ABSTRACT
BACKGROUND: Undiagnosed airflow limitation is common in the general population and is associated with impaired health and functional status. Smoking is the most important risk factor for this condition. Although primary care practitioners see most adult smokers, few currently have spirometers or regularly order spirometry tests in these patients. Brief medical advice has shown to be effective in modifying smoking habits in a large number of smokers but only a small proportion remain abstinent after one year. The aim of this study is to evaluate the effectiveness of regular reporting of spirometric results combined with a smoking cessation advice by a primary care physician on smoking quit rate in adult smokers. METHODS/DESIGN: Intervention study with a randomized two arms in 5 primary care centres. A total of 485 smokers over the age of 18 years consulting their primary care physician will be recruited.On the selection visit all participants will undergo a spirometry, peak expiratory flow rate, test of smoking dependence, test of motivation for giving up smoking and a questionnaire on socio-demographic data. Thereafter an appointment will be made to give the participants brief structured advice to give up smoking combined with a detailed discussion on the results of the spirometry. After this, the patients will be randomised and given appointment for follow up visits at 3, 6, 12 and 24 months. Both arms will receive brief structured advice and a detailed discussion of the spirometry results at visit 0. The control group will only be given brief structured advice about giving up smoking on the follow up. Cessation of smoking will be tested with the carbon monoxide test. DISCUSSION: Early identification of functional pulmonary abnormalities in asymptomatic patients or in those with little respiratory symptomatology may provide "ideal educational opportunities". These opportunities may increase the success of efforts to give up smoking and may improve the opportunities of other preventive actions to minimise patient risk. Comparing adult smokers in the intervention group with those in the control group, a minimum improvement expected with respect to the rates of smoking cessation would represent a large number of avoided morbimortality. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01296295.
Subject(s)
Directive Counseling , Primary Health Care , Smoking Cessation/statistics & numerical data , Smoking Prevention , Adult , Humans , SpirometryABSTRACT
Objetivo: Describir las características de los equipos de atención primaria (EAP) de la red Actuant Units per a la Salut (AUPA, Actuando Unidos por la Salud), conocer los elementos facilitadores y obstáculos para realizar proyectos comunitarios (PC), el impacto de participar en la red AUPA y las expectativas respecto a ésta. Diseño: Estudio transversal, descriptivo y analítico con recogida de datos mediante técnicas cuantitativas y cualitativas. Emplazamiento: Centros de atención primaria. Participantes: Quince EAP adscritos a la red AUPA antes de enero de 2006.Medidas principales : Variables referentes a las características de los EAP, profesionales, PC, facilitadores y obstáculos del PC, utilidad, expectativas e impacto de pertenecer a la red AUPA. Resultados principales: La mayoría de los centros son docentes y reciben apoyo metodológico externo. Los PC están en fases iniciales de desarrollo y la metodología más utilizada es atención primaria orientada a la comunidad (APOC). Los proyectos cuentan con participación de la comunidad y colaboración intersectorial. Enfermería es el colectivo más implicado. Los factores influyentes en el desarrollo del PC son la motivación de los profesionales, la formación previa en atención comunitaria (AC), el apoyo de dirección y la participación de personas clave y de la comunidad. Se pide más tiempo laboral para trabajar en AC, apoyo metodológico por expertos, mayor reconocimiento profesional, apoyo directivo del EAP y de la empresa. Conclusiones: Hace falta motivar profesionales, fomentar el conocimiento en AC y dar reconocimiento y apoyo de las instituciones y de la comunidad. Se percibe un beneficio del trabajo en red: compartir experiencias, compromiso y adquisición de conocimientos (AU)
Objective: To describe the characteristics of the AUPA Health Centres network, identify the favourable elements and the obstacles when carrying out community projects (CP), the impact of belonging to the AUPA network, and the types of support members expect from the AUPA Network. Design: A cross-sectional, descriptive and analytical study with analysis of information using quantitative and qualitative techniques. Location Primary Care. Participants15 centres of Primary Care belonging to the AUPA network before January 2006.Principal Measurements Variables regarding the characteristics of the Health Centres, professionals, CP, facilitators and obstacles of the CP, usefulness, expectations and impact of belonging to the AUPA network. Principal Results: The majority of centres are teaching and receive methodological external support. The majority of CP are in initial phases of development and the most used methodology is Community Oriented Primary Care (COPC). The projects have the support of the community and intersectorial collaboration. Nursing is the group most involved. The factors that influence development of the CP are the motivation of the professionals, previous training in community care, management support and the participation of key personnel and the community. The community centres require more time to work on CP, methodological support from experts, better professional recognition, support by the Health Centre management and companies. Conclusions: It is necessary to motivate professionals, promote knowledge in community care, giving recognition and support by the institutions and by the community. Work benefits are perceived from the network: sharing experiences, commitment and gaining knowledge (AU)
Subject(s)
Humans , Male , Female , Primary Health Care/methods , Primary Health Care/trends , Community Networks/organization & administration , Community Networks/standards , Community Medicine/methods , Primary Health Care/standards , Primary Health Care , Community Networks/trends , Community Networks , Community Medicine/organization & administration , Community Medicine/trends , Cross-Sectional StudiesABSTRACT
OBJECTIVE: To describe the characteristics of the AUPA Health Centres network, identify the favourable elements and the obstacles when carrying out community projects (CP), the impact of belonging to the AUPA network, and the types of support members expect from the AUPA Network. DESIGN: A cross-sectional, descriptive and analytical study with analysis of information using quantitative and qualitative techniques. LOCATION: Primary Care. PARTICIPANTS: 15 centres of Primary Care belonging to the AUPA network before January 2006. PRINCIPAL MEASUREMENTS: Variables regarding the characteristics of the Health Centres, professionals, CP, facilitators and obstacles of the CP, usefulness, expectations and impact of belonging to the AUPA network. PRINCIPAL RESULTS: The majority of centres are teaching and receive methodological external support. The majority of CP are in initial phases of development and the most used methodology is Community Oriented Primary Care (COPC). The projects have the support of the community and intersectorial collaboration. Nursing is the group most involved. The factors that influence development of the CP are the motivation of the professionals, previous training in community care, management support and the participation of key personnel and the community. The community centres require more time to work on CP, methodological support from experts, better professional recognition, support by the Health Centre management and companies. CONCLUSIONS: It is necessary to motivate professionals, promote knowledge in community care, giving recognition and support by the institutions and by the community. Work benefits are perceived from the network: sharing experiences, commitment and gaining knowledge.
Subject(s)
Community Health Services , Community Networks , Primary Health Care , Community Health Services/organization & administration , Cross-Sectional Studies , Humans , SpainABSTRACT
AIM: To evaluate the medium-term effectiveness of a group educational intervention in primary care aimed at improving attitudes and skills in self-care of the feet in patients with type 2 diabetes, and to determine the optimal time for reintervention. METHOD: We performed a before-after intervention study with a 24-month follow-up. The sample consisted of 76 patients with type 2 diabetes who underwent two group education sessions. Sociodemographic variables and variables related to the neurovascular status of the foot and with hygiene and self-care habits were measured. To compare the results, McNemar's test for paired data was used. RESULTS: The mean age was 66 years and 51% were men. Skills performance before-after (8 months) the intervention were as follows: correct hygiene 41%-86%, good-medium hydration 80%-97%, daily foot washing 42%-68%, proper tools use 41%-79%, proper shoes 9%-33%, proper nails 26%-74% (all differences with p < 0.001). Among patients that improved due to the sessions, skills were still correct at 24 months in 76% (95% CI: 61%-90%) for hygiene, 100% for hydration, 70% for daily foot washing (95% CI: 51%-90%), 74% for proper tools use (95% CI: 58-90%), 55% for proper shoes (95% CI: 34%-77%) and 81% for proper nails (95% CI: 68%-94%). CONCLUSIONS: The intervention improved all the skills studied. The effects of the sessions were still evident after 24 months in more than 70% of patients for all the variables studied except proper shoe use. Group education favors skills improvement. We suggest repeating the intervention every 24 months.
