Utilidad y fiabilidad de la ecografía clínica musculoesquelética en medicina familiar (2): lesiones musculares, artrosis, enfermedades reumatológicas y procedimientos ecoguiados / Usefulness and reliabitlity of musculoskeletal point of care ultrasound in family practice (2): Muscle injuries, osteoarthritis, rheumatological diseases and eco-guided procedures

Este artículo es continuación de la revisión iniciada en el número anterior sobre la utilidad de la ecografía clínica musculoesquelética en atención primaria, y completa los escenarios de lesiones musculares, artrosis, enfermedades reumatológicas y procesos ecoguiados

This article is a continuation of the review initiated in the previous issue about the usefulness of musculoskeletal point of care ultrasound in Primary Care, completing the scenarios of muscle injuries, osteoarthritis, rheumatological diseases and eco-guided procedures

[Usefulness and reliabitlity of musculoskeletal point of care ultrasound in family practice (2): Muscle injuries, osteoarthritis, rheumatological diseases and eco-guided procedures]. / Utilidad y fiabilidad de la ecografía clínica musculoesquelética en medicina familiar (2): lesiones musculares, artrosis, enfermedades reumatológicas y procedimientos ecoguiados.

This article is a continuation of the review initiated in the previous issue about the usefulness of musculoskeletal point of care ultrasound in Primary Care, completing the scenarios of muscle injuries, osteoarthritis, rheumatological diseases and eco-guided procedures.

[Usefulness and reliabitlity of musculoskeletal point of care ultrasound in family practice (1): Knee, shoulder and enthesis]. / Utilidad y fiabilidad de la ecografía clínica musculoesquelética en medicina familiar (1): rodilla, hombro y entesis.

Musculoskeletal ultrasound (MSU) is a technique which has been extended to practically all medical specialties that comprise this pathology. Family Doctor (FD) has not been away from this process due to its great wide of competences, using it in different scenarios inside his common practice in which he can get profits in a reliable, efficient and effective way. Ultrasound equipment incorporation in Primary Care (PC) centers is an increasing reality, contributing to high ranges of accessibility, immediacy and clinic handle capability, and thus, together with the high prevalence in this area in locomotor apparatus, turns MSU into an strategic action for the improvement of the resolving capacity and consequently for the health care. To ensure proficiency among users, it's being necessary to define the benefits and potential risks its use can cause, as well as its different scenarios, avoiding unnecessary explorations and optimizing the investment of this resource at PC level. This paper pretends to summarize the state of the art of the musculoskeletal ultrasound and its benefits for the FD into this efficient and effective scenarios.

Variability in the prescription of drugs with uncertain effectiveness. The case of SYSADOA in the Basque Country.

Background: The majority of clinical practice guidelines do not recommend the use of SYSADOA (Symptomatic Slow Action Drugs for Osteoarthritis) for the treatment of osteoarthritis because of the lack of evidence or uncertainty around their efficacy. Nevertheless, the Spanish Public Health Service continues funding these drugs. Aim: The aim of this study is to describe the prescription status of SYSADOA in the primary care units of the Basque Country during 2011; to determine if variability exists among them; and to examine if the variability could be explained by the health care region each PC unit belongs to. Methods: Prescription data for SYSADOA during 2011 was obtained from the Basque Ministry for Health. In the Basque Country, primary care is divided into seven regions, each region consisting of several primary care units, which were used as the unit of analysis. Defined daily doses (DDD) per 1,000 inhabitant-days (DHD) were calculated. Data were standardized by sex and age using the total population of the Basque Country as the reference population. Small area statistics were calculated (extremal quotient, coefficient of variation and systematic component of variation). The influence of the region to which primary care units belonged was also analysed. R software (version R-2.15.0) was used for the analysis. Results: SYSADOA prescription during 2011 accounted for an expense of 4.5 million euros for the Basque Health Service. The crude rate of consumption of SYSADOA was 7.81 DDD per 1,000 inhabitant-days. The obtained external quotient was 13.67. The prescription of SYSADOA of the primary care units located in the 95th percentile was six times higher than the ones located in the 5th percentile. The region to which units belonged accounted for 57% of the observed variability. Discussion: The uncertainty around these drugs could be reflected in the existing variability of their prescription level. The analysis of the variability in the prescription of drugs with no demonstrated efficacy could help in allocating resources into other services or health technologies supported by evidence, thereby contributing to the improvement of health outcomes.