Effectiveness of a chat-bot for the adult population to quit smoking: protocol of a pragmatic clinical trial in primary care (Dejal@).

BACKGROUND: The wide scale and severity of consequences of tobacco use, benefits derived from cessation, low rates of intervention by healthcare professionals, and new opportunities stemming from novel communications technologies are the main factors motivating this project. Thus, the purpose of this study is to assess the effectiveness of an intervention that helps people cease smoking and increase their nicotine abstinence rates in the long term via a chat-bot, compared to usual practice, utilizing a chemical validation at 6 months. METHODS: Design: Randomized, controlled, multicentric, pragmatic clinical trial, with a 6-month follow-up. SETTING: Healthcare centers in the public healthcare system of the Community of Madrid (Madrid Regional Health Service). PARTICIPANTS: Smokers > 18 years of age who attend a healthcare center and accept help to quit smoking in the following month. N = 460 smokers (230 per arm) who will be recruited prior to randomization. Intervention group: use of a chat-bot with evidence-based contents to help quit smoking. CONTROL GROUP: Usual treatment (according to the protocol for tobacco cessation by the Madrid Regional Health Service Main variable: Continuous nicotine withdrawal with chemical validation (carbon monoxide in exhaled air). Intention-to-treat analysis. Difference between groups in continuous abstinence rates at 6 months with their corresponding 95% confidence interval. A logistic regression model will be built to adjust for confounding factors. RESULTS: First expected results in January 2020. DISCUSSION: Providing science-based evidence on the effectiveness of clinical interventions via information technologies, without the physical presence of a professional, is essential. In addition to being more efficient, the characteristics of these interventions can improve effectiveness, accessibility, and adherence to treatment. From an ethics perspective, this new type of intervention must be backed by scientific evidence to circumvent pressures from the market or particular interests, improve patient safety, and follow the standards of correct practices for clinical interventions. TRIAL REGISTRATION: ClinicalTrials.gov, reference number NCT03445507.

Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain.

This study investigated effectiveness of manual therapy (MT) with transcutaneous electrical nerve stimulation (TENS) to reduce pain intensity in patients with mechanical neck disorder (MND). A randomized multi-centered controlled clinical trial was performed in 12 Primary Care Physiotherapy Units in Madrid Region. Ninety patients were included with diagnoses of subacute or chronic MND without neurological damage, 47 patients received MT and 43 TENS. The primary outcome was pain intensity measured in millimeters using the Visual Analogue Scale (VAS). Also disability, quality of life, adverse effects and sociodemographic and prognosis variables were measured. Three evaluations were performed (before, when the procedure finished and six months after). Seventy-one patients (79%) completed the follow-up measurement at six months. In more than half of the treated patients the procedure had a clinically relevant "short term" result after having ended the intervention, when either MT or TENS was used. The success rate decreased to one-third of the patients 6 months after the intervention. No differences can be found in the reduction of pain, in the decrease of disability nor in the quality of life between both therapies. Both analyzed physiotherapy techniques produce a short-term pain reduction that is clinically relevant.

[Reflections on the authorship of the scientific studies]. / Reflexiones sobre la autoría de los estudios científicos.

This document aims to comment on the currently used concepts of authorship of scientific articles. Parallelly, the question of the order of the authors is discussed. The concept of authorship according to contribution and of the special case of the group publications is approached. Special emphasis has been made in the bibliographic search on obtaining publications from groups of Spanish authors to illustrate how the group signing of the publications in our setting is done. Finally, the Clinical Research Group in Primary Care (G-ICAP) makes a series of recommendations in order to facilitate decision-making on these subjects, both for the studies of the G-ICAP itself as well as for other scientific studies developed in the health sciences setting. (c) 2009 Elsevier España, S.L. All rights reserved.

Reflexiones sobre la autoría de los estudios científicos / Reflections on the authorship of the scientific studies

Este documento persigue reflexionar sobre los conceptos de autoría de artículos científicos que se utilizan en la actualidad. Paralelamente, se abordan la cuestión del ‘”ordende los autores”, donde se incide en el concepto de la autoría por contribución, y del “caso especial de las publicaciones en grupo”. En la búsqueda bibliográfica se hizo especial hincapié en conseguir publicaciones de grupos de autores españoles, para ilustrar cómo se maneja la firma de las publicaciones en grupo en nuestro ámbito. Finalmente, el Grupo de Investigación Clínica en Atención Primaria (G-ICAP) sugiere una serie de recomendaciones, con el objetivo de facilitar la toma de decisiones sobre estos temas, tanto para los estudios del propio G-ICAP, como para otros estudios científicos que se desarrollen en el ámbito de las ciencias de la salud (AU)

This document aims to comment on the currently used concepts of authorship of scientific articles. Parallelly, the question of the “order of the authors” is discussed. The concept of authorship according to contribution and of the “special case of the group publications” is approached. Special emphasis has been made in the bibliographic search on obtaining publications from groups of Spanish authors to illustrate how the group signing of the publications in our setting is done. Finally, the Clinical Research Group in Primary Care (G-ICAP) makes a series of recommendations in order to facilitate decision-making on these subjects, both for the studies of the G-ICAP itself as well as for other scientific studies developed in the health sciences setting (AU)

Utilización de analgésicos opioides mayores en dos áreas sanitarias de España durante 2005 / No disponible

Objetivo: describir y comparar la prescripción de analgésicos opioides mayores en dos áreas sanitarias de España durante 2005. Método: Diseño: estudio descriptivo ecológico. Ámbito: Servicio de Salud de Lleida y Área Sanitaria 3 de la Comunidad de Madrid (A3-Madrid). Medidas principales de resultado: los sistemas de información de atención primaria de los servicios de Salud de Madrid y Lleida proporcionaron los datos relativos a la prescripción de opioides mayores. Se utilizó la clasificación farmacológica ATC/DDD (Anatómica-Terapéutica-Clínica/Dosis Diaria Definida) con los datos en DDD por millón de habitantes y día (DHD). Resultados: la DHD de opioides mayores fue de 3.690 para Lleida y 2.140 para A3-Madrid. El fentanilo constituye el 88% de los opioides prescritos en A3-Madrid comparado con el 52% en Lleida. La buprenorfina representa el 45% de los opioides prescritos en Lleida comparado con el4% en A3-Madrid. Conclusiones: la utilización de morfina ha sido sustituida por fármacos opioides de más reciente comercialización, principalmente las formas transdérmicas de fentanilo y buprenorfina (AU)

Objective: to compare and to describe the prescription of strong opioid analgesics in two sanitary districts of Spain during 2005. Method: Design: an ecological descriptive study. Setting: Lleida Health Service and the Third Sanitary District in Madrid (3D-Madrid) Community. Main outcome measures: a primary healthcare database supplied information regarding the prescription of strong opioids. We used the ATC/DDD (Anathomical-Therapeutical-Clinical/Defined Daily Dose) drug classification. Data obtained are expressed as Defined Daily Dose per 1,000,000 inhabitants per day (DHD).Results: DHDs of 3,690 for Lleida and of 2,140 for the Third SanitaryDistrict in Madrid (3D-Madrid) were found. Fentanyl constitutes 88 percent of prescribed opioids in 3D-Madrid versus 52 percent in Lleida. Buprenorphine represents 44 percent of prescribed opioids in Lleida versus 4 percent in 3D-Madrid.Conclusions: morphine has been substituted for by other drugs, mainly the transdermic forms of fentanyl and buprenorphine (AU)

Problemas sentidos por médicos de Atención Primaria del Área 3 de Madrid en la prescripción de medicamentos genéricos. Estrategias de mejora / Problems observed by Madrid Area.Primary Care physicians in theprescription of generic drugs. Improvement strategies

OBJETIVO. Mejorar la utilización de genéricos entre los profesionales del Área 3 de Atención Primaria de Madrid. Investigar las reticencias de los facultativos para su prescripción. MÉTODOS. Diseño: estudio cualitativo con entrevista individual y cuantitativo. Estrategias de intervención: 1) intervención grupal: sesión específica sobre genéricos impartida por el farmacéutico de Atención Primaria del Área en el Centro de Salud a 5 equipos de Atención Primaria; 2) intervención individual: ­ Entrevista del farmacéutico de Atención Primaria a 30 facultativos, realizada en su consulta. Análisis de la prescripción, información comparada con el resto de facultativos (equipo de Atención Primaria y Área) y principios activos sustituibles por especialidades farmacéuticas genéricas. ­ Monitorización mensual personalizada. Estas dos estrategias se compararon con un grupo control interno (resto de equipos del Área) y un grupo control externo, global Atención Primaria Comunidad de Madrid. Ámbito geográfico y período de estudio: Área 3 de Atención Primaria. 2005. Sistema de información: DataWareHouse específico de la Comunidad de Madrid, farm@drid. RESULTADOS. La eficacia de la intervención grupal fue ligeramente superior a la de la individual y bastante más eficaz que la no intervención. La desviación inicial del Área 3 sobre la Comunidad de Madrid se redujo notablemente (diferencia de 0,06% en diciembre de 2005). Los médicos del Área 3 detectan dificultades al prescribir genéricos, relacionadas generalmente con existencia de principios activos de uso habitual sin genérico, problemas estructurales e intrínsecos del profesional. CONCLUSIONES. Ambas intervenciones fueron eficaces, el resultado de la grupal fue ligeramente superior al de la individual. Los profesionales concluyen que es importante incrementar el tiempo dedicado por el médico al paciente y realizar campañas informativas

OBJECTIVE. To improve the use of generic drugs among the professionals of primary health care area 3. Investigate the reluctance of the professionals to prescribe them. METHODS. Design: qualitative study with individual and quantitative interview. Intervention strategies: 1) group intervention: Specific session on generic drugs given by the primary health care Pharmacist in the health site to 5 primary health care teams; 2) individual intervention: ­ Interview of the Area Pharmacist to 30 general practitioners in the health site. Analysis of the prescription, information compared with the rest of the general practitioners (Health Care Teams and Area) and active ingredients that could be substituted by generic pharmaceutical products. ­ Personalized monthly monitoring. These two strategies were compared with an Internal Control Group (the rest of the area teams) and an External Control Group, global primary care of the Madrid Community (MC). Geographic scope and study period: Area 3 of Primary Care. 2005. Information system: DataWareHouse specific for the MC, farm@drid. RESULTS. Efficacy of the group intervention was slightly greater than that of the individual one and much more than non-intervention. The initial deviation of Area 3 on the MC was significantly reduced (difference of 0.06% in December 2005). Area 3 physicians detect difficulties when prescribing generic drugs, generally related with the existence of active ingredients that are generally used without generic drugs, structural and intrinsic problems of the professional. CONCLUSIONS. Both interventions were efficacy. The result of the group one was slightly greater than the individual one. The professionals concluded that it is important to increase the time dedicated by the physician to the patient and to make information campaigns

[Calculation of the number of terminally ill patients through their use of opioid analgesics and tumor mortality]. / Estimación de la población de enfermos en situación terminal a través de la utilización de analgésicos opioides y de la mortalidad por tumores.

OBJECTIVE: To find the number of patients in terminal care in Madrid Health District 3. DESIGN: Ecological, descriptive study. SETTING: Eleven Health Districts. Madrid, Spain, 2002. MAIN MEASUREMENTS: Two models were used to calculate the number of patients in terminal care and were compared with data from the Primary Care Service Portfolio. Model A: consumption of morphine and fentanyl. The number of defined daily doses (DDD) of these active principles and the DDD per 1000 inhabitants and day (DID) were calculated. Prescription details: prescriptions charged to Social Security from registered doctors in Madrid (primary care and specialists). Model B: tumor mortality, i.e. the number of deaths due to tumors in the year 2000, published in 2004. RESULTS: The number of terminal patients calculated by the 2 models in 7 of the 11 Health Districts and in the Community of Madrid is higher than in the Primary Care Service Portfolio. In the Community of Madrid, morphine and fentanyl are prescribed basically in primary care (96%). There was an important jump in fentanyl prescription from 2001 to 2002, due to the main fentanyl prescribed being transdermal. CONCLUSIONS: There are differences between the models in calculation of terminal patients. Moreover, the models offer heterogeneous results between health districts. Fentanyl consumption has become greater than morphine use in Madrid. The registers of terminal patients and/or their recruitment need to be improved.

La automedicación responsable, la publicidad farmacéutica y su marco en la Atención Primaria / Responsible self-medication, over the counter drug publicity and its framework in Primary Care

La Organización Mundial de la Salud (OMS) ve en la automedicación responsable una fórmula válida de atención a la salud en las sociedades desarrolladas. Para ello se dispone de medicamentos clasificados como especialidades farmacéuticas publicitarias (EFP), que son las únicas de las que puede hacerse publicidad dirigida a la población, siempre bajo un control previo. La industria farmacéutica está demandando a la Administración un control menos estricto sobre las EFP para potenciar su desarrollo, sacar "marcas paraguas" o asumir directamente la responsabilidad de su publicidad ("autorregulación"); líneas éstas que el Ministerio de Sanidad y Consumo no considera prioritarias. En este artículo se revisan las ventajas e inconvenientes de las EFP, así como los requisitos que deberían darse para una automedicación responsable. Es clave la educación sanitaria de la población y la estrecha colaboración entre médicos y farmacéuticos. Los nuevos avances tecnológicos abren vías de colaboración para conseguir una automedicación responsable

The World Health Organization (WHO) considers responsible self-medication as a valid formula for health care in developed societies. For this, there are drugs classified as over the counter (OTC), which are the only ones that can use advertising aimed at the population, always under previous control. The pharmaceutical industry is demanding that the Administration control OTC drugs less strictly in order to potentiate their development, promote umbrella brands or directly assume responsibility for their publicity ("self-regulation"), lines which are not considered to be priority by the Ministry of Health and Consumer Affairs. This article reviews the advantages and disadvantages of the OTC and the requirements that should be used for responsible self-medication. Health care education of the population and strict collaboration between physicians and pharmacists are essential. The new technological advances open collaboration pathways to achieve responsible self-medication

Estimación de la población de enfermos en situación terminal a través de la utilización de analgésicos opioides y de la mortalidad por tumores / Calculation of the number of terminally ill patients through their use of opioid analgesics and tumor mortality

Objetivo. Conocer el número de pacientes en situación terminal del Área 3 de Madrid. Diseño. Estudio descriptivo, ecológico. Emplazamiento. Once áreas de salud. Comunidad de Madrid (CM). Año 2002. Mediciones principales. Se utilizan dos modelos para estimar a la población de pacientes en situación terminal y se comparan con los datos obtenidos en la cartera de servicios: ­ Modelo A. Consumo de opioides mayores (fentanilo y morfina). Se calcula el número de dosis diarias definidas (DDD) y la dosis diaria definida por 1.000 habitantes y día (DHD) para estos principios activos. Datos de prescripción: recetas facturadas por la Seguridad Social de médicos colegiados de la CM (atención primaria y especializada). ­ Modelo B. Mortalidad por tumores: número de defunciones por tumores del año 2000, publicado en 2004. Resultados. El número de pacientes en situación terminal estimado por los 2 modelos en 7 de las 11 áreas y en la CM es superior al obtenido en la cartera de servicios. La prescripción de opioides mayores se realiza fundamentalmente en atención primaria (96%) en la CM. Se produce un salto cuantitativo en la utilización de fentanilo entre 2001 y 2002, debido a la prescripción mayoritaria de fentanilo transdérmico. Conclusiones. Hay diferencias en la estimación de pacientes en situación terminal según los distintos modelos. Además, los modelos no presentan resultados coherentes entre las distintas áreas de salud. La utilización de fentanilo ha desplazado a la morfina en la CM. Es importante mejorar los registros y/o la captación de pacientes en situación terminal

Objective. To find the number of patients in terminal care in Madrid Health District 3. Design. Ecological, descriptive study. Setting. Eleven Health Districts. Madrid, Spain, 2002. Main measurements. Two models were used to calculate the number of patients in terminal care and were compared with data from the Primary Care Service Portfolio. Model A: consumption of morphine and fentanyl. The number of defined daily doses (DDD) of these active principles and the DDD per 1000 inhabitants and day (DID) were calculated. Prescription details: prescriptions charged to Social Security from registered doctors in Madrid (primary care and specialists). Model B: tumor mortality, i.e. the number of deaths due to tumors in the year 2000, published in 2004. Results. The number of terminal patients calculated by the 2 models in 7 of the 11 Health Districts and in the Community of Madrid is higher than in the Primary Care Service Portfolio. In the Community of Madrid, morphine and fentanyl are prescribed basically in primary care (96%). There was an important jump in fentanyl prescription from 2001 to 2002, due to the main fentanyl prescribed being transdermal. Conclusions. There are differences between the models in calculation of terminal patients. Moreover, the models offer heterogeneous results between health districts. Fentanyl consumption has become greater than morphine use in Madrid. The registers of terminal patients and/or their recruitment need to be improved

[Primary care doctors needs for information: analysis of questions and how they were answered]. / Necesidades de información de los médicos de atención primaria: análisis de preguntas y su resolución.

OBJECTIVE: To assess what information primary care doctors from 5 health areas of Madrid need, through the description of the frequency and kind of clinical questions that arise, the pattern of search for the answers and how well they were answered. DESIGN: Descriptive, observational study. Setting. Primary care consultations in health areas 1, 3, 8, 9, and 10, Madrid, Spain. PARTICIPANTS: Randomised sample, stratified by zone, and kind of doctor, of 125 doctors from each area (Madrid). Residents, locums, and university teachers were excluded. INTERVENTIONS: Doctors will be invited to be observed by video camera for about four hours of on-demand consultation. They will be asked between patients to specify the questions that arise and the sources of information used in the consultation. Unresolved questions will be followed up by means of phone contact 2 weeks later, to see whether they had found answers and what methods they used to find them. MAIN VARIABLES: number of recognised clinical questions formulated and their answers; number of clinical questions not recognised (as observed by video); each question's theme and kind of information; time used to look for answers; information resources used. Other variables: characteristics of the PC professionals taking part, consultations, health centres, and case-loads. DISCUSSION: Restrictions: Hawthorne effect or bias in the person observed and participants stage fright. Applicability: the results of the research will be used to plan the resources needed for doctors to enjoy and put into practice the best scientific knowledge.

Necesidades de información de los médicos de atención primaria: análisis de preguntas y su resolución / Primary care doctors’ needs for information: analysis of questions and how they were answered

Objetivo. Determinar las necesidades de información de los médicos de atención primaria de 5 áreas de salud de Madrid mediante la descripción de la frecuencia y el tipo de preguntas clínicas, el patrón de búsqueda y nivel de resolución de éstas. Diseño. Estudio observacional descriptivo. Emplazamiento. Consultas de atención primaria. Áreas de salud 1, 3, 8, 9 y 10 de Madrid. Participantes. Muestra aleatoria, estratificada por zona y tipo de médico, de 125 médicos de cada una de las áreas (Madrid). Se excluye a los médicos residentes, a los suplentes y a los que realizan actividades de enseñanza universitaria. Intervenciones. Se invitará a los médicos a ser observados mediante cámara de vídeo durante aproximadamente 4 h de consulta a demanda. Se les pedirá que especifiquen, entre paciente y paciente, las preguntas que surjan y las fuentes de información utilizadas dentro de la consulta. Las preguntas sin resolver serán seguidas mediante contacto telefónico 2 semanas después para determinar si se han obtenido respuestas y los métodos utilizados. Mediciones principales. Variables principales: número de preguntas clínicas formuladas reconocidas y sus respuestas; número de preguntas clínicas no reconocidas (observadas a través del vídeo); tema y tipo de información de cada pregunta; tiempo utilizado en buscar respuestas; recursos de información utilizados. Otras variables: características de los profesionales de atención primaria participantes, consultas, centros de salud y presión asistencial. Discusión. Una limitación es el efecto Hawthorne o sesgo del observado y miedo escénico de los participantes. En cuanto a la aplicabilidad de los resultados de la investigación, servirán para planificar los recursos necesarios para que los médicos dispongan y apliquen la mejor evidencia científica

Objective. To assess what information primary care doctors from 5 health areas of Madrid need, through the description of the frequency and kind of clinical questions that arise, the pattern of search for the answers and how well they were answered. Design. Descriptive, observational study. Setting. Primary care consultations in health areas 1, 3, 8, 9, and 10, Madrid, Spain. Participants. Randomised sample, stratified by zone, and kind of doctor, of 125 doctors from each area (Madrid). Residents, locums, and university teachers were excluded. Interventions. Doctors will be invited to be observed by video camera for about four hours of on-demand consultation. They will be asked between patients to specify the questions that arise and the sources of information used in the consultation. Unresolved questions will be followed up by means of phone contact 2 weeks later, to see whether they had found answers and what methods they used to find them. Main measurements. Main variables: number of recognised clinical questions formulated and their answers; number of clinical questions not recognised (as observed by video); each question's theme and kind of information; time used to look for answers; information resources used. Other variables: characteristics of the PC professionals taking part, consultations, health centres, and case-loads. Discussion: Restrictions: Hawthorne effect or bias in the person observed and participants´ stage fright. Applicability: the results of the research will be used to plan the resources needed for doctors to enjoy and put into practice the best scientific knowledge

The cost of inadequate prescriptions for hypolipidaemic drugs. VICAF Group.

BACKGROUND: The high consumption of hypolipidaemic agents warrants the study of the costs caused by these medicines being inadequately prescribed. OBJECTIVE: To quantify the economic cost generated in 1 year in primary care by inadequate (or unnecessary) prescriptions for hypolipidaemic drugs. METHODS: A cross-sectional study based on hypolipidaemic drug prescriptions for a population of pensioners ordered during 1 year by 49 family physicians from 4 health areas in Madrid, Spain. Each doctor completed a data collection sheet for each patient for whom a hypolipidaemic agent was prescribed. The adequacy of each prescription was evaluated according to 2 quality levels: for level 1, it was necessary to have knowledge of the following parameters: total cholesterol level at the start of treatment, low density lipoprotein cholesterol (LDL-C) level, whether dietary intervention preceded pharmacological treatment, patient age and risk factors; for level 2, it was not necessary to have knowledge of either diet before pharmacological treatment or LDL-C levels. Inadequate expenditure was quantified by physician, by type of doctor who initiated the pharmacological treatment (the family physician, specialist, other doctor), therapeutic group and agent. STUDY PERSPECTIVE: Primary healthcare management of 4 public health areas. RESULTS: The cost of inadequate prescriptions for hypolipidaemic drugs reached 116,480.60 US dollars ($US; 1997 values) for quality level 1 and $US37,893.37 for level 2. 12.3% of the health professionals ordered all their prescriptions inadequately (level 1). Of the total inadequate prescription expenditure, 20.4% represented treatments initiated by family physicians and 35.3% by specialists (level 1). Statins made up 78.2% of the total cost; the inadequate expenditure for this therapeutic group reached $US88,797 (level 1). Of the prescriptions for fibrates, 88% were inadequate (level 1). CONCLUSIONS: In this study, 67% of prescriptions for hypolipidaemic medicines were ordered inadequately in the pensioner population, which represents a considerable pharmacological expenditure. This percentage and the mean cost per inadequate prescription was higher if a specialist was the professional initiating the treatment. Therefore, it is necessary to run pharmaceutical prescription quality programmes with both primary care physicians and specialists involved.

[Validity of an indicator of the quality of pharmacological prescription in patients with hyperlipemia]. / Validez de un indicador de calidad de prescripción farmacológica en pacientes con hiperlipemia.

OBJECTIVES: The computer system for billing prescriptions (SIFAR in Spanish) enables indicators to be extracted for the study and follow-up of the use of medicines in the INSALUD primary care areas. Concretely, we studied the indicator referring to pensioners consumption of lipid-lowering drugs (PCLL), not validated, and whose value is expected to drop as quality increases. The objective was to calculate the correlation of the indicator of prescription of lipid-lowering drugs on the SIFAR with the proportion of lipid-lowerers prescribed correctly for pensioners (PCP). DESIGN: A descriptive study of correlation between two indicators of drug prescription. SETTING: Four health districts in Madrid. PARTICIPANTS: The prescriptions of 49 general practitioners, chosen at random on the basis of three strata defined by the value of the indicator, were studied. Each doctor filled out a protocol of data for each pensioner patient to whom he/she prescribed a lipid-lowerer during the study period. MEASUREMENTS AND MAIN RESULTS: The PCLL and PCP indicators were compared through the correlation of Spearman. 6,779 prescriptions for 1,125 patients were collected from the 49 participating doctors. The mean percentage of lipid-lowerers correctly prescribed was 31.9%, figure that rose to 77.5% when the LDL value was not specified. The correlation between the PCLL and the PCP was near zero. CONCLUSIONS: The PCLL indicator of the SIFAR does not discriminate quality in lipid-lowering drug prescription to people over 64.

Validez de un indicador de calidad de prescripción farmacológica en pacientes con hiperlipemia / Validity of an indicator of the quality of pharmacological prescription in patients with hyperlipaemia

Objetivos. El sistema informático de facturación de recetas (SIFAR) permite la obtención de indicadores para el estudio y seguimiento de la utilización de medicamentos en las áreas de atención primaria del INSALUD. Concretamente, estudiamos el indicador referido al consumo de hipolipemiantes en población pensionista (CHPP), no validado y cuyo valor es esperable que disminuya al incrementarse la calidad. El objetivo es estimar la correlación del indicador de prescripción de hipolipemiantes del SIFAR con el porcentaje de hipolipemiantes correctamente prescritos en pensionistas (PCP). Diseño. Estudio descriptivo de correlación entre 2 indicadores de prescripción farmacológica. Emplazamiento. Cuatro áreas de salud de Madrid. Participantes. Se estudian las prescripciones de 49 médicos generales, elegidos aleatoriamente a partir de 3 estratos definidos por el valor del indicador. Cada médico rellena un protocolo de datos por cada paciente pensionista al que prescribe un hipolipemiante durante el período del estudio. Mediciones y resultados principales. Se comparan los indicadores CHPP y PCP mediante correlación de Spearman. Se han recogido 6.779 prescripciones correspondientes a 1.125 pacientes de los 49 médicos que participaron. El porcentaje medio de envases de hipolipemiantes correctamente prescritos es del 31,9 por ciento, cifra que asciende al 77,5 por ciento si no se exige tener constancia del valor LDL. Las correlaciones obtenidas entre el CHPP y el PCP son cercanas a cero. Conclusiones. El indicador CHPP del SIFAR no discrimina la calidad de prescripción de hipolipemiantes en mayores de 64 años (AU)

[The quality of the drug treatment in hyperlipemia patients from 4 health areas. The VICAF Group]. / Calidad del tratamiento farmacológico en pacientes con hiperlipemia de 4 áreas de salud. Grupo VICAF.

OBJECTIVE: To calculate how suitable the lipid-lowering treatment prescribed for pensioners in primary care clinics in four health areas is. DESIGN: Cross-sectional descriptive study of quality of pharmacological treatment. SETTING: Four primary care health districts, INSALUD, Madrid. PARTICIPANTS: 1125 patients registered with 49 doctors, chosen at random on the basis of three strata defined by the value of the lipid-lowering drug indicator of prescription. For a year, each doctor filled in a protocol of variables for each pensioner to whom he/she prescribed a lipid-lowering drug. MEASUREMENTS AND MAIN RESULTS: An automated algorithm was designed to evaluate the suitability of the drugs treatment for each patient, according to scientific criteria including: cholesterol levels, LDL, age, and risk factors. Quality of prescription was finally measured for 1009 patients. The indication of the treatment was due to primary prevention in 65% of cases. 32% of patients were correctly treated. If LDL compliance was not demanded, the suitability figure rose to 77%. Drug treatment was more suitable when the doctor him/herself administered it (as against another doctor or a specialist; p = 0.001) or when the patient was on the list of the prescribing doctor (p < 0.0001). Proper indication was lower in patients over 74 (p < 0.0001). CONCLUSIONS: The quality of lipid-lowering drug prescription for pensioners in primary care clinics in four health districts, as a function of the criteria defined above, could be improved. LDL is the factor which most affects the procedure.

Calidad del tratamiento farmacológico en pacientes con hiperlipemia de 4 áreas de salud / Quality of pharmacological treatment of patients with hyperlipaemia from four health districts

Objetivo.Estimar la adecuación del tratamiento hipolipemiante prescrito a pensionistas en consultas de atención primaria de 4 áreas de salud. Diseño. Estudio descriptivo transversal de calidad del tratamiento farmacológico. Emplazamiento. Cuatro áreas de salud de atención primaria. INSALUD. Madrid. Sujetos. Un total de 1.125 pacientes adscritos a 49 médicos, elegidos aleatoriamente a partir de 3 estratos definidos por el valor del indicador de prescripción de hipolipemiantes. Cada médico rellenó un protocolo de variables por cada pensionista al que indicó un hipolipemiante durante un año. Mediciones y resultados principales. Se elaboró un algoritmo automatizado para valorar la adecuación del tratamiento farmacológico de cada paciente, según criterios científicos teniendo en cuenta: niveles de colesterol, LDL, edad y existencia de factores de riesgo. La calidad de la prescripción se midió finalmente en 1.009 pacientes. La indicación del tratamiento se debió a prevención primaria en un 65 por ciento de los casos. El 32 por ciento de pacientes estaba correctamente tratado. Si no se exige la cumplimentación de LDL, el porcentaje de adecuación asciende al 77 por ciento. El porcentaje de tratamiento farmacológico adecuado fue superior cuando lo realizó el propio facultativo (frente a otro facultativo o al especialista; p = 0,001) y cuando el paciente pertenecía al propio cupo del médico prescriptor (p < 0,0001). La correcta indicación fue menor en pacientes mayores de 74 años (p < 0,0001). Conclusiones.La calidad de la indicación de hipolipemiantes a pensionistas en consultas de atención primaria de 4 áreas de salud, en función de los criterios previamente definidos, es mejorable, siendo la LDLel factor que más influye en el proceso (AU)

[Validity of the attendance pressure indicator in a primary care area]. / Validez del indicador presión asistencial en un área de atención primaria.

OBJECTIVE: To measure the validity of the attendance pressure indicator in the Primary Care clinics at a Health Centre. DESIGN: An observational, crossover study. SETTING: Primary Care Area 3, Madrid. PATIENTS AND OTHER PARTICIPANTS: Stratified sampling by professional group and systematic sampling out of a total of 296 Primary Care team professionals in the area were performed. The size of the sample was 100: 40 general practitioners, 15 paediatricians and 45 nurses. Information on the attendance pressure indicator was gathered directly from the Health Centres and compared with that sent to Area 3's Information System (3-IS) by the professionals themselves. MEASUREMENTS AND MAIN RESULTS: The attendance pressure indicator showed the following ICC for Area 3: 0.86 (LL > or = 0.79) in general medicine, 0.79 (LL > or = 0.69) in paediatrics and 0.95 (LL > or = 0.93) in nursing. The over-notification found was: 1.35 users per day (p < 0.05) in general medicine, 1.47 (p < 0.05) in paediatrics and 0.47 in nursing. CONCLUSIONS: The measurement method of the attendance pressure indicator in Madrid's Primary Care Area 3 is valid for general medicine, paediatrics and nursing. A light, but statistically significant, over-notification to 3-IS was observed in general medicine and paediatrics, but this does not affect the validity of the indicator.