Dispensación de antibióticos en Oficina de Farmacia: demanda con receta / No disponible

Mejorar el uso de los antibióticos mediante la protocolización de la dispensación. Diseño: Estudio observacional transversal. Emplazamiento: Oficinas de Farmacia del Estado Español convocadas por Correo Farmacéutico. Participantes: Farmacéuticos comunitarios (titulares, adjuntos, sustitutos). Población diana: Personas que demandan antibióticos con receta médica para inicio o continuación de tratamiento. Intervenciones: Formación de los farmacéuticos participantes. En los pacientes: detección y resolución de carencias de información y Problemas Relacionados con Medicamentos (PRMs) en relación con la prescripción de antibióticos. Mediciones principales: Número de pacientes en los que se sospecha falta de información. Tipo de información de la que carecen en tratamientos inicio y continuación. Cuantificación y descripción de los PRMs, sus causas en tratamiento inicio y continuación. PRMs y causas por grupos terapéuticos. Resultados: 1.788 farmacéuticos participantes, 971 farmacias (4,8% de las farmacias de España). Se obtuvieron 52.753 registros válidos; 40.854 (77%) fueron de demandas de antibióticos con receta. En 33.352 ocasiones fue el propio paciente o cuidador quien realiza la demanda. En inicio tratamiento el 2% los pacientes no conocían la indicación, 12% no conoce la posología, 13% no conocía la duración y 17% tenía otras carencias de información. El 24,5% tenían alguna carencia. En continuación tratamiento los pacientes no conocen posología el 4%, duración de tratamiento 5% y 7% tenía otras carencias de información. El 34% de los demandantes tenía alguna carencia de información. En 3.001 (9%) ocasiones se detectó algún PRM, un 37% por problema de dosis, un 16% por interacción con otro medicamento, el 4% contraindicación, el 15% RAM y un 28 % por otras causas. En 87 ocasiones (0,26% del total de registros válidos) el paciente refirió ser alérgico al antibiótico que le habían prescrito. Conclusiones: La tercera parte de los pacientes a los que se les dispensó antibióticos por vía oral con receta se detectó alguna carencia de información. En un 9% de las ocasiones se detectaron problemas de seguridad o efectividad relacionados con ese antibiótico. En la farmacia comunitaria puede detectarse y corregirse esta situación, contribuyendo al uso correcto de los antibióticos (AU)

Objectives: To improve the use of the antibiotics in the population, offering a dispensing process with a structured interview and defined interventions. Design: Observational cross-sectional Study. Location: Community pharmacies of Spain summoned by the weekly edition of «Correo Farmacéutico». Participants: Community pharmacists (owners and employees). Setting: People asking for antibiotics with a prescription, at the onset of treatment or for the continuation of a treatment already in use. Interventions: 1. Training of participant pharmacists. 2. For patients: identifying and solving: a) lack of essential information and b) Drugs Related Problems (DRP) in connection with the antibiotics prescribed. Measures: Number of patients that were identified with lack of information. Type of information needed in the beginning or continuation treatments. Quantification and classification of DRP and their causes in the onset or continuation treatments. Type of DRP and its causes within each therapeutic group of antibiotics. Results: 1.788 participant pharmacists from 971 pharmacies (4,8% of the pharmacies of Spain) obtained 52.753 valid registrations of dispensing process of antibiotics. Of this total, 40.854 (77%) were antibiotic demand with a doctor prescription. In 33.352 cases the demand was done by the patient himself or the caregiver. In the onset of treatments: 2% the patients didn't know the indication; 12% doesn't know the dosage regimen; 13% he/she didn't know the length of the treatment and 17% he/she had other lacks of information. In treatment's continuation, the patients didn't know dosing or dosage regimen by 4%; duration of treatment by 5% and he/she had other lacks of information by 7%. In all, 34% of the patients had some lack of information. In 3.001 prescriptions (9%) some DRP was identified; 37% was a dosing problem, 16% was an interaction with another medication, 4% had contraindications, in 15% an Adverse Drug Reaction (ADR) was identified and 28% were DRP by other causes. In 87 occasions (0,26% of the total of valid registrations) the patient referred to be allergic to the antibiotic that have been prescribed to him/her. Conclusions: Lack of essential information was detected in a third of the patients who came to the pharmacies with an antibiotic prescription. In 9% of the cases, problems of security or effectiveness related with the antibiotic were identified. With an structured interview at the dispensing point in the community pharmacy those situations may be intervened and solved, promoting the appropriate use of the antibiotics (AU)

Instituto de Medicina Preventiva de la Defensa: Situación actual. Actividades / No disponible

No disponible

[Health care expenditure in Spain compared with developed Europe, 1985-2001. The Spanish primary health care, the European Cinderella]. / El gasto sanitario en España en comparación con el de la Europa desarrollada, 1985-2001. La atención primaria española, Cenicienta europea.

OBJECTIVE: To describe the evolution of the funds distribution in our health care system since the start of the primary care reform to 2001, in comparison with the European countries members of the Organisation for Economic Co-operation and Development (OECD). DESIGN: A longitudinal descriptive and retrospective study. PARTICIPANTS: European countries members of the OECD. SETTING: Countries members of the OECD. METHODS: The data come from the OECD database Health Data 2003. The data refer to period 1985-2001, and to a group of variables of health care expenditure by sectors and of income (Gross Domestic Product [GDP] per capita). We compare Spanish data series with those of the group of 22 European members countries of the OECD. RESULTS: Europe increased public expenditure on out-patient care both as a percentage of public health care expenditure and as a percentage of GDP. Spain reduced public expenditure on out-patient care in both senses. Spanish public expenditure on in-patient care reduced a great part of its difference with Europe so that since 1995 it is found, as a percentage of GDP, in the European average and, as per capita, it is according with the Spanish income. In contrast, public expenditure on out-patient care as a percentage of GDP in Spain is very much lower than the European average and, as per capita, is very much lower than the Spanish income. The Spanish private expenditure on out-patient is found among the highest in Europe and, compared with Europe, exceeds very much Spanish income, in contrast with his homonymous public. The Spanish private expenditure on in-patient care is found among the lowest in Europe and, compared with Europe, is very much lower than Spanish income level. CONCLUSIONS: With respect to public resources assigned, the reform of primary care in Spain has not been useful to approach Spanish primary health care level to Europe, in contrast with the Spanish hospital level. The difference between Spain and Europe in public expenditure on out-patient care as a percentage of GDP is, even, bigger than the one there was when the reform of Spanish primary care started.

La relación gestor-clínico: una perspectiva de médicos asistenciales / The manager-clinic relationship: a perspective from doctors providing health care

No disponible

El caso clínico en medicina general / The clinical case in general medicine

No disponible

[Continuity and longitudinal aspects of care in general practice in four European countries]. / Continuidad y longitudinalidad en medicina general en cuatro países Europeos.

BACKGROUND: The objective of the study was to compare continuity and longitudinality of care in general practice in four European countries with a public salary model. METHODS: Descriptive and prospective study. 63 general practitioners/family physicians working in public health centers registered all encounters (direct and indirect) over a period of one week in Spain, Finland, Portugal and Sweden. RESULTS: 92% of the contacts were office encounters: 75% were direct (face to face), the average number of encounters per doctor, per week was 103. The principal problem was chronic in 42% of cases and acute in 31%. The physician has previous knowledge of the principal problem in 63% of the encounters and previous knowledge of concurrent problems in 79%. In 66% of cases the doctor has previous knowledge of the patient relatives. CONCLUSIONS: The level of continuity and longitudinality is variable; from high to low: Portugal, Spain, Sweden and Finland. In Spain the duration of the encounter is short and repeated prescription are infrequent. In Portugal there are waitings lists which implies low accessibility for acute problems. In Finland general practitioners have no patients lists and the care is des-personalized. In Sweden there are waiting lists and high use of telephone encounters.

[The referral system: a study on relations between general practitioners and specialists]. / La demanda derivada: un estudio de la relación entre médicos generales y especialistas.

BACKGROUND: To describe the general practitioners referral patterns. There is special emphasis in the delay between the referral and the first consultation with the specialist. Also we consider other aspects of the coordination between both levels of care. METHODS: Cross-sectional study upon 8.095 referrals from 242 spanish doctors. RESULTS: The referral rate was 6.63%, higher in the 15-44 age group and also for men. We find a huge variability in the referral rates among doctors. The referral rates are higher to surgical specialties. The mean delay between referral and specialist appointment was 11 days. The general practitioners didn't receive communication from the specialists in 23.5 of the referrals. CONCLUSIONS: A considerable range of referral rates has been identified. There is a poor continuity and coordination in the patient care.

[Drug prescription in primary care. Pharmacoepidemiologic study in the Albacete area]. / Prescripción de medicamentos en Atención Primaria. Estudio fármacoepidemiológico en el área de Albacete.

Prescribing medication is a clinical procedure used quite often in Primary Care (PC). The quality of some prescriptions in the province of Albacete is studied, evaluating the characteristics of the PC physicians. The bottles of Cephalosporins, broad-spectrum Penicillins, Rawolfias, Diuretics, Beta-Blockers and Cerebral Blood Vessel Dilating Medications have been analyzed. Respectively, 38.4%, 30.8% and 28.5% of the physicians prescribed antibiotics, antihypertensives and blood vessel dilating medications acceptably. The logistic regression analysis only reveals a slight indication of: a better prescribing of antibiotics (p less than 0.02) at an older age, when employed in an urban environment and having a smaller number of patients to care for; and a better prescribing of cerebral blood vessel dilating medications (p less than 0.05) for specialists by way of MIR. The commercial information on medications could standardize behaviour with regard to writing prescriptions. To improve quality, it would be necessary to improve the scientific attitude of health care professionals.

Effect of desipramine on the contents of some free amino acids of mouse brain.

I.p. injections of desipramine-HCl (100 mg/kg) produced decreases in the contents of several amino acids of mouse brain after 1 h. Using a 10-100 mg/kg range of doses, these effects appeared to be dose-dependent for alpha-alanine and aspartate. These changes may be due, in part, to a decrease in cerebral oxidative metabolism (Krebs cycle activity) which occurs secondarily to desipramine-induced hypothermia.

'Binding' of glycine and gamma-aminobutyric acid to synaptosomal fractions of 6 regions of the feline brain; effects of strychnine.

GABA (6 X 10(-6) M) binding to synaptosome-enriched fractions of cat CNS exhibited a clear rostro-caudal gradient, whereas glycine (6 X 10(-6) M) binding was greatest to particles of cerebellar cortex, and this was followed by medulla approximately equal to caudate nucleus larger than or equal to cerebral cortex larger than or equal to pons larger than corona radiata. Strychnine-SO4 (10(-3) or 10(-4) M) inhibited the binding of GABA and glycine in all brain regions studied; at 10(-5) M this drug inhibited the binding of both GABA and glycine only to particles of the cerebral cortex.

[Constancy of total protein contents in various regions of the feline central nervous system (author's transl)]. / Constancia del contenido total de proteínas en varias regiones del sistema nervioso central del gato

A striking constancy of total protein content was shown in 45 regions of the feline CNS, recognized as markedly heterogeneous. The hypophysis differed from these tissues, due perhaps to its high blood element content. Synaptosomal fractions prepared from 17 regions of the CNS did not exhibit this constancy.

Water contents of various regions of the feline nervous system.

A systematic analysis of the regional water content of the feline nervous system was made. In general, areas rich in grey matter contained about 10-15% more water than white matter areas. Percentage water values were lowest for cranial and peripheral nerves and highest for cerebral cortex, cerebellar cortex, olfactory bulb and other grey matter regions. Values for cerebral cortex varied from about 81.5% for suprasplenic gyrus to over 84% for frontal gyrus. It is suggested that the effective concentrations of dissolved substances in various regions of the nervous system might be influenced greatly by these differences in water content.