¿Mejora la prescripción antibiótica en pediatras tras una intervención multidisciplinar? / Does the prescribing of antibiotics in paediatrics improve after a multidisciplinary intervention?

El consumo excesivo de antibióticos genera altas tasas de resistencia. En Aragón, los valores máximos de prescripción de antibióticos se alcanzan en los niños de 1 a 4 años, con una utilización que supera el 60%.ObjetivoEvaluar si una intervención multidisciplinar sobre pediatras de atención primaria reduce la utilización de antibióticos y mejora su perfil de prescripción. Método Se analizaron datos de prescripción de antibióticos antes y después de un proyecto de intervención sobre pediatras de atención primaria. La intervención consistió en un taller formativo sobre diagnóstico y tratamiento de las enfermedades infecciosas más prevalentes en pediatría, habilidades en entrevista clínica y adecuada utilización de test rápido de detección de estreptococo en faringe. Se aportaron guías de práctica clínica y documentos de consenso en patología infecciosa pediátrica y material divulgativo para padres. Se utilizó grupo control con pediatras no participantes. Resultados El consumo de antibióticos bajó de 19,17 dosis diarias definida por 1.000 habitantes/día (DHD) a 14,36 DHD entre los pediatras participantes y de 19,84 DHD a 16,02 DHD en controles, aunque la diferencia no fue significativa. Se produjo una disminución de la utilización de macrólidos y penicilinas de amplio espectro en ambos grupos. Conclusión La prescripción de antibióticos de los pediatras disminuyó, no observándose diferencias estadísticamente significativas entre los grupos de estudio. Dado el alto grado de satisfacción de los pediatras participantes, sería necesario continuar con este tipo de actividades para mejorar la utilización de antibióticos en nuestro ámbito

Antibiotics overuse is linked to elevated antimicrobial resistance. In Aragon, Spain, the highest antibiotic prescription rates occur among children from 1 to 4 years old. The rate of use in this age group is over 60%.AimTo evaluate the effect of multi-faceted intervention on Primary Care paediatricians to reduce antibiotic use and to improve antibiotic prescribing for paediatric outpatients. Methods Outpatient antimicrobial prescribing was analysed before and after an intervention in paediatricians. The intervention included a clinical education session about diagnosis and treatment in the most prevalent paediatric infectious diseases, a clinical interview and communication skills, a workshop on rapid Streptococcus antigen detection test and patient information leaflets and useful internet websites for parents. The control group included paediatricians without this educational intervention on antibiotics. Results Antibiotic prescribing decreased from 19.17 defined daily doses per 1000 inhabitants/day (DID) to 14.36 DID among intervention paediatricians vs 19.84 DID to 16.02 DID in controls. The decreasing was higher in the intervention group, but the effect was not statistically significant. Macrolides and broad-spectrum penicillins prescribing decreased in both groups. Conclusion Antibiotic prescribing decreased, but there were no statistically significant differences between the two groups. The high satisfaction of paediatricians in the intervention group makes it necessary to continue with these kinds of strategies to improve antibiotic use in outpatient

[Does the prescribing of antibiotics in paediatrics improve after a multidisciplinary intervention?]. / ¿Mejora la prescripción antibiótica en pediatras tras una intervención multidisciplinar?

UNLABELLED: Antibiotics overuse is linked to elevated antimicrobial resistance. In Aragon, Spain, the highest antibiotic prescription rates occur among children from 1 to 4 years old. The rate of use in this age group is over 60%. AIM: To evaluate the effect of multi-faceted intervention on Primary Care paediatricians to reduce antibiotic use and to improve antibiotic prescribing for paediatric outpatients. METHODS: Outpatient antimicrobial prescribing was analysed before and after an intervention in paediatricians. The intervention included a clinical education session about diagnosis and treatment in the most prevalent paediatric infectious diseases, a clinical interview and communication skills, a workshop on rapid Streptococcus antigen detection test and patient information leaflets and useful internet websites for parents. The control group included paediatricians without this educational intervention on antibiotics. RESULTS: Antibiotic prescribing decreased from 19.17 defined daily doses per 1000 inhabitants/day (DID) to 14.36 DID among intervention paediatricians vs 19.84 DID to 16.02 DID in controls. The decreasing was higher in the intervention group, but the effect was not statistically significant. Macrolides and broad-spectrum penicillins prescribing decreased in both groups. CONCLUSION: Antibiotic prescribing decreased, but there were no statistically significant differences between the two groups. The high satisfaction of paediatricians in the intervention group makes it necessary to continue with these kinds of strategies to improve antibiotic use in outpatients.

[Development of a system of quality indicators for primary care prescriptions]. / Indicadores de calidad de prescripción seleccionados mediante una técnica de consenso.

OBJECTIVE: To identify and validate indicators to improve the assessment of prescribing by primary care paediatricians, incorporating the values and views of the professionals involved. MATERIAL AND METHODS: Nominal group technique, validated through a Delphi survey. PARTICIPANTS: Paediatricians and primary care pharmacists. A nominal group was formed with thirteen specialists. The question raised at the meeting was: "What indicators focusing on the drug and what indicators linked to diagnosis and treatment do you find most helpful in assessing the quality of prescription in paediatrics?", each panellist proposed indicators that were discussed and weighted on a scale from 1 to 9. The highest scored indicators were included in a two round Delphi survey, intended for all paediatricians and primary care pharmacists. MEASUREMENTS: Validity of the indicator; Indicators with a median score equal to or greater than 7 were considered valid. Degree of consensus; it was considered that there was consensus if the interquartile range was not more than 3 points. RESULTS: We generated 29 indicators focusing on the drug and 27 incorporating the diagnosis. Nineteen focusing on the drug and 13 incorporating the diagnosis were included in the survey. There was a high degree of agreement between the group and survey results. CONCLUSIONS: A set of quality indicators for paediatric prescribing has been generated using this tecnique, with consensus of a representative group of stakeholders and validated by all of them.

Indicadores de calidad de prescripción seleccionados mediante una técnica de consenso / Development of a system of quality indicators for primary careprescriptions

Objetivo: Seleccionar y validar indicadores que permitan mejorar la evaluación de la prescripción de los pediatras de atención primaria, incorporando los valores y la opinión de los profesionales implicados. Material y métodos: Técnica de grupo nominal, validación mediante encuesta tipo Delphi. Participaron pediatras y farmacéuticos de atención primaria. Se formó un grupo nominal con 13 expertos. En la sesión se planteó la pregunta: "¿Qué indicadores centrados en el fármaco y qué indicadores que relacionen diagnóstico y tratamiento consideras más útiles para evaluar la calidad de la prescripción en pediatría?", cada panelista propuso indicadores que se discutieron y ponderaron en una escala del 1 al 9. Los indicadores más valorados se incluyeron en una encuesta tipo Delphi a dos rondas dirigida a todos los pediatras y farmacéuticos de atención primaria. Las mediciones realizadas fueron: la validez del indicador, se consideraron válidos los indicadores con una mediana de la puntuación igual o superior a 7; el grado de consenso, se consideró que había consenso si el rango intercuartílico no incluía más de 3 puntos. Resultados: Se generaron 29 indicadores centrados en el fármaco y 27 que incorporaban el diagnóstico. Se incluyeron en la encuesta 19 centrados en el fármaco y 13 que incorporaban el diagnóstico. Hubo un alto grado de acuerdo entre el grupo y los resultados de la encuesta. Conclusiones: Mediante esta técnica se ha generando una serie de indicadores de calidad de prescripción para pediatría consensuados por un grupo representativo de los agentes implicados y validado para el conjunto de éstos (AU)

Objective: To identify and validate indicators to improve the assessment of prescribing by primary care paediatricians, incorporating the values and views of the professionals involved. Material and methods: Nominal group technique, validated through a Delphi survey. Participants: Paediatricians and primary care pharmacists. A nominal group was formed with thirteen specialists. The question raised at the meeting was: "What indicators focusing on the drug and what indicators linked to diagnosis and treatment do you find most helpful in assessing the quality of prescription in paediatrics?", each panellist proposed indicators that were discussed and weighted on a scale from 1 to 9. The highest scored indicators were included in a two round Delphi survey, intended for all paediatricians and primary care pharmacists. Measurements: Validity of the indicator; Indicators with a median score equal to or greater than 7 were considered valid. Degree of consensus; it was considered that there was consensus if the interquartile range was not more than 3 points. Results: We generated 29 indicators focusing on the drug and 27 incorporating the diagnosis. Nineteen focusing on the drug and 13 incorporating the diagnosis were included in the survey. There was a high degree of agreement between the group and survey results. Conclusions: A set of quality indicators for paediatric prescribing has been generated using this tecnique, with consensus of a representative group of stakeholders and validated by all of them (AU)

Velocidad de incorporación de nuevos medicamentos en la práctica clínica / Time required to introduce new drugs into clinical practive

Objetivo: Analizar la velocidad de incorporación de nuevos medicamentos en la práctica clínica. Diseño: Estudio descriptivo retrospectivo. Unidad de estudio: Principios activos comercializados entre enero de 2003 y junio de 2004, excluidos los de uso estacional y los que no tienen establecida la dosis diaria definida (DDD). Emplazamiento: Primeros 2 años de comercialización de cada fármaco en atención primaria y atención especializada, en Aragón. Unidad de medida: Facultativos distintos que prescriben mensualmente cada fármaco y consumo mensual (DDD y gasto). Se utilizan las medias móviles de 3 meses. Se analizan también las categorías de aportación terapéutica. Resultados: En el cuarto mes se han incorporado el 33% de los facultativos que realizan alguna prescripción durante el primer año (35,6% intervalo de confianza (IC) del 95% 25,5-45,8), en el cuarto mes en atención primaria (31,5%, IC del 95% 21,4-41,5) y el primer mes en atención especializada (22,5%, IC del 95% 11,2-33,7). El 33% del consumo mensual máximo en DDD se alcanza en el cuarto mes durante el primer año (31,3% IC del 95% 22,2-40,5), en el quinto mes en atención primaria (25,4$%, IC del 95%: 10,7-40,2) y el primer mes en atención especializada (34,0%, IC del 95% 25,9-42,2). Los resultados en el segundo años son similares y el consumo máximo de DDD se produce un mes más tarde. No se aprecian diferencias según las categorías de aportación terapéutica. Conclusiones. La atención especializada se incorpora más rápidamente que la atención primaria. La velocidad de incorporación no parece relacionada con la aportación terapéutica. Para que los profesionales tengan la información sobre la utilización de nuevos medicamentos en un tiempo útil es necesario que dispongan de evaluaciones objetivas sobre su aportación terapéutica, como mínimo, antes del cuarto mes tras su comercialización (AU)

Objective: To analyze the time it takes for new medications to be introduced into clinical practice. Design: A retrospective, descriptive study focusing on the active ingredients commercialized between January 2003 and June 2004, with the exception of those of seasonal use and those for which the defined daily dose (DDD) had not yet been established. Study period and site: the first two years of commercialization of each drug employed in Primary Care and Specialized Care in Aragon, a region in northeastern Spain. Unit of measurement: The different physicians who prescribed each drug on a monthly basis and the monthly use (DDD and cost9. Moving averages of here months were utilized. Categories of therapeutic contribution were also analyzed. Results. By the fourth month, 33% of the physicians who made any prescriptions during the first year had become incorporated (35,6%, 95% CI:25,5%-45,8%) (4º month in Primary Care (31,5%, 95% CI; 21,4%-41,5%) and 1st month in Specialized Care (22,5%, 95% CI: 11.2%-33.7%). Thirty-three percent of the maximum monthly consumption in DDD was reached by the fourth month during the first year (31.3%, 95% CI: 22.2%-40,5%) (5th month in Primary Car (25,4%, 95% CI: 10,7%-40,2%) and 1st month in Specialized Care (34,0%, 95% CI: 25,9%-42,2%)). The results in the second year were similar, with the maximum consumption in terms of DDD occurring one month later. No differences were observed according to the category mary Care. The time required for incorporation does not appear to be related to the therapeutic contribution. In order for health care professionals to receive information on the utilization of new medications within a useful time frame, the must be provided with objective evaluations of the therapeutic contribution of these drugs within no more than four months of their commercialization (AU)

[Extra-hospital consumption of anti-infective agents in a defined daily doses per thousand inhabitants per day]. / Consumo extrahospitalario de antiinfecciosos en dosis diaria definida por mil habitantes y día.

OBJECTIVES: To analyse the non-hospital use of drugs against infection (excluding antivirals and antimycotics) in the province of Zaragoza during 1994 by means of the application of the concept of the defined daily dose (DDD) as a technical unit of measurement, and defined daily dose per 1000 inhabitants per day (DID) as an indicator to facilitate comparison. DESIGN: A retrospective observational study. SETTING: Primary care. PARTICIPANTS: All the prescriptions for medicines to combat infection filled outside the hospital (940,662 units) in the province of Zaragoza. These following subgroups: J01 Systemic antibiotics, J03 Systemic chemotherapy drugs, J04A Tuberculosis, G04A Antiseptic and urinary infection drugs and R05C1 Mucolytic and anti-infection expectorants. MEASUREMENTS AND MAIN RESULTS: 8.6% of the total medicine prescribed in 1994 were drugs to combat infection, with 17.70 DID. The 4 most commonly prescribed subgroups were: penicillin, macrolides, tetracycline and cephalosporins. The 10 most commonly used active principals were, in descending order: amoxycillin, amoxycillin/clavulanic, erythromycin, cotrimoxazol, doxycyclin, cyprofloxacin, norfloxacin, roxythromycin, clarithromycin, pipemidic acid. CONCLUSIONS: The use of drugs to combat infection in our province is essentially no different from what other authors have observed. It would be interesting to carry out a follow-up study on the use of third-generation fluorquinolones and cephalosporins in primary care and to relate use of them to the evolution of resistance to anti-microbe drugs.

[Rational use of drugs. Viewpoint of the users in the 3d Health Area of Saragossa]. / Uso racional de los medicamentos. El punto de vista de los usuarios del Area 3 de Salud de Zaragoza.

OBJECTIVE: To know the role of drugs and their use from the point of view of the National Health System users. DESIGN: Development of a qualitative method: focal groups of discussion. SITE: Health Area 3 of Zaragoza (Spain) which belongs to the Spanish National Health System. POPULATION: Groups of eight people who are representative of the rural and urban population. MAIN MEASUREMENT AND RESULTS: There were different meeting of one hour and a half for each. All of them started with the same question: What utility, use, and functions have drugs for all of you? All the session were recorded on video-tape and cassette to facilitate its typewriting. The general opinion was that users did not like to take drugs, nevertheless, it was a tool to solve easily and fast a health problem. At the same time, it was a cheap resource comparing to others as massage, health resort, diets... Drugs are seen as interchange currency in the medical bureau. There were critical opinions against abusive consumption of drugs. There is a lack of information concerning the utility and actions of drugs. CONCLUSIONS: The speech of user groups shows opposing points of view related to health professional opinions concerning drugs request from users and the role of drugs in the relationship doctor-patient.

[Importance of portal hypertension in the release of tissue plasminogen activator (t-PA): experimental study in the rat]. / Importancia de la hipertensión portal en la liberación de activador tisular del plasminógeno (t-PA): estudio experimental en la rata.

Tissue plasminogen activator (t-PA) activity was studied in three different experimental models of male Wistar rats; hepatic lesion without portal hypertension, portal hypertension without hepatic lesion and portal hypertension plus function liver suppression by ligation of both portal vein and hepatic artery. t-PA activity was higher in animals with portal hypertension alone than in animals with only hepatic lesion (146%). Maximal values were present in animals with functional liver suppression (1.774% vs. controls, 248% vs. hepatic lesion and 169% vs. portal hypertension only). These results suggest that both reduced hepatic t-PA clearance and portal hypertension could be involved in the increased t-PA activity normally appearing in chronic liver disease.