Management of obstructive sleep apnoea in a primary care vs sleep unit setting: a randomised controlled trial.

OBJECTIVE: To assess the effectiveness and cost-effectiveness of primary care (PC) and sleep unit (SU) models for the management of subjects with suspected obstructive sleep apnoea (OSA). METHODS: Multicentre, open-label, two-arm, parallel-group, non-inferiority randomised controlled trial. A total of 302 subjects with suspected OSA and/or resistant hypertension were consecutively enrolled, 149 were treated at 11 PC units and 153 patients at a SU. The primary outcomes were a 6-month change in the Epworth Sleepiness Scale (ESS) score and Health Utilities Index (HUI). The non-inferiority margin for the ESS score was -2.0. RESULTS: A total of 80.2% and 70.6% of the PC and SU patients were diagnosed with OSA, respectively, and 59.3% and 60.4% of those were treated with CPAP in PC and SU units, respectively. The Apnoea-Hypopnoea Index was similar between the groups (PC vs SU (median (IQR); 23.1 (26.8) events/h vs 21.8 (35.2) events/h), and the baseline ESS score was higher in the PC than in the SU group (10.3 (6.6) vs 9 (7.2)). After 6 months, the ESS score of the PC group decreased from a mean of 10.1 to 7.6 (-2.49; 95% CI -3.3 to -1.69), and that of the SU group decreased from 8.85 to 5.73 (-3.11; 95% CI -3.94 to 2.28). The adjusted difference between groups for the mean change in the ESS score was -1.25 (one-sided 95% CI -1.88; p=0.025), supporting the non-inferiority of PC management. We did not observe differences in the HUI between groups. The cost analysis showed a median savings of €558.14/patient for the PC setting compared with the SU setting. CONCLUSIONS: Among patients with suspected OSA, the PC model did not result in a worse ESS score or HUI than the specialist model and generated savings in terms of management cost. Therefore, the PC model was more cost-efficient than the SU model. TRIAL REGISTRATION: Results; >>NCT02234765, Clinical Trials.gov.

Espirometría como método de cribado y de intervención antitabaco en fumadores de alto riesgo en atención primaria / Spirometry as method of screening and intervention in high- risk smokers in primary care

Objetivo: Mostrar la efectividad del cribado en la detección de nuevos casos de enfermedad pulmonar obstructiva crónica (EPOC) en fumadores de alto riesgo, describir las características asociadas a EPOC y determinar la predisposición a dejar el tabaco. Diseño: Estudio transversal y multicéntrico. Emplazamiento: Áreas básicas de salud representativas de diferentes zonas rurales y urbanas de Lleida. Participantes: 497 fumadores activos sin EPOC de 40 a 70 años seleccionados aleatoriamente de la base de datos e-CAP de la historia clínica electrónica. Intervención: Se realiza espirometría. Se informa de los resultados espirométricos, se da consejo breve para dejar de fumar y se determina su predisposición a dejar el tabaco. Variables: Edad, género, altura, peso, hábito tabáquico, síntomas respiratorios y actividad física. Resultados: El 65,4% son hombres, edad 51±7,6 años. Fuman media de 32 paquetes/año, el 40,4% realiza actividad moderada, el 27,4% refiere algún síntoma respiratorio. El 25% presentan patrón obstructivo o mixto con grado de severidad moderado en el 75,8% de los casos. El 38,8% se plantea dejar el tabaco. Análisis multivariante, resultaron asociados a EPOC: género, edad 50 a 59 años e índice tabáquico >40. Realizar una actividad física moderada o intensa disminuye el riesgo de EPOC. Conclusiones: Realizar espirometría en fumadores de alto riesgo, mostrar los resultados espirométricos y consejo breve antitabaco permite detectar a casos de EPOC no diagnosticados previamente, ver su predisposición a dejar el tabaco y establecer un plan de tratamiento y seguimiento individualizado(AU)

Objective: To show the effectiveness of screening in the detection of new cases of COPD in smokers of high-risk, and to describe the characteristics associated with COPD, as well as determine the predisposition to quit. Design: A cross-sectional and multicentre study. Location: Basic Primary Care Centres representing different rural and urban areas of Lleida. Participants: A total of 497 active smokers without COPD from 40 to 70 years selected from the database Primary Care Database (e-CAP). Intervention: Spirometry was performed on all patients. The spirometry results were reported and brief counselling was given on quitting smoking and the readiness to stop smoking was determined. Variables: Age, gender, height, weight, smoking, respiratory symptoms and physical activity. Results: The majority of patients (65.4%) were men, age 51± 7.6 years. They smoked an average of 32 packs/year; 40.4% performed moderate activity and 27.4% referred to some respiratory symptoms. Of the 25% who had an obstructive or mixed pattern, 75.8% of the cases had a moderate level of severity. A decision to quit was made by 38.8%.In the multivariate analysis, gender, age 50 to 59 years and a smoking index >40 were associated with COPD. Moderate or intense physical activity decreased the risk of COPD. Conclusions: To perform spirometry in high-risk smokers, to show the spirometry results and give brief anti-smoking counselling, enables not previously diagnosed cases of COPD to be detected. It also helps to determine the readiness to stop smoking and to establish individualised treatment and follow-up plans(AU)

[Spirometry as method of screening and intervention in high- risk smokers in primary care]. / Espirometría como método de cribado y de intervención antitabaco en fumadores de alto riesgo en atención primaria.

OBJECTIVE: To show the effectiveness of screening in the detection of new cases of COPD in smokers of high-risk, and to describe the characteristics associated with COPD, as well as determine the predisposition to quit. DESIGN: A cross-sectional and multicentre study. LOCATION: Basic Primary Care Centres representing different rural and urban areas of Lleida. PARTICIPANTS: A total of 497 active smokers without COPD from 40 to 70 years selected from the database Primary Care Database (e-CAP). INTERVENTION: Spirometry was performed on all patients. The spirometry results were reported and brief counselling was given on quitting smoking and the readiness to stop smoking was determined. VARIABLES: Age, gender, height, weight, smoking, respiratory symptoms and physical activity. RESULTS: The majority of patients (65.4%) were men, age 51± 7.6 years. They smoked an average of 32 packs/year; 40.4% performed moderate activity and 27.4% referred to some respiratory symptoms. Of the 25% who had an obstructive or mixed pattern, 75.8% of the cases had a moderate level of severity. A decision to quit was made by 38.8%. In the multivariate analysis, gender, age 50 to 59 years and a smoking index>40 were associated with COPD. Moderate or intense physical activity decreased the risk of COPD. CONCLUSIONS: To perform spirometry in high-risk smokers, to show the spirometry results and give brief anti-smoking counselling, enables not previously diagnosed cases of COPD to be detected. It also helps to determine the readiness to stop smoking and to establish individualised treatment and follow-up plans.

El cuaderno de mando como herramienta para el control de gestión. Aplicación en Benito Menni CASM (St. Boi de Llobregat - Barcelona) / No disponible

No disponible