Resultados de la implementación de un programa piloto de optimización de antimicrobianos (PROA) en Atención Primaria / Results of implementation of a pilot antimicrobial stewardship program (ASP) in Primary Care

FUNDAMENTO: El objetivo de este estudio fue evaluar la implementación de un programa piloto de optimización de antimicrobianos (PROA) en equipos de Atención Primaria (EAP) en Navarra. MATERIAL Y MÉTODOS: Estudio experimental, no aleatorizado, realizado con datos del sistema de facturación de recetas. Se calculó la variación del uso de antibióticos antes (2018) y después (2019) de implementar el PROA en doce EAP, y se comparó con la variación en otros doce EAP sin PROA. Se consideró el consumo global y por grupo terapéutico: beta-lactámicos, fluoroquinolonas, macrólidos, cefalosporinas y fosfomicina-trometamol, expresado como número de pacientes tratados y DDD (dosis diarias definidas). RESULTADOS: El número de pacientes tratados con antibióticos disminuyó significativamente más en el grupo de EAP con PROA (-9,1 vs -1,7%), especialmente en el caso de fluoroquinolonas (-25 vs -20,4%), macrólidos (-20,4 vs -8,5%) y amoxicilina-clavulánico (-10,3 vs -2,5%). Las reducciones en DDD siguieron el mismo patrón. En ambos grupos de EAP se mantuvo constante el número de pacientes tratados con cefalosporinas de tercera generación, mientras que aumentaron de forma similar los tratados con cefalosporinas de primera generación y con penicilinas sensibles a betalactamasa. En los EAP con PROA aumentó significativamente menos el número de pacientes tratados con fosfomicina-trometamol (4,0 vs 11,5%), reduciendo su consumo en DDD mientras que aumentaron en los EAP sin PROA (-1 vs 10%, p < 0,001). CONCLUSIONES: Los EAP con PROA redujeron significativamente más el consumo global de antimicrobianos, fluoroquinolonas, macrólidos y amoxicilina-clavulánico que el grupo sin PROA. Estos resultados positivos han propiciado su extensión al resto de EAP de Navarra

BACKGROUND: The aim of this study was to evaluate the implementation of a pilot antimicrobial stewardship program (ASP) in Primary Health Care teams (PHCT) in Navarre (Spain). MATERIAL AND METHODS: Non-randomized experimental study performed with data obtained from the electronic pharmacy records. Differences in consumption of antibiotics before (2018) and after (2019) ASP implementation in twelve PHCT were calculated. Another twelve PHCT without ASP were used for comparison. We analysed data on global and beta-lactams, fluoroquinolones, macrolides, cephalosporines and fosfomycin-trometamol, expressed in number of treated patients and DDD (defined daily doses). RESULTS: The number of patients with prescribed antibiotics decreased significantly more in PHCT with ASP (-9.1 vs. -1.7%), particularly with fluoroquinolones (-25 vs. -20.4%), macrolids (-20.4 vs. -8.5%) and amoxicillin-clavulanic (-10.3 vs. -2.5%). Decreased DDD followed the same pattern. Both PHCT groups kept constant the number of patients with prescribed third generation cephalosporins, while those with prescribed first generation cephalosporins and betalactamase-sensible penicilins increased similarly. In PHCT with ASP, increased number of patients with prescribed phosphomycin-trometamol was smaller (4.0 vs. 11.5%) while its consumption expressed in DDDs was reduced while increasing in PHCT without ASP (-1 vs. 10%, p < 0.001). CONCLUSIONS: PHCT with ASP resulted in a significantly greater decrease in the global use of antimicrobials, fluoroquinolones, macrolides and amoxicillin-clavulanic than PHCT without ASP. These very positive results promoted their extension to the remaining PHCT

[Results of implementation of a pilot antimicrobial stewardship program (ASP) in Primary Care].

BACKGROUND: The aim of this study was to evaluate the implementation of a pilot antimicrobial stewardship program (ASP) in Primary Health Care teams (PHCT) in Navarre (Spain). MATERIAL AND METHODS: Non-randomized experimental study performed with data obtained from the electronic pharmacy records. Differences in consumption of antibiotics before (2018) and after (2019) ASP implementation in twelve PHCT were calculated. Another twelve PHCT without ASP were used for comparison. We analysed data on global and beta-lactams, fluoroquinolones, macrolides, cephalosporines and fosfomycin-trometamol, expressed in number of treated patients and DDD (defined daily doses). RESULTS: The number of patients with prescribed antibiotics decreased significantly more in PHCT with ASP (-9.1 vs. -1.7%), particularly with fluoroquinolones (-25 vs. -20.4%), macrolids (-20.4 vs. -8.5%) and amoxicillin-clavulanic (-10.3 vs. -2.5%). Decreased DDD followed the same pattern. Both PHCT groups kept constant the number of patients with prescribed third generation cephalosporins, while those with prescribed first generation cephalosporins and betalactamase-sensible penicilins increased similarly. In PHCT with ASP, increased number of patients with prescribed phos-phomycin-trometamol was smaller (4.0 vs. 11.5%) while its consumption expressed in DDDs was reduced while increasing in PHCT without ASP (-1 vs. 10%, p<0.001).

Heterogeneidad en el cribado poblacional de la fragilidad / Heterogeneity amongst different diagnostic tools in frailty screening

Fundamento: La fragilidad supone una situación de vulnerabilidad predisponente a resultados adversos en salud, relacionada con la edad y la pérdida de capacidad funcional. Aunque Atención Primaria (AP) es un nivel asistencial privilegiado para detectarla precozmente e instaurar medidas que frenen su progresión, no existe una herramienta gold standard para su detección. El objetivo es analizar la prevalencia de fragilidad en AP y evidenciar la herramienta diagnóstica más útil para este medio. Materialy métodos: Estudio transversal realizado en una muestra de 225 personas seleccionadas aleatoriamente de una población de 4.252 mayores de 75 años de tres zonas de Navarra. Se realizaron cuatro pruebas diagnósticas de fragilidad: el fenotipo de Fried, el Short Physical Performance Battery (SPPB), el Up-to Go (TUG) y el de la velocidad de la marcha (VM). Los participantes que no consiguieron finalizar alguna de las pruebas no fueron considerados en el análisis posterior. Resultados: El 51% de los participantes eran hombres, con edad media de 80,5 años, el 80% polimedicados, el 8,4% con deterioro cognitivo y el 31,1 y el 41,3% independientes para las actividades básicas e instrumentales, respectivamente, de la vida diaria. La prevalencia de fragilidad fue 8,4% (Fried), 13,7% (SPPB), 46,2% (TUG) y 52,2% (VM). Conclusiones. Se detectó gran heterogeneidad en la prevalencia de fragilidad según la herramienta diagnóstica empleada. Es necesaria una herramienta fiable, rápida y sencilla para la detección precoz de la fragilidad en AP por lo que, según los resultados y las peculiaridades de AP, proponemos el TUG o la VM como buenos predictores precoces de este deterioro

Background: Frailty means a state of vulnerability with a predisposition to adverse health outcomes, closely related to age and a consequent loss of functional capability. Early detection is important for initiating measures to slow its progression. Primary Health Care (PHC) occupies a privileged place in this. However, we do not possess a gold standard tool for its detection. Our aim is to analyse the prevalence of frailty in PHC and define the most useful diagnostic tool for this area. Methods: Cross-sectional study with 225 people were selected from a population of 4,252 people aged over 75 years-old, from three different basic health zones of Navarre. Four different diagnostic tests for frailty were conducted: the Fried phenotype, the Short Physical Performance Battery (SPPB), the Timed Up-to-Go test (TUG) and the Gait Speed test (GS). Patients who were unable to finish any of the tests weren't included in the subsequent analysis. Results: Fifty-one percent of participants were men, with mean age 80.5 years-old, 80% were taking more than five daily drugs, 8.4% had cognitive impairment, and 31.1 and 41.3% were independent for basic and instrumental activities, respectively, of daily living. The frailty prevalence was 8.3% for Fried phenotype, 13.7% for SPPB, 46.2% for TUG and 52.2% for Gait Speed. Conclusion: Great heterogeneity in the prevalence of frailty was shown depending on the tool employed. As a reliable, fast and simple tool for early detection of frailty is needed in PHC, based on our results and the particularities of PHC, we propose TUG or GS as good early predictors of this decline

[Heterogeneity amongst different diagnostic tools in frailty screening]. / Heterogeneidad en el cribado poblacional de la fragilidad.

BACKGROUND: Frailty means a state of vulnerability with a predisposition to adverse health outcomes, closely related to age and a consequent loss of functional capability. Early detection is important for initiating measures to slow its progression. Primary Health Care (PHC) occupies a privileged place in this. However, we do not possess a gold standard tool for its detection. Our aim is to analyse the prevalence of frailty in PHC and define the most useful diagnostic tool for this area. METHODS: Cross-sectional study with 225 people were selected from a population of 4,252 people aged over 75 years-old, from three different basic health zones of Navarre. Four different diagnostic tests for frailty were conducted: the Fried phenotype, the Short Physical Performance Battery (SPPB), the Timed Up-to-Go test (TUG) and the Gait Speed test (GS). Patients who were unable to finish any of the tests weren't included in the subsequent analysis. RESULTS: Fifty-one percent of participants were men, with mean age 80.5 years-old, 80% were taking more than five daily drugs, 8.4% had cognitive impairment, and 31.1 and 41.3% were independent for basic and instrumental activities, respectively, of daily living. The frailty prevalence was 8.3% for Fried phenotype, 13.7% for SPPB, 46.2% for TUG and 52.2% for Gait Speed. CONCLUSION: Great heterogeneity in the prevalence of frailty was shown depending on the tool employed. As a reliable, fast and simple tool for early detection of frailty is needed in PHC, based on our results and the particularities of PHC, we propose TUG or GS as good early predictors of this decline.