Resultados de un programa de coordinación y de información clínica compartida entre nefrología y atención primaria / Results of a Coordination Programme and Shared Clinical Information between Primary Care and Nephrology

Introducción: La elevada prevalencia de la enfermedad renal crónica (ERC) en la población general ha creado la necesidad de desarrollar una coordinación entre la atención especializada nefrológica y la atención primaria. Aunque diversos sistemas se han desarrollado para coordinar este proceso, la presentación de resultados es escasa y a veces contradictoria. Objetivo: Presentar los resultados de un programa de coordinación entre atención primaria y atención especializada nefrológica mediante consultorías y un sistema de información clínica compartida para facilitar la comunicación y mejorarlos criterios de derivación de los pacientes. Métodos: Elaboración de un programa consensuado entre la dirección médica de atención primaria y nefrología basado en los criterios del «Documento de consenso entre la S.E.N. y la semFYC» y en un protocolo de estudio y tratamiento de la hipertensión arterial (HTA). Explicación e implantación en los equipos de atención primaria. Creación de un programa deagendas de consultorías en atención primaria tanto presenciales como vía correo electrónico de nefrólogos. Implantación de un programa de formación continuada en enfermedades renales y en HTA durante las consultorias presenciales. Progresivo desarrollo en un período de 3 años (2007-2010)en un área de 426.000 habitantes con 230 médicos de familia. Utilización de un sistema de información clínica compartida llamado «Salut en Xarxa» que permite el acceso a informesclínicos, diagnósticos, prescripciones, analíticas y curso (..) (AU)

Introduction: The high prevalence of chronic kidney disease(CKD) in the general population has created a need to coordinate specialised nephrology care and primary care. Although several systems have been developed to coordinate this process, published results are scarce and contradictory. Objective: To present the results of the application of a coordinated programme between nephrology care and primary care through consultations and a system of shared clinical information to facilitate communication and improve the criteria for referring patients. Methods: Elaboration of a coordinated care programme by the primary care management team and the nephrology department, based on the SEN-SEMFYC consensus document and a protocol for the study and management of arterial hypertension (AHT).Explanation and implementation in primary health care (..) (AU)

[Use of a combination of non stress fetal heart rate monitoring and the oxytocin challenge test in high-risk pregnancies. The effects on perinatal mortality (author's transl)]. / Emploi combiné du monitorage foetal non stressant (MFNS) et de l'épreuve à l'ocytocine (oxytocin challenge test = OCT) dans les grossesses à haut risque: effets sur la mortalité périnatale.

A protocol for antepartum supervision which included "non stress fetal monitoring" (NSFM) and the "oxytocin Challenge Test" (OCT) was followed in a series of 640 high-risk pregnancies. The perinatal mortality in this group was compared with that obtained in a group of 3,049 non-selected deliveries which occurred during the same period of time and which were not monitored in the same way. The perinatal mortality which could be attributed to placental insufficiency in the first group (the supervised group) was at 4.68 per 1000, about half that of the non-supervised group (8.72 per 1000) in spite of the low number of high risk cases in the second group. When NSFM was normal in the week before delivery there was no single perinatal death due to placental insufficiency. When the NSFM was normal and the OCT was pathological the OCT Test was probably wrong. When the NSFM test was non-reactive placental insufficiency could be predicted in only 28 per cent of the cases although a combination of NSFM with a positive OCT Test predicted correctly 91.3 per cent of the cases of placental insufficiency. We consider that there is fetal distress due to placental insufficiency when having found signs indicative of fetal distress in delivery (a pH of less than 7.25, recent passage of meconium, the Apgar score less than 7 in the first minute, and pathological fetal heart rhythm (RFC) we can find no other cause to explain the signs such as a short cord, prematurity, obstetrical trauma, prolonged pregnancy and malformations, etc.