EQA-17: propuesta de un indicador sintético del producto de la atención primaria en mayores de 14 años / EQA-17: proposing a synthetic indicator to measure the outcomes of primary care teams in people over 14 years

Múltiples indicadores miden diferentes aspectos del amplio abanicode actividades que desarrollan los equipos de atención primaria(EAP). Sin embargo, su amplio número dificulta su interpretaciónpuesto que la mayoría aportan información parcial y no proporcionanuna visión global de los resultados. Este trabajo propone unmodelo teórico para el cálculo estandarizado de un indicador «sintético» que permita medir y comparar el producto clínico-asistencialgenerado por los EAPs. Para la construcción del indicador sintéticose realizó una metodología de trabajo en seis fases: 1) identificacióny selección de componentes para el indicador; 2) determinación deprevalencias y coberturas teóricas esperadas; 3) ponderación de loscomponentes; 4) establecimiento de estándares; 5) formulación delos subindicadores; 6) operativización del indicador sintético final.Se seleccionó un total de 10 problemas de salud propios de la AP, quese desglosaron finalmente en una escala estandarizada de calidadasistencial (EQA) con 17 ítems. Los problemas de salud que componeneste indicador sintético contemplan tanto la realización de actividadesde promoción de la salud (lucha antitabáquica) como actividadesde prevención primaria (vacunaciones antitetánica y antigripal),atención a patologías agudas (prescripción de antibióticos), yatención de patologías crónicas (enfermedad pulmonar obstructivacrónica, hipertensión, dislipemia, diabetes, insuficiencia cardiaca yfibrilación auricular). El concepto de un indicador "sintético" delproducto clínico-asistencial generado por los EAP puede aportar unmensaje dinamizante y motivador para muchos profesionales asistenciales,y su introducción podría ser útil para la mejora de losactuales modelos de gestión en atención primaria

There are many indicators to measure different aspects of the PrimaryHealth Care activities. However, the interpretation of most ofthem it is difficult because the majority give partial information. Thiswork proposes a standardised model to calculation of a syntheticindicator to measure the product of primary care teams. We made thiswork based on the sequential realization of a bibliographical review,a retrospective study to know registered morbidity, and the consentof a working group. For the design of the synthetic indicator wecarried out a sequential working methodology in six phases: 1) identificationand selection of components for the indicator; 2) determinationof theoretical prevalences and coverages; 3) ponderation ofthe components; 4) establishment of standards; 5) formulation of thecomponents; 6) application of the scale and calculation of the indicator.Ten health problems were selected; that supposed a standardisedscale of 17 items (EQA-17). The 10 problems of health which composedthis synthetic indicator contemplate the realization of activitiesof promotion of the health (smoking cessation), activities of primaryprevention (tetanus and influenza vaccination), care of acuteproblems (prescription of antibiotics), and care of chronic diseases(diabetes, chronic obstructive pulmonary disease, hypertension,patients with high-risk cardiovascular index, atrial fibrillation, andheart faillure). The concept of a synthetic indicator to measure thelevel of quality of the product generated by the primary care teamscould be useful for the improvement of the current evaluation modelsin primary care services

[Influenza vaccination and mortality in the elderly]. / Vacunación antigripal y mortalidad general en población mayor de 65 años.

BACKGROUND AND OBJECTIVE: Though there is a general agreement on the need of influenza vaccination (IV), very different results have been published about the magnitude of its effect. We evaluated the effectiveness of IV in the reduction of mortality in individuals over 65 years of age. PATIENTS AND METHOD: Prospective cohort study of all individuals over 65 attended in 8 urban primary care centers (n = 11,241). We assessed IV in autumn 2001 and considered the death from all causes during 2002 as a response variable. We calculated the global effectiveness (1-relative risk) and the necessary number of vaccinations in order to prevent 1 death (NNT = 1/attributable risk). RESULTS: Global effectiveness of IV was 2%, considering an NNT of 1667. No vaccination benefit among the 65-74 years-old group was observed, but IV proved 22% effectiveness (95% confidence interval, 3-38%) in individuals over 75, with an estimated NNT of 66 vaccinations (95% confidence interval, 38-435). CONCLUSIONS: Within a year with a moderate incidence of influenza, IV had a small effectiveness in preventing general mortality in our area, though it was especially effective among those at higher risk (over 75 and suffering from chronic pathologies).

Cobertura y asociación con variables clínicas de la vacunación antineumocócica en la población mayor de 65 años de Tarragona-Valls / Coverage and association with clinical variables of antipneumococcal vaccination of the population over 65 years-old in Tarragona-Valls

Fundamento: En Cataluña, el programa de vacunación antineumocócica(VAN), que incluye a todas las personas mayores de 65años se inició en 1999. Tres años después, analizamos las coberturasvacunales según presencia de factores de riesgo para padecer neumonía.Métodos: Estudio observacional transversal, emplazado en 8Áreas Básicas de Salud (ABS) de Tarragona. Se incluyeron todas laspersonas mayores de 64 años asignados a las 8 ABS participantes(n=11241). Mediante revisión de historias clínicas informatizadas ydel Registro informático de vacunaciones, valoramos en cadapaciente si había recibido la VAN antes de enero de 2002, así comola presencia de enfermedades o factores de riesgo para sufrir neumonía.Resultados: La cobertura vacunal global fue 44,4% (37,1% en65-74 años, 53,9% en 75-84 y 51,5% en 85-99 años). Las mayorescoberturas se dieron entre aquellos con neoplasia activa (56,7%),nefropatía crónica (55,3%), enfermedad pulmonar crónica (54,2%) ycardiopatía crónica (53,5%). Las menores coberturas se observaronen fumadores (38,9%), pacientes enólicos (43,6%) y hepatopatíacrónica (46,5%). La cobertura VAN fue 38,9% (IC 95%: 37,6-40,2)entre las personas sin ningún factor de riesgo, del 47,7% (IC 95%:46,1-49,4) entre aquellos con un factor, y del 52,7% (IC 95%:52,6-54,8) entre aquellos con dos o más factores.Conclusiones: A pesar de una cobertura global aceptable, existenamplios subgrupos de pacientes con alto riesgo que no han recibidola VAN. Los resultados sugieren que, tratando de alcanzar altascoberturas globales, la presencia de factores de riesgo es poco tenidaen cuenta para prescribir o no la VAN

Background: In Catalonia, a polyanccharide pneumococcalvaccine (PPV) programme which includes subjects over 65 yearsold, was started in 1999. Three years later, we study the vaccinecover in relation to the presence of risk factors for pneumonia.Methods: Cross-sectional observational study conducted in 8Basic Health Areas (BHA) of Tarragona. All the subjects over 65years old and assigned to one of the 8 basic health areas participatingin the study were included (n= 11241). Using computerized clinicalrecords and vaccination records we evaluated whether each patienthad received PPV before January 2002, and the presence of diseaseor risk factors for pneumonia.Results: Global vaccination coverage was 44.4% (37.1% in 65-74 years, 53.9% in 75-84 and 51.5% in 85-99 years). The greatestcoverage was recorded in subjects with active neoplasm (56.7%),chronic necropathy (55.3%), chronic lung disease (54.2%) and chroniccardiopathy (53.5%). The least coverage was recorded in smokers(38.9%), alcoholic patients (43.6%) and chronic liver disease(46.5%). AVP coverage was 38.9% (CI 95%: 37.6-40.2) in subjectswithout any risk factors, 47.7% (CI 95%: 46.1-49.4) in those withone factor, and 52.7% (CI 95%:52.6-54.8) in those with two or morefactors.Conclusions: In spite of an acceptable global coverage, there arelarge subgroups of high risk patients who have not received PPV. Theresults suggest that, in an attempt to achieve extended global coverage,the presence of risk factors is largely ignored when deciding whetherto prescribe PPV or not

[Coverage and association with clinical variables of antipneumococcal vaccination of the population over 65 years old in Tarragona-Valls]. / Cobertura y asociación con variables clínicas de la vacunación antineumocócica en la población mayor de 65 anos de Tarragona-Valls.

BACKGROUND: In Catalonia, a polyanccharide pneumococcal vaccine (PPV) programme which includes subjects over 65 years old, was started in 1999. Three years later, we study the vaccine cover in relation to the presence of risk factors for pneumonia. METHODS: Cross-sectional observational study conducted in 8 Basic Health Areas (BHA) of Tarragona. All the subjects over 65 years old and assigned to one of the 8 basic health areas participating in the study were included (n=11241). Using computerized clinical records and vaccination records we evaluated whether each patient had received PPV before January 2002, and the presence of disease or risk factors for pneumonia. RESULTS: Global vaccination coverage was 44.4% (37.1% in 65-74 years, 53.9% in 75-84 and 51.5% in 85-99 years). The greatest coverage was recorded in subjects with active neoplasm (56.7%), chronic necropathy (55.3%). chronic lung disease (54.2%) and chronic cardiopathy (53.5%). The least coverage was recorded in smokers (38.9%), alcoholic patients (43.6%) and chronic liver disease (46.5%). AVP coverage was 38.9% (CI 95%: 37.6-40.2) in subjects without any risk factors, 47.7% (CI 95%: 46.1-49.4) in those with one factor, and 52.7% (CI 95%: 52.6-54.8) in those with two or more factors. CONCLUSIONS: In spite of an acceptable global coverage, there are large subgroups of high risk patients who have not received PPV. The results suggest that, in an attempt to achieve extended global coverage, the presence of risk factors is largely ignored when deciding whether to prescribe PPV or not.