¿Cómo incorporar las utilidades de los pacientes a las decisiones clínicas?. Informe SESPAS 2008 / How should patients¿ utilities be incorporated into clinical decisions? 2008 SESPAS Report

Hay muchas situaciones clínicas en las que no se puedetomar una decisión ®correcta» desde el punto de vista técnico.Ejemplo de ello sería la cirugía electiva, donde atenderlas preferencias de los pacientes resulta ineludible. Una formade incorporar dichas preferencias es la aplicación del análisisde las decisiones clínicas. En este enfoque, primero secuantifican dichas preferencias (utilidades) y después se combinancon los conocimientos técnicos del médico. Al modeloresultante de toma de decisiones se le suele denominar ®tomade decisiones compartidas». En la revisión efectuada en esteartículo se constata que: a) dicho modelo, en caso de aplicarsesistemáticamente, podría mejorar la efectividad de lostratamientos y el bienestar de los pacientes; b) la práctica clínica,no obstante, se enfrenta a restricciones en forma de tiempoy recursos disponibles que hacen difícil su aplicación; c)la incorporación de las utilidades de los pacientes a las guíasde práctica clínica podría contribuir a estrechar la distanciaque separa las preferencias de los médicos de las de los pacientes;d) aparentemente, la aplicación de este tipo de análisisen España es muy ocasional, donde, incluso, se detectandeficiencias, no ya en la participación de los pacientes enlas decisiones clínicas, sino en el ejercicio del derecho a lainformación, y e) la alternativa de las ayudas a la decisión,aun cuando conozca una creciente expansión, no está librede problemas(AU)

There are many clinical situations in which there is no “right”decision from a technical point of view. An example of this iselective surgery, in which patients’ preferences are critical. Oneway to integrate patients’ preferences within clinical practiceis the application of decision analysis.According to this approach, preferences (utilities) are assessedand are then combined with physicians’ knowledge.This combination of evidence and utilities leads to the so-calledshared decision-making (SDM) model.The overview provided in the present article indicates that:a) The SDM model, if systematically applied, could improvetreatment effectiveness and patients well being; b) clinical practice,nevertheless, faces barriers in the form of time and resourceconstraints, limiting the application of such a model;c) discrepancies between patients’ and doctors’ preferencescould be narrowed if patients’ utilities were included in clinicalpractice guidelines; d) the application of this kind of analysisseems to be scarce in Spain. Moreover, information providedto patients is probably insufficient; and e) patientdecision aids, even though their use is rapidly growing, aresubject to certain problems(AU)

[Treatment with omeprazole, clarithromycin and amoxicillin for one week. Their efficacy and tolerance in eradicating Helicobacter pylori in primary care]. / Tratamiento con omeprazol, claritromicina y amoxicilina durante una semana. Efectividad y tolerancia en la erradicación de Helicobacter pylori en atención primaria.

OBJECTIVE: To study the effectiveness and tolerance of the combination of omeprazole, clarithromycin and amoxycillin taken for a week on the eradication of Helicobacter pylori (HP) in patients with peptic ulcer and symptomatic chronic gastritis. DESIGN: Intervention study. SETTING: Urban health centre. PATIENTS: 121 patients, diagnosed by fiber gastroscopy and with an HP infection demonstrated by the urease test, breath test, serology or biopsy, were studied prospectively. 13 suffered from a gastric ulcer, 54 from duodenal ulcer and 54 from chronic gastritis. Two patients stopped treatment because of side-effects, but were included in the study (analysis by treatment intention). INTERVENTIONS: The combination of omeprazole (20 mg/12 hours), amoxycillin (1 gr/12 hours) and clarithromycin (500 mg/12 hours) was administered for a week. No medication was prescribed afterwards. Therapeutic compliance (count of tablets and interview) and side-effects were systematically evaluated. Four to eight weeks later patients took a breath test with Urea C14 to confirm eradication. RESULTS: Average age was 47 (SD 14.5); 54% were women. Eradication was confirmed in 80.2% of cases (CI 95%; 73.1-87.3). Side-effects were light or moderate in all cases: the most common were dysgeusia (67%), nausea (18%) and diarrhoea (17%). CONCLUSIONS: The triple therapy of omeprazole, amoxycillin and clarithromycin for a week is efficacious in eradicating HP. It is extremely easy to apply, and there are few relevant side-effects.