[How suitable is thromboembolism prophylaxis for patients with chronic auricular fibrillation at 3 primary care centers]. / Adecuación de la profilaxis tromboembólica en pacientes con fibrilación auricular crónica en 3 centros de atención primaria.

OBJECTIVE: To find just how suitable thromboembolism prophylaxis (TEP) is in a group of patients with chronic auricular fibrillation belonging to the primary care environment. DESIGN: Cross-sectional and descriptive multi-centre study. SETTING: The study was performed at 3 urban primary care centres in Madrid. PARTICIPANTS: All the patients recorded up to April 2001 with the diagnosis of chronic auricular fibrillation (n=274) were included. Patients with no clinical history or who had a valve prosthesis were excluded. MAIN MEASUREMENTS: Demographic variables, existence of factors of risk of embolism, presence of counter-indications for oral anti-coagulants, and the kind of thromboembolic prophylaxis taken were collected. RESULTS: A total of 274 patients were evaluated. Average age was 75 (SD, 9) and 52% were women. 82% of patients had at least one factor of risk of thromboembolism. The most commonly used kind of TEP was oral anti-coagulants. 45% of patients did not receive suitable TEP. 13.5% of patients at risk of embolism and who had no kind of TEP were found. CONCLUSIONS: There is a high percentage of patients with chronic auricular fibrillation and a high risk of embolism, who do not receive adequate TEP, in the absence of counter-indications to taking oral anticoagulants. There is great scope for improvement, which is within professionals' possibilities.

[Prescription of non-steroidal anti-inflammatories and gastric protectors in emergency service]. / Prescripción de antiinflamatorios no esteroideos y protectores gástricos en urgencias.

OBJECTIVES: To find the number of patients seen in casualty who received gastropathy prophylaxis with NSAIDs that complied with the pharmaco-therapeutic guidelines of the health district. DESIGN: Descriptive study of technical-scientific quality. SETTING: The Casualty Department of the Ramón y Cajal hospital. PARTICIPANTS: Randomised sample of 400 emergencies attended in January 1999 and 2000, excluding paediatric cases, people previously treated with gastro-protectors, patients admitted and the deceased. Main measurements. On the basis of casualty records: suitability of indication and criteria used; if unsuitable, how; adequacy of selection of the principle, patient' age and sex, digestive pathology history, area and year of care. RESULTS: NSAIDs were prescribed in 37.9% of cases (33.27-42.79), with prescription unsuitable in 21.19% (15.2-28.3). 15% (9.5-22) were unsuitable by default; and 54.2% (35.1-72.1), by excess. Unsuitability was greater among women, if there was history of digestive pathology, and among older people, with no differences found for area or year of care. The choice of gastric protector was not suitable in any case. CONCLUSIONS: Given the amount of primary care prescription originating in hospital casualty departments, and its effect on the training of family medicine interns, strategies coordinated between health care levels must be introduced in order to improve gastric protection prescription in NSAID gastropathy prophylaxis. The effectiveness of these strategies must be evaluated.

Prescripción de antiinflamatorios no esteroideos y protectores gástricos en urgencias / Prescription of non-steroidal anti-inflammatories and gastric protectors in casualty

Objetivos. Conocer la proporción de pacientes atendidos en urgencias en los que se hace profilaxis de gastropatía por aintiinflamatorios no esteroideos (AINE) de forma adecuada a la guía farmacoterapéutica del área sanitaria. Diseño. Estudio descriptivo de la calidad científico-técnica. Emplazamiento. El Servicio de Urgencias del hospital Ramón y Cajal. Participantes. Muestra aleatoria de 400 urgencias atendidas en enero de 1999 y de 2000 en la que no se incluyen a los pacientes en edades pediátricas, en tratamiento previo con gastroprotectores, ingresados y fallecidos. Mediciones principales. A partir de la hoja de urgencias se determinaron la adecuación de la indicación y los criterios utilizados, el tipo de inadecuación, la adecuación de la selección del principio, la edad y el sexo del paciente, los antecedentes de enfermedades digestivas, el área y el año de atención. Resultados. Se prescribió AINE a un 37,9 por ciento de los casos (33,27-42,79 por ciento), fue inadecuada la prescripción de gastroprotección en un 21,19 por ciento (15,2-28,3 por ciento): inadecuación por defecto del 15 por ciento (9,5-22 por ciento) e inadecuación por exceso del 54,2 por ciento (35,1-72,1 por ciento). El porcentaje de inadecuación fue mayor entre las mujeres, si había antecedentes de enfermedades digestivas y entre las personas más mayores, no encontrándose diferencias en relación con el área o el año de atención. En ningún caso la selección del fármaco gastroprotector fue adecuada. Conclusiones. Dada la importancia en atención primaria de la prescripción inducida desde las urgencias hospitalarias y su influencia en la formación de residentes de medicina de familia, es necesario implantar estrategias coordinadas entre niveles asistenciales de mejora de la prescripción de gastroprotección para la profilaxis de gastropatía por AINE, siendo imprescindible la evaluación de la efectividad de dichas estrategias. (AU)