expenses in the Putumayo Department: An Analytical Study

Introduction. Out-of-pocket (OOP) expenses are costs that can become a barrier to accessing health services. Objective. To analyze barriers and factors associated with incurring OOP expenses related to health care in the Putumayo Department, Colombia. Methods. We conducted an analytical cross-sectional study of 784 adults who sought outpatient, inpatient, or emergency care. OOP expenditure was determined using a previously validated instrument administered by trained professionals. Descriptive analyses were followed by bivariate and multivariable logistic regression analyses. Results. Median age was 43 years [Q1: 30; Q3: 61], and median OOP expenditure was 100,000 Colombian pesos (COP) [Q1: 20,000; Q3: 210,000]. Belonging to a race other than mestizo, being enrolled in the special contributory regime, residing in rural or dispersed rural areas, visiting a general practitioner (GP), having been hospitalized in the past six months, and having diabetes mellitus (DM) or hypertension (HTN) were associated with higher odds of incurring OOP expenses. Conversely, being aged ≥50 years, having secondary, technical, or university education, and having visited the emergency department (ED) in the past six months were associated with lower odds of incurring such expenses. Conclusions. Belonging to a race other than mestizo, enrollment in the contributory regime, living in rural and dispersed rural areas, consulting a GP, hospitalization in the past six months, and DM and HTN were associated with a higher probability of having incurred OOP expenses. In contrast, age ≥50 years, secondary, technical, and university education, and ED use in the past six months were associated with a lower probability of incurring these expenses.

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Revista Gerencia Y Politicas De Salud

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Adult-onset Still\'s disease presenting with atypical cutaneous findings: A case report and review of similar cases in Latin American patients

Most patients with adult-onset Still\'s disease (AOSD) present with an evanescent, salmon-colored exanthema that is more prominent during febrile peaks and is considered a major diagnostic criterion. However, over the past two decades, an increasing number of atypical cutaneous findings have been reported. Herein, we present a case of AOSD with atypical skin lesions in a Colombian woman and a review of similar cases in Latin American patients. A 21-year-old female was hospitalized for a 3-month history of intermittent fever, joint pain, and pruritic, erythematous rash. On admission, she exhibited polymorphous macules and papules (linear, urticarial) and lichenoid plaques accompanied by eyelid edema, all of which persisted after febrile peaks subsided. The patient fulfilled Yamaguchi\'s criteria for AOSD. A skin biopsy reported multiple apoptotic keratinocytes within the epidermis and a dermal perivascular inflammatory infiltrate. This histopathological pattern has been consistently associated with persistent pruritic eruptions (PPEs), which are characteristic of AOSD with atypical skin lesions. We searched six databases for AOSD cases with atypical cutaneous findings in Latin American patients. Altogether, there were 17 patients (76% female), of whom 14 underwent a skin biopsy: 42% of skin specimens exhibited distinct epidermal alterations compatible with PPEs, while the remaining 58% corresponded to urticaria, dermographism, or classic Still\'s disease rash. Our literature review showed that in Latin American patients with AOSD, atypical skin lesions can correspond to true PPEs but primarily to alternative diagnoses. A skin biopsy is a valuable tool for establishing a prompt diagnosis.

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Revista Colombiana De Reumatologia