[Introduction of capillary glycosylated haemoglobin determination in a Primary Care Health Area: Multicentre study of the evolution of patients with type 2 diabetes mellitus]. / Implantación de la determinación de hemoglobina glucosilada capilar en un Área de Salud: estudio multicéntrico sobre evolución de pacientes con diabetes mellitus de tipo 2.

PURPOSE: The aim of this study was to evaluate the efficiency of a joint intervention that included educational components, self-assessment, and information to optimise diabetes control through the introduction of instant capillary glycosylated haemoglobin (HbA1c) determination in Primary Care. MATERIALS AND METHODS: A multicentre prospective descriptive study was carried out over 3years in 10Primary Care Centres of the Area VII Murcia East. At the end of the study there were 804 patients with type 2 diabetes (DM2). Patients were divided into 4 groups based on initial values of HbA1c, and if changes in their treatment were needed. HbA1c, body mass index, and blood pressure were monitored. A financial assessment was also performed on the impact of the implementation of a protocol to measure instant capillary RESULTS: A significant reduction was observed in HbA1c values. The initial HbA1c mean value was 7.4±1.4%, which decreased to a final value of 6.9±1.0% (P<.001). At the end of the study, 71.4% of patients included reached diabetic control objectives. In addition, the financial assessment demonstrated that the implementation of this diabetes control system led to a decrease of the 24.7% in spending on glucose strips after the first year of study in Area VII Murcia Health Service. CONCLUSIONS: The introduction of capillary HbA1c determination in Primary Care has demonstrated to improve diabetes control and the efficiency of the health personnel. Furthermore, a reduction in the health costs of patients with DM2 was also shown.

[Postgraduate education in family and community medicine. The importance of differences between health care activity of the tutor and the resident]. / La formación posgraduada en medicina familiar y comunitaria. La importancia de las diferencias entre la actividad asistencial del tutor y del residente.

OBJECTIVE: To find the health-care activity of Family and Community Medicine (FCM) Interns (I) during their third year of Primary Care duties, to check the existence of significant differences with the Tutor's (T) health-care activity, and to evaluate, using the requests for complementary tests and the referral rate, possible qualitative differences in the outcome of on-demand consultations. DESIGN: A descriptive and retrospective observation study, with two parts, each corresponding to one objective. SETTING: Primary Health Care. The Carmen Health Centre in Murcia, used for teaching postgraduate FCM. PATIENTS AND OTHER PARTICIPANTS: A sample of 489 cases of those requesting health consultations between February 1st and December 21st, 1990 for the first part of the study; and all those consultations between April 8th and May 8th, 1991 for the second part. Covering five family practices. MEASUREMENTS AND MAIN RESULTS: The variables studied were: gender, age, the first or second medical consultation, administrative consultations, reasons for the consultation, the number of inter-referrals and the number of complementary tests. The I had fewer consultations a day than the T (p < 0.001), with a greater proportion of young people between 26 and 35 (p < 0.001) and with first (p < 0.001) and administrative (p < 0.001) consultations predominating. However no differences were observed regarding requests for complementary tests and referral rates. CONCLUSIONS: 1. Significant differences exist between the health-care activity of the T and the I. 2. The population selects the doctor who is going to care for them. 3. There were no differences observed in requests for complementary tests and the referral rates. 4. It would be important to assess the teaching repercussion of these differences and to introduce corrective mechanisms if it is thought necessary.

[Enteropathic arthritis]. / Artritis enteropática.

AIM: Description of a clinical case of enteropathic arthritis. DESIGN: Descriptive study. SITE. Health Centre. PATIENTS AND OTHER PARTICIPANTS: A clinical case is described, starting with back pain where X-rays perceive no irregularity. Later a diagnosis of Crohn's disease is made. Finally lesions characteristic of anchylo-poyethic spondylitis appear. INTERVENTIONS: Corticosteroid treatment. MEASUREMENTS AND MAIN FINDINGS: Clinical investigations and complementary diagnoses. CONCLUSIONS: Way in which spondylitis presents, with no clear X-ray indications. Importance of closely following the development of this type of patient.