Effectiveness of individual and group multicomponent interventions for smoking cessation in primary care: a quasi-experimental study.

BACKGROUND: The efficacy of smoking cessation interventions can be quite diverse in day-to-day clinical practice. OBJECTIVE: To analyse the effectiveness in smoking cessation of multicomponent interventions carried out in groups or individually in primary care practices. METHODS: A quasi-experimental, multicentre study of 12-month follow-up of patients treated in multicomponent smoking cessation interventions was carried out in Urban health care centres in Sevilla, Spain. Two hundred and twenty smoking patients, ≥18 years of age, participated either in a multicomponent intervention group (n = 145; mean age 51.7 years; 53.1% women) or in individual interventions (n = 77; mean age 50.5 years; 61.0% women). The abstinence or relapse status was computed from patient self-reports, confirmed by relatives or companions when possible and supplemented by CO-oxymetry tests in 89 patients. RESULTS: The overall percentage of smoking cessation was 36.9% (37.9% with group and 35.1% with individual intervention, P = 0.398). Patients who quit smoking were younger (48.7 versus 52.9 years old, P < 0.01), with fewer years of smoking (32.9 versus 36.8 years, P < 0.05), with higher education (39.0% versus 25.0%, P < 0.05) and had received pharmacological treatment (91.5% versus 67.9%, P < 0.001). In the multivariate analysis, level of education [odds ratio (OR): 1.995; 95% confidence interval (CI): 1.065-3.735, P < 0.01], group intervention (OR: 1.743; 95% CI: 1.006-3.287, P < 0.05) and drug prescription (OR: 2.368; 95% CI: 1.126-4.980, P < 0.05) were significantly associated with smoking cessation. CONCLUSIONS: Our study found that multicomponent group and individual interventions in primary care were associated with an overall quit rate of smoking of 36.9% at 12-month follow-up, with higher probability of success among patients with higher education and those who received the group intervention and drug treatment.

Evaluación de la calidad de la atención al paciente hipertenso en el Centro de Salud de Torreblanca, empleando la técnica del muestreo aleatorio por lotes / Evaluation of the quality of care in hypertensive patients in the Torreblanca Health Center, usingthe technique of lot quality assurance sampling

Objetivos: Evaluar la calidad de la atención al paciente hipertenso en el Centro de Salud de Torreblanca con el empleo de la técnica del muestreo aleatorio por lotes (LQAS) en el que cada cupo médico se constituyó como un lote (unidad de análisis). Además, determinar si el LQAS es una buena herramienta para la evaluación de unidades clínicas. Material y métodos: Estudio descriptivo longitudinal y retrospectivo, realizado en el Centro de Salud de Torreblanca, en el que se evaluó a un total de 3.178 pacientes mayores de 14 años diagnosticados de hipertensión arterial (HTA) (presión arterial [PA] > 140/90 mmHg) atendidos en el Centro Sanitario de Torreblanca. Las mediciones principales fueron: a) evaluación del riesgo cardiovascular (RCV); b) indicación de modificaciones del estilo de vida; c) pacientes en tratamiento con diuréticos tiazídicos y/o bloqueadores beta; d) registro de la HTA, y e) control de la HTA (PA ¾ 140/90 mmHg). Resultados: De los 12 lotes analizados ninguno cumplió con los 5 indicadores a los estándares prefijados, 1 cupo médico cumplió con 4 indicadores, 3 cumplieron con 3, 7 con 2 y 1 sólo con uno. En cuanto al porcentaje global de cumplimiento de los indicadores, el 21% de los pacientes hipertensos tienen calculado el RCV, al 58% de éstos se les han indicado modificaciones del estilo de vida y el 61% está en tratamiento con diuréticos tiazídicos y/o bloqueadores beta, y se registró la PA en los últimos 9 meses al 77,5%. Tienen un adecuado control de la PA (# 140/90 mmHg) el 56,8% de los pacientes hipertensos. Conclusiones: La calidad de la atención al paciente hipertenso en nuestro centro de salud es buena, en líneas generales, sobre todo en el apartado del tratamiento y seguimiento, y es deficiente en lo que se refiere al aspecto del diagnóstico evaluado (determinación del RCV). Consideramos la técnica del LQAS ideal para establecer un sistema periódico de evaluación dentro de las actividades rutinarias de los servicios o centros de salud

Objectives: To evaluate the quality of care in hypertensive patients in the Torreblanca Health center by using the method of lot quality assurance sampling (LQAS) with each patient list (quota) being constructed as a batch (unit of analysis), and to determine whether LQAS is a useful tool for the evaluation of clinical units. Material and methods: Descriptive, longitudinal, retrospective study, set in The Torreblanca Health Center. The participants were patients aged more than 14 years old diagnosed with hypertension (blood pressure > 140/90 mmHg) attended in the Torreblanca Health Center. Total number of patients = 3,178. Main measurements: 1) Evaluation of cardiovascular risk (CVR). 2) Indication of lifestyle modifications. 3) Patients under treatment with thiazide diuretics and/or beta blockers (BB). 4) Recording of hypertension. 5) Control of hypertension (blood pressure ¾ 140/90 mmHg) Results: Of the 12 lots analyzed, none complied with the five indicators to the preestablished standard: compliance with four indicators was found in one lot, compliance with three indicators was found in three lots, compliance with two indicators was found in seven lots, and compliance with only one indicator was found in one lot. The overall percentage of compliance with the indicators was as follows: CVR was calculated in 21% of hypertensive patients; of these, lifestyle modification was recommended in 58%, and 61% were under treatment with thiazide diuretics and/or beta blockers; blood pressure had been registered in the previous 9 months in 77.5% and was adequately controlled (# 140/90 mmHg) in 56% of hypertensive patients. Conclusions: The quality of care in hypertensive patients in our health center is good in general terms, especially treatment and follow-up. Improvements are required in the element of diagnosis evaluated (CVA determination). We believe that the technique of LQAS is an ideal tool for establishing a periodic evaluation system within the routine activities of health centers or services