Control de los principales factores de riesgo cardiovascular de la cardiopatía isquémica en prevención secundaria en Aragón: estudio COCINA / Control of major cardiovascular risk factors of ischemic heart disease in secondary prevention in Aragón: COCINA study

La cardiopatía isquémica sigue siendo una de las principales causas de muerte en España. De acuerdo con la American Heart Association/American College of Cardiology (AHA/ACC) y sociedades europeas y nacionales, la prevención secundaria para este tipo de pacientes consta del control de los principales factores de riesgo cardiovascular (FRCV) y de hábitos de estilo de vida adecuados. Objetivo: Conocer el grado de control de los diferentes FRCV en la población aragonesa en prevención secundaria. Diseño: Estudio descriptivo transversal en una muestra de 705 pacientes de Aragón que hubieran sufrido un evento cardioisquémico, seleccionados de forma oportunística en las consultas de los médicos de familia participantes en las 3 provincias aragonesas. El estudio se llevó a cabo en el segundo semestre del año 2012. Intervención: Medir el grado de control de los diferentes FRVC y hábitos de estilos de vida en esta población. Variables medidas: Antropométricas, de los diferentes FRCV, de tratamiento y otras. Resultados: El 58% de los varones y el 52% de las mujeres cumplen criterios de control de las variables medidas. El mejor resultado lo obtiene la cesación tabáquica y el peor el IMC. La HTA, la dislipidemia y la diabetes mellitus alcanzan resultados de control pobres. Conclusión: Los resultados ponen de manifiesto que el grado de control de los diferentes FRCV es todavía escaso, máxime en variables como la dislipidemia y la diabetes mellitus. Solo un 16,5% de pacientes cumplen criterios de control, teniendo en cuenta los FRCV modificables farmacológicamento

Ischemic heart disease remains a leading cause of death in Spain. According to the American Heart Association/American College of Cardiology (AHA/ACC) and European national societies, secondary prevention for these patients consists of control of major cardiovascular risk factors (CVRF) and suitable lifestyle habits. Objective: To determine the degree of control of CVRF in the Aragonese population in secondary prevention. Design: Cross-sectional study of a sample of 705 patients of Aragon who had suffered a cardiac event, selected opportunistically in consultations of family physicians participating in the 3 provinces of Aragon. The study was conducted in the second half of 2012. Intervention: To measure the degree of control of different FRVC and lifestyle habits in this population. Variables measured: Anthropometric, different cardiovascular risk factors, treatment and lifestyle. Results: 58% of men and 52% of women met criteria for monitoring of measured variables. The best result was obtained with smoking cessation and the worst with BMI. Hypertension, Dyslipidemia and Diabetes Mellitus achieve poor control results. Conclusion: The results show that the degree of control of CVRF is still low, especially in variables such as dyslipidemia and Diabetes Mellitus. Only 16.5% of control patients met criteria given the pharmacologically-modifiable cardiovascular risk factors

[Control of major cardiovascular risk factors of ischemic heart disease in secondary prevention in Aragón: COCINA study]. / Control de los principales factores de riesgo cardiovascular de la cardiopatía isquémica en prevención secundaria en Aragón: estudio COCINA.

UNLABELLED: Ischemic heart disease remains a leading cause of death in Spain. According to the American Heart Association/American College of Cardiology (AHA/ACC) and European national societies, secondary prevention for these patients consists of control of major cardiovascular risk factors (CVRF) and suitable lifestyle habits. OBJECTIVE: To determine the degree of control of CVRF in the Aragonese population in secondary prevention. DESIGN: Cross-sectional study of a sample of 705 patients of Aragon who had suffered a cardiac event, selected opportunistically in consultations of family physicians participating in the 3 provinces of Aragon. The study was conducted in the second half of 2012. INTERVENTION: To measure the degree of control of different FRVC and lifestyle habits in this population. VARIABLES MEASURED: Anthropometric, different cardiovascular risk factors, treatment and lifestyle. RESULTS: 58% of men and 52% of women met criteria for monitoring of measured variables. The best result was obtained with smoking cessation and the worst with BMI. Hypertension, Dyslipidemia and Diabetes Mellitus achieve poor control results. CONCLUSION: The results show that the degree of control of CVRF is still low, especially in variables such as dyslipidemia and Diabetes Mellitus. Only 16.5% of control patients met criteria given the pharmacologically-modifiable cardiovascular risk factors.

Utilización de prácticas inefectivas en atención primaria: opinión de los profesionales / Use of ineffective practices in primary health care: professional opinions

Objetivo. Estimar la frecuencia de prácticas inefectivas en la atención primaria (AP) en función de la opinión de profesionales clínicos, así como valorar la importancia, consecuencias y factores que pueden estar contribuyendo a su mantenimiento. Material y métodos. Encuesta de opinión online a una muestra de conveniencia de 575 profesionales de la AP seleccionados a partir de artículos publicados en los últimos años de las revistas Atención Primaria y Semergen. Resultados. Respondieron 212 encuestados (37%). Para el 70,6% (IC 95%: 64,5-73,7) el problema de las prácticas inefectivas resultó frecuente o muy frecuente en AP y la importancia fue valorada con una puntuación media de 7,3 (DE = 1,8) sobre 10. Las principales consecuencias de las prácticas inefectivas fueron poner en peligro la sostenibilidad del sistema (48,1%; IC 95%: 41,2-54,9) y el daño a los pacientes (32,1%; IC 95%: 25,7-38,5). Contribuyeron a su mantenimiento los propios pacientes (28%; IC 95%: 22,6-35,0), la carga de trabajo (26,4%; IC 95%: 20,3-32,5) y la falta de formación continuada (19,3%; IC 95%: 13,9-24,7). Los procesos clínicos con mayor grado de utilización inadecuada fueron la prescripción de antibióticos en determinadas infecciones, la periodicidad del cribado del cáncer de cérvix, el control farmacológico de la diabetes tipo 2, la utilización de psicofármacos en ancianos y el uso de analgésicos en pacientes con hipertensión o insuficiencia renal. Conclusiones. La utilización de intervenciones inefectivas en AP fue apreciada como un problema muy relevante que afectaría a muchos pacientes, pondría en peligro la sostenibilidad del sistema y causaría daño a los pacientes (AU)

Objective. To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. Material and methods. An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. Results. A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD] = 1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. Conclusions. The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients (AU)

[Use of ineffective practices in Primary Health Care: professional opinions]. / Utilización de prácticas inefectivas en atención primaria: opinión de los profesionales.

OBJECTIVE: To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. MATERIAL AND METHODS: An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. RESULTS: A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD]=1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. CONCLUSIONS: The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients.

Cultura de seguridad del paciente en residentes de medicina familiar y comunitaria de Aragón / Patient safety culture in family and community medicine residents in Aragon

Introducción: Una adecuada cultura de seguridad del paciente es la primera recomendación para mejorar la misma. El objetivo fue conocer la cultura de seguridad del paciente (SP) en los residentes de medicina familiar y comunitaria para identificar estrategias de mejora. Métodos: Encuesta transversal online dirigida a los residentes de las unidades docentes de medicina de familiar y comunitaria de Aragón. Se utilizó el cuestionario Medical Office Survey on Patient Safety Culture (MOSPS) traducido, validado y adaptado al español. Para el análisis de los resultados se agruparon las respuestas en 12 dimensiones y se calculó el valor medio de cada dimensión. Las percepciones se describieron mediante los porcentajes de respuestas positivas (PRP) y negativas (PRN) de cada dimensión. Resultados: Se observaron resultados positivos en el «seguimiento de la atención a los pacientes» y el «trabajo en equipo». Se apreciaron diferencias significativas en las dimensiones «intercambio de información con otros dispositivos asistenciales», «formación del personal» y «percepciones generales sobre la SP y la calidad». Los participantes del estudio valoraron negativamente el «ritmo y carga de trabajo». Conclusiones: Las instituciones prestadoras de servicios de salud y su personal son cada vez más conscientes de la importancia de mejorar la SP, y los resultados de este estudio permitieron mostrar información que ayuda a identificar debilidades para diseñar iniciativas y estrategias y establecer mejoras de las prácticas asistenciales (AU)

Introduction: having an appropriate patient safety culture is the first recommendation to improve it. The aim of this article is to determine the safety culture in family medicine residents and then to identify improvement strategies. Methods: an online cross-sectional survey of residents in family medicine teaching units of Aragon using the translated, validated and adapted to Spanish, Medical Office Survey on Patient Safety Culture (MOSPS) questionnaire. The results were grouped in 12-dimensional responses for analysis, and the mean value of each dimension was calculated. Perceptions were described by Percentages of Positive (PRP) and Negative Responses (PRN) to each dimension. Results: positive results were seen in «the Patient Care Tracking/Follow-up». There were significant differences in the «Information Exchange With Other Settings», «Staff Training» and «Overall Perceptions of Patient Safety and Quality». Study participants viewed «Work Pressure and Pace» negatively. Conclusions: the institutions providing health services, as well as their staff, are increasingly aware of the importance of improving Patient Safety, and the results of this study allowed us to present information that helps identify weaknesses, and to design initiatives and strategies to improve care practices

[Patient safety culture in family and community medicine residents in Aragon]. / Cultura de seguridad del paciente en residentes de medicina familiar y comunitaria de Aragón.

INTRODUCTION: having an appropriate patient safety culture is the first recommendation to improve it. The aim of this article is to determine the safety culture in family medicine residents and then to identify improvement strategies. METHODS: an online cross-sectional survey of residents in family medicine teaching units of Aragon using the translated, validated and adapted to Spanish, Medical Office Survey on Patient Safety Culture (MOSPS) questionnaire. The results were grouped in 12-dimensional responses for analysis, and the mean value of each dimension was calculated. Perceptions were described by Percentages of Positive (PRP) and Negative Responses (PRN) to each dimension. RESULTS: positive results were seen in «the Patient Care Tracking/Follow-up¼. There were significant differences in the «Information Exchange With Other Settings¼, «Staff Training¼ and «Overall Perceptions of Patient Safety and Quality¼. Study participants viewed «Work Pressure and Pace¼ negatively. CONCLUSIONS: the institutions providing health services, as well as their staff, are increasingly aware of the importance of improving Patient Safety, and the results of this study allowed us to present information that helps identify weaknesses, and to design initiatives and strategies to improve care practices.

Mortalidad reducible como indicador de efectividad de los servicios sanitarios en España antes y después de las transferencias / Amenable mortality as indicator of effectiveness of health care services in Spain before and after transferences

Objetivo. Describir la evolución de la mortalidad reducible por acción de los servicios sanitarios (MRASS) en España y evaluar si las transferencias sanitarias han supuesto algún cambio significativo. Métodos. La MRASS se definió a partir de una lista de causas utilizada en otros estudios. Se analizan tasas de MRASS ajustadas por edad y sexo en los períodos 1999-2001 y 2006-2008, justo antes y 5 años tras culminar el proceso de transferencias. Resultados. La MRASS representó el 24% de las defunciones en personas de 0-74 años. Descendió entre ambos períodos en mayor medida (19,4%) que el resto de causas (14,5%). El grupo de causas que más descendieron fueron: cardiopatía isquémica (28,0%), resto de enfermedades vasculares (26,8%), enfermedades quirúrgicas y errores médico-quirúrgicos (25,9%) y diabetes (22,5%). Aunque existieron diferencias entre comunidades autónomas (CCAA), no se apreció que estas diferencias ni la evolución de la MRASS se relacionaran con las transferencias. Navarra y Madrid presentaron las menores tasas de MRASS y Canarias, Asturias, Andalucía, Ceuta y Melilla, las mayores. Baleares fue la CCAA donde más disminuyó la MRASS. Conclusiones. La MRASS representa una importante proporción de la experiencia de mortalidad de personas de 0-74 años. Ha descendido en todas las CCAA, y aunque hay grandes diferencias entre ellas, no parece que el proceso de transferencias sanitarias influyera en su evolución en el período estudiado. Pese a limitaciones, la MRASS es un indicador que se debe considerar para monitorizar y detectar debilidades en la efectividad de los sistemas asistenciales(AU)

Objective. To describe the evolution of amenable mortality (MRASS) in Spain and to evaluate differences in trend patterns before and after health care services were tranferred to local authorities. Methods. MRASS was defined from a list of causes of death used in other studies. We analyzed the change in sex-age-standardized death rates of MRASS in two periods: 1999-2001 and 2006-2008, just before, and five years after, the health care transfers were completed. Results. MRASS represented 24% of deaths in persons from 0 to 74 years old. MRASS has seen a reduction (19.4%) between the two periods over and above other causes of mortality (14.5%). The group of causes of mortality which showed most reduction: ischemic heart disease (28%), other vascular disease (27%), surgical conditions and surgical-medical errors (26%), and diabetes (22.5%). Although there were differences between the districts, health care transfers have not created significant variations in MRASS. Navarra and Madrid showed lower rates of MRASS, and the Canary Islands, Asturias, Andalusia, Ceuta and Melilla had higher rates. The Balearic Islands showed the greatest reduction in MRASS. Conclusions. MRASS constitutes an important proportion of trends of mortality in persons between 0-74 years. It has declined in all districts. Even though there were large differences between districts, there does not appear to be any direct influence due to health care transfer in amenable mortality trends. In spite of limitations, MRASS is an indicator to be considered when monitoring and detecting weaknesses in the effectiveness of health care systems(AU)

Incidencia de eventos adversos posquirúrgicos en un hospital de tercer nivel / Incidence of postoperative adverse events in a tertiary hospital

Objetivos. Determinar la proporción de reintervenciones, mortalidad, incidencia, gravedad y grado de evitabilidad de eventos adversos posquirúrgicos (EAP) en un hospital de tercer nivel. Métodos. Revisión retrospectiva de una muestra aleatoria de 350 cirugías realizadas en 2009 en pacientes mayores de 14 años. Para identificar los EAP, determinar su gravedad y establecer su grado de evitabilidad se utilizaron clasificaciones preestablecidas. Resultados. Se detectaron 113 EAP en 61 pacientes, el 17,4% de los 350 pacientes estudiados. El 4,3% de los pacientes fue reintervenido y la mortalidad a los 30 días fue del 2,6%. Los EAP más frecuentes fueron: infección de herida quirúrgica (15,0%), hematoma o hemorragia de herida (9,7%) y anemia por sangrado (8,8%). Los factores asociados a los pacientes que adquirieron un EAP fueron el uso anestesia general, grado ASA≥3, estancia media, edad media y servicios con cirugía de mayor repercusión sistémica. Cerca del 70% de los EAP estaban recogidos en el informe de alta. El 72,6% de EAP fueron de gravedad leve, el 11,5% de gravedad moderada y el 15,9% muy graves. Un 39,9% de EAP tenían una probabilidad alta de haberse evitado. No se encontró relación entre la evitabilidad y la gravedad de los EAP. Conclusiones. La alta proporción de pacientes intervenidos con EAP, las reintervenciones consecuentes y la mortalidad en el postoperatorio inmediato señalan la importancia de implantar acciones para reducir la magnitud y el impacto de los eventos adversos, teniendo en cuenta que más del 40% de los EAP podría ser evitado(AU)

Objectives. To determine the proportion of reoperations, mortality, incidence, severity and degree of preventability of postoperative adverse events (PAE) in a teaching hospital. Methods. Retrospective review a random sample of 350 surgical interventions realized in 2009 in patients over 14 years. To identify PAE, determine its severity and its degree of preventability, we used a previous classification. Results. Were detected PAE 113 in 61 patients, 17.4% of the 350 patients studied. 4.3% of patients were reoperated and mortality at 30 days was 2.6%. The most frequent PAE were: infection of surgical wound (15,0%), hematoma or hemorrhage of wound (9,7%) and anemia for bled (8,8%). The factors associated with the patients who acquire a PAE were the use general anesthesia, ASA>3, average stay, average age and more complex surgical services. About 70% of CP were included in the discharge report. The 72.6% of PAE were classified as mild in severity, 11.5% of moderate severity and 15.9% as very serious. 39,9% of the PAE had a high probability of having been avoided. One did not find relation between the preventability and the gravity of the PAE. Conclusions. The high proportion of patients surgically operated with PAE, the consequent reoperations and the mortality in the post operatory immediate indicates the importance of implementing actions to reduce the magnitude and impact of these adverse events, especially considering that over 40% of same could be avoided(AU)

[Amenable mortality as indicator of effectiveness of health care services in Spain before and after transferences]. / Mortalidad reducible como indicador de efectividad de los servicios sanitarios en España antes y después de las transferencias.

OBJECTIVE: To describe the evolution of amenable mortality (MRASS) in Spain and to evaluate differences in trend patterns before and after health care services were transferred to local authorities. METHODS: MRASS was defined from a list of causes of death used in other studies. We analyzed the change in sex-age-standardized death rates of MRASS in two periods: 1999-2001 and 2006-2008, just before, and five years after, the health care transfers were completed. RESULTS: MRASS represented 24% of deaths in persons from 0 to 74 years old. MRASS has seen a reduction (19.4%) between the two periods over and above other causes of mortality (14.5%). The group of causes of mortality which showed most reduction: ischemic heart disease (28%), other vascular disease (27%), surgical conditions and surgical-medical errors (26%), and diabetes (22.5%). Although there were differences between the districts, health care transfers have not created significant variations in MRASS. Navarra and Madrid showed lower rates of MRASS, and the Canary Islands, Asturias, Andalusia, Ceuta and Melilla had higher rates. The Balearic Islands showed the greatest reduction in MRASS. CONCLUSIONS: MRASS constitutes an important proportion of trends of mortality in persons between 0-74 years. It has declined in all districts. Even though there were large differences between districts, there does not appear to be any direct influence due to health care transfer in amenable mortality trends. In spite of limitations, MRASS is an indicator to be considered when monitoring and detecting weaknesses in the effectiveness of health care systems.

[Incidence of postoperative adverse events in a tertiary hospital]. / Incidencia de eventos adversos posquirúrgicos en un hospital de tercer nivel.

OBJECTIVES: To determine the proportion of reoperations, mortality, incidence, severity and degree of preventability of postoperative adverse events (PAE) in a teaching hospital. METHODS: Retrospective review a random sample of 350 surgical interventions realized in 2009 in patients over 14 years. To identify PAE, determine its severity and its degree of preventability, we used a previous classification. RESULTS: Were detected PAE 113 in 61 patients, 17.4% of the 350 patients studied. 4.3% of patients were reoperated and mortality at 30 days was 2.6%. The most frequent PAE were: infection of surgical wound (15,0%), hematoma or hemorrhage of wound (9,7%) and anemia for bled (8,8%). The factors associated with the patients who acquire a PAE were the use general anesthesia, ASA>3, average stay, average age and more complex surgical services. About 70% of CP were included in the discharge report. The 72.6% of PAE were classified as mild in severity, 11.5% of moderate severity and 15.9% as very serious. 39,9% of the PAE had a high probability of having been avoided. One did not find relation between the preventability and the gravity of the PAE. CONCLUSIONS: The high proportion of patients surgically operated with PAE, the consequent reoperations and the mortality in the post operatory immediate indicates the importance of implementing actions to reduce the magnitude and impact of these adverse events, especially considering that over 40% of same could be avoided.