Characteristics of patients with panic disorder attended in primary care during the COVID-19 pandemic: A cross-sectional multicenter study / Características de los pacientes con trastorno de pánico atendidos en atención primaria durante la pandemia por COVID-19: un estudio transversal multicéntrico

Objective: To assess the prevalence of panic disorder during the second and third waves of the COVID-19 pandemic. Design: Cross-sectional multicenter study. Setting: Primary care. Participants: Participating primary care physicians selected patients visiting their primary care centers for any reason over a 16-month period. Main outcome measure: Diagnosis of panic disorder was established using The Primary Care Evaluation of Mental Disorders (PRIME-MD) instrument. Results: Of a total of 678 patients who met the inclusion criteria, 36 presented with panic disorder, with a prevalence of 5.3% (95% confidence interval 3.6–7.0). A total of 63.9% of cases occurred in women. The mean age was 46.7±17.1 years. Socioeconomic difficulties, such as very low monthly income rate, unemployment, and financial constraints to make housing payments and to make ends meet were more frequent in patients with panic disorders as compared to patients without panic disorder. A high level of stress (Holmes–Rahe scale>300), concomitant chronic fatigue syndrome and irritable bowel disease, and having financial difficulties in the past 6 months were associated with factors of panic disorder. Discussion: This study characterizes patients with panic disorder diagnosed with a validated instrument during the COVID-19 pandemic and identified risk factors for this disease. Conclusions: In non-selected consecutive primary care attendees in real-world conditions during the COVID-19 pandemic, the prevalence of panic disorder was 5.3%, being more frequent in women. There is a need to enhance primary care resources for mental health care during the duration of the pandemic and beyond.(AU)

Objetivo: Evaluar la prevalencia del trastorno de pánico durante la segunda y tercera olas de la pandemia por COVID-19. Diseño: Estudio transversal multicéntrico. Emplazamiento: Atención primaria. Participantes: Los médicos participantes seleccionaron a pacientes atendidos en atención primaria por cualquier motivo durante 16 meses. Medición principal: Trastorno de pánico diagnosticado usando el cuestionario Primary Care Evaluation Mental Disorders (PRIME-MD).Resultados: De un total de 678 pacientes elegibles, 36 presentaban un trastorno de pánico, con una prevalencia del 5,3% (intervalo de confianza del 95% 3,6-7,0). Un 63,9% de los casos se presentaron en mujeres. La edad media fue de 46,7±17,1 años. Las dificultades socioeconómicas, como bajos ingresos mensuales, falta de empleo y restricciones económicas para pagos de la vivienda y llegar a final de mes eran más frecuentes en los pacientes con trastorno de pánico que en aquellos sin. Los factores asociados al trastorno de pánico fueron un alto nivel de estrés (escala de Holmes-Rahe > 300), síndrome de fatiga crónica concomitante e intestino irritable y dificultades económicas en los últimos 6 meses. Discusión: Este estudio caracteriza a los pacientes con trastorno de pánico diagnosticados mediante un instrumento validado durante la pandemia por COVID-19 e identifica los factores de riesgo. Conclusiones: En pacientes consecutivos no seleccionado en condiciones del mundo real durante la pandemia por COVID-19, la prevalencia del trastorno de pánico fue del 5,3%, siendo más frecuente en mujeres. Es necesario aumentar los recursos para la salud mental durante y más allá de la duración de la pandemia.(AU)

Recomendaciones para la detección, investigación y derivación del dolor lumbar inflamatorio en Atención Primaria / Reccomendations for the detection, study and referral of inflammatory low-back pain in Primary Care

Objetivo. Diseñar una estrategia de detección y derivación precoz de pacientes con posible espondiloartritis mediante el desarrollo de recomendaciones consensuadas dirigidas a los médicos de Atención Primaria (AP). Métodos. Se utilizó una metodología modificada de RAND/UCLA y revisión sistemática de la literatura. Se seleccionó un grupo de discusión formado por reumatólogos y médicos de AP. Se estudió el mapa del proceso y se propusieron recomendaciones y algoritmos que fueron sometidos a 2 rondas Delphi para evaluar el grado de aceptación y preferencia de criterios en un grupo amplio de reumatólogos y médicos de AP. Del análisis de la segunda ronda Delphi se extrajeron las recomendaciones finales. Resultados. Se presentan recomendaciones, junto con su grado medio de acuerdo, para la derivación rápida de pacientes con sospecha de espondiloartritis. En concreto, se recomienda investigar el dolor lumbar crónico en menores de 45 años en 4 fases: 1) clínica: preguntas clave; 2) clínica: preguntas extra; 3) exploración física, y 4) pruebas complementarias. Se debe derivar a Reumatología si existen: 1) dolor lumbar inflamatorio; 2) signos indicativos de espondiloartritis, o 3) HLA B27 positivo, elevación de proteína C reactiva o signos radiológicos de sacroilitis. Se incluyen recomendaciones sobre el proceso de derivación y otras adicionales. Conclusiones. El grado de acuerdo con estas sencillas recomendaciones es amplio. Es necesario diseñar estrategias de formación y sensibilización desde los servicios de Reumatología para mantener una óptima colaboración de AP en la identificación de los casos y facilitar que los servicios de Reumatología estén preparados para asumir las derivaciones (AU)

Objective. To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians. Methods. We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round. Results. We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years be performed in four phases 1) clinical: key questions, 2) clinical: extra questions, 3) physical examination, and 4) additional tests. Conclusions. The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments (AU)

Reccomendations for the detection, study and referral of inflammatory low-back pain in primary care.

OBJECTIVE: To design a strategy for the early detection and referral of patients with possible spondyloarthritis based on recommendations developed, agreed upon, and directed to primary care physicians. METHODS: We used a modified RAND/UCLA methodology plus a systematic literature review. The information was presented to a discussion group formed by rheumatologists and primary care physicians. The group studied the process map and proposed recommendations and algorithms that were subsequently submitted in two Delphi rounds to a larger group of rheumatologists and primary care physicians. The final set of recommendations was derived from the analysis of the second Delphi round. RESULTS: We present the recommendations, along with their mean level of agreement, on the early referral of patients with possible spondyloarthritis. The panel recommends that the study of chronic low back pain in patients under 45 years be performed in four phases 1) clinical: key questions, 2) clinical: extra questions, 3) physical examination, and 4) additional tests. CONCLUSIONS: The level of agreement with these simple recommendations is high. It is necessary to design strategies for the education and sensitization from rheumatology services to maintain an optimal collaboration with primary care and to facilitate referral to rheumatology departments.