Caracterización del servicio de venta online de medicamentos en las farmacias catalanas durante el periodo 2015-2019 / Characterization of the online sale service of medicines in the catalan pharmacies during the period 2015-2019

INTRODUCCIÓN: En julio de 2015, entró en vigor la normativa de venta a distancia de medicamentos de no prescripción a través de las páginas webs de las oficinas de farmacia, una nueva forma de dispensación y atención farmacéutica. OBJETIVOS: Conocer cuál ha sido el grado de implantación del servicio en las farmacias comunitarias de Cataluña, después de 5 años de inicio de la actividad. MÉTODOS: Estudio descriptivo de las páginas web activas de las farmacias de Cataluña durante el periodo 2015-2019, a partir de la revisión periódica y sistemática de dichas páginas web realizadas por el Departament de Salut. RESULTADOS: En 5 años, un 3,77% de las farmacias comunitarias catalanas disponen de página web activa de venta de medicamentos de no prescripción, porcentaje superior a la media española (2,03%). El año 2015 fue el que registró un mayor número de inicios de actividad, mientras que 2018 y 2019 fueron los que registraron menos inicios de actividad. Asimismo, en 2019 se registró el mayor número de suspensión de páginas web. En relación a las bajas, el 41,67% fueron a petición de la propia farmacia y el resto por resolución administrativa debido a un mantenimiento deficiente. CONCLUSIONES: El servicio de venta online de medicamentos de no prescripción a través de páginas web desde la farmacia comunitaria no ha conseguido una buena implantación desde su entrada en vigor. La tendencia actual es un descenso progresivo de la cobertura del servicio por no aportar un valor añadido, ni a la población ni al farmacéutico

OBJECTIVES: To find out what the degree of implementation of the service has been in community pharmacies in Catalonia, after 5 years of operation. METHODS: It was carried out a descriptive study about the evolution of the number of active web pages of pharmacies in Catalonia during the 2015-2019 period, based on the activity communications made by pharmacies and the systematic review of the web pages made by the Department of Health. RESULTS: After 5 years, 3.77% of the community pharmacies in Catalonia have an active website for the online sale of non-prescription drugs, a higher percentage than the Spanish average (2.03%). 2015 was the year with the highest number of activity starts, while 2018 and 2019 were the years with the least activity starts. In addition, in 2019 it was recorded the largest number of web pages suspensions. In relation to the casualties, 41.67% were at the request of the pharmacy itself and the rest by administrative resolution due to poor maintenance. CONCLUSIONS: The distance selling service of non-prescription drugs through websites from the community pharmacy has not achieved a good implementation since its entry into force and the current trend is a progressive decrease in service coverage for not providing a benefit, neither to the population, nor to the professional pharmaceutical service

Quality indicators for patient safety in primary care. A review and Delphi-survey by the LINNEAUS collaboration on patient safety in primary care.

BACKGROUND: Quality indicators are measured aspects of healthcare, reflecting the performance of a healthcare provider or healthcare system. They have a crucial role in programmes to assess and improve healthcare. Many performance measures for primary care have been developed. Only the Catalan model for patient safety in primary care identifies key domains of patient safety in primary care. OBJECTIVE: To present an international framework for patient safety indicators in primary care. METHODS: Literature review and online Delphi-survey, starting from the Catalan model. RESULTS: A set of 30 topics is presented, identified by an international panel and organized according to the Catalan model for patient safety in primary care. Most topic areas referred to specific clinical processes; additional topics were leadership, people management, partnership and resources. CONCLUSION: The framework can be used to organize indicator development and guide further work in the field.

Vicente Ortún, director. La refundación de la atención primaria. Madrid: Springer Healthcare Ibérica; 2011. ISBN: 978-84-938062-0-0. 120 p / No disponible

No disponible

[Cardiovascular disease prevalence in recent diagnosed type 2 diabetic patients]. / Prevalencia de enfermedad cardiovascular en personas recién diagnosticadas de diabetes mellitus tipo 2.

OBJECTIVE: To determine the prevalence of cardiovascular disease at diagnosis of type 2 diabetes mellitus. METHODS: Retrospective observational study in an urban primary health care centre between 1991 and 2000. Review of clinical patient characteristics, cardiovascular disease and risk factors, in the year of diabetes diagnosis. Patients without any glycaemia recorded before diagnostic were excluded. Logistic regression was done to identify the variables associated to cardiovascular events. RESULTS: From 598 cases of diabetes diagnosed, 487 with previous glycaemia were included for the analysis (mean age [SD], 60.4 [10.9]; 53% women). The prevalence of cardiovascular risk factors was: obesity 61.1%, hypertension 71.9%, hypercholesterolemia 52%, hypertriglyceridemia 35.3% and present or previous smoking habit (24 and 16,6%). 96.9% of them presented at least one of the studied cardiovascular risk factors and 53.4% three or more. 78 patients (16%; CI95%: 12.8-19.3) had cardiovascular disease before or during the first year of diagnosis (men 21.4% and women 11.2%). The prevalence of cardiovascular disease increased progressively with the number of cardiovascular risk factors. The significant predictive variables of cardiovascular disease (logistic regression) were: age 55 years (OR = 2.91; CI95%: 1.46-5.80), smoking habit (OR = 2.28; CI95%: 1.15-4.51) and HbA1c 7% (OR = 1.8; CI95%: 1.1-3.1). CONCLUSIONS: A high prevalence of cardiovascular disease and cardiovascular risk factors at diabetes diagnosis was observed. Age, smoking habit and elevated glycated haemoglobin were the variables related to cardiovascular disease.

Prevalencia de enfermedad cardiovascular en personas recién diagnosticadas de diabetes mellitus tipo 2 / Cardiovascular disease prevalence in recent diagnosed type 2 diabetic patients

Objetivo: Conocer la prevalencia de la enfermedad cardiovascular en el momento del diagnóstico de la diabetes mellitus tipo 2.MétodosEstudio observacional retrospectivo realizado en un centro de atención primaria urbano entre 1991 y 2000. Revisión de las características clínicas, factores de riesgo y enfermedad cardiovascular el año del diagnóstico de diabetes. Se excluyeron los pacientes sin glucemias previas al diagnóstico. Se realizó un análisis de regresión logística para identificar las variables asociadas a la presencia de eventos cardiovasculares.Resultados: De los 598 nuevos casos de diabetes diagnosticados se analizaron los 487 que tenían valores previos de glucemia (media de edad [desviación estándar]: 60,4 [10,9] años; un 53% eran mujeres). La prevalencia de factores de riesgo cardiovascular fue: obesidad 61,1%, hipertensión arterial 71,9%, hipercolesterolemia 52%, hipertrigliceridemia 35,3% y tabaquismo actual 24% o previo 16,6%. El 96,9% tenía algún factor de riesgo cardiovascular y el 53,4% tres o más. Un total de 78 pacientes presentaron enfermedad cardiovascular anterior o detectada durante el primer año de diagnóstico (16%; intervalo de confianza del 95%[IC95%]: 12,8–19,3; varones 21,4% y mujeres 11,2%). La prevalencia de enfermedad cardiovascular aumentó con el número de factores de riesgo cardiovascular. El análisis de regresión logística mostró una asociación de la enfermedad cardiovascular y la edad ≥55 años (odds ratio [OR]=2,91; IC95%: 1,46–5,80), el tabaquismo (OR=2,28; IC95%: 1,15–4,51) y los valores de hemoglobina glucosilada (HbA1c) ≥7% (OR=1,85; IC95%: 1,10–3,1).Conclusiones: Se observa una elevada prevalencia de factores de riesgo y enfermedad cardiovascular en el momento del diagnóstico de la diabetes; la edad, el tabaquismo y la HbA1c son las variables relacionadas con la enfermedad cardiovascular (AU)

Objective: To determine the prevalence of cardiovascular disease at diagnosis of type 2 diabetes mellitus.Methods: Retrospective observational study in an urban primary health care centre between 1991 and 2000. Review of clinical patient characteristics, cardiovascular disease and risk factors, in the year of diabetes diagnosis. Patients without any glycaemia recorded before diagnostic were excluded. Logistic regression was done to identify the variables associated to cardiovascular events.Results: From 598 cases of diabetes diagnosed, 487 with previous glycaemia were included for the analysis (mean age [SD], 60.4 [10.9]; 53% women). The prevalence of cardiovascular risk factors was: obesity 61.1%, hypertension 71.9%, hypercholesterolemia 52%, hypertriglyceridemia 35.3% and present or previous smoking habit (24 and 16,6%). 96.9% of them presented at least one of the studied cardiovascular risk factors and 53.4% three or more. 78 patients (16%; CI95%: 12.8–19.3) had cardiovascular disease before or during the first year of diagnosis (men 21.4% and women 11.2%). The prevalence of cardiovascular disease increased progressively with the number of cardiovascular risk factors. The significant predictive variables of cardiovascular disease (logistic regression) were: age ≥55 years (OR=2.91; CI95%: 1.46–5.80), smoking habit (OR=2.28; CI95%: 1.15–4.51) and HbA1c ≥7% (OR=1.8; CI95%: 1.1–3.1).Conclusions: A high prevalence of cardiovascular disease and cardiovascular risk factors at diabetes diagnosis was observed. Age, smoking habit and elevated glycated haemoglobin were the variables related to cardiovascular disease (AU)

[Prescribing non-steroidal antiinflammatory drugs and gastrointestinal protection in primary care]. / Adecuación de la prescripción de antiinflamatorios no esteroideos y gastroprotección en atención primaria.

OBJECTIVE: To assess whether prescribing non-steroidal anti-inflammatory drugs (NSAIDs) is adequate for gastrointestinal protection associated with NSAID use. DESIGN: Cross-sectional descriptive study. SETTING: Primary Care Centre in La Mina, Barcelona, Spain. PARTICIPANTS: A random sample of 500 patients, stratified by doctor was selected from a total of 4504 patients with an NSAID prescription. MAIN MEASUREMENTS: The dependent variables were the adequacy of NSAID prescription and gastrointestinal protection. The independent variables were: age, sex, concomitant treatments, type and number of NSAIDs. The variables were collected from the clinical history. RESULTS: The 476 patients included with an NSAID prescription had a mean age of 47.9 (18.1) years, and 63.4% were women. The NSAIDs most prescribed were, ibuprofen (60.3%), diclofenac (23.1%), and naproxen (4.0%). The most common reason for prescribing the NSAID was locomotor system pathology; 45.4%. The prescription was adequate in 44.7% (95% CI, 40.2-49.3), and inadequate in 23.5% (95% CI, 19.8-27.6). It was inadequate in 49.5% of patients over 65 years, while in under 65 year-olds 16.5% were inadequate. Gastrointestinal protection was inadequate in 28.2% (95% CI, 22.7-35.7); 12.8% excessive and 16% insufficient. In the multivariate analysis, the inadequacy probability of NSAIDs is 5.45 times greater in patients of 65 or more years than in younger patients. CONCLUSIONS: NSAID prescribing and gastrointestinal protection can be considered to be inadequate in 25% of patients. Advanced age is a major risk factor in inadequate prescribing.

Adecuación de la prescripción de antiinflamatorios no esteroideos y gastroprotección en atención primaria / Prescribing non-steroidal antiinflammatory drugs and gastrointestinal protection in primary care

Objetivo. Valorar la adecuación de laprescripción de antiinflamatorios noesteroideos (AINE) y la gastroprotecciónasociada a su uso.Diseño. Estudio descriptivo, transversal.Emplazamiento. Centro de Atención Primariade La Mina (Barcelona).Participantes. De las 4.054 personas conprescripción de AINE, se seleccionó unamuestra aleatoria estratificada por facultativode 500 pacientes.Mediciones principales. Las variablesdependientes fueron la adecuación de laprescripción de AINE y gastroprotección.Las variables independientes fueron: edad,sexo, enfermedades previas, tratamientosconcomitantes, tipo y número de AINE,motivo y tipo de prescripción del AINE. Lasvariables se recogieron de la historia clínica.Resultados. Se incluyó a 476 pacientescon prescripción de AINE. El 63,4% eranmujeres y la media ± desviación estándarde edad fue 47,9 ± 18,1 años. Los AINEmás prescritos fueron ibuprofeno (60,3%),diclofenaco (23,1%) y naproxeno (4%). Elmotivo de prescripción más frecuente fue laafección del aparato locomotor (45,4%). Lasprescripciones fueron adecuadas en el 44,7%(intervalo de confianza [IC] del 95%, 40,2-49,3) e inadecuadas en el 23,5% (IC del 95%,19,8-27,6). La inadecuación en mayores de65 años fue del 49,5%, mientras que enmenores de 65 años fue del 15,6%. Lagastroprotección fue inadecuada en el 28,2%(IC del 95%, 22,7-35,7); el 12,8% por excesoy el 16% por defecto. En el análisismultivariable, la probabilidad deinadecuación de los AINE es 5,45 vecesmayor en los pacientes de 65 años o másque en los menores.Conclusiones. La prescripción de AINEy la gastroprotección pueden considerarseinadecuadas en una cuarta parte de lospacientes. La edad avanzada es el principalfactor de riesgo de prescripción inadecuada

Objective. To assess whether prescribingnon-steroidal anti-inflammatory drugs(NSAIDs) is adequate for gastrointestinalprotection associated with NSAID use.Design. Cross-sectional descriptive study.Setting. Primary Care Centre in La Mina,Barcelona, Spain.Participants. A random sample of 500patients, stratified by doctor was selectedfrom a total of 4504 patients with anNSAID prescription.Main measurements. The dependent variableswere the adequacy of NSAID prescriptionand gastrointestinal protection. Theindependent variables were: age, sex,concomitant treatments, type and numberof NSAIDs. The variables were collectedfrom the clinical history.Results. The 476 patients included with anNSAID prescription had a mean age of 47.9(18.1) years, and 63.4% were women. TheNSAIDs most prescribed were, ibuprofen(60.3%), diclofenac (23.1%), and naproxen(4.0%). The most common reason forprescribing the NSAID was locomotorsystem pathology; 45.4%. The prescriptionwas adequate in 44.7% (95% CI, 40.2-49.3),and inadequate in 23.5% (95% CI, 19.8-27.6). It was inadequate in 49.5% of patientsover 65 years, while in under 65 year-olds16.5% were inadequate. Gastrointestinalprotection was inadequate in 28.2% (95%CI, 22.7-35.7); 12.8% excessive and 16%insufficient. In the multivariate analysis, theinadequacy probability of NSAIDs is 5.45times greater in patients of 65 or more yearsthan in younger patients.Conclusions. NSAID prescribing andgastrointestinal protection can be consideredto be inadequate in 25% of patients.Advanced age is a major risk factorin inadequate prescribing

[Experience of the quality improvement plan for the La Mina Health Centre (1989-2004)]. / Experiencia del plan de mejora de la calidad del Centro de Salud La Mina (1989-2004).

OBJECTIVES: To describe how well the problems detected by a quality improvement plan (QIP) for a health care team (HCT) were solved; and to analyse the identification methods, the quality causes and dimensions affected by the problems detected, and the participation of professionals. DESIGN: Descriptive study. Evaluation of the situation in December 2004 of the problems identified since 1989. SETTING: Urban HCT, with 58 professionals caring for a population of 18,897 inhabitants in the La Mina District, Barcelona, Spain. PARTICIPANTS: Five-hundred and thirty problems identified. MAIN MEASUREMENTS: Number and kind of detections and problems; identification methods; quality dimensions; causes; degree of solution, by method and cause; degree of solution of the QIP (of "internal" problems, excluding the problems caused externally or by patients); professional participation. RESULTS: In 312 meetings, there were 963 detections (annual average, 60.1; SD, 18.8), corresponding to 530 problems (annual average, 33.1; SD, 12.4). Of these 530 problems, 411 improved (77.5%). Of the 258 "internal" problems, 225 improved. The degree of solution of the QIP was 87.2%. The identification method that detected most problems (53.02% of the total) was the active listening of the quality improvement group. The quality dimensions most affected by the problems were effectiveness (31.7%) and accessibility (20.4%). The most frequent cause of problems and, at the same time, the category with the highest improvement rate (81.6%) was internal organization; 83.9% of professionals took part in the QIP. CONCLUSIONS: Having a QIP at our centre facilitated the management of the quality of care delivery.

Experiencia del plan de mejora de la calidad del Centro de Salud La Mina (1989-2004) / Experience of the quality improvement plan for the La Mina Health Centre (1989-2004)

Objetivo. Describir el grado de solución de los problemas detectados mediante un plan de mejora de la calidad (PMC) en un equipo de atención primaria (EAP) y analizar métodos de identificación, causas y dimensiones de la calidad afectadas por los problemas detectados y la participación del profesional. Diseño. Estudio descriptivo. Evaluación de la situación en diciembre de 2004 de los problemas identificados desde 1989. Emplazamiento. EAP urbano, constituido por 58 profesionales, que atiende a una población de 18.897 habitantes en el barrio de La Mina, Barcelona. Participantes. En total, 530 problemas identificados. Mediciones principales. Número y tipo de detecciones y problemas; métodos de identificación; dimensiones de la calidad; causas; grado de solución, por método y causa; grado de solución del PMC (de los problemas «internos», excluidos los problemas con causa externa o del paciente), y participación del profesional. Resultados. En 312 reuniones se realizaron 963 detecciones (media anual, 60,1 ± 18,8) que correspondieron a 530 problemas (media anual, 33,1 ± 12,4). De estos 530 problemas se mejoraron 411 (77,5%). De los 258 problemas «internos» se mejoraron 225. El grado de solución del PMC fue del 87,2%. El método de identificación que detectó más problemas (53,02% del total) fue la escucha activa del grupo de mejora de calidad. Las dimensiones de la calidad más afectadas por los problemas fueron la efectividad (31,7%) y la accesibilidad (20,4%). La causa más frecuente y, a su vez, con mayor índice de mejora (81,6%) fue la organización interna. El 83,9% de los profesionales participó en el PMC. Conclusiones. Disponer de un PMC en nuestro centro ha facilitado la gestión de la calidad asistencial

Objectives. To describe how well the problems detected by a quality improvement plan (QIP) for a health care team (HCT) were solved; and to analyse the identification methods, the quality causes and dimensions affected by the problems detected, and the participation of professionals. Design. Descriptive study. Evaluation of the situation in December 2004 of the problems identified since 1989. Setting. Urban HCT, with 58 professionals caring for a population of 18 897 inhabitants in the La Mina District, Barcelona, Spain. Participants. Five-hundred and thirty problems identified. Main measurements. Number and kind of detections and problems; identification methods; quality dimensions; causes; degree of solution, by method and cause; degree of solution of the QIP (of "internal" problems, excluding the problems caused externally or by patients); professional participation. Results. In 312 meetings, there were 963 detections (annual average, 60.1; SD, 18.8), corresponding to 530 problems (annual average, 33.1; SD, 12.4). Of these 530 problems, 411 improved (77.5%). Of the 258 "internal" problems, 225 improved. The degree of solution of the QIP was 87.2%. The identification method that detected most problems (53.02% of the total) was the active listening of the quality improvement group. The quality dimensions most affected by the problems were effectiveness (31.7%) and accessibility (20.4%). The most frequent cause of problems and, at the same time, the category with the highest improvement rate (81.6%) was internal organization; 83.9% of professionals took part in the QIP. Conclusions. Having a QIP at our centre facilitated the management of the quality of care delivery

[Incidence of type 2 diabetes and its diagnosis process in the decade 1991-2000 in a primary health care centre]. / Incidencia de diabetes tipo 2 y análisis del proceso diagnóstico en un centro de atención primaria durante la década de los noventa.

BACKGROUND AND OBJECTIVE: To determine the annual incidence and reasons for diagnosing type 2 diabetes mellitus (T2DM) from 1991 to 2000. PATIENTS AND METHOD: We performed a retrospective, longitudinal study. The clinical records of all new cases of T2DM registered in an urban primary care center over a 10-year period were reviewed. The annual incidence and prevalence in the population aged more than 14 years old were calculated. Statistical analyses of temporal trends and periodicity (monthly, seasonal and annual) were performed with ARIMA models (Box-Jenkins), Poisson parametrical regression and semiparametrical (GAM) models. RESULTS: There were 598 true new cases of T2DM (mean age [SD]: 59.7 [11.4] years; 51.3% women). The most frequent associated cardiovascular risk factors were obesity (58.5%) and hypertension (68.2%). The main reasons for diagnosing T2DM were the presence of previous hyperglycemia (64.7%) and the application of protocols for other cardiovascular risk factors (12.4%).The annual incidence was 37.9 per 10,000 persons (95% CI, 34.9-40.9) with no differences between sexes. The prevalence of T2DM at the beginning and end of the study period was 4.4 (95% CI, 2.0-4.8) and 5.5% (95% CI, 5.2-5.9) (25% relative increase). There was no significant temporal trend in the incidence of T2DM over the years. CONCLUSIONS: The observed incidence of T2DM is high compared with that reported in other studies. The increase in prevalence was not related to a progressive increase in the incidence. The most frequent reasons for diagnosing T2DM were previous hyperglycemia and the application of protocols for other cardiovascular risk factors. This finding seems to be related to an early diagnosis and could benefit these patients.

Incidencia de diabetes tipo 2 y análisis del proceso diagnóstico en un centro de atención primaria durante la década de los noventa / Incidence of type 2 diabetes and its diagnosis process in the decade 1991-2000 in a primary health care centre

Fundamento y objetivo: Conocer la incidencia anual y los motivos de diagnóstico de la diabetes mellitus tipo 2 (DM2) en el período 1991-2000. Pacientes y método: Estudio longitudinal retrospectivo. Revisión de las historias clínicas de todos los nuevos casos de DM2 registrados en un centro de salud urbano durante 10 años. Cálculo de la prevalencia e incidencia anuales en la población mayor de 14 años. Análisis de las tendencias temporales y periodicidad en la incidencia de DM2 (mensual, estacional y anual) mediante modelos ARIMA (Box-Jenkins), modelo paramétrico de regresión de Poisson y modelos semiparamétricos (GAM). Resultados: Se identificaron 598 nuevos casos de DM2 (edad media [DE], 59,7 [11,4] años; 51,3% mujeres). Los factores de riesgo cardiovascular más frecuentes fueron la obesidad (58,5%) y la hipertensión arterial (68,2%). Los principales motivos de diagnóstico fueron: hiperglucemias previas (64,7%) y la aplicación de protocolos de otros factores de riesgo cardiovascular (12,4%). La incidencia anual fue de 37,9 por 10.000 personas (intervalo de confianza [IC] del 95%, 34,9-40,9), sin diferencias significativas entre ambos sexos. La prevalencia de DM2 al principio y al final del estudio fue del 4,4% (IC del 95%, 2,0-4,8) y el 5,5% (IC del 95%, 5,2-5,9) (un 25% de incremento relativo), sin que el análisis de tendencias mostrara un incremento progresivo de la incidencia. Conclusiones: La incidencia observada es superior a la descrita en otros estudios. El incremento de la prevalencia no se relaciona con un incremento progresivo de la incidencia. Los motivos de diagnóstico más frecuentes fueron el seguimiento de hiperglucemias previas y la aplicación de protocolos de otros factores de riesgo cardiovascular. Este hecho parece indicar un diagnóstico precoz que podría beneficiar a estos pacientes

Background and objective: To determine the annual incidence and reasons for diagnosing type 2 diabetes mellitus (T2DM) from 1991 to 2000. Patients and method: We performed a retrospective, longitudinal study. The clinical records of all new cases of T2DM registered in an urban primary care center over a 10-year period were reviewed. The annual incidence and prevalence in the population aged more than 14 years old were calculated. Statistical analyses of temporal trends and periodicity (monthly, seasonal and annual) were performed with ARIMA models (Box-Jenkins), Poisson parametrical regression and semiparametrical (GAM) models. Results: There were 598 true new cases of T2DM (mean age [SD]: 59.7 [11.4] years; 51.3% women). The most frequent associated cardiovascular risk factors were obesity (58.5%) and hypertension (68.2%). The main reasons for diagnosing T2DM were the presence of previous hyperglycemia (64.7%) and the application of protocols for other cardiovascular risk factors (12.4%).The annual incidence was 37.9 per 10,000 persons (95% CI, 34.9-40.9) with no differences between sexes. The prevalence of T2DM at the beginning and end of the study period was 4.4 (95% CI, 2.0-4.8) and 5.5% (95% CI, 5.2-5.9) (25% relative increase). There was no significant temporal trend in the incidence of T2DM over the years. Conclusions: The observed incidence of T2DM is high compared with that reported in other studies. The increase in prevalence was not related to a progressive increase in the incidence. The most frequent reasons for diagnosing T2DM were previous hyperglycemia and the application of protocols for other cardiovascular risk factors. This finding seems to be related to an early diagnosis and could benefit these patients