[Randomized clinical trial on the efficacy of global geriatric assessment in primary care]. / Ensayo clínico aleatorizado sobre la eficacia de la valoración geriátrica integral seguida de intervención en atención primaria.

OBJECTIVE: the family doctor is in a unique position to prevent complications in the elderly population. The aim of this study was to evaluate the efficacy of a multifactorial intervention in reducing morbidity and mortality after a global geriatric assessment (GGA) was performed. MATERIAL AND METHODS: a randomized clinical trial with a control group was carried out in elderly patients aged more than 75 years old visited in the primary care setting over a 18-month period. An individualized intervention was applied to all patients in the intervention group (IG) identified as frail by the GGA. A group session was offered to the remaining patients in the IG. RESULTS: there were 620 participants: 49.7% were randomized to the IG and 50.3% to the control group (CG). Follow-up was completed by 430 (69.4%) participants. At the end of the study, the CG showed a significantly greater risk of depression (Yesavage) than the IG (P=.048). During the follow-up, 13% of the IG and 5% of the CG changed their initial status of frailty to one of non-frailty, while 11% of the IG and 22% of the CG were newly diagnosed as frail (P< .001). The total number of events (nursing home admission, home visits, deaths) was 15% in the IG and 17% in the CG (P=.64). CONCLUSIONS: the intervention proved to be effective in containing the number of patients newly diagnosed as frail and in increasing the number of participants who reversed their status from frail to non-frail during the follow-up. GGA is effective if used in conjunction with an intervention.

Ensayo clínico aleatorizado sobre la eficacia de la valoración geriátrica integral seguida de intervención en atención primaria / Randomized clinical trial on the efficacy of global geriatric assessment followed by intervention in primary care

Objetivo: el médico de familia es el primer profesional de salud que puede actuar preventivamente sobre la población anciana de riesgo. El objetivo de este estudio es evaluar la eficacia de una intervención multifactorial tras la valoración geriátrica integral (VGI) en términos de morbimortalidad. Material y métodos: ensayo clínico aleatorizado, con grupo control (GC), en personas mayores de 75 años visitadas en las consultas de un centro de atención primaria durante un período de 18 meses. Según la VGI, se clasificó al anciano como frágil o no; en el grupo de intervención (GI) los pacientes frágiles recibieron una intervención personalizada, mientras que a los no frágiles se les ofreció participar en una sesión grupal. Resultados: participaron en el estudio 620 sujetos, el 49,7% aleatorizados al GI y el 50,3% al GC. Realizaron la visita de seguimiento 430 (69,4%) pacientes. En la visita final, los pacientes del GC mostraron un riesgo significativamente superior de depresión (Yesavage) que el GI (p = 0,048). Durante el seguimiento, el 13% del GI modificó su estado inicial de frágiles a no frágiles frente al 5% del GC, mientras que el 11% del GI pasó a ser nuevos pacientes frágiles frente al 22% del GC (p < 0,001). Se registró un 15% de eventos (ingreso en residencia, atención domiciliaria o defunción) en el GI frente a un 17% en el GC (p = 0,64). Conclusiones: la intervención se mostró efectiva al contener el número de pacientes frágiles de nuevo diagnóstico y al aumentar el número de pacientes que revirtieron el proceso en el GI durante el seguimiento. La VGI resulta efectiva si se asocia a una intervención

Objective: the family doctor is in a unique position to prevent complications in the elderly population. The aim of this study was to evaluate the efficacy of a multifactorial intervention in reducing morbidity and mortality after a global geriatric assessment (GGA) was performed. Material and methods: a randomized clinical trial with a control group was carried out in elderly patients aged more than 75 years old visited in the primary care setting over a 18-month period. An individualized intervention was applied to all patients in the intervention group (IG) identified as frail by the GGA. A group session was offered to the remaining patients in the IG. Results: there were 620 participants: 49.7% were randomized to the IG and 50.3% to the control group (CG). Follow-up was completed by 430 (69.4%) participants. At the end of the study, the CG showed a significantly greater risk of depression (Yesavage) than the IG (P=.048). During the follow-up, 13% of the IG and 5% of the CG changed their initial status of frailty to one of non-frailty, while 11% of the IG and 22% of the CG were newly diagnosed as frail (P<.001). The total number of events (nursing home admission, home visits, deaths) was 15% in the IG and 17% in the CG (P=.64). Conclusions: the intervention proved to be effective in containing the number of patients newly diagnosed as frail and in increasing the number of participants who reversed their status from frail to non-frail during the follow-up. GGA is effective if used in conjunction with an intervention

[Evaluative study of medical-care costs in primary care]. / Estudio evaluativo de los costes asistenciales en atención primaria.

OBJECTIVE: To estimate the real costs of medical care by diagnostic groups at a primary care centre. DESIGN: Descriptive, retrospective study, based on the review of computerized medical records. SETTING: Urban primary care centre (PCC). PARTICIPANTS: All patients who attended the PCC during 2005. MAIN MEASUREMENTS: Mean medical care cost per visit in euros, broken down for health professionals, diagnostic procedures and drugs costs, and stratified by diagnostic groups. RESULTS: The most frequent visits were for pulmonary, locomotor, cardiovascular, and gastro-intestinal conditions. The mean number of visits per patient attended was 8.7 (SD, 9.4); and per patient registered at the centre, 5.9 (8.7). The highest costs were for cardiovascular (18.96%; 95% CI, 18.93%-18.99%), locomotor (11.21%; 95% CI, 11.18%-11.23%), psychological (10.69%, 95% CI, 10.66%-10.71%), pulmonary (10.20%; 95% CI, 10.17%-10.22%) and endocrinal-nutritional (9.61%; 95% CI, 9.58%-9.63%) problems. Drugs expenditure accounted for 65% of the total cost; visits to health professionals, for 33%; and procedures, for 2%. Overall cost per inhabitant was 239.1 (493.6) euros, and per patient attended was 349.5 (563.5). CONCLUSIONS: Cardiovascular disease conditions are much the most costly ones in terms of overall medical cost. Psychological conditions are located in second place in terms of pharmaceutical cost; and in third place, in terms of overall medical-care cost.

Estudio evaluativo de los costes asistenciales en atención primaria / Evaluative study of medical-care costs in primary care

Objetivo. Estimar los costes reales asistenciales por grupos patológicos de un centro de salud. Diseño. Estudio descriptivo, retrospectivo, realizado a partir de la revisión de historias clínicas informatizadas. Emplazamiento. Centro de salud urbano. Participantes. Todos los pacientes que se visitaron en el centro de salud durante el año 2005. Medidas principales. Se ha calculado el coste asistencial medio en euros por visita diferenciando por profesional, procedimientos y gasto farmacéutico, imputándose a la enfermedad que lo ha generado. Resultados. Las visitas por problemas de los aparatos respiratorio, locomotor, circulatorio y digestivo fueron las más frecuentes. El número medio de visitas por paciente atendido fue de 8,7 ± 9,4, y por paciente adscrito al centro, de 5,9 ± 8,7. Los costes más altos se atribuyen problemas circulatorios (18,96%; intervalo de confianza [IC] del 95%, 18,93-18,99%), del aparato locomotor (11,21%; IC del 95%, 11,18-11,23%), psicológicos (10,69%; IC del 95%, 10,66-10,71%), respiratorios (10,20%; IC del 95%, 10,17-10,22%) y del sistema endocrino-metabólico y nutrición (9,61%; IC del 95%, 9,58-9,63%). El gasto farmacéutico representó el 65% de los costes totales, las visitas al profesional el 33% y los procedimientos, el 2%. El coste total por habitante fue de 239,1 ± 493,6 euros, y por habitante visitado, de 349,5 ± 563,5 euros. Conclusiones. Las enfermedades del aparato circulatorio son, con diferencia, las que tienen un coste asistencial total más alto. Los problemas psicológicos ocupan el segundo lugar desde un punto de vista del gasto farmacéutico y el tercer lugar desde un punto de vista de costes asistenciales totales

Objective. To estimate the real costs of medical care by diagnostic groups at a primary care centre. Design. Descriptive, retrospective study, based on the review of computerized medical records. Setting. Urban primary care centre (PCC). Participants. All patients who attended the PCC during 2005. Main measurements. Mean medical care cost per visit in euros, broken down for health professionals, diagnostic procedures and drugs costs, and stratified by diagnostic groups. Results. The most frequent visits were for pulmonary, locomotor, cardiovascular, and gastro-intestinal conditions. The mean number of visits per patient attended was 8.7 (SD, 9.4); and per patient registered at the centre, 5.9 (8.7). The highest costs were for cardiovascular (18.96%; 95% CI, 18.93%-18.99%), locomotor (11.21%; 95% CI, 11.18%-11.23%), psychological (10.69%, 95% CI, 10.66%-10.71%), pulmonary (10.20%; 95% CI, 10.17%-10.22%) and endocrinal-nutritional (9.61%; 95% CI, 9.58%-9.63%) problems. Drugs expenditure accounted for 65% of the total cost; visits to health professionals, for 33%; and procedures, for 2%. Overall cost per inhabitant was 239.1 (493.6) euros, and per patient attended was 349.5 (563.5). Conclusions. Cardiovascular disease conditions are much the most costly ones in terms of overall medical cost. Psychological conditions are located in second place in terms of pharmaceutical cost; and in third place, in terms of overall medical-care cost