[Dementias in the primary care setting]. / Las demencias en el ámbito de la atención primaria.

OBJECTIVE: To study the epidemiological, demographic, social and family, and clinical variables of the population suffering dementia in our health district. DESIGN: A retrospective evaluation of medical records. SETTING: A rural health district. PATIENTS: All those patients with a diagnosis of dementia in 1995. MEASUREMENTS AND RESULTS: The evaluation was based on primary care medical records. The prevalence of dementia in the over-65s ranged, according to the population group, between 1.29 and 5.19 per 100 inhabitants. 90.2% of patients with dementia remained living at home. Their average age was 79.8 (SD, 7.4). 57% had Alzheimer's disease. 40% were in advanced stages of the disease (stage III and IV). Only 26% of the patients were referred to Neurology in 1995. 35% of the patients took no medication for their dementia. 45.6% were included in a home care programme. The main carer was the son or daughter in 47.8% of cases. Expectation of life from when dementia was diagnosed was 5.53 (SD 4.64) years. Patients with dementia died in their own homes in 47% of cases, the main cause of death being infection. CONCLUSIONS: In our rural environment most patients with dementia remained with their families. In most cases the aetiological diagnosis of dementia could be made from primary care.

[A re-evaluation of the program for diabetes mellitus type 2. A proposal for quality indices]. / Reevaluación del programa de diabetes mellitus tipo II. Propuesta de indicadores de calidad.

OBJECTIVE: To find out how accurate our records are and the state of health of the patients with diabetes mellitus type II (DM) in our Base Health Area (BHA) in Osona county (Barcelona), both before and after introducing a new procedure. DESIGN: Quality control study based on the medical records (PCMR) of DM patients. The evaluation took place between 1.1.90 and 31.12.90; and the re-evaluation between 1.1.91 and 31.12.91, after the DM procedure had been put in place as a corrective measure. PATIENTS: 198 patients: all of those suffering from DM type II. MAIN MEASUREMENTS AND RESULTS: 110 women and 88 men, with an average age of 65.4 +/- 11.9, were under study. We observed from the records of attendance that 94.4% were or had been smokers, whereas the question of the eye fundus was only mentioned in 36.8%. The introduction of a procedure has improved the records in almost every parameter. In 1991, 36.8% of the patients had normal-weight criteria, 33.3% had good biochemical control and 15.6% fulfilled both these criteria. CONCLUSIONS: Those tests which could be performed with few instruments were carried out much better than those which needed more complex technology or specialist support. Arising from this study, the authors propose four indicators of quality control: 1) Weight normality. 2) Annual plasmatic fructosamine. 3) Annual eye fundus check. 4) Annual proteinuria check.