Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People.

BACKGROUND: SARS-CoV-2 has caused a high mortality in institutionalised individuals. There are very few studies on the involvement and the real impact of COVID-19 in nursing homes. This study analysed factors related to morbidity and mortality of COVID-19 in institutionalised elderly people. METHODS: This cohort study included 842 individuals from 12 nursing homes in Sant Cugat del Vallès (Spain) from 15 March to 15 May 2020. We evaluated individual factors (demographic, dependence, clinical, and therapeutic) and those related to the nursing homes (size and staff) associated with infection and mortality by SARS-CoV-2. Infection was diagnosed by molecular biology test. RESULTS: Of the 842 residents included in the analysis, 784 underwent a Polymerase Chain Reaction (PCR) test; 74.2% were women, the mean age was 87.1 years, and 11.1% died. The PCR test was positive in 44%. A total of 33.4% of the residents presented symptoms compatible with COVID-19 and of these, 80.9% were PCR-positive for SARS-CoV-2. Infection by SARS-CoV-2 among residents was associated with the rate of staff infected in the homes. Mortality by SARS-CoV-2 was related to male sex and a greater grade of dependence measured with the Barthel index. CONCLUSIONS: SARS-Cov-2 infection in institutionalised people is associated with the infection rate in nursing home workers and mortality by SARS-Cov-2 with sex and greater dependency according to the Barthel index. Adequate management of nursing home staff and special attention to measures of infection control, especially of individuals with greater dependence, are keys for successful management of future pandemic situations.

Conciliación y prescripción electrónica / The conciliation and electronic prescription

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Salut al cor/salud en el corazón»: resultados del programa de educación sanitaria en salud cardiovascular de Mútua Terrassa / Healthy heart: Results of a community education program on cardiovascular health

OBJETIVO: Mejorar los conocimientos de la población sobre hábitos cardiosaludables mediante un programa de formación complementado por una Web y actividades comunitarias. DISEÑO: Ensayo clínico controlado donde la intervención es la participación en el Aula de Formación en Salud Cardiovascular (AFSC). Emplazamiento: Población de 80.000 habitantes. Participantes: Pacientes, ambos sexos, 55-70 años, con al menos un factor de riesgo cardiovascular (RCV). Intervención: El grupo intervención estaba formado por los pacientes que participaron en el AFSC. La intervención constaba de un curso presencial de 20 h en el que se ofrecía una Web de apoyo y se organizaban actividades complementarias. Las clases fueron impartidas por 3 enfermeras de atención primaria. Mediciones principales: La variable principal fue el conocimiento sobre el RCV. Variables secundarias: edad, sexo, factores de RCV, estilos de vida, visitas a los centros, consumo farmacéutico, adherencia terapéutica y satisfacción con el programa. RESULTADOS: Se evaluaron los datos de los pacientes de los 10 primeros cursos (n = 150). Se observa una mejora estadísticamente significativa en el conocimiento general sobre el RCV en el GI (de 87,3 al 100%) respecto al GC (84,5 al 92,7%), p < 0,001 y una mejora en la actividad física (GI: del 71,2 al 83,1% frente GC: del 72,6 al 78,2%), p = 0,05. El número de visitas totales en atención primaria (medicina y enfermería) disminuyó más en el GI que en el GC. La valoración del curso ha sido elevada. CONCLUSIONES: Se demuestra la efectividad de esta experiencia para mejorar conocimientos sobre salud cardiovascular y algunos hábitos de vida saludable

OBJECTIVE: To improve the knowledge of the population about heart-healthy habits through a training program supplemented by a web site and community activities. DESIGN: A controlled clinical trial with intervention done through participation in the Cardiovascular Health Training Classroom (CHTC) Location: A town of 80,000 inhabitants. Participants: Patients: both sexes, aged 55 to 70 years, with at least one cardiovascular risk factor (CVRF). Intervention: The intervention group (IG) consisted of patients who participated in the CHTC. Intervention was carried out through a 20-hour presential group course in which a support web site was offered and complementary activities were organized. Classes were taught by three Primary Care nurses. Main measurements: The primary endpoint was knowledge of CVRF. The secondary variables were age, sex, CVRF, lifestyle, visits to health centers, pharmaceutical use adherence, and satisfaction with the program. RESULTS: Data from patients in the first 10 courses (n = 150) were evaluated. A statistically significant improvement was observed in overall knowledge of CVRF in the IG (87.3% to 100%) compared with control group (GC) (84.5% to 92.7%), p<.001, as well as an improvement in physical activity is (IG: 71.2% to 83.1% versus CG: 72.6% to 78.2%), p=.05. The total number of Primary Care visits (medical and nursing) decreased in the IG more than in the CG. The satisfaction rate of the course was very high. CONCLUSIONS: This experience is effective in improving cardiovascular health knowledge and promoting some healthy habits

[Healthy heart: Results of a community education program on cardiovascular health]. / «Salut al cor/salud en el corazón¼: resultados del programa de educación sanitaria en salud cardiovascular de Mútua Terrassa.

OBJECTIVE: To improve the knowledge of the population about heart-healthy habits through a training program supplemented by a web site and community activities. DESIGN: A controlled clinical trial with intervention done through participation in the Cardiovascular Health Training Classroom (CHTC) LOCATION: A town of 80,000 inhabitants. PATIENTS: both sexes, aged 55 to 70 years, with at least one cardiovascular risk factor (CVRF). INTERVENTION: The intervention group (IG) consisted of patients who participated in the CHTC. Intervention was carried out through a 20-hour presential group course in which a support web site was offered and complementary activities were organized. Classes were taught by three Primary Care nurses. MAIN MEASUREMENTS: The primary endpoint was knowledge of CVRF. The secondary variables were age, sex, CVRF, lifestyle, visits to health centers, pharmaceutical use adherence, and satisfaction with the program. RESULTS: Data from patients in the first 10 courses (n=150) were evaluated. A statistically significant improvement was observed in overall knowledge of CVRF in the IG (87.3% to 100%) compared with control group (GC) (84.5% to 92.7%), p<.001, as well as an improvement in physical activity is (IG: 71.2% to 83.1% versus CG: 72.6% to 78.2%), p=.05. The total number of Primary Care visits (medical and nursing) decreased in the IG more than in the CG. The satisfaction rate of the course was very high. CONCLUSIONS: This experience is effective in improving cardiovascular health knowledge and promoting some healthy habits.

AINE y riesgo cardiovascular / NSAIDS and cardiovascular risk

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Elaboración, implantación y seguimiento de un protocolo de osteoporosis posmenopáusica: colaboración entre Atención Primaria y el Servicio de Reumatología / Elaboration, implementation and follow-up of a postmenopausal osteoporosis protocol: Collaboration between the Primary care and Rheumatology departments

Objetivo Con el objetivo de mejorar la gestión clínica de la osteoporosis posmenopáusica, se ha realizado una intervención basada en la implantación y seguimiento de un protocolo consensuado entre la Atención Primaria y la Especializada de la Mútua de Terrassa. Métodos Estudio descriptivo y de intervención. La intervención consistió en la elaboración de un protocolo consensuado, que fue presentado en todos los centros. Los datos se han evaluado a partir de densitometrías óseas solicitadas por los médicos de familia durante 1 año. Resultados Se han solicitado un total de 1.165 densitometrías, de las cuales 689 son para diagnóstico de nuevas pacientes. Para la evaluación del protocolo se han obtenido datos de 560. 502 densitometrías realizadas (89,6%, IC95%: 87,1–92,2) cumplían con los criterios de indicación marcados por el protocolo. Del total de pacientes que recibieron tratamiento con fármacos antirresortivos (43 osteopénicas y 167 osteoporóticas), el 83,7% (IC95%: 69,3–93,2) y el 89,8% (IC95%: 85,2–94,4), respectivamente, cumplía con las recomendaciones de primera elección. El consumo de fármacos durante el año 2007 se ha reducido en 152.745 euros (−6,3%), aunque el número de pacientes tratadas ha aumentado en 565 (+4,9%) respecto al año anterior. 442 (78,9%, IC95%: 75,6–82,3) densitometrías presentaron un resultado de osteopenia u osteoporosis. Se observan diferencias estadísticamente significativas de los resultados según la edad de las pacientes y el motivo de solicitud. Conclusiones La puesta en marcha del protocolo ha permitido gestionar de forma eficiente el proceso clínico de la osteoporosis en nuestro ámbito (AU)

Objective To improve the clinical management of postmenopausal osteroporosis, an intervention based on the implementation of a guideline agreed to between the Primary Care and Specialized departments of all centers at “Mutua of Terrassa” was carried out. Methods Descriptive and interventional study. The intervention consisted of the elaboration of a consensus guideline that was presented in all centers. Results were assessed from bone densitometry studies requested by family physicians over 1 year. Results 1.165 densitometric studies were requested, of which 689 were for the diagnosis of new patients. For the evaluation of the guidelines, details were obtained from 560. 502 studies (89,6% IC95% 87,1–92,2) complied with indication criteria established in the guideline. Of the total of patients who received bisphosphonates and other drugs affecting bone metabolism (43 osteopenic and 167 osteoporotic), 83,7% (IC95% 69,3–93,2) and 89,8% (IC95% 85,2–94,4) respectively complied with drug recommendations. Drug consumption during the year 2007 was reduced by 152.745 euros (−6,3%) although the number of patients increased in 565 (+4,9%) with respect to the previous year. 442 (78,9% IC95% 75,6–82,3) densitometries presented a result in the osteopenia or osteroporosis category. There were statistically significant differences of the results according to the patients' age and the motive for the bone densitometry request. Conclusions Implementation of the guideline allowed for the effective management of the clinical process of osteroporosis in our field (AU)

[Elaboration, implementation and follow-up of a postmenopausal osteoporosis protocol: Collaboration between the Primary care and Rheumatology departments]. / Elaboración, implantación y seguimiento de un protocolo de osteoporosis posmenopáusica: colaboración entre Atención Primaria y el Servicio de Reumatología.

OBJECTIVE: To improve the clinical management of postmenopausal osteroporosis, an intervention based on the implementation of a guideline agreed to between the Primary Care and Specialized departments of all centers at "Mutua of Terrassa" was carried out. METHODS: Descriptive and interventional study. The intervention consisted of the elaboration of a consensus guideline that was presented in all centers. Results were assessed from bone densitometry studies requested by family physicians over 1 year. RESULTS: 1.165 densitometric studies were requested, of which 689 were for the diagnosis of new patients. For the evaluation of the guidelines, details were obtained from 560. 502 studies (89,6% IC95% 87,1-92,2) complied with indication criteria established in the guideline. Of the total of patients who received bisphosphonates and other drugs affecting bone metabolism (43 osteopenic and 167 osteoporotic), 83,7% (IC95% 69,3-93,2) and 89,8% (IC95% 85,2-94,4) respectively complied with drug recommendations. Drug consumption during the year 2007 was reduced by 152.745 euros (-6,3%) although the number of patients increased in 565 (+4,9%) with respect to the previous year. 442 (78,9% IC95% 75,6-82,3) densitometries presented a result in the osteopenia or osteroporosis category. There were statistically significant differences of the results according to the patients' age and the motive for the bone densitometry request. CONCLUSIONS: Implementation of the guideline allowed for the effective management of the clinical process of osteroporosis in our field.

Sistemas de gestión para la renovación de recetas médicas: estrategia para optimizar su utilización / Repeat prescription management systems: strategy for optimising their use

Objetivo: Mejorar el cumplimiento de los pacientes con el sistema de medicación repetida. Evaluar los motivos de impuntualidad en la recogida de las recetas y su relación con el incumplimiento terapéutico declarado por el mismo paciente.DiseñoEstudio de intervención cuasiexperimental antes-después con grupo control.EmplazamientoCentro de atención primaria que atiende a una población de 62.981 habitantes.ParticipantesPacientes con enfermedades crónicas incluidos en el sistema de gestión de medicación repetida (100 en el grupo control y 100 en el grupo intervención) que son impuntuales al recoger las recetas.IntervencionesSesión informativa-educativa consistente en una breve entrevista con la farmacéutica del centro de atención primaria, en la que se educaba al usuario en el cumplimiento del sistema de medicación repetida y del tratamiento, se identificaban los motivos de impuntualidad y se realizaba el test de Morisky-Green.Mediciones principalesPuntualidad de los pacientes en las recogidas de recetas posteriores a la intervención. Motivo de impuntualidad en la recogida de reclutamiento. Cumplimiento terapéutico según el test de Morisky-Green.ResultadosGlobalmente se obtuvo una mejora absoluta de la puntualidad del 17% en el grupo intervención (el 60% de los pacientes del grupo intervención y el 43% del grupo control fueron puntuales tanto en la primera como en la segunda recogida de seguimiento). Las mujeres del grupo intervención fueron más puntuales. No se observaron diferencias por edad, número de medicamentos o motivo de impuntualidad.ConclusionesEs posible mejorar el cumplimiento de los pacientes con el sistema de medicación repetida mediante una sencilla intervención informativa-educativa(AU)

Objective: To improve patient compliance with a repeat prescription system. To evaluate the reasons for not being punctual in collecting prescriptions and the non-compliance declared by the patients themselves.DesignQuasi-experimental study before and after intervention including a control group.SettingPrimary health care centre which serves a population of 62,981 inhabitants.ParticipantsPatients with chronic diseases included in the repeat prescription management system (100 in the control group and 100 in the intervention group) who were unpunctual in collecting their prescriptions.InterventionsAn informative-educational session consisting of a short interview with the pharmacist from Primary Health Care Centre, in which the patient was educated on compliance of the repeat prescription system and treatment. The reasons for the unpunctuality were identified and the Moriskey-Green test was performed.Main measurementsPunctuality of the patients in collecting their prescriptions after the intervention. Reasons for unpunctuality recorded at recruitment. Therapeutic compliance according to the Moriskey-Green test.ResultsThere was an overall absolute improvement of 17% in punctuality in the intervention group (60% of the patients in the intervention group and 43% in the control group were punctual in the first as well as in the second follow up. Women were more punctual in the intervention group. There were no differences seen due to age, number of medications or reason for unpunctuality.ConclusionsIt is possible to improve patient compliance with the prescription renewal system using a simple informative-educational intervention(AU)

[Repeat prescription management systems: strategy for optimising their use]. / Sistemas de gestión para la renovación de recetas médicas: estrategia para optimizar su utilización.

OBJECTIVE: To improve patient compliance with a repeat prescription system. To evaluate the reasons for not being punctual in collecting prescriptions and the non-compliance declared by the patients themselves. DESIGN: Quasi-experimental study before and after intervention including a control group. SETTING: Primary health care centre which serves a population of 62,981 inhabitants. PARTICIPANTS: Patients with chronic diseases included in the repeat prescription management system (100 in the control group and 100 in the intervention group) who were unpunctual in collecting their prescriptions. INTERVENTIONS: An informative-educational session consisting of a short interview with the pharmacist from Primary Health Care Centre, in which the patient was educated on compliance of the repeat prescription system and treatment. The reasons for the unpunctuality were identified and the Moriskey-Green test was performed. MAIN MEASUREMENTS: Punctuality of the patients in collecting their prescriptions after the intervention. Reasons for unpunctuality recorded at recruitment. Therapeutic compliance according to the Moriskey-Green test. RESULTS: There was an overall absolute improvement of 17% in punctuality in the intervention group (60% of the patients in the intervention group and 43% in the control group were punctual in the first as well as in the second follow up. Women were more punctual in the intervention group. There were no differences seen due to age, number of medications or reason for unpunctuality. CONCLUSIONS: It is possible to improve patient compliance with the prescription renewal system using a simple informative-educational intervention.

[Management systems for the renewal of medical prescriptions: the vision of users and health professionals]. / Sistemas de gestión para la renovación de recetas médicas: la visión del usuario y del profesional sanitario.

OBJECTIVE: To find the degree of satisfaction of users and doctors who use the repeat medical prescription system. DESIGN: Multi-centre, cross-sectional study. SETTING: Four primary care centres covering 160 000 inhabitants. PARTICIPANTS: Users included in the repeat medical prescription system and doctors who use it. MAIN MEASUREMENTS: Questionnaire on satisfaction. MAIN RESULTS: Users (52.4% women) filled in 429 questionnaires (mean age, 64.2; SD, 13.98). Average medicines taken were 4.4 (SD, 3.04). The period established for picking up prescriptions was usually 60 days (77.4%). 83.9% (95% CI, 80.4-87.4) of those questioned stated they had no problems, with a mean degree of satisfaction at 8.4 (SD, 1.52). There were no significant differences for gender (P=.53). There was a very weak but significant positive correlation between the score and the age of those questioned (r(2)=1%; P=.03). Mean score of satisfaction had statistically significant differences, depending on the PCC. 86.9% (95% CI, 83.8-90.1) of users collected the prescriptions within the term set. The factors associated with greater adherence were age and a greater number of medicines per person. Doctors filled in 47 questionnaires. Mean score was 7.42 (SD, 1.09) and all except one (98%; 95% CI, 89.1-99.9) thought that the system meant an improvement in clinical management. CONCLUSION: Users are very satisfied, although they believe certain organisational points should be improved in order to improve accessibility.

Sistemas de gestión para la renovación de recetas médicas: la visión del usuario y del profesional sanitario / Management systems for the renewal of medical prescriptions: the vision of users and health professionals

Objetivo. Conocer el grado de satisfacción de los usuarios y médicos que utilizan el sistema de repetición de recetas médicas. Diseño. Estudio multicéntrico, transversal. Ámbito. Cuatro centros de atención primaria que atienden a 160.000 habitantes. Participantes. Usuarios incluidos en el sistema de repetición de recetas médicas y médicos que lo utilizan. Mediciones principales. Encuesta de satisfacción. Resultados principales. Se han realizado 429 encuestas a usuarios (edad media 64,2 ± 13,98 años, con un 52,4% de mujeres). El promedio de medicamentos que tomaban era de 4,4 ± 3,04. El período establecido para la recogida de recetas era principalmente de 60 días (77,4%). El 83,9% (intervalo de confianza [IC] del 95%, 80,4-87,4) de los encuestados declaró no haber tenido problemas y la puntuación media de satisfacción fue de 8,4 ± 1,52. No se observaron diferencias estadísticamente significativas según el sexo (p = 0,53). Hay una correlación positiva muy débil aunque significativa entre la puntuación y la edad de los encuestados (r² = 1%; p = 0,03). La puntuación media de satisfacción presentaba diferencias estadísticamente significativas según el centro de atención primaria. El 86,9% (IC del 95%, 83,8-90,1) de los usuarios recogió las recetas en el plazo fijado. Los factores que se asociaron con un mayor cumplimiento fueron la edad y el mayor número de medicamentos por persona. Se realizaron 47 encuestas a los médicos. La puntuación media fue de 7,42 ± 1,09 y todos excepto uno (98%; IC del 95%, 89,1-99,9) opinaron que había sido una mejora para la gestión de la consulta. Conclusión. Los usuarios están muy satisfechos aunque consideran que deben mejorarse aspectos relacionados con la organización para mejorar la accesibilidad

Objective. To find the degree of satisfaction of users and doctors who use the repeat medical prescription system. Design. Multi-centre, cross-sectional study. Setting. Four primary care centres covering 160 000 inhabitants. Participants. Users included in the repeat medical prescription system and doctors who use it. Main measurements. Questionnaire on satisfaction. Main results. Users (52.4% women) filled in 429 questionnaires (mean age, 64.2; SD, 13.98). Average medicines taken were 4.4 (SD, 3.04). The period established for picking up prescriptions was usually 60 days (77.4%). 83.9% (95% CI, 80.4-87.4) of those questioned stated they had no problems, with a mean degree of satisfaction at 8.4 (SD, 1.52). There were no significant differences for gender (P=.53). There was a very weak but significant positive correlation between the score and the age of those questioned (r²=1%; P=.03). Mean score of satisfaction had statistically significant differences, depending on the PCC. 86.9% (95% CI, 83.8-90.1) of users collected the prescriptions within the term set. The factors associated with greater adherence were age and a greater number of medicines per person. Doctors filled in 47 questionnaires. Mean score was 7.42 (SD, 1.09) and all except one (98%; 95% CI, 89.1-99.9) thought that the system meant an improvement in clinical management. Conclusion. Users are very satisfied, although they believe certain organisational points should be improved in order to improve accessibility

Atención farmacéutica integrada: proyecto de colaboración entre un centro de atención primaria y las farmacias comunitarias / No disponible

Objetivo: establecer una colaboración entre farmacéuticos comunitarios y farmacéuticos de Atención Primaria a través de un estudio donde se recogen los motivos de consulta que la población realiza en las farmacias comunitarias. Diseño: Estudio descriptivo y prospectivo. Ámbito de estudio: farmacias comunitarias del término municipal de Sant Cugat del Vallès y el Centro de Atención Primaria de referencia (población = 69.000 habitantes). Período de estudio: 1 año natural (febrero 2004 hasta enero 2005). Variables estudiadas: sexo, edad, motivos y tipos de consulta. Resultados: al inicio del estudio, participaron 11 de las 15 farmacias comunitarias (73%), y al final del mismo quedaron 9 (60%). Se registraron n = 1.101 consultas. El 71,8% eran mujeres. El motivo de consulta más frecuente fue el de «solicitar consejo farmacéutico» en un 42,8% (IC 95%: 39,9% a 45,7%) de los casos. Las consultas más frecuentes, agrupadas por patologías, fueron las relacionadas con la patología respiratoria (18,3%; IC 95%: 16,0% a 20,5%), seguidas de las dermatológicas (13,2%; IC 95%: 11,2% a 15,2%) Se elaboraron dos protocolos de abordaje terapéutico para la tos y el resfriado común. Se consensuó el correcto procedimiento de la toma de la tensión arterial entre los farmacéuticos comunitarios y el equipo de atención primaria (AU)

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Effectiveness of the combination of feedback and educational recommendations for improving drug prescription in general practice.

BACKGROUND: Although there is a great concern regarding rational use of drugs, the available evidence for the most appropriate strategies to improve prescribing is scarce. GOAL: The goal of this study was to evaluate the effectiveness of the combination of feedback of individualized prescribing data and educational recommendations for improving the quality of prescribing in general practice. METHOD: A quasiexperimental intervention study was conducted in which prescribing rates of 282 family physicians before and after the intervention were compared. Physicians assigned to the individualized feedback group (n = 195) received individual instruction with specific recommendations for improvement according to their baseline prescribing quality levels, whereas physicians in the minimal intervention group (n = 87) only received standard nonindividualized prescribing data for the practice group as a whole. RESULTS: A trend toward increasing high pharmacologic intrinsic value in both groups was observed. Overprescription of antibiotics showed a decrease in the individualized feedback group (P = 0.006) and it did not change in the minimal intervention group. A different trend in the values in each group was observed with nonsteroidal antiinflammatory drugs, although it was not statistically significant. Overprescription of antiulcerative agents decreased among physicians in the individualized feedback group (P = 0.003); however, there were not statistically significant differences as compared with the minimal intervention group. Changes in indicators of drug selection were more favorable for the group with individualized feedback, although no statistically significant differences were observed. Pharmaceutical expenditure increased significantly in the minimal intervention group as compared with the individualized feedback group, with an approximate difference of dollars 7.87 per inhabitant and trimester (P = 0.003). CONCLUSION: The intervention showed that improving the quality of prescribing was feasible, particularly in overprescribing, and was associated with considerable savings in pharmaceutical costs.

Perfil del paciente polimedicado en Atención Primaria e intervención para disminuirla polimedicación de ansiolíticos / Profile of the polymedicated patient in Primary Health Care and intervention aimed at reducing anxiolytic polymedication

Introducción: La polimedicación en pacientes crónicos en Atención Primaria es un problema grave por sus múltiples interacciones y contraindicaciones. Objetivos: Describir la población crónica polimedicada y realizar una intervención de mejora en el grupo de medicamentos más prescrito. Métodos: Primera fase: estudio descriptivo, transversal sobre el perfil de los pacientes polimedicados de 5 Centros de Atención Primaria (CAP). Segunda fase: intervención de mejora del uso de benzodiazepinas (BDZ) en uno de los CAP a través de una sesión informativa junto a la entrega a cada médico del resultado de una revisión de los Carnets de Largo Tratamiento (CLT) con polimedicación ansiolítica. Variables: Sexo, edad, número de medicamentos por CLT, medicamentos de eficacia dudosa, grupos farmacológicos más prescritos, número de benzodiazepinas por CLT, benzodiazepina más prescrita y porcentaje de reducción del número de BDZ. Resultados: El 19,66 por ciento de pacientes crónicos están polimedicados con una media de 7,80 medicamentos por CLT; 59,52 por ciento son mujeres con una media de edad de 70,40 años. El porcentaje de medicamentos de eficacia dudosa es bajo y el grupo farmacológico más prescrito en los polimedicados es el de los ansiolíticos. Tras la intervención el número de BDZ totales disminuyó un 2,3 por ciento, aunque no se encontraron diferencias estadísticamente significativas (chi cuadrado 0,26; p=0,88). Conclusiones: Existe una elevada proporción de pacientes polimedicados en Atención Primaria. La intervención de mejora en el consumo de BDZ demuestra que resulta difícil disminuir su uso, debido seguramente a las complicaciones de su retirada. Debe promoverse el uso racional de BDZ antes de instaurar un tratamiento (AU)

Introduction: Polimedication in cronic patients in primary care is an important problems for their frequent interactions and connterindications. Objectives: To describe the polimedicated cronic population and to make and intervention in order to improve this situation within the group of the most prescribed medicines. Methods: First fuse: descriptive transversal study on the polimedicate patients profile in 5 primary care centers (CAP). Second Fase: intervention to improve the use of benzodiacepines (BDZ) in one of the CAP though on informative session and to delivering the results of a review of the long treatment cards (CLT) with ansiolitic polimedication. Variables: Sex, age, number of drug for CH: drugeduce its use, drugs with questionable efficacy, most prescribed pharmacological groups, number of BDZ per CLT, most prescribed (BDZ). Results: 19.66% of the cronic patients were polimedicated with a mean of 7.80 drugs per CTL; 59.52% were women with a mean age of 70.4% the percentage of questionable efficacy of drugs prescribed was low and the most prescribed pharmacological group in polimedicated patients were ansiolitics. After the intervention the total number of BZP was reduced in a 2.3% without statistical significant differences (X 0,26; P=0.88). Conclusions: There are a high proportion of polimedicated patients in primary a care. The intervention to improve BDZ use shows that is dificult to reduced its use, probably because the complications for discontinuing. The rational use of BZD should be promoted before to start a treatment (AU)