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Idoneidad en el tratamiento de pacientes con hipertensión arterial

Objetivo. En primer lugar estima la idoneidad del tratamiento de los pacientes con hipertensión arterial (HTA) diagnosticados en Atención Primaria en función de la conjunción de dos criterios, el control de las cifras de presión arterial (PA) alcanzada y la adecuación de la prescripción farmacológica, y en segundo lugar estimar el coste mensual medio por paciente y analizar los factores asociados al mismo. Diseño. Estudio de utilización de medicamentos de tipo indicación-prescripción. Ámbito. Pacientes que acuden a la Atención Primaria. Pacientes. Quinientos once pacientes de ambos sexos (311 mujeres y 200 varones) mayores de 18 años seleccionados aleatoriamente del registro de HTA. Resultados. Edad media 66 ñ 1 años. Presentan patología asociada (bloqueo AV, obstrucción crónica al flujo aéreo, gota, coronariopatía, diabetes mellitus, insuficiencia cardíaca) 246 (47,6 por ciento) pacientes, y los 3 últimos procesos, 61 (31,6 por ciento) pacientes. El porcentaje de pacientes con PA controlada (< 140 y < 90 mmHg) es 26,8 por ciento y el de pacientes con una prescripción farmacológica adecuada según criterios explícitos 77,5 por ciento. El coste mensual medio es 2.267 y está explicado en el 43 por ciento por la adecuación de la prescripción, la comorbilidad y el número de fármacos prescritos. Conclusión. Los pacientes analizados están siendo tratados con fármacos hipotensores seleccionados en función de la patología asociada que presentan, si bien pocos son los que alcanzan unas cifras de PA controladas (AU)

[Coronary risk and prescription in primary care patients with hypercholesterolemia]. / Riesgo coronario y prescripción en pacientes con hipercolesterolemia en atención primaria.

OBJECTIVE: In patients with hypercholesterolaemia determinate the prevalence of high coronary risk (CR), study the lipid lowering treatment applied and determinate if there is any change in CR after a period of treatment. DESIGN: Cross-sectional. EMPLACEMENT: Primary care. PATIENTS: 583 patients with hypercholesterolaemia both sex, older than 25 years registered in chronic mobility, randomized selected. MEASUREMENT AND RESULTS: Applying the Framingham coronary multivariate risk method we estimate high CR > 20%. Patients with a previous history of cardiovascular event, were treated in a 50%, more frequently younger subjects, rising 220 mg/dl of final cholesterol level. Patients without any cardiovascular event known, the 32.5% (28.0-36.7%) have a CR > 20%. Subjects with high CR have 4.9 (3.0-8.2) more probability if receiving treatment than the others with lower risk. The lipid-lowering treatment is explained in a 67% because the high CR and the family history of coronary event. After at least one year period there is a reduction in those with high CR (difference relative of proportions 28.7% [20.4-37.1]).

Riesgo coronario y prescripción en pacientes con hipercolesterolemia en atención primaria / Coronary risk and prescription in primary care patients with hypercholesterolaemia

Objetivo. Analizar el riesgo coronario, el tratamiento prescrito y determinar si tras un período se modifica el riesgo coronario (RC) de la población con hipercolesterolemia en atención primaria (AP). Diseño. Observacional transversal. Emplazamiento. Población consultante en un equipo de AP urbano de Madrid. Pacientes. Quinientos ochenta y tres pacientes diagnosticados de hipercolesterolemia de ambos sexos y mayores de 25 años que constan en el registro de morbilidad, seleccionados aleatoriamente. Mediciones y resultados principales. El RC determinado por el método de Framingham lo consideramos alto si es > 20 por ciento a los 10 años. Los pacientes con enfermedad cardiovascular (ECV) inicial tienen prescritos hipolipemiantes la mitad de ellos, con más frecuencia los más jóvenes, presentando un colesterol final de 220 mg/dl de media. Entre los pacientes sin ECV inicial, un 32,5 por ciento (28,0-36,7 por ciento) tiene un RC > 20 por ciento y éstos presentan 4,9 por ciento (3,0-8,2) más probabilidad de recibir fármacos que los que lo tienen inferior. La prescripción de hipolipemiantes está explicada en un 68 por ciento por el RC elevado y la historia familiar de cardiopatía isquémica. Tras al menos un año de seguimiento, constatamos una reducción en la proporción de pacientes con RC alto (diferencia relativa de proporciones 28,7 por ciento [20,4-37,1]). Conclusión. La mitad de los pacientes con ECV o con un RC elevado sin ECV reciben hipolipemiantes. La mayor parte de la prescripción de fármacos está asociada al RC y en la consulta de AP se consigue disminuir la prevalencia de sujetos con RC elevado (AU)

[Antitetanus vaccination in the adult: systematic offer in primary care as an effective approach]. / Vacunación antitetánica en el adulto: la oferta sistemática en atención primaria como un abordaje efectivo.

OBJECTIVE: To establish the effectiveness of a broad offer for tetanus vaccination (ATT), to any person visiting his general practitioner, by evaluating its coverage, acceptance by patients and final vaccination figures. DESIGN: Intervention study of nonrandom type. SETTING: Primary care. PATIENTS: 1349 people aged > or = 24 registered with a general practitioner, of which 1048 were user's people. MEASUREMENTS AND MAIN RESULTS: Find out all people seeking primary care if they has been vaccinated against tetanus, recording the next token dosage or inoculating it, according to the recommendations of the Centers for Disease Control. We offered vaccination to 90.7% of the user's people, without significant difference as to age and sex groups, and to 70.7% of the registered population. The proposal was rejected by 8.9% of people who need to initiate vaccination. The 17.1% of the population stated that they had been inoculated the whole vaccination cycle, and after the treatment the rate rose to 81.5% of intervener's people. CONCLUSION: The broad offer for ATT vaccination to people seeking primary care, whatever the reason is, the final result is 8 patients vaccinated out of 10 of the offer's people. This is an easily measurable example of what can be achieved both with registered population and people seeking primary care if we include preventive programmes and health promotion in the daily medical attention demanded by patients who go to primary care centers.

[The follow-up of a patient cohort with arterial hypertension in primary care]. / Seguimiento de una cohorte de pacientes con hipertensión arterial en atención primaria.

OBJECTIVE: To establish effectiveness of the hypertension program basing on the detection degree, decreasing of blood pressure and control of hypertension. DESIGN: Intervention study. SETTING: Primary care. PATIENTS: A group > or = 14 years of age, treated by the primary health care and selected at random (3,349). Here we found all the patients with hypertension (237). INTERVENTION AND MAIN RESULTS: Hypertension program approval of the public health department. Criteria followed are those suggested in report V of the Joint National COMMITTEE: Global prevalence of hypertension is 7.1% and in the group > or = 65 years of age 51.3%. Average decrease of the systolic blood pressure is 18.9 mmHg and that of the diastolic blood pressure 13.5 mmHg, both with p < 0.001. Decrease for patients with mild hypertension was 5.4-13.8 mmHg for systolic and 6.7-11.8 for diastolic. Patients with moderate hypertension 17.3-22.5 and 12.2-15.7 mmHg respectively and patients with severe hypertension 27.6-43.0 and 15.0-23.0 mmHg. The 39.7% of hypertensive patients have systolic < 140 mmHg and 70.0% have diastolic < 90 mmHg at the end of monitoring period. CONCLUSIONS: Actual application of hypertension program by our primary care system allows detection of elderly patients with high blood pressure, major decrease of blood pressure, together with a greater decrease even whether they high at the beginning of the monitoring.

[Service demand flow and planning in primary care]. / Flujo de demanda de servicios y planificación en atención primaria.

OBJECTIVE: We wish to know the moment from which people first came into contact with general practitioners in Primary Care and which socio-demographic variables influence this. DESIGN: Prospective, observational study. SETTING: Primary Care, general practitioners. PARTICIPANTS: 469 people newly registered with a general practitioner. Follow-up study is 12 months. MEASUREMENTS AND MAIN RESULTS: We have made a Kaplan-Meier survival analysis and a comparison of curves with a log rank test. 50% of population visit for the first time during the fourth months following their registration. 75% of newly-registered of people attend at least once during the first year following registration. Women are more likely to attend than men (p < 0.001), people older than 53 years of age (p < 0.001) and young people with chronic health problems (p < 0.01) are also more likely to visit the doctor than others. CONCLUSIONS: At least one time at year had attended 75% of people of new registration in Primary Care. Women, people older than 53 and young people with chronic health problems attend before. This observation leads us to begin the "finding case" strategy as a screening method, to use this fact to instigate prevention activities, health education campaigns and to avoid overburdening the workload, in order to manage services request.