COPD from an everyday primary care point of view.

INTRODUCTION: The purpose of this study is to use real world evidence on treatment use to evaluate drug superiority within the same treatment group. METHODS: Retrospective cohort analysis using the Spanish Database for Pharmacoepidemiological Research in Primary Care (BIFAP). Data includes longitudinal routine clinical data extracted from practice records of 7,890,485 patients. All subjects with an incident diagnosis of COPD in the database BIFAP between January 1 2010 and December 31 2012 were included in the cohort study. Cox regression analysis was performed to compare the hazard of COPD exacerbation outcome of the four principal cohorts (no therapy, monotherapy, double therapies with and without corticoids, and triple therapy) and within each principal cohort between the different treatment combinations. RESULTS: 27,739 patients with COPD were included in the analysis. The median age was 64 years, male proportion was 69% and 70% were smokers. 58,042.9 person--years of follow-up were obtained for the cohort with a mean follow-up of 2.09 years per subject. The strongest factor associated with an increased risk of exacerbation was suffering an exacerbation the previous year (HR = 1.82[1.76--1.87 95%CI]). No differences were found between the most frequent monotherapies, double therapies without corticoid, or triple therapy. When comparing the different combinations of double therapies with corticoid, salmeterol/fluticasone combination (HR = 1.16[1.08--1.24]) revealed a higher adjusted hazard of exacerbation when compared with formoterol/budesonide. CONCLUSIONS: Treatment with a combination of budesonide/formoterol was associated with lower exacerbations than the treatment with fluticasone/salmeterol. The analysis did not reveal any differences in terms of exacerbation in monotherapy, double therapy without corticoids, and triple therapy combinations.

Calidad del registro del diagnóstico de demencia en atención primaria. La situación en España en el periodo 2002-2011 / Quality of registration of dementia diagnosis in primary care: The situation in Spain in 2002-2011

OBJETIVO: Comprobar el diagnóstico asociado al tratamiento específico para demencia en la historia clínica electrónica de atención primaria (HCE-AP) y analizar los factores asociados a la calidad del registro. MÉTODO: Estudio descriptivo de los pacientes con anticolinesterásicos o memantina registrados en la Base para Investigación Farmacoepidemiológica en atención primaria (BIFAP) 2011: 24.575 pacientes entre 2002 y 2011. Los diagnósticos asociados a la primera prescripción de estos fármacos se agruparon en 5 categorías: «demencia», «alteraciones de memoria», «enfermedades relacionadas con demencia», «procesos intercurrentes» y «códigos de conveniencia». Se calculó la prevalencia de cada categoría por edad y sexo en cada año de estudio (IC 95%) y se analizaron asociaciones y tendencia 2002-2011, utilizando diferencias de proporciones para muestras independientes y regresión logística binaria. RESULTADOS: El 56,5% (IC 95%: 55,8-57,1) de los pacientes tenían asociado código «demencia» a la primera prescripción. Se registró mejor en mujeres (OR: 1,09 [IC 95%: 1,03-1,15]) y al aumentar el tiempo transcurrido (OR: 1,07 [IC 95%: 1,06-1,08] por cada año de seguimiento). Los «códigos de conveniencia» (16,3% [IC 95%: 15,8-16,7]) se utilizaron más en mujeres y ≥ 80 años; las «alteraciones de memoria» (12,4% [IC 95%: 12,0-12,8]), «enfermedades relacionadas» (4,6% [IC 95%: 4,4-4,8]) y «procesos intercurrentes» (10,3% [IC 95%: 9,9-10,6]) más en hombres y < 80 años. De 2002 a 2011 mejoró el uso de «códigos de conveniencia». CONCLUSIONES: Casi la mitad de los pacientes con anticolinesterásicos o memantina no tienen registrado diagnóstico de demencia en su HCE-AP. El registro mejora al aumentar el tiempo de seguimiento. Se requieren mejoras de la HCE-AP, coordinación asistencial adecuada y actitud activa para aumentar la calidad del registro de demencia

OBJECTIVE: To ascertain the diagnosis associated with specific treatment for dementia in the Primary Care Electronic Clinical Record (PC-ECR) and to analyse the factors associated with the quality of registration. METHODS: Descriptive study of patients taking cholinesterase inhibitors or memantine registered in Database for pharmacoepidemiological research in PC (BIFAP) 2011: 24,575 patients between 2002 and 2011. Diagnoses associated with first prescription of these drugs were grouped into 5 categories: 'dementia', 'memory impairment', 'dementia-related diseases', 'intercurrent processes' and 'convenience codes'. We calculated the prevalence of each category by age and sex for each study year (95% CI) and analysed the associations and trend for 2002-2011 using difference in proportions in independent samples and binary logistic regression. RESULTS: A code of 'dementia' was associated with first prescription in 56.5% (95% CI: 55.8-57.1) of PATIENTS: It was higher in women [OR 1.09 (95% CI: 1.03-1.15)] and with increasing follow-up time [OR 1.07 (95% CI: 1.06-1.08) for each year of follow-up]. 'Convenience codes' [16.3% (95% CI: 15.8-16.7)] were coded more frequently in women and in those ≥ 80 years; 'Memory impairment' [12.4% (95% CI: 12.0-12.8)], 'related diseases' [4.6% (95% CI: 4.4-4.8)] and 'intercurrent processes' [10.3% (95% CI: 9.9-10.6)] were used more in men and in persons < 80 years. Between 2002 and 2011 improved the use of 'convenience codes'. CONCLUSIONS: Almost half of the patients taking cholinesterase inhibitors or memantine do not have a diagnosis of dementia registered in their PC-ECR. Registration improves with increasing time of follow-up. Improvements are needed in the PC-ECR, adequate care coordination, and proactive approach to increase the quality of dementia registration

[Quality of registration of dementia diagnosis in primary care: The situation in Spain in 2002-2011]. / Calidad del registro del diagnóstico de demencia en atención primaria. La situación en España en el periodo 2002-2011.

OBJECTIVE: To ascertain the diagnosis associated with specific treatment for dementia in the Primary Care Electronic Clinical Record (PC-ECR) and to analyse the factors associated with the quality of registration. METHODS: Descriptive study of patients taking cholinesterase inhibitors or memantine registered in Database for pharmacoepidemiological research in PC (BIFAP) 2011: 24,575 patients between 2002 and 2011. Diagnoses associated with first prescription of these drugs were grouped into 5 categories: "dementia", "memory impairment", "dementia-related diseases", "intercurrent processes" and "convenience codes". We calculated the prevalence of each category by age and sex for each study year (95%CI) and analysed the associations and trend for 2002-2011 using difference in proportions in independent samples and binary logistic regression. RESULTS: A code of "dementia" was associated with first prescription in 56.5% (95%CI: 55.8-57.1) of patients. It was higher in women [OR1.09 (95%CI: 1.03-1.15)] and with increasing follow-up time [OR1.07 (95%CI: 1.06-1.08) for each year of follow-up]. "Convenience codes" [16.3% (95%CI: 15.8-16.7)] were coded more frequently in women and in those ≥80 years; "Memory impairment" [12.4% (95%CI: 12.0-12.8)], "related diseases" [4.6% (95%CI: 4.4-4.8)] and "intercurrent processes" [10.3% (95%CI: 9.9-10.6)] were used more in men and in persons <80 years. Between 2002 and 2011 improved the use of "convenience codes". CONCLUSIONS: Almost half of the patients taking cholinesterase inhibitors or memantine do not have a diagnosis of dementia registered in their PC-ECR. Registration improves with increasing time of follow-up. Improvements are needed in the PC-ECR, adequate care coordination, and proactive approach to increase the quality of dementia registration.

Estudio descriptivo sobre el uso de antiinflamatorios no esteroideos por vía intramuscular para el tratamiento de la lumbalgia aguda en las consultas de Atención Primaria en España durante 2002-2011 / Descriptive study on the use of NSAIDs intramuscularly for the treatment of acute low back pain in primary care consultations in Spain during 2002-2011

Objetivo: Describir la evolución de la prescripción de antiinflamatorios no esteroideos (AINE) por vía intramuscular para el tratamiento de un primer episodio de lumbalgia en Atención Primaria en España entre 2002 y 2011. Diseño del estudio: Estudio descriptivo transversal. Emplazamiento: Atención Primaria. Participantes: 604.423 pacientes ≥ 20 años con al menos un episodio de lumbalgia registrado en la historia de la base de datos BIFAP. Mediciones principales: Las variables estudiadas fueron los episodios codificados por L03, L84 y L86 según la Clasificación Internacional de Atención Primaria (CIAP-2) y los fármacos de los grupos M01A, N02BB02 y N02BB91 de la clasificación Anatómico-Terapéutica-Química de la OMS. También las variables sexo y edad. Resultados: La edad media de diagnóstico de un primer episodio de lumbalgia fue de 49 años; el 59% eran mujeres. Se prescribieron 342.514 AINE, el 95,51 % por vía oral (el más prescrito ibuprofeno), el 4,11 % por vía intramuscular (el más prescrito diclofenaco) y el 0,38 % por vía rectal (el más prescrito diclofenaco). La prescripción por vía intramuscular se asoció a ser varón, lumbalgia irradiada y la edad. Conclusiones: La prescripción de AINE para el tratamiento del dolor lumbar ha ido aumentando en el periodo estudiado. A pesar de que se observa una tendencia a la disminución, la vía intramuscular se sigue utilizando, por lo que sería recomendable incluir en las guías de práctica clínica recomendaciones acerca del uso de esta vía de administración de AINE para el tratamiento del dolor lumbar (AU)

Objective: To describe the evolution of intramuscular non-steroidal anti-inflammatory (NSAID) prescriptions for the treatment of a first episode of low back pain in primary care in Spain between 2002 and 2011. Study design: Descriptive cross-sectional study. Setting: Primary care. Participants: 604,423 patients ≥ 20 years who had a first episode of low back pain registered on the BIFAP database. Measurements: The variables studied were coded episodes L03, L84 and L86 according to the International Classification of Primary Care (ICPC-2) and the drugs M01A, N02BB02 and N02BB91 groups of Anatomical-Therapeutic-Chemical WHO classification. Also sex and age variables. Results: The average age of diagnosis of a first episode of back pain was 49 years; 59% were women. 342,514 NSAID were prescribed, 95.51% orally (the most frequently prescribed being ibuprofen), 4.11% intramuscularly (the most frequently prescribed being diclofenac) and 0.38% rectally (the most frequently prescribed being diclofenac). Intramuscular prescription was associated with being male, radiated low back pain and age. Conclusions: The prescription of NSAIDs for the treatment of low back pain has increased in the period studied. Although a downward trend is observed, the intramuscular route is still used. Therefore it would be advisable to include recommendations about the use of this route of administration of NSAID for the treatment of low back pain in clinical practice guidelines (AU)

Nuevas tecnologías en atención primaria: personas, máquinas, historias y redes. Informe SESPAS 2012 / New technologies in primary care: people, machines, records, and networks. SESPAS Report 2012

Las nuevas tecnologías y la importancia de su desarrollo en la atención primaria de salud se dibujan hoy de forma clara. La tecnología es importante en tanto en cuanto contribuye a resolver los problemas prácticos que aparecen cuando intentamos mejorar la atención al paciente. Bajo el epígrafe de «nuevas tecnologías de información y comunicación» en salud podemos encontrar muchas utilidades, pero nos centraremos en dos de sus exponentes más cualificados: la historia clínica electrónica e Internet, sin olvidar que más importante que las tecnologías es el fin para lo que se crean y se usan, y por supuesto las personas que las utilizan (AU)

The new technologies and the importance of their development in primary care are clear. Technology is important insofar as it helps to resolve practical problems that arise when attempts are made to improve patient care. Many applications can be found under the heading of "new information and communication technologies" in healthcare, but the present article focusses on two of the most significant examples: the electronic health record and the Internet, bearing in mind that the aims being sought and the people using these applications are more significant than the technologies themselves (AU)

[New technologies in primary care: people, machines, records, and networks. SESPAS Report 2012]. / Nuevas tecnologías en atención primaria: personas, máquinas, historias y redes. Informe SESPAS 2012.

The new technologies and the importance of their development in primary care are clear. Technology is important insofar as it helps to resolve practical problems that arise when attempts are made to improve patient care. Many applications can be found under the heading of "new information and communication technologies" in healthcare, but the present article focusses on two of the most significant examples: the electronic health record and the Internet, bearing in mind that the aims being sought and the people using these applications are more significant than the technologies themselves.

[Professional debate on shortage of physicians]. / El debate profesional acerca de la escasez de médicos.

We do not know the best answer to problems due to shortage of physicians (absolute number and by specialities) but perhaps what is important is the lack of a professional debate about what means 'to be' a physician. In this paper we address four key professional questions: 1/ the over-training of physicians when health demand now includes minor problems, 2/ predominance of physician-patient direct encounters in a world of telecommunications and indirect encounters, 3/ the need to delegate power and responsibilities to other health professionals as a consequence of new technology developments and changes in role-design, and 4/ too much emphasis in diagnosis with the danger to initiate cascades with its side-effects. Practical answers to these questions require changes in pre and postgraduate education, improvement in health services organization to profit the use of telecommunications and analysis and re-design of the limits in between professions, levels of care, institutions and health and social sectors.

OSIRIS: a tool for retrieving literature about sequence variants.

UNLABELLED: Sequence variants, in particular single nucleotide polymorphisms (SNPs), are key elements for the identification of genes associated with complex diseases and with particular drug responses. The search for literature about sequence variation is hampered by the large number of allelic variants reported for many genes and by the variability in both gene and sequence variants nomenclatures. We describe OSIRIS, a search tool that integrates different sources of information with the aim to retrieve literature about sequence variation of a gene. In addition, it provides a method to link a dbSNP entry with the articles referring to it. AVAILABILITY: OSIRIS is available for public use at http://ibi.imim.es/

[Computer-assisted clinical decision support systems]. / Sistemas informáticos de soporte a la decisión clínica.

This review deals with the historical evolution and methodological basis of computerized medical decision support tools. It also reviews the verification, validation and impact evaluation methods of these systems. The acceptability of them from the health professionals depends on the pro-activity and usefulness of the systems, between other factors. The clinical impact evaluation methods are described in deep detail and the Hunt et al review of 1998 is updated.