Uso del Vitalograph COPD-6 en atención primaria como herramienta para la deshabituación tabáquica / Use of COPD-6 Vitalograph in Primary Care as tool for smoking cessation

Objetivos. Principal: valorar la evolución del tabaquismo tras usar el Vitalograph COPD-6 en los fumadores que acuden a una consulta de medicina familiar (CMF) a lo largo de 3 años (3/2011-2/2013). Secundarios: valorar si se producen nuevos diagnósticos de EPOC y comparar los datos de abandono tabáquico con los de una consulta específica de tabaquismo (CET) de otro CS. Metodología. Se ha utilizado el vitalograph (medidor manual electrónico de la función pulmonar) y el cooxímetro en 176 fumadores (búsqueda activa). Variables: nivel de consumo (paquetes/año), grado dependencia tabáquica (test de Fageström breve), CO exhalado en partes por millón (ppm), antecedentes personales de EPOC o enfermedad cardiovascular (ECV). El paciente realiza 3 maniobras de espiración forzada y el vitalograph registra la función pulmonar (FEV1, FEV6, FEV1/FEV6) y la edad pulmonar estimada (EPE). Valoramos la actitud del paciente (fases: precontemplación, contemplación y preparación) antes y después de realizar la prueba e indicarle los resultados. Valoración de la evolución tabáquica de los pacientes. Resultados. En la CMF se han evaluado 176 fumadores y en la CET 33. CMF/CET: edad 45,9/51,6 años (p = 0,042); paquetes año 25,5/39,3 (p = 0,0001); pacientes que abandonan tabaquismo que utilizan fármacos para deshabituación 2/9. En CMF: edad-EPE 45,9/57,4 (p = 0,000). En CET: edad-EPE 51,6/74,3 (p = 0,000). Evolución consumo CMF/CET: abandono 24,5%/48,5% (p = 0,004). IC diferencia (6,4-42,8%). En CMF nuevo diagnóstico EPOC en 6 fumadores. Conclusiones. El Vitalograph COPD-6 es un instrumento fácil y rápido de usar en la consulta diaria. El porcentaje de abandono tabáquico en la CMF (búsqueda activa) el abandono logrado es alto (AU)

Objectives. Primary objective: To assess the evolution of smoking cessation process after using a COPD-6 Vitalograph in smokers that came to a primary care practice (PCP) during a three year period (March 2011- February 2013). Secondary objectives: To assess if there are any new COPD diagnoses and to compare the smoking cessation outcomes to those of a specific smoking cessation practice (SSCP) from another healthcare centre. Methodology. Two devices were used: Vitalograph (electronic device measuring the lung function) and the CO-oximeter, in 176 patients (active search of smokers). Variables: tobacco pack-years, tobacco dependence (shortened Fagerström test), CO in exhaled breath (in parts per million-ppm), personal history of COPD or cardiovascular disease (CVD). The patients performed three forced exhalations and the Vitalograph registered the lung function (FEV1, FEV6, FEV1/FEV6) and the estimated lung age (ELA). Patient attitude was assessed (phases: pre-contemplation, contemplation, preparation) before and after the test, informing them of the outcomes. Patient progress in the smoking cessation process was also recorded. Results. A total of 176 smokers were studied in PCP and 33 in SSCP. PCP/SSCP: age: 45.9/51.6 years old (p = 042); pack-years 25.5/39.3 (p = 0001); patients who quit smoking and used medicines for it 2/9. In PCP: age-ELA 45.9/57.4 (p = 0.000). In SSCP: age-ELA 51.6/74.3 (p = 000). Smoking habit evolution PCP/SSCP: cessation 24.5%/48.5% (p = 004). Difference 24%. CI difference (6.4-42.8%). In PCP new COPD diagnosis in 6 smokers. Conclusions. COPD-6 Vitalograph is a fast and easy to use tool in day-to-day practice. The percentage of smoking cessation is better in SSCP, although a high smoking cessation rate was obtained in PCP (active search) (AU)

[Use of COPD-6 Vitalograph in Primary Care as tool for smoking cessation]. / Uso del Vitalograph COPD-6 en atención primaria como herramienta para la deshabituación tabáquica.

PRIMARY OBJECTIVE: To assess the evolution of smoking cessation process after using a COPD-6 Vitalograph in smokers that came to a primary care practice (PCP) during a three year period (March 2011- February 2013). SECONDARY OBJECTIVES: To assess if there are any new COPD diagnoses and to compare the smoking cessation outcomes to those of a specific smoking cessation practice (SSCP) from another healthcare centre. METHODOLOGY: Two devices were used: Vitalograph (electronic device measuring the lung function) and the CO-oximeter, in 176 patients (active search of smokers). VARIABLES: tobacco pack-years, tobacco dependence (shortened Fagerström test), CO in exhaled breath (in parts per million-ppm), personal history of COPD or cardiovascular disease (CVD). The patients performed three forced exhalations and the Vitalograph registered the lung function (FEV1, FEV6, FEV1/FEV6) and the estimated lung age (ELA). Patient attitude was assessed (phases: pre-contemplation, contemplation, preparation) before and after the test, informing them of the outcomes. Patient progress in the smoking cessation process was also recorded. RESULTS: A total of 176 smokers were studied in PCP and 33 in SSCP. PCP/SSCP: age: 45.9/51.6 years old (p=042); pack-years 25.5/39.3 (p=0001); patients who quit smoking and used medicines for it 2/9. In PCP: age-ELA 45.9/57.4 (p=0.000). In SSCP: age-ELA 51.6/74.3 (p=000). Smoking habit evolution PCP/SSCP: cessation 24.5%/48.5% (p=004). Difference 24%. CI difference (6.4-42.8%). In PCP new COPD diagnosis in 6 smokers. CONCLUSIONS: COPD-6 Vitalograph is a fast and easy to use tool in day-to-day practice. The percentage of smoking cessation is better in SSCP, although a high smoking cessation rate was obtained in PCP (active search).

Evaluación durante 6 años de la dislipidemia en un centro de salud. Importancia de las acciones de mejora / A 6-year evaluation of dyslipidemia in a health center: Importance of improvement actions

Introducción. La dislipidemia, sobre todo el aumento del colesterol LDL, se ha demostrado como uno de los factores de riesgo más importantes en la génesis de la afectación coronaria. La prevalencia de las dislipidemias en España es alta. El objetivo del presente trabajo es valorar la evolución de los pacientes dislipidémicos de nuestro centro de salud durante 6 años y ver si se ha producido una mejora en el control de los mismos tras la presentación de la evaluación de los 3 primeros años y la actualización del protocolo de dislipidemias del centro de salud. Pacientes y método. Evaluación Periodo 1 (2006-2008): 267 pacientes dislipidémicos. Evaluación Periodo 2 (2009-2011): 222 pacientes, excluidos exitus y cambios de domicilio. Variables: edad, sexo, antecedentes personales de ECV, factores de riesgo vascular, lípidos, número de analíticas, tratamiento farmacológico, niveles de riesgo CV y porcentajes en objetivos de control. Resultados. Edad media 66,2 años (DE 13,4), mujeres 66,3%. Periodo 1-Periodo 2: colesterol total: 221,9-196,6 mg/dl (p = 0,000); colesterol LDL: 147,9-115,8 mg/dl (p = 0,000). En objetivos terapéuticos, pacientes riesgo alto: 14-50,5% (p = 0,024); riesgo medio: 35-68,1% (p = 0,038); riesgo bajo: 44-68,2% (p = NS). Tratamiento farmacológico 68-77% (p = 0,000). Modificación tratamiento: 30-43% (p = 0,001). Cumplimiento terapéutico: 75-86% (p = 0,003). Sin tratamiento riesgo alto: 15,4-16,3% (p = NS). Conclusiones. Se ha producido una mejoría significativa en el Periodo 2, sobre todo en los pacientes de riesgo alto, tras presentar los resultados de la evaluación del Periodo 1 y haber actualizado, en el centro de salud, el protocolo de dislipidemias. Hay pacientes con riesgo alto sin tratamiento hipolipidemiante que se deben detectar y revisar. (AU)

Introduction. Dyslipidemia, especially an increased LDL-cholesterol, has been shown to be one of the most important risk factors in the genesis of coronary involvement. The prevalence of dyslipidemias in Spain is high. The objective of this study is to assess the progress of dyslipidemic patients in our health center over a 6-year period, and see if there has been any improvement in its control after the presentation of the evaluation of the first 3 years, as well as an updated dyslipidemia protocol. Patients and methods. Assessment Period 1 (2006-2008): 267 patients with dyslipidemia. Assessment Period 2 (2009-2011): 222 patients, excluding exitus and address changes. Variables: age, sex, personal history of CVD, vascular risk factors, lipids, drug treatment, risk levels, and percentages of CV control objectives. Results. Mean age was 66.2 years (SD 13.4), 66.3% women. Period 1-Period 2: Total cholesterol: 221.9-196.6 mg/dl (P = .000); LDL-cholesterol: 147.9-115.8 mg/dl (P = .000). In high risk patients, therapeutic targets: 14-50.5% (P = .024); medium risk: 35-68.1% (P = .038); low risk: 44-68.2% (P = NS). Pharmacotherapy 68-77% (P = .000). Changing treatment: 30-43% (P = .001). Adherence: 75-86% (P = .003). Untreated high risk: 15.4-16.3% (P = NS). Conclusions. There was a significant improvement in Period 2, especially in high-risk patients, after presenting the results of the evaluation for Period 1 and with the updated dyslipidemia protocol. There are high risk patients without lipid-lowering treatment to be detected and reviewed (AU)

[A 6-year evaluation of dyslipidemia in a health center: Importance of improvement actions]. / Evaluación durante 6 años de la dislipidemia en un centro de salud. Importancia de las acciones de mejora.

INTRODUCTION: Dyslipidemia, especially an increased LDL-cholesterol, has been shown to be one of the most important risk factors in the genesis of coronary involvement. The prevalence of dyslipidemias in Spain is high. The objective of this study is to assess the progress of dyslipidemic patients in our health center over a 6-year period, and see if there has been any improvement in its control after the presentation of the evaluation of the first 3 years, as well as an updated dyslipidemia protocol. PATIENTS AND METHODS: Assessment Period 1 (2006-2008): 267 patients with dyslipidemia. Assessment Period 2 (2009-2011): 222 patients, excluding exitus and address changes. VARIABLES: age, sex, personal history of CVD, vascular risk factors, lipids, drug treatment, risk levels, and percentages of CV control objectives. RESULTS: Mean age was 66.2 years (SD 13.4), 66.3% women. Period 1-Period 2: Total cholesterol: 221.9-196.6 mg/dl (P=.000); LDL-cholesterol: 147.9-115.8 mg/dl (P=.000). In high risk patients, therapeutic targets: 14-50.5% (P=.024); medium risk: 35-68.1% (P=.038); low risk: 44-68.2% (P=NS). Pharmacotherapy 68-77% (P=.000). Changing treatment: 30-43% (P=.001). Adherence: 75-86% (P=.003). Untreated high risk: 15.4-16.3% (P=NS). CONCLUSIONS: There was a significant improvement in Period 2, especially in high-risk patients, after presenting the results of the evaluation for Period 1 and with the updated dyslipidemia protocol. There are high risk patients without lipid-lowering treatment to be detected and reviewed.

Evaluación progresiva del grado de satisfacción entre los trabajadores de un Centro de Salud tras su informatización / No disponible

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