[Cost and management of asthma attacks treated in primary care (COAX Study)]. / Coste y manejo de las crisis asmáticas atendidas en atención primaria (estudio COAX).

OBJECTIVES: To estimate the cost and characterize the management of asthma attacks in primary care. DESIGN: Prospective, observational study of 1 year's duration. Setting. 10 physician's offices at 9 primary care centers located in 5 provinces (Asturias, Barcelona, Cadiz, Madrid, and Valencia) of Spain. PARTICIPANTS: 10 family physicians who saw 133 consecutive patients with an asthma attack. METHOD: Prospective, observational study; no intervention was used. Direct and indirect costs arising from asthma attacks were calculated. Episodes were treated according to the physicians' habitually used procedures; the study protocol did not specify any predetermined intervention. RESULTS: The attacks were classified as mild in 43.6% of the cases, moderately severe in 43.6%, and severe in 12.8%. Of all severe attacks, 17.2% occurred in patients with intermittent asthma. The more severe the attack, the less preventive treatment patients had received previously. The mean cost of asthma attacks was 166.7 (95% CI, 146.5-192.3); 80% (132.4) (95% CI, 122.7-143.8) were direct costs and 20% (34.3) (95% CI, 17-56.2) were indirect costs. The most economical management option was to change treatment, perform diagnostic tests and have the patient attend 2 follow-up appointments with the physician. CONCLUSIONS: Mean cost of each asthma attack treated in primary care was 166.7 (95% CI, 146.5-192.3), of which 80% were direct costs and 20% indirect costs.

[Effectiveness of a recuperative primary care intervention in patients with chronic obstructive pulmonary disease]. / Efectividad de una intervención rehabilitadora, realizada en atención primaria, en la evolución de los pacientes con EPOC.

OBJECTIVES: The main objective is to assess the effect of a respiratory rehabilitation programme on the quality of life of patients with COPD. Secondary aims are to determine whether the intervention, as against the habitual monitoring, improves tolerance to exercise and pulmonary function, and reduces dyspnoea, the number of crises and hospital admissions due to COPD and the medication used to control the disease. DESIGN: Pragmatic cluster-randomised clinical trial. SETTING: Clinics of 16 PC teams in various health areas of the Community of Madrid. PARTICIPANTS: 476 patients with light-moderate COPD, who sign their informed consent. VARIABLES: Quality of life, number of crises, packages of medicines used to control the disease, unscheduled attendance, pulmonary function, dyspnoea and tolerance to exercise. METHOD: The consultations will be assigned to the control and intervention groups at random. At each clinic there will be a randomised selection from all patients with COPD and in a stable clinical condition. 238 patients are needed in each group, in order to detect a minimum difference of 4 points in quality of life, assuming a standard deviation of 16, 95% confidence level, 80% power and 20% losses. The effect between each factor and the variables evaluated through multivariate analysis will be calculated. DISCUSSION: This research project aims to show that a basic recuperative intervention, which is feasible and primary care-based, can achieve improvements in the quality of life of patients with COPD.

Coste y manejo de las crisis asmáticas atendidas en atención primaria (estudio COAX) / Cost and management of asthma attacks treated in primary care (COAX study)

Objetivos. Estimar el coste y conocer el manejo de una crisis asmática en atención primaria. Diseño. Estudio observacional, prospectivo. Emplazamiento. Diez consultas de 9 centros de atención primaria de 5 provincias (Asturias, Barcelona, Cádiz, Madrid y Valencia). Participantes. Diez médicos de familia que incluyeron, secuencialmente, a 133 pacientes con una crisis de asma. Mediciones principales. Se calcularon los costes directos e indirectos que supone una crisis de asma. El episodio se trató como habitualmente venía haciéndolo cada médico, sin que la intervención estuviera previamente definida en el protocolo del estudio. Resultados. Se observaron un 43,6% de crisis leves, un 43,6% de crisis moderadas y un 12,8% de crisis graves. El 17,2% de estas últimas ocurrieron en pacientes con asma intermitente. Cuanto más grave era la crisis, menor era el tratamiento preventivo anterior a ella. El coste medio de una crisis asmática fue de 166,7 € (intervalo de confianza [IC] del 95%, 146,5-192,3), el 80% (132,4 €; IC del 95%, 122,7-143,8) debido a costes directos y el 20% (34,3 €, (IC del 95%, 17-56,2) a costes indirectos. La opción más económica de manejo de una crisis fue «cambiar el tratamiento, realizar una prueba diagnóstica y 2 visitas médicas». Conclusiones. El coste medio de una crisis asmática tratada en atención primaria fue de 166,7 € (IC del 95%, 146,5-192,3), el 80% debido a costes directos y el 20% a costes indirectos

Objectives. To estimate the cost and characterize the management of asthma attacks in primary care. Design. Prospective, observational study of 1 year's duration. Setting. 10 physician's offices at 9 primary care centers located in 5 provinces (Asturias, Barcelona, Cadiz, Madrid, and Valencia) of Spain. Participants. 10 family physicians who saw 133 consecutive patients with an asthma attack. Method. Prospective, observational study; no intervention was used. Direct and indirect costs arising from asthma attacks were calculated. Episodes were treated according to the physicians' habitually used procedures; the study protocol did not specify any predetermined intervention. Results. The attacks were classified as mild in 43.6% of the cases, moderately severe in 43.6%, and severe in 12.8%. Of all severe attacks, 17.2% occurred in patients with intermittent asthma. The more severe the attack, the less preventive treatment patients had received previously. The mean cost of asthma attacks was €166.7 (95% CI, 146.5-192.3); 80% (€132.4) (95% CI, 122.7-143.8) were direct costs and 20% (€34.3) (95% CI, 17-56.2) were indirect costs. The most economical management option was to change treatment, perform diagnostic tests and have the patient attend 2 follow-up appointments with the physician. Conclusions. Mean cost of each asthma attack treated in primary care was €166.7 (95% CI, 146.5-192.3), of which 80% were direct costs and 20% indirect costs

Efectividad de una intervención rehabilitadora, realizada en atención primaria, en la evolución / How much a recuperative primary care intervention affects the evolution of patients with chronic obstructive pulmonary disease

Objetivos. El objetivo principal es valorar la efectividad de un programa de rehabilitación respiratoria en la calidad de vida de pacientes con enfermedad pulmonar obstructiva crónica (EPOC). Los objetivos secundarios son: determinar si la intervención mejora la tolerancia al ejercicio y la función pulmonar, y disminuye la sensación de disnea, el número de exacerbaciones, los ingresos hospitalarios por EPOC y el consumo de medicación necesario para el adecuado control de la enfermedad frente al seguimiento habitual. Diseño. Ensayo clínico aleatorizado por grupos pragmático. Emplazamiento. Consultas de 16 equipos de atención primaria, repartidos por diferentes áreas sanitarias de la Comunidad de Madrid. Participantes. Se incluirá en el estudio a 476 pacientes con EPOC leve-moderada, que firmarán el consentimiento informado. Variables. Calidad de vida, número de agudizaciones, envases de medicación utilizados para el control, visitas no programadas, función pulmonar, disnea y tolerancia al ejercicio. Método. Se realizará asignación aleatoria de las consultas a cada grupo, control e intervención. En cada consulta se realizará una selección aleatoria del total de pacientes con EPOC, en situación clínica estable. Se precisan 238 pacientes en cada grupo para detectar una diferencia mínima de 4 puntos en la calidad de vida, asumiendo una desviación estándar de 16, un nivel de confianza del 95%, una potencia del 80% y unas pérdidas del 20%. Se estimará el efecto entre el factor de estudio y las variables evaluadas mediante análisis multivariante. Discusión. Este proyecto de investigación pretende demostrar que una intervención rehabilitadora básica, factible e implementada en atención primaria permite alcanzar mejoras en la calidad de vida de los pacientes con EPOC

Objectives. The main objective is to assess the effect of a respiratory rehabilitation programme on the quality of life of patients with COPD. Secondary aims are to determine whether the intervention, as against the habitual monitoring, improves tolerance to exercise and pulmonary function, and reduces dyspnoea, the number of crises and hospital admissions due to COPD and the medication used to control the disease. Design. Pragmatic cluster-randomised clinical trial. Setting. Clinics of 16 PC teams in various health areas of the Community of Madrid. Participants. 476 patients with light-moderate COPD, who sign their informed consent. Variables. Quality of life, number of crises, packages of medicines used to control the disease, unscheduled attendance, pulmonary function, dyspnoea and tolerance to exercise. Method. The consultations will be assigned to the control and intervention groups at random. At each clinic there will be a randomised selection from all patients with COPD and in a stable clinical condition. 238 patients are needed in each group, in order to detect a minimum difference of 4 points in quality of life, assuming a standard deviation of 16, 95% confidence level, 80% power and 20% losses. The effect between each factor and the variables evaluated through multivariate analysis will be calculated. Discussion. This research project aims to show that a basic recuperative intervention, which is feasible and primary care-based, can achieve improvements in the quality of life of patients with COPD