[Effectiveness of the protocols on cardiovascular risks in the Basque Country]. / Efectividad de los protocolos sobre riesgos cardiovasculares en el País Vasco.

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.

Análisis de calidad de las guías de práctica clínica sobre riesgos cardiovasculares en el país vasco y propuesta para su evaluación / Analysis of the quality of guidelines to clinical practice on cardiovascular risk in the basque country and proposal for their evaluation

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)

Efectividad de los protocolos sobre riesgos cardiovasculares en el País Vasco / Effectiveness of the protocols on cardiovascular risks in the basque country

Objetivos. Conocer la efectividad de los protocolos clínicos para la detección y control de los riesgos cardiovasculares más importantes: tabaquismo, hipertensión arterial, hiperlipemia y diabetes mellitus. Diseño. Estudio descriptivo. transversal. Emplazamiento. Centros de atención primaria del País Vasco. Participantes. Un total de 1.485 historias clínicasde usuarios de 40-75 años que han acudido a consulta en los 2 últimos años, adscritos a médicos de atención primaria del País Vasco, que utilizan habitualmente la historia clínica. Mediciones y resultados. Se envió encuesta a responsables de los 103 centros jerarquizados, solicitando información sobre uso de protocolos para la detección y control de los problemas estudiados y se pidieron copias. Contestaron 77 centros (76 por ciento) y 66 remitieron 170 protocolos. Se analizaron 990 historias clínicas de médicos que utilizan los 4 protocolos y 495 de médicos que no usan ninguno, pertenecientes a 45 médicos de 22 centros distintos, seleccionadas de forma aleatoria y estratificada según su centro esté adscrito al PAPPS o sea docente para MFyC. Los centros que usan protocolos presentan una mayor calidad en detección del tabaquismo, 24,6 frente a 11,9 por ciento (p < 0,0005); hiperlipemia, 61,8 frente a 53,1 por ciento (p < 0,001), y diabetes mellitus, 75,0 frente a 66,1 por ciento (p < 0,0005). La diferencia es menor para hipertensión arterial, 56,8 frente 52,1 por ciento (p = 0,097). No se encuentran diferencias de calidad en el control de estos problemas. Conclusiones. La utilización de protocolos de riesgos cardiovasculares por los centros de atención primaria se relaciona con una mejora en la calidad de su detección, aunque no con la de su control (AU)

[Quality analysis of clinical practice guidelines on cardiovascular risks in the Basque country and a proposal for their evaluacion]. / Análisis de calidad de las guías de práctica clínica sobre riesgos cardiovasculares en el País Vasco y propuesta para su evaluación.

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.

[Knowledge and attitudes related with cancer prevention in a population served at a health center]. / Conocimientos y actitudes relacionados con la prevención del cáncer en la población atendida en un centro de salud.

OBJECTIVE: To assess the knowledge and attitudes that patients seen at a health centre had of cancer risk factors and their prevention. DESIGN: A descriptive crossover study. Non-probabilistic sampling by quota. Survey with questionnaire. SETTING: Rekaldeberri Health Centre (Bilbao). PARTICIPANTS: 400 people aged between 14 and 74 who attended the Centre for any reason during June and July 1995. MEASUREMENTS AND MAIN RESULTS: 276 patients (69%) thought that cancer was preventable. The cancers most often cited as preventable were lung in men and breast in women. 371 (93%) related cancer to tobacco; 372 (93.1%) to sun-bathing without protection; 267 (66.8%) to excess of alcohol. 192 (48%) thought that diet could play a protective role. 339 (84%) thought that early diagnosis was possible: of these, 60.5% cited breast cancer. 222 women (96.7%) knew about mammography; and 166 (79.4%), cytology. In age groups for whom these techniques are appropriate, 32 women (56.1%) had had the first, and 136 (76%) the second. 258 (64.5%) did not smoke; 230 (57.5%) did not drink; 156 (39%) always used protective cream; and 328 (82%) ate fruit and/or vegetables daily or almost daily. CONCLUSIONS: The population group studied had a good understanding of cancer risk factors and prevention.

[Evaluation of the type II diabetic population attended by a primary care team]. / Evaluación de la población diabética tipo II atendida en un equipo de atención primaria.

OBJECTIVES: To find the degree of control, the prevalence of complications and cardiovascular risk factors (CVRF), and the drugs treatment used for type II diabetics. DESIGN: A descriptive crossover study. SETTING: Rekaldeberri Health Centre, Bilbao. PATIENTS: 202 diabetes II patients selected at random. INTERVENTIONS: Data were gathered by interviews, physical examinations and further tests. MAIN RESULTS: 52.2% of the sample were women. Average age was 66.6 50% of the diabetics had been diagnosed for 8 years or more. Microalbuminuria was detected in 21.9% of the patients, Microangiopathy in 24.8%, Neuropathy in 11.4% and diabetic foot in 10.4%. The years of evolution and appearance of complications had a significant connection. 64.4% of patients had a good or acceptable metabolic control. Worse metabolic control of diabetes was connected with the appearance of retinopathy and neuropathy. 47.5% were hypertensive. 21.3% smoked, 35.6% had cholesterol figures over 250 mgr/dl. Their mean Body mass index was 28.1. 40.6% were treated exclusively by diet, 9.9% with insulin and 35.6% with medicines taken orally. CONCLUSIONS: A high percentage of diabetics had a good or acceptable control of their disease. Prevalence of complications was less than in other studies, whereas CVRFs were similar. We do not discount the presence of bias in the comparison because of different diagnostic methods.

[Characteristics of the family medicine chest in the Rekaldeberri-Bilbao neighborhood]. / Características del botiquín familiar en el barrio de Rekaldeberri-Bilbao.

OBJECTIVE: To study the characteristics of first-aid kits used by families in the Rekaldeberri area of Bilbao (Spain) and their relationship with social and economic variables. DESIGN: Cross-sectional study. PARTICIPANTS: Households of 319 patients of the Health Center. MEASUREMENTS AND MAIN RESULTS: Interview with family and observation of first-aid kit used at home. A total number of 5170 medicines were computed with a median of 14 per household (range 1-58). More medicines were seen at households where a higher social prevailed. No relationship was found with respect to people over 65 or children under 7 nor with regard to the fact that some people were undergoing chronic treatment. The most represented anatomic & therapeutic groups are N (Central Nervous System): 19.7% and D (Dermatological): 19%. Expired medicines were found in 52.7% of the households. "Hazardous locations" were found in 3.4% of the households. CONCLUSIONS: Our population stores-up large quantities of medicines. There is a population group, however, that does not even have a basic first-aid family kit capable of meeting primary needs. Counselling relative to expiration of medicines is thus required.

[Prescription of cerebral and peripheral vasodilators in primary health care: a study in the health district of Bilbao]. / Prescripción de vasodilatadores cerebrales y periféricos en atención primaria de salud: estudio en la comarca sanitaria de Bilbao.

OBJECTIVE: To assess cerebral and peripheral vasodilators prescriptions (uncertain or nil intrinsic value) and determine other associated values (personal, labour and medical training). DESIGN: A descriptive study. SETTING: General Practice. Health district of Bilbao. PARTICIPANTS: 122 general practitioners, observed between September & December 1992 (three months). MEASUREMENTS AND MAIN RESULTS: On average, each doctor filled in 95 prescriptions covering these three drugs, thus representing 2,3% of the overall expenditure. In an ANOVA, the number of pensioners and type of care provided proved to be variables most closely associated to prescriptions. The overall expenditure generated and the number of prescriptions made covering these drugs were lower in the case of primary health care teams. We would like to stress how important it is to perform prescription quality control and suggest actions to be taken for this purpose.

[Health self-perception in the elderly: relationship with several socioeconomic and health variables]. / Autopercepción de salud en el anciano: relación con algunas variables socioeconómicas y de salud.

AIMS: To learn how the elderly people in our health area see their own state of health (AS) in relation with certain variables. DESIGN: Transverse. Survey of socio-economic and health characteristics. LOCATION: Community oriented primary care. PATIENTS OR OTHERS PARTICIPANTS: 232 psychically capable people aged 65 or over, selected at random among those attended by three general medical groups of the Rekaldeberri Primary Care Unit (Bilbao). MEASUREMENTS AND MAIN RESULTS: 41.4% considered their health to be good or very good. The association between AS and various variables is worked out by odds ratio calculation using logistic regression. Age and sex ar not significantly associated with AS. The variables most closely associated to negative AS were the number of illnesses affecting daily life, the number of symptoms, the number of pharmaceutical products consumed and functional incapacity of any degree. CONCLUSIONS: Patients' perception of their own health varies widely between the different studies. As is an easy parameter to obtain, summarizes both subjective and objective aspects, and is useful in assessing an elderly person's overall state of health.

[Hospital emergency service utilization by the population from a primary health center: level of suitability]. / Estudio de la utilización de servicios de urgencias hospitalarios por la población de un EAP: grado de adecuación.

A descriptive study on hospital record corresponding to 379 patients over 14 years, from the Health Center of Rekaldeberri (Bilbao), who attended any of the hospital emergency services available in the province, during the last quarter of 1989 is presented. Objectives were to identify circumstances that motivated consultation, and its apropriateness. Data were recorded by family doctors. As much as 76% of them attended on one's own initiative being this proporcion larger among the youngest. The most frequent diagnosis was the one that corresponded to "Accidents, injuries, poisoning, and violence", 37.5% of the total. 20.8% of the patients were admitted to the hospital. We considered consultation to be apropriate 55.1% of the times, with larger percentages among those who were sent by family doctors (91.1%) and those advanced in years. Lastly data are compared to other studies and we make some considerations about primary health care's responsibility for massification of hospital emergency services.