ABSTRACT
OBJECTIVES: To find the effectiveness of clinical protocols in detecting and monitoring the most important cardiovascular risk factors: tobacco dependency, high blood pressure, hyperlipaemia and diabetes mellitus. DESIGN: Cross-sectional descriptive study. SETTING: Primary care centres in the Basque Country. PARTICIPANTS: 1485 clinical histories of users aged between 40 and 75 who had attended for consultation over the previous two years, registered with general practitioners in the Basque Country who normally use clinical histories. MEASUREMENTS AND MAIN RESULTS: A questionnaire was sent to the people in charge of the 103 hierarchically organised centres requesting information on the use of protocols to detect and monitor the problems studied, and copies of protocols were requested. 77 centres (76%) replied and 66 sent 170 protocols. 990 clinical histories of doctors who used the four protocols and 495 of doctors who used none were analysed. These clinical histories belonged to lists of 45 doctors from 22 centres, chosen at random and stratified by whether their centre is registered with the PAPPS (preventive programme) or is a family and community medicine teaching centre. The centres using protocols were better at detecting tobacco dependency (24.6% vs 11.9%--p < 0.0005), hyperlipaemia (61.8% vs 53.1%--p < 0.001) and diabetes mellitus (75% vs 66.1%--p < 0.0005). The difference was less in the case of high blood pressure: 56.8% vs 52.1% (p = 0.097). No differences in quality in the monitoring of these problems were found. CONCLUSIONS: The use of cardiovascular risk protocols by primary care centres is related to an improvement in the quality of cardiovascular risk detection, although not of its control.
Subject(s)
Cardiovascular Diseases/prevention & control , Clinical Protocols , Adult , Aged , Cardiovascular Diseases/diagnosis , Cross-Sectional Studies , Data Interpretation, Statistical , Diabetes Mellitus/diagnosis , Diabetes Mellitus/therapy , Humans , Hyperlipidemias/diagnosis , Hyperlipidemias/therapy , Hypertension/diagnosis , Hypertension/therapy , Middle Aged , Primary Health Care , Risk Factors , Smoking/adverse effects , SpainABSTRACT
Objetivos. Conocer la implantación y calidad de las guías de práctica clínica (GPC) para el manejo de los riesgos cardiovasculares más importantes: tabaquismo, hipertensión arterial, hiperlipemia y diabetes mellitus. Elaboración de un modelo para evaluar la calidad de las GPC en atención primaria. Diseño. Estudio descriptivo, transversal. Emplazamiento. Los centros de atención primaria del País Vasco. Participantes. Un total de 170 GPC utilizadas actualmente para el manejo de los 4 riesgos cardiovasculares referidos. Mediciones y resultados. Se solicitó información sobre el uso de GPC y se pidieron copias de las utilizadas a los responsables de los 103 centros jerarquizados. Contestaron 77 centros (76 por ciento) y 66 declararon el uso de alguna de ellas. Se recibió un total de 170 GPC. A partir de propuestas previas no específicas para la atención primaria, se elaboraron 21 criterios de calidad de las GPC agrupados en 6 bloques. El mayor nivel de calidad se observó en el bloque correspondiente a la claridad del procedimiento clínico, con un cumplimiento del 63 por ciento de las GPC, seguido por la descripción general (54 por ciento) y la evaluación y medida del impacto (30 por ciento). Los bloques con peor nivel de cumplimiento fueron la identificación de las personas involucradas en su diseño (23 por ciento), la evidencia de sus recomendaciones (19 por ciento) y las condiciones de aplicación (4 por ciento). Conclusiones. Se propone un modelo para la evaluación de la calidad de las GPC. Se aprecian importantes deficiencias en su calidad, más acusadas en aspectos tan claves como el soporte bibliográfico de sus recomendaciones, la previsión de condiciones para su aplicación y la identificación de autores y revisores (AU)
Subject(s)
Humans , Spain , Tobacco Use Disorder , Practice Guidelines as Topic , Risk Assessment , Quality Control , Cardiovascular Diseases , Cross-Sectional Studies , Hypertension , HyperlipidemiasABSTRACT
OBJECTIVES: To find the implantation and quality of clinical practice guidelines (CPG) to manage the major cardiovascular risks: tobacco dependency, hypertension, hyperlipaemia and diabetes mellitus. To work out a model to evaluate the quality of the CPG in primary care. DESIGN: Cross-sectional descriptive study. SETTING: The primary care centres of the Basque Country. PARTICIPANTS: 170 CPG used at present to manage the four mentioned cardiovascular risks. MEASUREMENTS AND MAIN RESULTS: Information was requested on the use of CPG and copies of their guidelines were requested from those in charge of 103 ranked centres. 77 centres replied (76%), of which 66 said they used one of them. A total of 170 CPG were received. On the basis of non-specific prior proposals for primary care, 21 quality criteria for the CPG, grouped in 6 blocks, were drawn up. Top quality was found in the block for clarity of clinical procedure with 63% compliance with the CPG, followed by general description (54%), and evaluation and measurement of impact (30%). The blocks with worst compliance were identification of people involved in their design (23%), evidence of their recommendations (19%) and conditions of application (4%). CONCLUSIONS: A model was proposed to evaluate the quality of the CPG. Major deficiencies in quality were found. These were most marked in key aspects such as bibliographic support for their recommendations, envisaging of conditions for application and identification of authors and reviewers.
Subject(s)
Cardiovascular Diseases/prevention & control , Practice Guidelines as Topic/standards , Cross-Sectional Studies , Humans , Hyperlipidemias/prevention & control , Hypertension/prevention & control , Quality Control , Risk Assessment , Smoking Prevention , SpainABSTRACT
OBJECTIVE: To identify differences in mortality between communities in function of certain socio-economic factors. Firstly, between the urban and rural population of Navarra; and secondly, among different neighbourhoods in Pamplona categorised according to their socioeconomic status. DESIGN: Descriptive study. As the instrument of comparison, the standard mortality rates (SMR) have been used with the direct method. The relationship between mortality and socio-economic status in the neighbourhoods of Pamplona has been analysed by means of lineal regression. SITE. Institute of Public Health of Navarra. PATIENTS OR OTHERS PARTICIPANTS: Those people recorded on the Municipal Censuses of Navarra in 1986, who were between 25 and 74 years old. 8,086 of these died during our period of study, which covered the five years between 1985 and 1989. MAIN MEASUREMENTS AND RESULTS: The SMRs for all causes in men (741 x 10(6)) and women (324 x 10(6)) who live in rural communities are significantly lower (p less than 0.05) than those in urban communities (863 and 390). The specific cause of death which marks the most difference between the two types of community are tumours (p less than 0.05). In the capital (Pamplona), masculine mortality was found to increase in line with the socio-economic status of the neighbourhood lived in (p = 0.017). CONCLUSIONS: There is greater mortality in urban than in rural communities; and in neighbourhoods with low socio-economic status as against those with a high status. However, in this second case, the greater mortality only applies to men.
Subject(s)
Mortality , Age Factors , Cause of Death , Chi-Square Distribution , Confidence Intervals , Humans , Regression Analysis , Rural Population/statistics & numerical data , Socioeconomic Factors , Spain , Urban Population/statistics & numerical dataABSTRACT
A revision of the bibliography has been carried out, referring to the influence of people's social economic condition to the cause and age at death. Special interest was taken in collecting works carried out after the Black Report was published, taking its particular relevance into account.
