Baja concordancia entre la información clínica de atención primaria y hospital / Low concordance between primary care and hospital clinical information

OBJETIVOS: Medir la concordancia respecto a las enfermedades crónicas registradas en atención primaria (AP) y hospitalaria, y valorar la utilidad de sus registros asistenciales con fines de investigación. Emplazamiento: Estudio transversal retrospectivo integrando información diagnóstica de AP y hospitalaria de la población de Aragón ingresada en 2010. PARTICIPANTES: Se analizó a 75.176 pacientes INTERVENCIONES: Se analizaron coincidencias, divergencias e índice kappa de los diagnósticos registrados en AP y hospital, estratificando por grupos de edad y sexo. MEDICIONES PRINCIPALES: Enfermedades estudiadas: EPOC, diabetes, hipertensión, enfermedad cerebrovascular, cardiopatía isquémica, asma, epilepsia e insuficiencia cardiaca. RESULTADOS: La concordancia fue mayor en hombres y entre los 45-64 años. Diabetes fue el diagnóstico más concordante (índice kappa: 0,75) mientras que asma obtuvo los valores más bajos (índice kappa: 0,34). CONCLUSIONES: La baja concordancia de la información diagnóstica contenida en AP y hospital obliga a adoptar medidas que permitan a los profesionales sanitarios a conocer el conjunto de problemas de salud que presenta un paciente

OBJECTIVES: To measure the diagnostic agreement between Primary Care (PC) and hospital information systems, in order to assess the usefulness of health care records for research purposes. SETTING: Cross-sectional retrospective study integrating PC and hospital diagnostic information for the Aragon population admitted to hospital in 2010. PARTICIPANTS: 75.176 patients were analysed. INTERVENTIONS: Similarities, differences and the kappa index were calculated for each of the diagnoses recorded in both information systems. MAIN MEASUREMENTS: The studied diseases included COPD, diabetes, hypertension, cerebrovascular disease, ischaemic heart disease, asthma, epilepsy, and heart failure. RESULTS: Diagnostic concordance was higher in men and between 45 and 64 years. Diabetes was the condition showing the highest concordance (kappa index: 0.75), while asthma had the lowest values (kappa index: 0.34). CONCLUSIONS: The low concordance between the diagnostic information recorded in PC and in the hospital setting calls for urgent measures to ensure that healthcare professionals have a comprehensive picture of patient's health problems

Patterns of pharmaceutical use for immigrants to Spain and Norway: a comparative study of prescription databases in two European countries.

BACKGROUND: Although equity in health care is theoretically a cornerstone in Western societies, several studies show that services do not always provide equitable care for immigrants. Differences in pharmaceutical consumption between immigrants and natives are explained by variances in predisposing factors, enabling factors and needs across populations, and can be used as a proxy of disparities in health care use. By comparing the relative differences in pharmacological use between natives and immigrants from the same four countries of origin living in Spain and Norway respectively, this article presents a new approach to the study of inequity in health care. METHODS: All purchased drug prescriptions classified according to the Anatomical Therapeutic Chemical (ATC) system in Aragon (Spain) and Norway for a total of 5 million natives and nearly 100,000 immigrants for one calendar year were included in this cross-sectional study. Age and gender adjusted relative purchase rates for immigrants from Poland, China, Colombia and Morocco compared to native populations in each of the host countries were calculated. Direct standardisation was performed based on the 2009 population structure of the OECD countries. RESULTS: Overall, a significantly lower proportion of immigrants in Aragon (Spain) and Norway purchased pharmacological drugs compared to natives. Patterns of use across the different immigrant groups were consistent in both host countries, despite potential disparities between the Spanish and Norwegian health care systems. Immigrants from Morocco showed the highest drug use rates in relation to natives, especially for antidepressants, "pain killers" and drugs for peptic ulcer. Immigrants from China and Poland showed the lowest use rates, while Colombians where more similar to host countries. CONCLUSIONS: The similarities found between the two European countries in relation to immigrants' pharmaceutical use disregarding their host country emphasises the need to consider specific immigrant-related features when planning and providing healthcare services to this part of the population. These results somehow remove the focus on inequity as the main reason to explain differences in purchase between immigrants and natives.

[Low concordance between primary care and hospital clinical information]. / Baja concordancia entre la información clínica de atención primaria y hospital.

OBJECTIVES: To measure the diagnostic agreement between Primary Care (PC) and hospital information systems, in order to assess the usefulness of health care records for research purposes. SETTING: Cross-sectional retrospective study integrating PC and hospital diagnostic information for the Aragon population admitted to hospital in 2010. PARTICIPANTS: 75.176 patients were analysed. INTERVENTIONS: Similarities, differences and the kappa index were calculated for each of the diagnoses recorded in both information systems. MAIN MEASUREMENTS: The studied diseases included COPD, diabetes, hypertension, cerebrovascular disease, ischaemic heart disease, asthma, epilepsy, and heart failure. RESULTS: Diagnostic concordance was higher in men and between 45 and 64 years. Diabetes was the condition showing the highest concordance (kappa index: 0.75), while asthma had the lowest values (kappa index: 0.34). CONCLUSIONS: The low concordance between the diagnostic information recorded in PC and in the hospital setting calls for urgent measures to ensure that healthcare professionals have a comprehensive picture of patient's health problems.