Medicalización de la vida (II) / Medicalisation of every-day life (II)

La medicalización de la vida es uno de los problemas que actualmente contribuyen a la masificación de las consultas del Médico de Familia y de los Servicios de Urgencias, provocando, a la vez, dificultades para proporcionar una atención de alta calidad y frustración en una buena parte de los profesionales. Entendemos por medicalización el proceso de convertir situaciones que han sido siempre normales en cuadros patológicos y pretender resolver, mediante la medicina, situaciones que no son médicas, sino sociales, profesionales o de las relaciones interpersonales. Los profesionales sanitarios son, a la vez, actores y victimas de dicho proceso. La medicalización tiene como principales consecuencias la trasformación de personas sanas en enfermos, el aumento de daños iatrogénicos, el consumo de recursos sanitarios y la pérdida de eficacia y eficiencia de los mismos. Entre las actuaciones recomendadas cabe destacar acciones encaminadas a regular las expectativas de la población, delimitar el campo de acción de la medicina, fomentar el autocuidado y actuar de acuerdo con las evidencias sanitarias existentes (AU)

Medicalisation of every-day life is one of the problems currently contributing to the massification of visits to Doctors' surgeries or Hospital Emergency Departments, thus making it difficult to provide high quality healthcare and causing frustration for many health professionals. Medicalisation is understood as being the process of turning normal human conditions into medical conditions or diseases and trying to resolve them through medicines. Such conditions are not medical, but social or professional conditions or issues related to interpersonal relationships. Health professionals are both the actors and the victims of this process. The main consequences of medicalisation are: transforming healthy persons into patients, increasing iatrogenic harm and the consumption of healthcare resources and loss of efficacy and efficiency of the same. Amongst the recommended actions we emphasise those directed towards regulating the expectations of the population, restricting the field of action of medicine, encouraging self-care and acting according to current healthcare evidence (AU)

Valoración Clínica y Calidad de Vida relacionada con la Salud del Paciente con Insomnio / Quality of life of people with insomnia in the Toledo health area

Objetivo. Valoración clínica y de la calidad de vida del paciente insomne. Tipo de estudio. Descriptivo transversal. Emplazamiento. Atención Primaria de Toledo. Población. Pacientes diagnosticados de insomnio antes de enero de 2008. Mediciones. Revisión historia clínica: registro de actividades diagnóstico-terapéuticas y entrevista telefónica para realizar historia del sueño y cuestionario EQ-5D. Resultados. N = 94. Edad media 60,3 ± 14,3 años. 79,8% mujeres. El 73,4% (IC 95%: 62,0- 80,0) presentaba eficiencia del sueño ≤ 90%. El 69,1% (IC 95%: 58,6-78,0) refería dormir mal. Repercusiones: 76,8% dice levantarse cansado, interfiere en la actividad del 70,6%; al 63,2% le ocasiona distracciones y al 39,7% somnolencia diurna. El 58,1% sufre insomnio de conciliación, 25,8% de mantenimiento, 8,6% despertar precoz. El 27,8% de pacientes recibió recomendaciones de higiene del sueño. Principios más prescritos: lorazepam (47,2%), lormetazepam (23,6%) y zolpidem (19,1%). Mediana de duración del tratamiento: 32 semanas (RI 58). Actualmente no tomaba tratamiento el 24,7%. De ellos, decía dormir bien el 21,7%. Consideraba su salud buena/muy buena el 17,2% de los tratados y el 26,1% de los no tratados. Presentaban peores puntuaciones en EVA del EQ-5D los de mayor edad (r = -0,33; p = 0,001), los que referían dormir mal (55,8 vs 53,2; t = 0,52; p > 0,05), aquellos con despertar precoz (F = 3,51; p = 0,01) y los tratados farmacológicamente (51,5 vs 61,5; t = 1,93; p = 0,06). Conclusiones. La mayoría de los pacientes insomnes continúa durmiendo mal y presenta mala eficiencia del sueño aún con tratamiento farmacológico. La principal repercusión es el cansancio, que interfiere en su actividad habitual. El insomnio repercute negativamente en la calidad de vida(AU)

Objective. Clinical assessment and quality of life of the insomniac patient. Design. cross-sectional study. Setting. Primary Health Care. Toledo (Spain). Participants. Patients diagnosed with insomnia before January 2009. Measurements. Medical history review: record of diagnostic and therapeutic activities. Telephone interview: sleep history and EQ-5D questionnaire Results. N = 94. Average age 60.3 ± 14.3 years, 79.8% are women. 73.4% (95%CI 62.0–80.0%) had less than 90% sleep efficiency and 69.1% said they sleep badly. Impact: 76.8% get up feeling tired; in 70.6% insomnia interferes with their activities, in 63.2% it causes distractions and in 39.7% daytime sleepiness. 58.1% have conciliation insomnia, 25.8% have maintenance insomnia, and 8.6% early awakening. 27.8% of patients received advice on sleep hygiene. The most commonly prescribed drugs were lorazepam (47.2%), lormetazepam (23.6%) and zolpidem (19.1%). Median duration of treatment was 32 weeks (RI 58). Currently 24.7% are not taking any treatment, 21.7% of whom said they sleep well. 17.2% of those who were treated and 26.1% of those who were not considered they were in good or very good health. Older patients (r= -0.33; p = 0.001), those who said they sleep badly (55.8 vs 53.2; t = 0, 52; p > 0.05), those with early awakening (F = 3.51; p = 0.01) and those on pharmacotherapy (51.5 vs 61.5; t = 1.93 p = 0.06) had the worst scores in the EQ5D. Conclusions. Most patients with insomnia continue to sleep badly and have poor sleep efficiency, even with pharmacological treatment. The main impact is tiredness, which interferes with their normal activities. Insomnia has a negative effect on the quality of life(AU)

Medicalización de la vida (I) / Medicalisation of every-day life (I)

La medicalización de la vida es uno de los problemas que actualmente contribuyen a la masificación de las consultas del Médico de Familia y de los Servicios de Urgencias, provocando, a la vez, dificultades para proporcionar una atención de alta calidad y frustración en una buena parte de los profesionales. Entendemos por medicalización el proceso de convertir situaciones que han sido siempre normales en cuadros patológicos y pretender resolver, mediante la medicina, situaciones que no son médicas, sino sociales, profesionales o de las relaciones interpersonales. La medicalización es un proceso continuo que se autoalimenta y crece de forma constante, facilitado por una situación en la que la sociedad va perdiendo toda capacidad de resolución y su nivel de tolerancia. Su origen es multifactorial, existiendo diversas causas y actores implicados (sociedad, medios de comunicación, industria farmacéutica, políticos, gestores y profesionales sanitarios), jugando el sector sanitario un papel fundamental en dicho proceso. Los profesionales sanitarios son, a la vez, actores y victimas de dicho proceso. Presentamos en este documento una reflexión sobre el proceso de medicalización de la vida y los factores intervinientes(AU)

Medicalisation of every-day life is one of the problems currently contributing to the massification of visits to the Doctors’ surgeries or Hospital Emergency Departments, thus making it difficult to provide high quality healthcare and causing frustration for many health professionals. Medicalisation is understood as being the process of turning normal human conditions into medical conditions and trying to resolve them through medicines. Such conditions are not medical, but social or professional conditions or having to do with interpersonal relationships. Medicalisation is an on-going process that feeds on itself and is steadily growing, aided by a situation in which society is losing all ability of resolution and tolerance. Its origin is multifactorial, and there are several causes and actors implicated (society, the media, the pharmaceutical industry, politicians, managers and health professionals), the health sector playing a key role in this process. Health professionals are both the actors and the victims of this process. We present a reflection on the process of medicalisation of every-day life and the intervening factors(AU)

Atención continuada, ¿un factor de riesgo cardiovascular más a considerar? / Continuous care, one more cardiovascular risk factor to consider?

Objetivo. Valorar cambios en la presión arterial (PA) de los profesionales de Atención Primaria (AP) durante la realización de Atención Continuada (AC) y su relación con el rol profesional, nivel de ansiedad y apoyo social. Método. Estudio descriptivo, transversal, multicéntrico y prospectivo. Población: sanitarios de AP del Área de Salud de Toledo que realicen AC. Criterios de exclusión: hipertensión arterial diagnosticada, raza negra, enfermedad cardiovascular o tratamientos crónicos. Muestreo voluntario. Variables: sociodemográficas; laborales; cuestionario STAI (ansiedad estado/rasgo); cuestionario ISTAS21 (riesgos psicosociales laborales), y monitorización ambulatoria de la PA con holter durante 2 jornadas de 24h: una de AC y otra de descanso laboral no saliente de guardia. Resultados. El MAPA mostró diferencias significativas en la PA sistólica diurna: descanso 115,9±8,3mmHg/guardia 120,2±8,1 (t=4,319; p<0,001); diastólica diurna: descanso 73,3±5,9mmHg/guardia 77,9±6,1 (t=6,555; p<0,001); sistólica nocturna: descanso 106,8±8,3mmHg/guardia 111,6±9,5 (t=3,4; p<0,001); diastólica nocturna: descanso 65,1±5,6mmHg/guardia 69,1±6,9 (t=4,14; p<0,001). No encontramos relación entre las variaciones en la PA, la categoría o el rol. Las dimensiones del ISTAS (situación desfavorable-intermedia para la salud) y el nivel de ansiedad (media de 5/10 durante la guardia) tampoco se relacionaban con la PA. Conclusiones. Existen cambios significativos en la PA de los profesionales durante la realización de guardias, independientemente del rol profesional, nivel de ansiedad o riesgo psicosocial. Demostrada la variación de la PA durante la AC, será necesario realizar estudios para valorar su repercusión en la salud (AU)

Objective. To assess blood pressure (BP) in Primary Care (PC) professionals while working extra shifts and its relationship with the professional role, anxiety level and social support. Method. Descriptive, cross-sectional, multicentre and prospective study. Population: PC health workers from Toledo Health Area who work on-call shifts. Exclusion criteria: diagnosed hypertension, African origin, cardiovascular disease or chronic treatment. Voluntary sampling. Variables: sociodemographic, occupational and STAI questionnaire (anxiety state/feature); ISTAS21 questionnaire (psychosocial risks at work), and Ambulatory BP Monitoring with a Holter for two days, 48h: one of them during the shift and the other one during a day without being on-call. Results. The BP monitor showed significant differences in daytime systolic BP: rest day115.9±8,3mmHg/ Shift mean: 120.2±8,1 (t=4.319; P<0.001); daytime diastolic: rest day 73.3±5.9mmHg/Shift 77.9±6.1 (t=6.555; P<0.001); night systolic: rest day 106.8±8.3mmHg/shift 111.6±9.5 (t=3.4; P<0.001); night diastolic: rest day 65.1±5.6mmHg/Shift 69.1±6.9 (t=4.14; P<0.0001). We found no relationship between variations in the BP, the category or role. The ISTAS dimensions (health situation status) and the anxiety level (average of 5/10 during the shift) are not related with the BP either. Conclusions. There are significant changes in the BP of the professional during the extra shifts, independently of professional role, anxiety level or psychosocial risk. Studies need to be conducted on the demonstrated variation in BP working extra shifts to assess its impact on health (AU)

[Continuous care, one more cardiovascular risk factor to consider?]. / Atención continuada, ¿un factor de riesgo cardiovascular más a considerar?

OBJECTIVE: To assess blood pressure (BP) in Primary Care (PC) professionals while working extra shifts and its relationship with the professional role, anxiety level and social support. METHOD: Descriptive,, cross-sectional, multicentre and prospective study. POPULATION: PC health workers from Toledo Health Area who work on-call shifts. EXCLUSION CRITERIA: diagnosed hypertension, African origin, cardiovascular disease or chronic treatment. Voluntary sampling. VARIABLES: sociodemographic, occupational and STAI questionnaire (anxiety state/feature); ISTAS21 questionnaire (psychosocial risks at work), and Ambulatory BP Monitoring with a Holter for two days, 48h: one of them during the shift and the other one during a day without being on-call. RESULTS: The BP monitor showed significant differences in daytime systolic BP: rest day115.9±8,3mmHg/ Shift mean: 120.2±8,1 (t=4.319; P<0.001); daytime diastolic: rest day 73.3±5.9mmHg/Shift 77.9±6.1 (t=6.555; P<0.001); night systolic: rest day 106.8±8.3mmHg/shift 111.6±9.5 (t=3.4; P<0.001); night diastolic: rest day 65.1±5.6mmHg/Shift 69.1±6.9 (t=4.14; P<0.0001). We found no relationship between variations in the BP, the category or role. The ISTAS dimensions (health situation status) and the anxiety level (average of 5/10 during the shift) are not related with the BP either. CONCLUSIONS: There are significant changes in the BP of the professional during the extra shifts, independently of professional role, anxiety level or psychosocial risk. Studies need to be conducted on the demonstrated variation in BP working extra shifts to assess its impact on health.

¿Cómo son las páginas webs de los laboratorios farmacéuticos dirigidas a los usuarios? / How are the websites of pharmaceutical companies directed at users?

ObjetivoDescribir el contenido y la estructura de las páginas webs de los laboratorios farmacéuticos (LF) con información sanitaria dirigida a pacientes.DiseñoDescriptivo transversal. Variables: temas de salud tratados y 9 apartados: población diana y objetivos, política editorial, autoría, actualización de contenidos, protección de datos personales, interactividad, accesibilidad, publicidad y sellos de calidad.EmplazamientoInternet.ParticipantesTodas las páginas webs en español de LF con información sanitaria dirigida a pacientes.MedicionesSe estudiaron las 60 páginas webs encontradas. Temas más frecuentes: neurología-salud mental (19,3%) y digestivos (12%). Pocas especifican la dirección del responsable del sitio (51,7%), del responsable de la calidad (10%) o de los autores del texto (15%). Casi dos tercios tienen fecha de publicación del contenido (66,7%), pero de actualización sólo el 13,3%. Declara política de privacidad y protección de datos el 65% y sólo posibilita controlar el uso de datos personales el 28,3%. Un 10% permite dudas en línea y un tercio tiene área de preguntas más frecuentes. El 41,7% omite que su información no reemplaza la consulta médica. Un 11,7% permite descargar material didáctico (infantil). El 93,3% adapta su lenguaje al destinatario, pero ninguna es accesible para discapacitados. Mayoritariamente (86,7%) muestran el logotipo del laboratorio en todas las páginas. Sólo el 16,7% son máscaras para la publicidad. Exclusivamente 9 páginas webs tienen sello de calidad (HONcode).ConclusionesSon páginas dirigidas más a informar superficialmente sobre una enfermedad que a publicitar directamente un principio activo o una marca determinada. Sin embargo, su fiabilidad debe ser baja al desconocerse autores y fuentes de información. La información sanitaria de Internet debe ser veraz y estar avalada por autores o fuentes de información adecuadas; así, Internet podrá ser una verdadera herramienta de educación sanitaria(AU)

ObjectiveTo describe the content and structure of the websites of pharmaceutical companies (PC) with health information to patients.DesignDescriptive, cross-sectional.Main measurementshealth topics treated, and 9 sections: objectives and target population; editorial policy, authoring, updating of content, personal data protection, interactivity, accessibility, advertising labels.SettingInternet.ParticipantsAll PC websites with patient health information in Spanish.ResultsWe studied 60 sites found. Most common: 19.3% neurology, mental health and 12% digestive diseases. Few specify the address of the person responsible for the site (51.7%), responsible for quality (10%) or the authors of the text (15%). Nearly 2/3 show the date of publication of content (66.7%), but only 13.3% updated. Privacy and data protection are mentioned in 65%, with only 28.3% allowing control of the use of personal data. Only 10% allow expressing doubts online and 1/3 of the sites have frequently asked questions. A total of 41.7% omitted to say their information does not replace medical advice. Educational materials (for children) can be downloaded in 11.7%. Almost all (93.3%) adapted their language to the recipient, but none are accessible to disabled people. The majority (86.7%) have the company logo on all pages. Only 16.7% are fronts for advertising, and only 9 sites have a quality seal (HONcode).ConclusionsPages are designed to give superficial information on a disease than directly advertise a particular brand or active ingredient. However, their reliability has to be low due to the authors and sources of information being unknown. If Internet health information was truthful and backed up by authors or appropriate information sources, the Internet could well be a genuine health education tool(AU)

¿También somos variables ante la Evidencia? / Do we also vary when faced with evidence based treatment?

Objetivo. Describir la variabilidad terapéutica entre médicos de Atención Primaria (AP) ante casos clínicos con evidencia respecto a su tratamiento. Diseño. Descriptivo y transversal. Emplazamiento. Área de Salud de Toledo. Participantes. Médicos de familia con contrato estable. Mediciones principales. Encuesta anónima y autocumplimentada con 6 casos clínicos frecuentes: 1) Neumonía típica adquirida en la Comunidad, varón joven sin complicaciones (tratamiento según evidencia: amoxicilina), 2) Herpes zoster oftálmico (antiviral + paracetamol/codeína), 3) Artrosis en posmenopáusica sin osteoporosis (paracetamol), 4) Cistitis, mujer joven sin complicaciones (amoxicilina-clavulánico, norfloxacino y fosfomicina), 5) gastroprotección en paciente con corticoides (no), 6) Prevención trombosis venosa profunda, varón joven sin factores de riesgo con esguince de tobillo (no heparina de bajo peso molecular). Se recogieron datos del médico (edad, sexo, MIR, años de experiencia) y entorno laboral (contrato, presión asistencial, cupo, distancia al hospital). Resultados. N = 146 (tasa de respuesta 51%). Caso 1: tratamiento según evidencia 6,8% (IC 95%: 4,7-8,9); Caso 2: 31,5% (IC 95%: 27,7-35,3); Caso 3: 80,8% (IC 95%: 77,5-84,1); Caso 4: 90,5% (IC 95%: 88,1-92,9); Caso 5: 15,9% (IC 95%: 12,9-18,9); Caso 6: 72,5% (IC 95%: 68,7-76,2). Las variables sexo, contrato, cupo, distancia al hospital y presión asistencial no se relacionaron con la respuesta. En el caso 2 se encontraron diferencias estadísticamente significativas respecto a edad (p<0,0001) y experiencia (p<0,01). En los casos 1 y 5 sólo para formación MIR (p<0,05 y p<0,005 respectivamente). Conclusiones. Constatamos variabilidad en la prescripción incluso ante situaciones para las que existe evidencia científica. Muchas de las actitudes terapéuticas no coinciden con la mayoría de las recomendaciones. El mejor conocimiento de la práctica clínica es fundamental para aumentar la calidad asistencial, al detectar áreas de mejora para las que priorizar actuaciones (AU)

Objective. To determine treatment variability among Primary Care (PC) doctors using clinical cases with evidence based treatment. Design. Descriptive, cross-sectional study. Setting. Toledo Health Area Participants. General practitioners with a stable contract. Main measurements. Self-complete, anonymous questionnaire on six common clinical cases: 1) Community acquired pneumonia, young maln with no complications (evidence based treatment: amoxicillin), 2) Herpes zoster ophthalmicus (antiviral + paracetamol/codeine), 3) Osteoarthritis in post-menopause without osteoporosis (paracetamol), 4) Cystitis, young woman with no complications (amoxicillin-clavulanic acid, norfloxacin and phosphomycin), 5) gastroprotection in patient taking corticoids (no), 6) Prevention of deep vein thrombosis, young man with no risk factors and a sprained ankle (not low molecular weight heparin). The doctors’ characteristics were collected (age, sex, medical residency training (MIR), years of experience) work conditions (contract, attendance pressure, quota, distance from hospital). Results. N = 146 (response rate 51%). Case 1: evidence based treatment 6.8% (95%CI: 4.7-8.9); Case 2: 31.5% (95%CI: 27.7-35.3); Case 3: 80.8% (95%CI: 77.5-84.1); Case 4: 90.5% (95%CI: 88.1-92.9); Case 5: 15.9% (95% CI: 12.9-18.9); Case 6: 72.5% (95% CI: 68.7-76.2). The variables of sex, contract, distance from hospital and attendance pressure were not related to response. In case 2 statistically significant differences were found with respect to age, (p<0.0001) and experience (p<0.01) and in cases 1 and 5 only with respect to MIR (p<0.05 and p<0.005 respectively). Conclusions. We found prescription variability even in clinical situations for which there was scientific evidence. Many of the treatment habits did not coincide with most of the recommendations. Better knowledge of clinical practice is essential to improve healthcare quality. Areas for improvement need to be detected in order to prioritize actions (AU)

[How are the websites of pharmaceutical companies directed at users?]. / ¿Cómo son las páginas webs de los laboratorios farmacéuticos dirigidas a los usuarios?

OBJECTIVE: To describe the content and structure of the websites of pharmaceutical companies (PC) with health information to patients. DESIGN: Descriptive, cross-sectional. MAIN MEASUREMENTS: health topics treated, and 9 sections: objectives and target population; editorial policy, authoring, updating of content, personal data protection, interactivity, accessibility, advertising labels. SETTING: Internet. PARTICIPANTS: All PC websites with patient health information in Spanish. RESULTS: We studied 60 sites found. Most common: 19.3% neurology, mental health and 12% digestive diseases. Few specify the address of the person responsible for the site (51.7%), responsible for quality (10%) or the authors of the text (15%). Nearly 2/3 show the date of publication of content (66.7%), but only 13.3% updated. Privacy and data protection are mentioned in 65%, with only 28.3% allowing control of the use of personal data. Only 10% allow expressing doubts online and 1/3 of the sites have frequently asked questions. A total of 41.7% omitted to say their information does not replace medical advice. Educational materials (for children) can be downloaded in 11.7%. Almost all (93.3%) adapted their language to the recipient, but none are accessible to disabled people. The majority (86.7%) have the company logo on all pages. Only 16.7% are fronts for advertising, and only 9 sites have a quality seal (HONcode). CONCLUSIONS: Pages are designed to give superficial information on a disease than directly advertise a particular brand or active ingredient. However, their reliability has to be low due to the authors and sources of information being unknown. If Internet health information was truthful and backed up by authors or appropriate information sources, the Internet could well be a genuine health education tool.

Prescripción de medicamentos de utilidad terapéutica baja en atención primaria de la provincia de Toledo: variabilidad de uso / Prescription of medicines of low therapeutic utility in primary care in Toledo province: variability of use

No disponible

No disponible

Variabilidad en la prescripción farmacéutica de atención primaria de castilla la mancha durante 2003 / Variability in primary care drug prescription in 2003 in Castile-la Mancha, Spain

Fundamento: Detectar la variabilidad en la práctica clínica esimportante, ya que puede implicar infra o sobreutilización de recursos.El objetivo del estudio fue estudiar en Castilla la Mancha lavariabilidad de la prescripción farmacéutica en Atención Primaria,en función de determinadas características sociosanitarias de cadazona de salud.Métodos: Se revisó en 180 zonas de salud la prescripción en2003 de varios grupos terapéuticos, recogiendo las siguientes variables:número de envases prescritos por 100 habitantes, porcentaje demayores de 65 años en la zona, frecuentación (consultas/1.000 habitantes),médicos/1.000 habitantes y distancia al hospital de referencia.Resultados: La mayor variabilidad en la prescripción se encontróen los fibratos (coeficiente de variación de 42,95%) y antiH2(38,61%). El grupo con mejor correlación entre su tasa de prescripcióny las variables analizadas fue el de los inhibidores de la enzimade conversión de la angiotensina (r de Spearman promedio 0,719);por contra, los antidepresivos tuvieron una correlación débil(0,324). El porcentaje de mayores de 65 años y la frecuentación sonlas variables que más aparecen de forma significativa en los modelosde regresión múltiple construidos para cada grupo terapéutico.El mayor coeficiente de determinación se encontró en el modelo delos inhibidores de la enzima de conversión de la angiotensina(R2=0,761). El coeficiente de determinación promedio de todos losgrupos, ponderado en base al volumen de prescripción, fue de0,492.Conclusiones: Se observa gran variabilidad en la prescripciónfarmacéutica según las distintas zonas. En general, las variables analizadasexplican en parte dicha variabilidad

Background: Detecting variability in clinical practice isimportant, given that it may entail the underuse or overuse ofresources. This study was aimed at studying the variability of drugprescription in Primary Care in Castile-La Mancha in terms of certainsociosanitary characteristics of each health district.Methods: The prescribing of various therapeutic groups in 2003was reviewed in 180 health districts, the following variables havingbeen gathered: number of packages having been prescribed per 100inhabitants, percentage of inhabitants over age 65 in the district, visitrate (visits/1,000 inhabitants), physicians/1,000 inhabitants and distanceto the reference hospital.Results: The greatest degree of drug-prescribing variability wasfound regarding fibrates (42.95% variance factor) and H2-blockers(38.61%). The group showing the closest correlation between itsprescription rate and the variables analyzed was that of the angiotensin-converting enzyme inhibitors (mean Spearman r: 0.719);antidepressants however showing a weak correlation (0.324).Thepercentage of inhabitants over age 65 and the visit rate are thevariables arising more significantly in the multiple regressionmodels constructed for each treatment group. The highest determinationcoefficient was found in the angiotensin enzyme-convertinginhibitors (R2=0.761). The mean determination coefficient for all ofthe groups, weighted on the basis of the prescribing volume, was0.492.Conclusions: A high degree of drug-prescribing variability wasfound to exist according to the different districts. Generally speaking,the variables analyzed explain part of this variability

[Variability in primary care drug prescription in 2003 in Castile-la Mancha, Spain]. / Variabilidad en la prescripción farmacéutica de atención primaria de Castilla la Mancha durante 2003.

BACKGROUND: Detecting variability in clinical practice is important, given that it may entail the underuse or overuse of resources. This study was aimed at studying the variability of drug prescription in Primary Care in Castile-La Mancha in terms of certain sociosanitary characteristics of each health district. METHODS: The prescribing of various therapeutic groups in 2003 was reviewed in 180 health districts, the following variables having been gathered: number of packages having been prescribed per 100 inhabitants, percentage of inhabitants over age 65 in the district, visit rate (visits/1,000 inhabitants), physicians/1,000 inhabitants and distance to the reference hospital. RESULTS: The greatest degree of drug-prescribing variability was found regarding fibrates (42.95% variance factor) and H2-blockers (38.61%). The group showing the closest correlation between its prescription rate and the variables analyzed was that of the angiotensin-converting enzyme inhibitors (mean Spearman p: 0.719); antidepressants however showing a weak correlation (0.324). The percentage of inhabitants over age 65 and the visit rate are the variables arising more significantly in the multiple regression models constructed for each treatment group. The highest determination coefficient was found in the angiotensin enzyme-converting inhibitors (R2=0.761). The mean determination coefficient for all of the groups, weighted on the basis of the prescribing volume, was 0.492. CONCLUSIONS: A high degree of drug-prescribing variability was found to exist according to the different districts. Generally speaking, the variables analyzed explain part of this variability.