Intervention for control of hypertension in Catalonia, Spain (INCOTECA Project): results of a multicentric, non-randomised, quasi-experimental controlled intervention study.

OBJECTIVE: The purpose of this study was to assess the effectiveness of a quality improvement (QI) plan aimed at primary healthcare teams (PHCTs) to optimise hypertension control and to compare it with standard clinical care. METHODS: Design Multicentric, non-randomised, quasi-experimental controlled intervention study. Setting 5 PHCTs in the intervention and 13 in the standard care group in the province of Barcelona, Catalonia, Spain. Participants This is a population-based study in which all patients over 18 years of age with a diagnosis of hypertension before 1 January 2006 were included (n=9877 in the intervention group and n=21 704 in the control group). Intervention A QI plan that targeted primary care professionals. The plan included training sessions, implementation of recommended clinical practice guidelines for the management of hypertensive patients and audit and feedback to health professionals. Main outcome measure Prevalence of hypertensive patients with an adequate blood pressure (BP) control. RESULTS: The adjusted difference between intervention and standard care groups in the odds of BP control was 1.3 (95% CI 1.1 to 1.6, p=0.003). Results of the mixed model on repeated measures showed that, on average, an individual in the intervention group had an increase of 92% in the odds of BP control (OR 1.9, 95% CI 1.7 to 2.1). CONCLUSIONS: The implementation of a QI plan can improve BP control. This strategy is potentially feasible for up-scaling within the existing PHCTs. TRIAL REGISTRATION: ClinicalTrials.gov MS: 1998275938244441.

Utilización de los absorbentes para incontinencia en 2 residencias geriátricas / Use of absorbent products for incontinence in 2 geriatric nursing homes

Objetivo. Conocer la distribución de frecuencia de uso de los distintos tipos de absorbentes, en función de las características físicas del residente y su nivel de autonomía, tras la implementación de la guía sobre el uso de absorbentes en la incontinencia urinaria del Institut Català de la Salut (ICS). Método. Estudio observacional, descriptivo, transversal, de 12 meses de duración en 2 residencias geriátricas de Cerdanyola del Vallès (Barcelona). Se incluyeron a los residentes con diagnóstico de incontinencia y en tratamiento paliativo con absorbentes. Variables principales: proporción de tipos de absorbente utilizados; proporción de residentes con una selección de talla de absorbente incorrecta; número de cambios diarios y estado del absorbente; número de cambios según valor del índice de Barthel. Resultados. Del total de residentes (n = 74), el 74,3% (55) presentaba incontinencia urinaria y fecal; el 89,2% (66) utilizaba 2 tipos de absorbente (mayoritariamente combinación tipo día con tipo noche elástico); en el 21,6% (16) de los residentes la talla utilizada no era la recomendada por la guía del ICS. La media global del número de cambios diarios de absorbente por residente fue de 4,1 (desviación estándar [DE] = 1,76) y la media de fugas 0,11 (DE = 0,37). En los residentes con un índice de Barthel < 33 puntos, la media de cambios diarios fue de 4,48 (DE = 1,58). Conclusiones. Los residentes incontinentes con menor autonomía necesitaban un mayor número de cambios de absorbente, hecho que debería considerarse cuando se analiza el consumo de los absorbentes en las residencias. En general hubo un correcto seguimiento de las recomendaciones de la guía del ICS

Objective. To assess the frequency distribution of the use of absorbent products among nursing home residents, adjusted by physical characteristics and level of autonomy, after the implementation of the clinical practice guideline (CPG) on urinary incontinence at the Institut Català de la Salut (ICS) in Spain. Method. We performed an observational, descriptive, cross sectional study over a 12-month period in two nursing homes in Cerdanyola del Vallès. Inclusion criteria: nursing home residents with a diagnosis of incontinence and current use of absorbent products. Principal outcomes: the percentage distribution of different absorbent products, the percentage of residents using inadequately sized absorbent products, the number of diapers changed daily, and the number of daily changes adjusted by Barthel's Index. Results. There were 74 participants, of whom 55 (74.3%) had urinary and fecal incontinence. Sixty-six participants (89.2%) used two different kinds of diaper (mainly a combination of a daily type and a night elastic type). In 16 nursing home residents (21.6%) diaper size was not in accordance with the recommendations of the CPG. The overall mean number of daily diaper changes per resident was 4.1 (SD = 1.76) and the mean number of daily leaks was 0.11 (SD = 0.37). Residents with a Barthel Index score of less than 33 points had a mean of 4.48 (SD = 1.58) daily diaper changes. Conclusions. Nursing home residents with less autonomy need a greater number of diaper changes. This finding should be considered when analyzing consumption of absorbent products in nursing homes. In general, the ICS's CPG on the use of absorbent products were correctly implemented