ABSTRACT
Objetivo: Estimar la prevalencia de pacientes con terapia anticoagulante oral (TAO) en la Comunitat Valenciana (CV) y evaluar la calidad del seguimiento de la TAO con antagonistas de la vitaminaK (AVK) realizado en atención primaria. Diseño: Estudio observacional transversal realizado a través de la Red Centinela Sanitaria de la Comunitat Valenciana (RCSCV), que incluye una encuesta y el análisis retrospectivo del control de la TAO. Emplazamiento: Atención primaria (AP), Comunitat Valenciana (CV), España. Participantes: Todos los pacientes con ≥18años con TAO que consultaron durante el año 2014. La población cubierta por los 59 médicos de la RCSCV supone un 2,2% de la población adulta de la CV, y es representativa de esta. Mediciones principales: Datos demográficos, socioeconómicos, de salud y referentes a la TAO. La calidad del seguimiento de la TAO con AVK fue valorada mediante el porcentaje de tiempo dentro de rango terapéutico (TRT), calculado mediante el método Rosendaal. Resultados: Se registraron 1.144 pacientes (edad media 74,5±11años; 49,7% mujeres). La prevalencia de TAO en la CV es de 1,3 casos por 100 habitantes. El perfil característico de estos pacientes es una persona añosa, pluripatológica, con bajo nivel educativo, que vive acompañada. La fibrilación auricular es la indicación más habitual. El 82,8% de los pacientes con TAO con AVK llevaron seguimiento a través de AP. El TRT medio fue del 65,0%, y el 53,9% de pacientes presentaron un TRT ≥65%. El 74,4% de los pacientes con un control inadecuado fueron percibidos como bien controlados por el médico de AP. Conclusiones: La prevalencia de la TAO es alta y se prevé que siga aumentando. El grado de control alcanzado cumple con el estándar de calidad generalmente aceptado (TRT medio ≥ 65%) y es comparable al observado en otros estudios nacionales e internacionales. Sin embargo, hay un amplio margen de mejora. Es crucial optimizar la gestión de esta terapia de la manera más eficaz y coste-efectiva posible. Entre otras medidas, se debe mejorar el acceso de los facultativos a la información clínica de sus pacientes (AU)
Objective: To estimate the prevalence of patients with oral anticoagulant therapy (OAT) in the Region of Valencia and to evaluate the quality of management of OAT with vitamin K antagonists (VKA) carried out in primary healthcare. Design: Observational cross-sectional study conducted through the Health Sentinel Network of the Region of Valencia, which includes a survey and the retrospective analysis of OAT monitoring. Setting: Primary healthcare, Region of Valencia, Spain. Subjects: All patients aged 18years or older on OAT who consulted during the year 2014. The population covered by the 59 doctors of the Health Sentinel Network constitutes 2.2% of the adult population of the Region of Valencia, and it is representative of it. Key measurements Demographic, socioeconomic and health data as well as information concerning OAT. Quality of OAT management with VKA was assessed by means of the percentage of time in therapeutic range (TTR), computed using the Rosendaal method. Results: A total of 1,144 patients were recorded (mean age 74.5±11 years; 49.7% women). Prevalence of OAT in the Region of Valencia is 1.3 cases per 100 population. The characteristic profile of these patients is an old person, with several comorbidities and a low level of education, who lives accompanied. Atrial fibrillation is the most common indication. 82.8% of patients on OAT with VKA were monitored in primary healthcare. The average TTR was 65.0%, and 53.9% of patients had a TTR ≥ 65%. Among inadequately controlled patients, 74.4% were perceived as well-controlled by their primary care doctor. Conclusions. Prevalence of OAT is high, and it is expected to increase. The degree of control achieved meets the generally accepted quality standard (mean TTR ≥ 65%), and it is comparable to that observed in other national and international studies. However, there is wide scope for improvement. It is crucial to optimize the management of this therapy in the most effective and cost-effective way. Among other measures, access of physicians to their patients clinical information should be improved (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Anticoagulants/therapeutic use , Blood Coagulation Disorders/drug therapy , Medication Therapy Management/organization & administration , Cross-Sectional Studies , Quality of Health Care/trends , Sentinel Surveillance , Primary Health Care/organization & administration , Electronic Prescribing/statistics & numerical dataABSTRACT
OBJECTIVE: To estimate the prevalence of patients with oral anticoagulant therapy (OAT) in the Region of Valencia and to evaluate the quality of management of OAT with vitaminK antagonists (VKA) carried out in primary healthcare. DESIGN: Observational cross-sectional study conducted through the Health Sentinel Network of the Region of Valencia, which includes a survey and the retrospective analysis of OAT monitoring. SETTING: Primary healthcare, Region of Valencia, Spain. SUBJECTS: All patients aged 18years or older on OAT who consulted during the year 2014. The population covered by the 59 doctors of the Health Sentinel Network constitutes 2.2% of the adult population of the Region of Valencia, and it is representative of it. KEY MEASUREMENTS: Demographic, socioeconomic and health data as well as information concerning OAT. Quality of OAT management with VKA was assessed by means of the percentage of time in therapeutic range (TTR), computed using the Rosendaal method. RESULTS: A total of 1,144 patients were recorded (mean age 74.5±11 years; 49.7% women). Prevalence of OAT in the Region of Valencia is 1.3 cases per 100 population. The characteristic profile of these patients is an old person, with several comorbidities and a low level of education, who lives accompanied. Atrial fibrillation is the most common indication. 82.8% of patients on OAT with VKA were monitored in primary healthcare. The average TTR was 65.0%, and 53.9% of patients had a TTR ≥65%. Among inadequately controlled patients, 74.4% were perceived as well-controlled by their primary care doctor. CONCLUSIONS: Prevalence of OAT is high, and it is expected to increase. The degree of control achieved meets the generally accepted quality standard (mean TTR ≥65%), and it is comparable to that observed in other national and international studies. However, there is wide scope for improvement. It is crucial to optimize the management of this therapy in the most effective and cost-effective way. Among other measures, access of physicians to their patients' clinical information should be improved.
Subject(s)
Anticoagulants/therapeutic use , Drug Monitoring/standards , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Population Surveillance , Primary Health Care , Spain , Young AdultABSTRACT
The aim is to describe impact on health of unintentional injuries (E800-E949, CIE-9) (V01-X59, Y40-Y86, Y88, Y89 CIE10) in terms of mortality and morbidity and to make certain recommendations regarding information systems. Transport, including occupational transport, is the activity that causes highest mortality, 5,920 in 2002. However, the overall number of deaths for the rest of circumstances where injuries occurred (falls, burns, drowning and others) rises to 5,032, the above being injuries that take place where we live and work, that is domestic, leisure and workplace settings. For the severity of road traffic injuries data are provided from the analysis of the Minimum Basic Data Set after Hospital Discharge in Spain. Differences are shown between severe injuries reported by the Traffic General Directorate (26,566) and hospital discharges for the same year (40,174). For leisure and domestic injuries, Primary Health Care sentinel networks are those producing the most information about the situation, particularly in the field of childhood injuries. The consultation incidence for this cause fluctuates between 931 and 1118 in the under 14s and between 1306 and 1971 in the under 5 s. For injuries occurring in the workplace the best information is provided by specific registry systems. Their incidence was 75.5 for the year 2000 and 70.5 in year 2002 for every 1000 workers paying national insurance.
Subject(s)
Accidents, Home/statistics & numerical data , Accidents, Occupational/statistics & numerical data , Accidents, Traffic/statistics & numerical data , Wounds and Injuries/epidemiology , Accidents, Home/mortality , Accidents, Traffic/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Athletic Injuries/epidemiology , Athletic Injuries/mortality , Cause of Death , Child , Child, Preschool , Female , Humans , Incidence , Infant , Leisure Activities , Male , Middle Aged , Spain/epidemiology , Wounds and Injuries/mortality , Young AdultABSTRACT
Se pretende describir el impacto en la salud de las lesiones no intencionales (E800-E949, CIE-9) (V01-X59, Y40-Y86, Y88, Y89 CIE10) en términos de mortalidad y morbilidad y hacer algunas recomendaciones sobre los sistemas de información. El transporte, incluido el laboral, es la actividad que mayor mortalidad produce, 5.920 defunciones en 2002. Sin embargo, el número total de muertes para el resto de las circunstancias que produjeron la lesiones (caídas, quemaduras, ahogamientos y otros) se eleva a 5.032, y son éstas las que se producen en los entornos donde vivimos y trabajamos, o sea lesiones domésticas, de ocio y de trabajo. Para la gravedad de las lesiones por tráfico se ofrecen datos del análisis del Conjunto Mínimo Básico de Datos al Alta Hospitalaria en España. Se muestran las diferencias entre las lesiones graves que declara la Dirección General de Tráfico (26.566) y las altas hospitalarias para ese mismo año (40.174). Para las de ocio y domésticas, las redes centinela en atención primaria son las que están produciendo más información sobre la situación, especialmente en las lesiones infantiles. La incidencia de consulta por esta causa oscila entre 931 y 1118 en < de 14 años y entre 1.306 y 1.971 en < de 5 años. Para los que se producen en el medio laboral son los sistemas de registro específicos los que producen la mayor información. Su incidencia fue 75,5 para el año 2000 y de 70,5 en el año 2002 por cada 1.000 trabajadores afiliados a la Seguridad Social (AU)
The aim is to describe impact on health of unintentional injuries (E800-E949, CIE-9) (V01-X59, Y40-Y86, Y88, Y89 CIE10) in terms of mortality and morbidity and to make certain recommendations regarding information systems. Transport, including occupational transport, is the activity that causes highest mortality, 5,920 in 2002. However, the overall number of deaths for the rest of circumstances where injuries occurred (falls, burns, drowning and others) rises to 5,032, the above being injuries that take place where we live and work, that is domestic, leisure and workplace settings. For the severity of road traffic injuries data are provided from the analysis of the Minimum Basic Data Set after Hospital Discharge in Spain. Differences are shown between severe injuries reported by the Traffic General Directorate (26,566) and hospital discharges for the same year (40,174). For leisure and domestic injuries, Primary Health Care sentinel networks are those producing the most information about the situation, particularly in the field of childhood injuries. The consultation incidence for this cause fluctuates between 931 and 1118 in the under 14s and between 1306 and 1971 in the under 5 s. For injuries occurring in the workplace the best information is provided by specific registry systems. Their incidence was 75.5 for the year 2000 and 70.5 in year 2002 for every 1000 workers paying national insurance (AU)
