Incidence of COVID-19 in patients under chronic treatment with hydroxychloroquine.

OBJECTIVE: To analyze the incidence of Covid-19 in patients who are chronic users of hydroxychloroquine. PATIENTS AND METHODS: Cross-sectional retrospective observational multicenter study in health areas and districts from Castilla La-Mancha and Andalucia. Of the 4451 participants included in the first recruitment, 3817 with valid data were selected. The main variable of the study is the presence or absence of Covid-19 infection by clinical, serological or polymerase chain reaction diagnosis. Sociodemographic and clinical variables and treatment and concomitant comorbidities were recorded. RESULTS: 169 (4,45%) patients had Covid-19 infection, of which 12 (7.1 %) died and 32 (18.9%) required hospital admission. Previous respiratory pathology was related to Covid-19 infection (P < .05). Maculopathy appears in 5.3% of patients and is significantly related to the dose of hydroxychloroquine consumed (P < .05). CONCLUSION: There is no relationship between chronic use of hydroxychloroquine and the incidence of Covid-19.

OBJETIVO: Analizar la incidencia de la enfermedad del coronavirus 19 (COVID-19) en pacientes consumidores crónicos de hidroxicloroquina. PACIENTES Y MÉTODOS: Estudio multicéntrico observacional retrospectivo transversal en Áreas de Salud de Castilla La-Mancha y distritos sanitarios de Andalucía. De los 4.451 participantes incluidos en el primer reclutamiento se seleccionaron 3.817 sujetos con datos válidos. La variable principal del estudio ha sido la presencia o ausencia de infección por la COVID-19 por diagnóstico clínico, serológico o por reacción en cadena de la polimerasa. Se registraron variables sociodemográficas, clínicas y tratamientos y comorbilidades concomitantes. RESULTADOS: Ciento sesenta y nueve (4,45%) pacientes presentaron infección por la COVID-19, de los cuales fallecieron 12 (7,1%) y 32 (18,9%) requirieron ingreso hospitalario. La enfermedad respiratoria previa se relacionó con la infección por la COVID-19 (p < 0,05). La maculopatía aparece en un 5,3% de los pacientes y está relacionada significativamente con la dosis de hidroxicloroquina consumida (p < 0,05). CONCLUSIÓN: No existe relación entre consumo crónico de hidroxicloroquina e incidencia de la COVID-19.

Incidencia de la COVID-19 en pacientes en tratamiento crónico con hidroxicloroquina / Incidence of COVID-19 in patients under chronic treatment with hydroxychloroquine

Objetivo: Analizar la incidencia de la enfermedad del coronavirus 19 (COVID-19) en pacientes consumidores crónicos de hidroxicloroquina.Pacientes y métodosEstudio multicéntrico observacional retrospectivo transversal en Áreas de Salud de Castilla La-Mancha y distritos sanitarios de Andalucía. De los 4.451 participantes incluidos en el primer reclutamiento se seleccionaron 3.817 sujetos con datos válidos. La variable principal del estudio ha sido la presencia o ausencia de infección por la COVID-19 por diagnóstico clínico, serológico o por reacción en cadena de la polimerasa. Se registraron variables sociodemográficas, clínicas y tratamientos y comorbilidades concomitantes.ResultadosCiento sesenta y nueve (4,45%) pacientes presentaron infección por la COVID-19, de los cuales fallecieron 12 (7,1%) y 32 (18,9%) requirieron ingreso hospitalario. La enfermedad respiratoria previa se relacionó con la infección por la COVID-19 (p<0,05). La maculopatía aparece en un 5,3% de los pacientes y está relacionada significativamente con la dosis de hidroxicloroquina consumida (p<0,05).ConclusiónNo existe relación entre consumo crónico de hidroxicloroquina e incidencia de la COVID-19. (AU)

Objective: To analyze the incidence of Covid-19 in patients who are chronic users of hydroxychloroquine.Patients and methodsCross-sectional retrospective observational multicenter study in health areas and districts from Castilla La-Mancha and Andalucia. Of the 4451 participants included in the first recruitment, 3817 with valid data were selected. The main variable of the study is the presence or absence of Covid-19 infection by clinical, serological or polymerase chain reaction diagnosis. Sociodemographic and clinical variables and treatment and concomitant comorbidities were recorded.Results169 (4,45%) patients had Covid-19 infection, of which 12 (7.1%) died and 32 (18.9%) required hospital admission. Previous respiratory pathology was related to Covid-19 infection (P<.05). Maculopathy appears in 5.3% of patients and is significantly related to the dose of hydroxychloroquine consumed (P<.05).ConclusionThere is no relationship between chronic use of hydroxychloroquine and the incidence of Covid-19. (AU)

Patients receiving a high burden of antibiotics in the community in Spain: a cross-sectional study.

Some patients in the community receive a high burden of antibiotics. We aimed at describing the characteristics of these patients, antibiotics used, and conditions for which they received antibiotics. We carried out a cross-sectional study. Setting: Thirty Health Primary Care Areas from 12 regions in Spain, covering 5,960,191 inhabitants. Patients having at least 30 packages of antibacterials for systemic use dispensed in 2017 were considered. Main outcome measures: Prevalence of antibiotic use, conditions for which antibiotics were prescribed, clinical characteristics of patients, comorbidities, concomitant treatments, and microbiological isolates. Patient's average age was 70 years; 52% were men; 60% smokers/ex-smokers; 54% obese. Overall, 93% of patients had, at least, one chronic condition, and four comorbidities on average. Most common comorbidities were cardiovascular and/or hypertension (67%), respiratory diseases (62%), neurological/mental conditions (32%), diabetes (23%), and urological diseases (21%); 29% were immunosuppressed, 10% were dead at the time of data collection. Patients received three antibiotic treatments per year, mainly fluoroquinolones (28%), macrolides (21%), penicillins (19%), or cephalosporins (12%). Most frequently treated conditions were lower respiratory tract (infections or prophylaxis) (48%), urinary (27%), and skin/soft tissue infections (11%). Thirty-five percent have been guided by a microbiological diagnosis, being Pseudomonas aeruginosa (30%) and Escherichia coli (16%) the most frequent isolates. In conclusion, high antibiotic consumers in the community were basically elder, with multimorbidity and polymedication. They frequently received broad-spectrum antibiotics for long periods of time. The approach to infections in high consumers should be differentiated from healthy patients receiving antibiotics occasionally.

[Incidence of COVID-19 in patients under chronic treatment with hydroxychloroquine]. / Incidencia de la COVID-19 en pacientes en tratamiento crónico con hidroxicloroquina.

OBJECTIVE: To analyze the incidence of Covid-19 in patients who are chronic users of hydroxychloroquine. PATIENTS AND METHODS: Cross-sectional retrospective observational multicenter study in health areas and districts from Castilla La-Mancha and Andalucia. Of the 4451 participants included in the first recruitment, 3817 with valid data were selected. The main variable of the study is the presence or absence of Covid-19 infection by clinical, serological or polymerase chain reaction diagnosis. Sociodemographic and clinical variables and treatment and concomitant comorbidities were recorded. RESULTS: 169 (4,45%) patients had Covid-19 infection, of which 12 (7.1%) died and 32 (18.9%) required hospital admission. Previous respiratory pathology was related to Covid-19 infection (P<.05). Maculopathy appears in 5.3% of patients and is significantly related to the dose of hydroxychloroquine consumed (P<.05). CONCLUSION: There is no relationship between chronic use of hydroxychloroquine and the incidence of Covid-19.

Successful improvement of antibiotic prescribing at Primary Care in Andalusia following the implementation of an antimicrobial guide through multifaceted interventions: An interrupted time-series analysis.

BACKGROUND: Most effective strategies designed to improve antimicrobial prescribing have multiple approaches. We assessed the impact of the implementation of a rigorous antimicrobial guide and subsequent multifaceted interventions aimed at improving antimicrobial use in Primary Care. METHODS: A quasi-experimental study was designed. Interventions aimed at achieving a good implementation of the guide consisted of the development of electronic decision support tools, local training meetings, regional workshops, conferences, targets for rates of antibiotic prescribing linked to financial incentives, feedback on antibiotic prescribing, and the implementation of a structured educational antimicrobial stewardship program. Interventions started in 2011, and continued until 2018. Outcomes: rates of antibiotics use, calculated into defined daily doses per 1,000 inhabitants-day (DID). An interrupted time-series analysis was conducted. The study ran from January 2004 until December 2018. RESULTS: Overall annual antibiotic prescribing rates showed increasing trends in the pre-intervention period. Interventions were followed by significant changes on trends with a decline over time in antibiotic prescribing. Overall antibiotic rates dropped by 28% in the Aljarafe Area and 22% in Andalusia between 2011 and 2018, at rates of -0.90 DID per year (95%CI:-1.05 to -0.75) in Aljarafe, and -0.78 DID (95%CI:-0.95 to -0.60) in Andalusia. Reductions occurred at the expense of the strong decline of penicillins use (33% in Aljarafe, 25% in Andalusia), and more precisely, amoxicillin clavulanate, whose prescription plummeted by around 50%. Quinolones rates decreased before interventions, and continued to decline following interventions with more pronounced downward trends. Decreasing cephalosporins trends continued to decline, at a lesser extent, following interventions in Andalusia. Trends of macrolides rates went from a downward trend to an upward trend from 2011 to 2018. CONCLUSIONS: Multifaceted interventions following the delivering of a rigorous antimicrobial guide, maintained in long-term, with strong institutional support, could led to sustained reductions in antibiotic prescribing in Primary Care.

Long-term impact of an educational antimicrobial stewardship programme in primary care on infections caused by extended-spectrum ß-lactamase-producing Escherichia coli in the community: an interrupted time-series analysis.

BACKGROUND: There is little evidence on the ecological effect and sustainability of antimicrobial stewardship programmes (ASPs) in primary-care settings. We aimed to determine whether a multimodal, educational ASP would be sustainable in the long-term and reduce the incidence of infections caused by extended-spectrum ß-lactamase-producing Escherichia coli in the community by optimising antibiotic use. METHODS: We did this quasi-experimental intervention study in 214 primary health centres of four primary health-care districts in Andalusia, Spain. Local multidisciplinary teams, comprised of general practitioners, paediatricians, primary-care pharmacists, and epidemiologists, were created in each district and implemented a multimodal, education-based ASP. The core activity of the programme consisted of regular one-to-one educational interviews between a reference interviewing physician and prescribing physicians from each centre on the appropriateness of their most recent (same or preceding day) antibiotic prescriptions based on a structured questionnaire. Appropriate prescribing was defined as compliance of all checklist items with the reference guidelines. An average of five educational interviews were scheduled per prescriber per study year. We did an interrupted time-series analysis to assess the effect of the intervention on quarterly antibiotic use (prescription and collection by the patient) and quality of prescriptions (as defined daily doses per 1000 inhabitants per day) and incidence per 1000 inhabitants of E coli producing extended-spectrum ß-lactamase (ESBL) isolated from urine samples. FINDINGS: The study was done between January, 2012, and December, 2017, in a pre-intervention period of 2012-13 and an intervention period of 2014-17. Throughout the study period, there were 1387 physicians (1116 general practicioners and 271 paediatricians) in the included health centres serving a mean population of 1 937 512 people (299 331 children and 1 638 181 adults). 24 150 educational interviews were done over the 4 years. Inappropriate antibiotic prescribing was identified in 1794 (36·5%) of 4917 educational interviews in 2014 compared with 1793 (26·9%) of 6665 in 2017 (p<0·0001). The intervention was associated with a sustained reduction in the use of ciprofloxacin (relative effect -15·9%, 95% CI -23·9 to -8·0) and cephalosporins (-22·6%, -35·9 to -9·2), and a sustained increase in the use of amoxicillin (22·2%, 6·4 to 38·0) and fosfomycin trometamol (6·1%, 2·6 to 9·6). The incidence density of ESBL-producing E coli decreased by -0·028 cases per 1000 inhabitants (95% CI -0·034 to -0·021) after the start of the programme, reversing the pre-intervention increase and leading to a relative reduction of -65·6% (-68·2 to -63·0) 4 years later. INTERPRETATION: Our data suggest that implementation of a multimodal ASP in primary care that is based on individual educational interviews improves the use of antibiotics and results in a sustained significant reduction of infections by ESBL-producing E coli in the community. This information should encourage the implementation of ASPs in primary care. FUNDING: Instituto de Salud Carlos III, Spanish Government (PI14/01523).

The Effect of Monthly Medication on Mortality After a Coronary Event.

AIM: The aim of this study was to analyze how the consumption of medication over time affects the survival rate in patients with a coronary event and whether there is a gender difference. METHODS: The study included 804 patients admitted to 4 hospitals with a coronary event during 2007. Monitoring after coronary event was carried out during 2007 and every 6 months in the subsequent 2 years (2008 and 2009) throughout the review of the clinical history of the patient. The main outcome was the analysis of mortality after the coronary event. Kaplan-Meier survival curves were plotted to calculate the time to death, comparing women versus men for 4 medication groups: aspirin, statins, ß-blockers, and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs). A Cox regression model was used for the final mortality analysis. RESULTS: During the follow-up time, 172 deaths were assessed. Each month of treatment with aspirin, statins, ß-blockers, or ACEI/ARB was associated with a decrease in mortality between 13.0% and 0.5% (univariate analysis). The Kaplan-Meier method revealed a significant reduction in mortality after the coronary event for each month of treatment with aspirin (men), statins (men), and ß-blockers (both men and women). No significant effect in survival was observed in either gender with ACEI/ARB treatment. The final multivariable model (Cox regression) showed that the taking of aspirin, statins, ß-blockers, or ACEI/ARB is able to reduce mortality rates up to 7.0% (aspirin) throughout each month of treatment after a coronary event without any influence of gender. CONCLUSION: Aspirin, statins, ß-blockers, and ACEI/ARB revealed a protective character with each month of treatment throughout the follow-up period, in terms of risk reduction of death. Aspirin and statins showed the maximum benefit, followed by ACEI/ARB and ß-blockers.

Aspectos clave en el abordaje de las infecciones desde la farmacia comunitaria / Key factors in the approach to infections from the community pharmacy

La resistencia a los antimicrobianos es un problema de Salud Pública mundial debido a su aumento exponencial en muchas partes del mundo en los últimos años, y a que la generación de nuevos antibióticos es muy escasa. Aunque las bacterias multirresistentes se detectan principalmente en los hospitales, la Organización Mundial de la Salud (OMS) ha advertido que la reducción de las resistencias bacterianas debe alcanzarse a través de la mejora del uso de antibióticos en la comunidad. El farmacéutico comunitario es el último contacto que tiene el paciente antes de recibir el antibiótico. La información que estos profesionales pueden ofrecer a los pacientes puede influir en gran manera en sus expectativas ante el papel de los antibióticos en las infecciones. Por este motivo, la propia OMS ha establecido que la implicación del farmacéutico comunitario es fundamental en la lucha contra la amenaza de las resistencias bacterianas. Este artículo, adaptación del capítulo "El papel de la Farmacia Comunitaria en los Programas de Optimización de antimicrobianos" de la "Guía de Terapéutica Antimicrobiana del Aljarafe 3ª edición", está orientado a proporcionar información sobre el papel del farmacéutico comunitario en relación a su participación en los programas de optimización de antimicrobianos (PROA) en nuestro país. El artículo también proporciona herramientas útiles para la adquisición de las competencias para la integración del farmacéutico comunitario como miembros de los equipos multidisciplinares PROA en la comunidad

Antimicrobial resistance is a worldwide public health problem because of two main aspects. On the one hand, during the last years, it has been rising exponentially in many parts of the world. On the other hand, the creation of antibiotics is very limited. Although multiresistant bacteria are mainly detected in hospitals, the World Health Organization (WHO) has warned that the reduction of bacterial resistances must be reached through the improvement in the usage of antibiotics among the community. The community pharmacist is the last contact that has the patient before receiving the antibiotic. The information that these professionals can offer to patients may largely influence in their expectations of antibiotics' role in infections. For this reason, the WHO itself has established that the community pharmacist's implication is essential in the fight against the threat of bacterial resistances. This article is an adaptation of the chapter "The role of the Community Pharmacy in the Programs of antimicrobial agents' Optimization" published in the "Guide of Antimicrobial Therapy of the Aljarafe 3rd edition", focused on providing information about the role of the community pharmacist related to his participation in the programs of antimicrobial agents' optimization (PROA) in our country. The article also provides useful tools to get the competences for the integration of community pharmacists as members of the (PROA) multidisciplinary teams in the community

Selección de indicadores para la monitorización continua del impacto de programas de optimización de uso de antimicrobianos en Atención Primaria / Selection of indicators for continuous monitoring of the impact of programs optimizing antimicrobial use in Primary Care

OBJETIVOS: Construir indicadores básicos para el seguimiento y monitorización de la prescripción y uso adecuado de antimicrobianos en Atención Primaria, en base a las recomendaciones basadas en la evidencia y valorar la factibilidad de los indicadores resultantes para la monitorización de los antibióticos. MÉTODOS: Se realizó una revisión bibliográfica sobre indicadores de calidad de la prescripción de antimicrobianos a través de una búsqueda electrónica, limitándose al periodo 2001-2012. Se completó con una búsqueda «ad hoc» en las páginas web de los Servicios de Salud nacionales e internacionales. Los indicadores finales fueron elegidos por consenso por un grupo multidisciplinar de profesionales con dedicación al manejo de las infecciones desde varios ámbitos. Se verificó la factibilidad y la aplicabilidad de estos indicadores mediante la creación de informes y explotación de los datos en el sistema de facturación de recetas del Servicio de Salud. RESULTADOS: Se localizaron 22 indicadores. El grupo de consenso seleccionó 16 indicadores. Once de ellos miden la selección específica de antimicrobianos y 5 son tasas de consumo. Los indicadores fueron aplicados satisfactoriamente a la base de datos de prescripción, pudiéndose realizar comparaciones entre distintas áreas geográficas y observar tendencias de prescripción. CONCLUSIÓN: Se requiere la definición de indicadores básicos de seguimiento de uso de antibióticos adaptados a la realidad local. Los resultados de estos indicadores pueden ser objeto de retroinformación a los profesionales y ser utilizados para evaluar el impacto de la implantación de programas de optimización de uso de antimicrobianos

OBJECTIVES: To determine core indicators for monitoring quality prescribing in Primary Care based on the evidence, and to assess the feasibility of these indicators for monitoring the use of antibiotics. METHODS: A literature review was carried out on quality indicators for antimicrobial prescribing through an electronic search limited to the period 2001-2012. It was completed with an "ad hoc" search on the websites of public national and international health services. Finally, indicators were chosen by consensus by a multidisciplinary group of professionals dedicated to managing infections from several areas. The feasibility and applicability of these indicators was verified through the reporting and use of data in the prescription database. RESULTS: Twenty two indicators were found. The consensus group selected 16 indicators. Eleven of them measure the specific antimicrobial selection, and 5 are consumption rates. The indicators were successfully applied to the prescription database, being able to make comparisons between different geographical areas and to observe trends in prescriptions. CONCLUSION: The definition of a basic set of indicators to monitor antibiotic use adapted to local conditions is required. The results of these indicators can be used for feedback to professionals and for evaluating the impact of programs aimed at improving antimicrobial use

[Selection of indicators for continuous monitoring of the impact of programs optimizing antimicrobial use in Primary Care]. / Selección de indicadores para la monitorización continua del impacto de programas de optimización de uso de antimicrobianos en Atención Primaria.

OBJECTIVES: To determine core indicators for monitoring quality prescribing in Primary Care based on the evidence, and to assess the feasibility of these indicators for monitoring the use of antibiotics. METHODS: A literature review was carried out on quality indicators for antimicrobial prescribing through an electronic search limited to the period 2001-2012. It was completed with an "ad hoc" search on the websites of public national and international health services. Finally, indicators were chosen by consensus by a multidisciplinary group of professionals dedicated to managing infections from several areas. The feasibility and applicability of these indicators was verified through the reporting and use of data in the prescription database. RESULTS: Twenty two indicators were found. The consensus group selected 16 indicators. Eleven of them measure the specific antimicrobial selection, and 5 are consumption rates. The indicators were successfully applied to the prescription database, being able to make comparisons between different geographical areas and to observe trends in prescriptions. CONCLUSION: The definition of a basic set of indicators to monitor antibiotic use adapted to local conditions is required. The results of these indicators can be used for feedback to professionals and for evaluating the impact of programs aimed at improving antimicrobial use.

Improving the appropriateness of antimicrobial use in primary care after implementation of a local antimicrobial guide in both levels of care.

OBJECTIVE: This study aims to assess the effectiveness of multiple interventions carried out during the implementation of a guide, on the improvement of the appropriateness of antimicrobial prescribing in primary care. DESIGN: This is a cross-sectional before/after study carried out in Aljarafe Health Care Area (Andalusia, Spain), with a population of 368,728 inhabitants assisted in 37 health centers. SUBJECTS: Subjects include patients with antibiotic prescriptions during 2009 (pre-intervention phase) or 2012 (postintervention phase) selected by simple random sampling (confidence level, 95%; accuracy, 5%), with infections registered in the electronic clinical history. INTERVENTIONS: This study involve training sessions in primary care centers and hospital services, incorporation of the electronic guide to the Health Care Service Websites, and incorporation of the guide to the Digital Health History as a tool to support decision making. MAIN OUTCOME: Difference on appropriate antibiotic prescribing before and after interventions resulted from the study. Other variables also include age, gender, type of pharmacy, antibiotic prescribed, number of treatments per year, infection site, and main comorbidities SOURCES: In addition, this study uses computerized pharmacy records of reimbursed and dispensed drugs and electronic medical histories. RESULTS: The percentage of appropriate antibiotic prescribing increased from 36% in 2009 to 57% in 2012 (p < 0.001) is shown. The improvement was observed in all age patients of any sex and was higher among working-age patients and patients with comorbidities. The best results were observed in the group of beta-lactams and in the treatment of respiratory and skin infections. CONCLUSION: The realization of multifactorial interventions involving professionals from both levels of care could be an effective strategy to improve the use of antimicrobials in primary care.

Adecuación de la prescripción de antibióticos en un área de atención primaria: estudio descriptivo transversal / Appropriateness of antibiotic prescribing in a primary care area: A cross-sectional study

OBJETIVO: Analizar las características de la población que recibe tratamiento antibiótico y valorar la adecuación de estos tratamientos a sus indicaciones. MÉTODOS: DISEÑO: estudio descriptivo transversal de prescripción-indicación. EMPLAZAMIENTO: Un distrito de atención primaria en Andalucía. PARTICIPANTES: Pacientes adscritos a claves médicas del distrito. Se seleccionó una muestra por muestreo aleatorizado simple (nivel de confianza: 95%; precisión: 5%) de pacientes con prescripciones de antimicrobianos en 2009. Variable principal: adecuación de la prescripción de antibióticos a las recomendaciones de las guías locales. Los datos fueron obtenidos a través del sistema de facturación de recetas y la historia de salud digital. RESULTADOS: El 25% de la población del área recibió antibióticos durante 2009. La muestra (1.266 pacientes) presentó las siguientes características: el 57.9% eran mujeres, con una media de edad de 41 (± 1) años. El 39,3% eran pensionistas. La adecuación del tratamiento antibiótico fue del 19,9%, sin que se observaran diferencias de género. Se obtuvieron diferencias estadísticamente significativas relacionadas con la edad, y los mayores de 65años fueron el grupo de pacientes con mayor porcentaje de inadecuación. Los principales motivos de inadecuación fueron: no presentar registro de infección (44,5%), duración del tratamiento errónea (15,5%) y antibiótico incorrecto (11,5%). CONCLUSIÓN: Existe un alto grado de inadecuación en la prescripción de antibióticos en atención primaria. El alto grado de infra-registro, principalmente en pacientes de edades superiores, seguido de la utilización de pautas y tipo de antibióticos erróneos constituyen los principales motivos de inadecuación

OBJECTIVE: To assess the profile of patients receiving antibiotics and the appropriateness of these precriptions for the clinical conditions. METHODS: DESIGN: Cross-sectional study of prescription-indication. SETTING: A primary health care area in Andalusia. Subjects: Patients assigned to primary care centres. Patients with antibiotic prescriptions during 2009 were selected by simple random sampling (confidence level: 95%, accuracy: 5%). Primary endpoint: appropriateness of antibiotics prescribing to recommendations included in local guidelines. Data were obtained through the billing computerised prescriptions system and medical histories. RESULTS: Twenty-five per cent of the population area received antibiotics during 2009. The 1,266 patient samples showed the following characteristics: 57.9% were women, with a mean age of 41 (± 1) years. There were 39.3% pensioners. The percentage of appropriate antibiotic prescriptions was 19.9%, with no difference due to gender. Statistically significant differences were related to age, being those over 65 years the group of patients with the highest percentage of inappropriateness. The main reasons for inappropriateness were: no recording of the infectious process (44.5%), a wrong treatment duration (15.5%), and the use of an inadequate antibiotic (11.5%). CONCLUSION: There is a high level of inappropriateness in antibiotic prescribing in primary care. The high level of under-recording of diagnoses, mainly in elderly patients, followed by the use of wrong schedules, and the wrong type of antibiotics were the main reasons of inappropriateness

[Appropriateness of antibiotic prescribing in a primary care area: a cross-sectional study]. / Adecuación de la prescripción de antibióticos en un área de atención primaria: estudio descriptivo transversal.

OBJECTIVE: To assess the profile of patients receiving antibiotics and the appropriateness of these prescriptions for the clinical conditions. DESIGN: Cross-sectional study of prescription-indication. SETTING: A primary health care area in Andalusia. SUBJECTS: Patients assigned to primary care centres. Patients with antibiotic prescriptions during 2009 were selected by simple random sampling (confidence level: 95%, accuracy: 5%). Primary endpoint: appropriateness of antibiotics prescribing to recommendations included in local guidelines. Data were obtained through the billing computerised prescriptions system and medical histories. RESULTS: Twenty-five per cent of the population area received antibiotics during 2009. The 1,266 patient samples showed the following characteristics: 57.9% were women, with a mean age of 41 (±1) years. There were 39.3% pensioners. The percentage of appropriate antibiotic prescriptions was 19.9%, with no difference due to gender. Statistically significant differences were related to age, being those over 65 years the group of patients with the highest percentage of inappropriateness. The main reasons for inappropriateness were: no recording of the infectious process (44.5%), a wrong treatment duration (15.5%), and the use of an inadequate antibiotic (11.5%). CONCLUSION: There is a high level of inappropriateness in antibiotic prescribing in primary care. The high level of under-recording of diagnoses, mainly in elderly patients, followed by the use of wrong schedules, and the wrong type of antibiotics were the main reasons of inappropriateness.

Riesgos asociados a la utilización de antimicrobianos en personas mayores / No disponible

Objetivos: Describir los cambios fisiológicos más relevantes asociados al envejecimiento, las características de las infecciones en estos pacientes así como los efectos adversos más frecuentes e interacciones farmacológicas graves de los antimicrobianos en los mayores. Material y Métodos: Se realizó una revisión bibliográfica sobre los riesgos asociados al uso de antibióticos en ancianos. La información se apoyó en la actualización de la evidencia científica y la información de las Fichas Técnicas de los medicamentos. La búsqueda se limitó a los últimos 11 años, seleccionándose documentos publicados en español, inglés o francés. Se realizó una búsqueda electrónica de fuentes secundarias (revisiones sistemáticas) y una búsqueda manual “ad hoc”, partiendo de la bibliografía recuperada, estudios primarios, informes de agencias de evaluación de medicamentos, guías de práctica clínica y documentos de Sociedades Científicas. Se utilizaron como fuentes de información: Pubmed, Embase, Iowa Drug Information Service (IDIS), WinSPIRS 5.00, Up to Date, The Cochrane Library®. Resultados: Se localizaron 321 resultados, tras eliminar los que no cumplían criterios de inclusión 52 documentos, además de las fichas técnicas de todos los antibióticos citados, se incluyeron en la revisión bibliográfica. Conclusiones: Los pacientes mayores adquieren con mayor frecuencia infecciones por patógenos multi-resistentes y sufren más complicaciones graves de las infecciones. Los antibióticos son un grupo de fármacos especialmente sensibles a los cambios fisiológicos producidos por la edad, lo que puede condicionar la respuesta a los estos y exige en muchas ocasiones modificaciones posológicas con el fin de evitar intoxicaciones y/o fracasos terapéuticos. Este trabajo aporta información sobre estos cambios fisiológicos y los riesgos de los antibióticos en las personas mayores, aspectos necesarios para elegir un tratamiento adecuado (AU)

Aim: Describe the most important physiological changes associated with aging, the characteristics of infections in these patients and the most common side effects and severe interactions with antimicrobials in older people. Material and methods: We conducted a literature review on the risks associated with the use of antibiotics in the elderly. The information was based on the update of the scientific evidence and information from the drug Sheets. The search was limited to the past 11 years, selected papers published in English, Spanish or French. We performed an electronic search of secondary sources (systematic reviews) and a manual search “ad hoc” basis of the literature retrieved, primary studies, reports of drug evaluation agencies, clinical practice guidelines and documents of Scientific Societies. Information sources: Pubmed, Embase, Iowa Drug Information Service (IDIS), WinSPIRS 5.00, Up to Date, The Cochrane Library®. Results: We identified 321 results, after eliminating those who did not meet inclusion criteria 52 papers in addition to the technical specifications of all mentioned antibiotics were included in the literature review. Conclusion: Older patients can acquire infections more frequently multi-resistant pathogens and suffer more serious complications of infections. The antibiotics is a group of drugs sensitive to the physiological changes induced by aging, which may influence the response to these and often requires dosage modifications to avoid poisoning and / or therapeutic failures. This paper provides information on these physiological changes and risks of antibiotics in the elderly, aspects necessary to choose a proper treatment (AU)

Compliance with quality prescribing indicators in terms of their relationship to financial incentives.

OBJECTIVE: To develop quality prescribing indicators for general practitioners (GPs) who are non-monitored and not included in pay-for-performance programs, and to determine compliance with incentivized and non-incentivized indicators. STUDY DESIGN: Descriptive cross sectional study. SETTING: Aljarafe Primary Health Care Area (Andalusian Public Health Care Service, Spain), a rural and suburban area with a population of 323,857 inhabitants. Health assistance in this area is provided by 176 GPs in 37 health centers. Prescribing indicators were developed by a multidisciplinary group using a qualitative technique based on consensus. The members of the consensus group searched for updated recommendations focused on clinical evidence. Prescribing data were obtained from the computerised pharmacy records of reimbursed drugs and clinical data from the electronic clinical databases and hospital admission records. RESULTS: Fourteen indicators based on the selection of drugs of different therapeutic groups or linked to patient´s clinical information were designed. The compliance with indicators based on the selection of drugs linked to financial incentives was higher than that of indicators not linked to financial incentives. The compliance with indicators based on clinical information varied widely. Inappropriate prescribing ranged from 7 %, in the use of long-acting beta-agonists in asthma, to 86 % in the use of drugs for the prevention of osteoporotic fractures in young women. CONCLUSIONS: This study shows better compliance by GPs with indirect and incentivized quality prescribing indicators, included in pay-for-performance programs, compared with not-incentivized indicators based on the relative use of drugs and on the appropriateness prescribing.

Errores vacunales y situacionesque pueden conducir a erroresen Atención Primaria de salud / Vaccination errors and situations that may lead to mistakes in Primary Care

Objetivo: identificar errores en la administración de vacunas así como situacionesrelacionadas con la similitud de los envases que pudieran dar lugar a errores, enun distrito del Servicio Andaluz de Salud en el año 2007. Los resultados del estudiose utilizaron en una estrategia de difusión, tanto interna como externa.Material y método: estudio descriptivo en el Distrito Sanitario Aljarafe (Sevilla) delServicio Andaluz de Salud (SAS). Se recopiló la información sobre notificacionesde errores en la vacunación durante el año 2007. Se analizaron las similitudesen la denominación y etiquetado entre las vacunas disponibles en los centros.Resultados: se detectaron ocho errores reales por la administración de la vacunaantineumocócica 23-valente en lugar de la vacuna antigripal. Estos errores se debierona la gran similitud en el etiquetado. Se identificaron otros 15 situacionesque pueden conducir a errores relacionadas con el diseño y la denominación. Ladifusión interna se realizó mediante el envío de documentación a los responsablesde la gestión de vacunas en el Área y al Servicio Andaluz de Salud y mediantesesiones informativas para el equipo de Enfermería en los centros. Los errores vacunalesfueron notificados al Instituto para el Uso Seguro de los Medicamentos,que lo comunicó a la Agencia Española de Medicamentos y Productos Sanitariosy a los laboratorios fabricantes de las vacunas implicadas.Conclusiones: las vacunas constituyen un grupo de medicamentos con una alta probabilidadde conducir a errores de administración, relacionados en gran medidacon la similitud en la denominación y el etiquetado. Mientras no se adopten medidaspara diferenciarlas claramente, se requiere el esfuerzo de los profesionalesen la identificación correcta de los cartonajes para evitar errores en la administración (AU)

Objective: to identify errors in the administration of vaccines as well as errors thatcould be a result of similar packaging, in a district of the Andalusian Health Servicein 2007. The results of this study were used in both an internal and externaldissemination strategy.Material and method: descriptive study in the Health District of Aljarafe (Seville)of the Andalusian Health Service (AHS). Information regarding vaccination errorsreported in 2007 was gathered. Similarities in the names and labelling of the differentvaccines available in the centres were analyzed.Results: eight real errors were detected after the administration of the 23-valentantipneumococcic vaccine instead of the flu vaccine. These errors were due to thehighly similar labelling of both types of vaccine. 15 other situations which couldlead to errors related with design and name were identified. Internal disseminationwas carried out via the distribution of documentation to those in charge of vaccinemanagement in the Area and to the Andalusian Health Service and by meansof informative sessions for the Nursing team in these centres. Vaccination errorswere reported to the Institute for the Safe Use of Drugs, which in turn informedthe Spanish Drug and Healthcare Products Agency and laboratories which manufacturedthe vaccines involved.Conclusions: vaccines are a group of drugs presenting a high probability of leadingto administration errors due to their similarities in name and labelling. Untilmeasures are adopted to clearly differentiate them, professionals are required tobe careful in the correct identification of drug packages to avoid administrationerrors (AU)

Antibiotic prescribing patterns and hospital admissions with respiratory and urinary tract infections.

OBJECTIVE: To explore the relationship between antibiotic prescribing indicators for assessing the prescribing quality of general practitioners (GPs) and populations' health outcome indicators. DESIGN: Descriptive cross-sectional study. SETTING: Aljarafe Primary Health Care Area (population 321,034) under the administrative jurisdiction of the Andalusian Public Health Care Service, Spain. In total, 162 GPs, representing 95.29% of the total number of GPs in the study area, were included in the analysis. METHODS: Antibiotic prescribing indicators based on clinical evidence and recommendations from local resistance patterns were chosen by the consensus group technique. Hospital admissions due to respiratory tract and urinary infections in the three hospitals of the study area were recorded. Multiple regression analysis was carried out to determine the relationship between community prescribing of antibiotics and hospital admissions due to serious complications from respiratory and urinary infections. RESULTS: The higher prescribing of antibiotics adjusted for patients and working days was associated with a significantly higher number of adjusted hospital admissions due complications arising from respiratory and urinary infections (p < 0.001) (R (2) = 0.142). This relationship was not found for indicators based on the relative prescribing of recommended first-line versus second and third-line antibiotics. There were fewer patients of women GPs admitted to hospitals (p = 0.021). CONCLUSIONS: Our findings show a statistically significant relationship-at the GPs level-between the quantitative antibiotic prescribing rate and standardized hospital admissions due to complications arising from respiratory and urinary infections of the assisted patients. Strategies should be addressed to reduce unnecessary antibiotic prescribing in primary care.

Development of NSAIDs prescription indicators based on health outcomes.

OBJECTIVE: To explore the relationship between prescribing indicators aimed at assessing the prescribing quality of general practitioners (GPs) and indicators of health outcomes at the population level. DESIGN: Ecological study. SETTING: Aljarafe Primary Health Care Area (population 321,034), part of the Andalusian Public Health Care Service, Spain. A total of 162 GPs, representing 95.29% of the total GPs in the study area, participated in the analysis. METHODS: The prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) was determined using evidence-based indicators chosen by the consensus group technique. Admissions to hospitals in the study area due to digestive ulcer, bleeding or perforation were recorded. Multivariate regression analysis was then carried out to determine both the amount of variation in hospital admissions that can be explained by a combination of prescribing indicators and the strength and direction of independent associations with individual indicators. RESULTS: The higher prescription of NSAIDs adjusted for patients and working days (p = 0.002) and the higher relative prescription of gastroprotective agents versus NSAIDs (p < 0.001) were associated with a higher number of adjusted hospital admissions due to gastrointestinal adverse events (coefficient of correlation R = 0.378). In addition, the higher number of prescriptions for analgesics than for NSAIDs was related to fewer admissions (p = 0.028). There were fewer patients of GPs with postgraduate training admitted to hospital for these complaints (p = 0.049). CONCLUSIONS: The risk of hospitalization for serious gastrointestinal adverse events can be partially linked to the prescribing of NSAIDs based on an analysis of the prescribing indicators. A higher prescribing of NSAIDs was associated with significantly higher admissions. This relationship was not found for indicators based on the relative use of some NSAIDs versus total NSAIDs or on the use of gastroprotective drugs.