[Back pain: do we follow the recommendations in the guidelines?]. / Lumbalgia: seguimos las recomendaciones de las guías?

OBJECTIVE: To describe how patients with back pain are usually handled at a health centre. DESIGN: Retrospective, descriptive study. SETTING: Urban health centre. PARTICIPANTS: All patients seen for back pain in the centre's general medical consultations during 2003. MAIN MEASUREMENTS: Patients' personal details, clinical characteristics of back pain (alarm signals), semiological data, request for further tests, treatments prescribed, referral to specialists. RESULTS: Five hundred and thirty eight clinical histories were included. 53.2% of patients were women, and 33.6% were over 55. 35% of patients were not questioned on pain characteristics; and in over half the cases (54.6%), there were no questions on the presence of alarm signals, either. Only in 0.6% of cases was any analogical visual scale used to assess pain. Only 46.8% of the x-rays taken were thought to be well indicated, in terms of pre-established criteria. Total rest was not normally advised (1.9%); the drugs most commonly prescribed were NSAIDs (39.6%). CONCLUSIONS: Clinical evaluation of patients with back pain is still inadequate in our centre, and x-rays are requested without adherence to formal or explicit criteria. We prescribe more NSAIDs than paracetamol for therapy.

Lumbalgia: ¿seguimos las recomendaciones de las guías? / Back pain: do we follow the recommendations in the guidelines?

Objetivo. Describir el tratamiento habitual de los pacientes con lumbalgia en un centro de salud. Diseño. Estudio descriptivo, retrospectivo. Emplazamiento. Centro de salud urbano. Participantes. Todos los pacientes atendidos por lumbalgia en las consultas de medicina general del centro durante el año 2003. Mediciones principales. Datos de filiación de los pacientes, características clínicas de la lumbalgia (señales de alarma), datos semiológicos, solicitud de pruebas complementarias, tratamientos prescritos y derivación a especialistas. Resultados. Se incluyeron 538 historias clínicas. El 53,2% correspondía a mujeres y el 33,6% tenía más de 55 años. No se realizó interrogatorio sobre las características del dolor en un 35% de pacientes, y en más de la mitad de los casos (54,6%) tampoco se interrogó sobre la presencia de señales de alerta. Respecto a la evaluación del dolor, sólo en el 0,6% de los casos se había utilizado una escala visual analógica (EVA). Únicamente el 46,8% de las radiografías realizadas se consideró bien indicado según criterios preestablecidos. El reposo absoluto no se recomendó de forma habitual (1,9%) y los fármacos más prescritos (39,6%) fueron los antiinflamatorios no esteroideos (AINE). Conclusiones. La evaluación clínica de los pacientes con lumbalgia sigue siendo inadecuada en nuestro centro y la solicitud de estudios radiológicos se realiza sin tener en cuenta criterios formales y explícitos. En el apartado terapéutico, prescribimos más AINE que paracetamol

Objective. To describe how patients with back pain are usually handled at a health centre. Design. Retrospective, descriptive study. Setting. Urban health centre. Participants. All patients seen for back pain in the centre's general medical consultations during 2003. Main measurements. Patients' personal details, clinical characteristics of back pain (alarm signals), semiological data, request for further tests, treatments prescribed, referral to specialists. Results. Five hundred and thirty eight clinical histories were included. 53.2% of patients were women, and 33.6% were over 55. 35% of patients were not questioned on pain characteristics; and in over half the cases (54.6%), there were no questions on the presence of alarm signals, either. Only in 0.6% of cases was any analogical visual scale used to assess pain. Only 46.8% of the x-rays taken were thought to be well indicated, in terms of pre-established criteria. Total rest was not normally advised (1.9%); the drugs most commonly prescribed were NSAIDs (39.6%). Conclusions. Clinical evaluation of patients with back pain is still inadequate in our centre, and x-rays are requested without adherence to formal or explicit criteria. We prescribe more NSAIDs than paracetamol for therapy

[Variability of prescriptions in prevailing indications in primary care: a multicenter study. Study of Prescriptions in Primary Care (GEPAP)]. / Variabilidad de la prescripción en indicaciones prevalentes en atención primaria: un estudio multicéntrico. Estudio de la Prescripción en Atención Primaria (GEPAP).

OBJECTIVES: It seems convenient to have information on how drugs are used in everyday's practice in order to be able to make drug selection proposals. The aim of this study was to describe the prescription profile in a number of prevalent indications and its variability among the participating centres. DESIGN: Cross-sectional descriptive study. SETTING: Four Primary care centres. PARTICIPANTS: Each of the 32 participating physicians collected information on 200 consecutive patients who received a prescription between October 1994 and January 1995. MEASUREMENTS AND MAIN RESULTS: 5932 patients, with a mean age of 56 years (SD = 18 years) were included. We analysed the prescriptions they received for hypertension (988 patients), hyperlipidaemia (254), peptic ulcer (PU) (136), nonulcer dyspepsia (271), chronic obstructive lung disease (COLD) (293), asthma (134) and depression (261). We describe the number of different drugs used (range: 14 for PU-63 for hypertension), the number of drugs that accounted for 90% of the prescriptions (range: 5 for PU-20 for depression), the number of recently marketed drugs (range: 0 for PU-9 for hypertension) and the proportion of prescribed drugs they accounted for (range: 0% for PU-12.4% for depression). We found an important variability among the participating centres in all the considered indications; for instance, statins for hyperlipidaemia. CONCLUSION: A rather high variability in prescription habits among participating centres was found. Prescription was highly concentrated in a few number of drugs, and the use of recently marketed drugs accounted for less than 10% of all prescriptions, although data show variability according to the considered indications.

[The allocation of the pharmacy budget to health centers]. / Asignación del presupuesto de farmacia a los centros de salud.

OBJECTIVE: To design a mathematical model which permits pharmacy budgets to be assigned to Health Centres (HC), examining the social and demographic variables and health service usage which explain the variability of the pharmaceutical expenditure (PE) of the HCs. DESIGN: A descriptive, crossover study. SETTING: 17 HC of the Insitut Català de la Salut (Catalan Health Service) in the city of Barcelona during 1994. MEASUREMENTS AND MAIN RESULTS: Relationships among the following variables at the 17 HCs were studied: pharmaceutical expenditure per inhabitant (PEi), frequency of attendance (FRA), care pressure (CP), percentage of the population 65 or over (P65), percentage of the population with medical records (PPR), index of family economic capacity (IFEC), ratio of comparative mortality (RCM) and ratio of potential years of life lost (RPYLL). In the bivariant analysis, those variables with a statistically significant linear correlation with PEi were FRA (r = 0.67; p < 0.01), PPR (r = 0.56; p <0.01), IFEC (r = -0.68; p < 0.01), RCM (r = 0.61; p < 0.01) and RPYLL (r = 0.62; p <0.01). In the multivariant analysis, IFEC, P65 and FRA enabled 94% of the PEi variability to be explained (r2 = 0.94; p < 0.001). Through multiple regression a mathematical formula for calculating the PE of HCs was obtained. CONCLUSION: The model presented enables pharmacy budgets to be assigned to the HCs if the IFEC, P65 and FRA of the population attended is known.

[Functional classification of chronic alcoholic hepatopathy in primary care]. / Clasificación funcional de la hepatopatía crónica alcohólica en atención primaria.

OBJECTIVE: To evaluate the use of Pugh's Classification in assessing patients with diffuse alcoholic Chronic Hepatopathy in the out-patient context. DESIGN: Descriptive-retrospective study. SITE. The Base Health Area of "La Mina" in Barcelona. PATIENTS OR OTHER PARTICIPANTS: 143 patients over the age of 14 diagnosed as suffering diffuse chronic Hepatopathy were identified. 37 of these were excluded because of lack of data. MAIN MEASUREMENTS AND RESULTS: The following data were gathered: those relating to semeiology, anamnesis, quantifying alcoholic intake, where the original diagnosis was made, how rapidly the condition evolved, laboratory and complementary explorations' parameters. Out of the 106 patients studied 71 (67%) were classified in group A; 22 (21%) in B and 13 (12%) in C. No significant differences were found in relation to age or sex. Significant differences concerning the speed of the condition's evolution and the average intake in grammes of alcohol per day were observable. The number of hospital admissions increased as the patient's functional stage became worse and complications increased. CONCLUSIONS: Pugh's test was shown to be useful in the out-patient context for classifying patients suffering chronic diffuse Hepatopathy in line with the severity of their condition.

[Hereditary familial neuropathies: genetic counseling and early diagnosis in primary care]. / Neuropatías heredofamiliaries: consejo genético y diagnóstico precoz en atención primaria.

We present 5 cases of sensitive-motor hereditary neuropathies which were detected or controlled in primary care. Four patients had Charcot-Marie-Tooth disease (type I) and the remaining patient is a carrier of Dejerine-Sottas disease (type III). Regardless of the age of presentation of the disease, the evolution has been slow but steady in all cases. Talipes cavus is the most frequent secondary deformity. An electroneuromyographic study and a neural biopsy were the complementary diagnostic tests used. Three of the patients presented family antecedents. We believe that early diagnosis, family study and genetic advice are of great importance in primary care.

[Monoclonal gammapathy of uncertain significance. A perspective from the primary care setting]. / Gammapatía monoclonal de significado incierto. Una perspectiva desde la atención primaria.

Eight cases of monoclonal gammapathy of uncertain significance are reported. They were detected from routine analysis in patients from the general population who consulted for several diseases to a primary care center. One patient developed multiple myeloma and the rest remained stable. As there is no effective method to identify which patients with monoclonal gammapathy of uncertain significance will undergo a malignant transformation, it is suggested that periodical clinical and laboratory controls are the only effective means for the monitoring of this type of patients.