Supervised exercise for acute coronary patients in primary care: a randomized clinical trial.

BACKGROUND: Functional capacity is a prognostic factor for coronary patients; accordingly, they are recommended to walk. OBJECTIVE: To assess whether an exercise program supervised in primary care increases their functional capacity more than unsupervised walking. METHODS: A randomized clinical trial was carried out at eight primary care centres of the Spanish Health Service and involving 97 incident cases of low-risk acute coronary patients, <80 years old, randomly assigned to either an unsupervised walking program (UW group; n = 51) or a 6-month cycle ergometer exercise program with gradually increasing frequency and workload intensity supervised by primary care nurses (SE group; n = 46). The two groups received the same common components of secondary prevention care. Changes in functional capacity were assessed in terms of peak oxygen consumption (VO2peak) during exercise testing measured at baseline and at 7 months by cardiologists blinded to group assignment. RESULTS: Overall, 76% of participants completed the study, 30 in the SE and 44 in the UW. Both groups increased baseline-adjusted VO2peak: 5.56ml/kg per minute in the SE (95% confidence interval [CI] 3.38-7.74) and 1.64ml/kg per minute in the UW (95% CI -0.15 to 3.45). The multivariate-adjusted difference between groups was 4.30ml/kg per minute (95% CI 1.82-6.79; P = 0.001) when analyzing completers and 2.83ml/kg per minute (95% CI 0.61-5.05; P = 0.01) in the intention-to-treat analysis, including all participants with baseline values carried forward for those lost to follow-up. CONCLUSIONS: A cycle ergometer exercise program supervised by primary care nurses increased the functional capacity of coronary patients more than unsupervised walking with a clinically relevant difference.

[Quality of life related to health as a factor explaining the use of family medical consultation: a study on the behavioral model]. / La calidad de vida relacionada con la salud como factor explicativo de la utilización de la consulta de medicina de familia: un estudio bajo el modelo conductual.

BACKGROUND: Health services utilization has been studied under several conceptual models. This study is aimed to assess the influence of Health Related Quality of Life (HRQL) on the variability of the primary care consultation utilization under the <> METHODS: A cross-sectional study. Interviews were conducted with 451 subjects at six health centers in the Community of Madrid. Environmental and individual characteristics (predisposing, enabling and need factors) and HRQL (EuroQol-5D) were collected. Annual visits were retrieved from the computerized clinical history. RESULTS: Median utilization was 13 visits/year (interquartile range 7-20). HRQL explained 5,2% of utilization variability, living in high-income areas an additional 2.4%, age a 7.4%, incomes a 1.0% and <> (chronic illnesses or a hospital admission in the last year) explained an additional 4.1% of the variability. Each increase of the tercile in the perception of HRQL was associated with a decrease of 13,8% of the number of visits/year. Living in high-income areas, and each increase of 1000 in the incomes decreased the percentage of annual visits 17.5 % and 9.5% respectively. Age is associated with an increase of 8.0% of annual visits per decade. Suffering from chronic illnesses or a hospital admission in the last year increased the average number of visits/year to 51.9 and 26.5%. CONCLUSIONS: HRQL is independently associated with the variability of the demand for the family physician after adjusting by << health need>> factors as the <> proposes.

La calidad de vida relacionada con la salud como factor explicativo de la utilización de la consulta de medicina de familia: un estudio bajo el modelo conductual / Quality of life related to health as a factor explaining the use of family medical consultation: a study on the behavioral model

Fundamento: La utilización de servicios sanitarios se ha estudiado desde varios modelos conceptuales. El objetivo de este trabajo es valorar la influencia de la calidad de vida relacionada con la salud (CVRS) en la variabilidad de la utilización de la consulta de atención primaria bajo el «modelo conductual». Métodos: Estudio transversal analítico. Se entrevistó a 451 sujetos de 6 centros de salud en la Comunidad de Madrid. Se recogieron características relacionadas con factores ambientales e individuales (predisponentes, facilitadores y de necesidad) y la CVRS (Euroqol-5D). La utilización se recogió de la historia clínica informatizada. Resultados: Hubo una mediana de 13 visitas/año (rango intercuartil 7-20). La CVRS explicaba un 5,2% de la variabilidad en la utilización, vivir en barrios de rentas altas un 2,4%, la edad un 7,4%, la renta individual un 1,0% y los factores relacionados con «necesidad» (enfermedades crónicas e ingresos hospitalarios) explicaban un 4,1% de variabilidad adicional. Cada cambio de tercil de la CVRS se asoció con una disminución del 13,8% en las consultas/año. La residencia en zonas de renta alta y cada aumento de 1000 de renta individual disminuían la utilización un 17,5% y un 9,5% respectivamente. La edad se asociaba con un aumento de un 8,0% de visitas/año por década. El sufrir enfermedades crónicas o ingresos hospitalarios suponía aumentar un 51,9% y un 26,5% las visitas anuales. Conclusiones: La CVRS se asocia de manera independiente con la variabilidad en la utilización de la consulta del médico de familia, una vez ajustado el efecto de la necesidad, como propone el «modelo conductual»(AU)

Background: Health services utilization has been studied under several conceptual models. This study is aimed to assess the influence of Health Related Quality of Life (HRQL) on the variability of the primary care consultation utilization under the «behavioral model» Methods: A cross-sectional study. Interviews were conducted with 451 subjects at six health centers in the Community of Madrid. Environmental and individual characteristics (predisposing, enabling and need factors) and HRQL (EuroQol-5D) were collected. Annual visits were retrieved from the computerized clinical history. Results: Median utilization was 13 visits/year (interquartile range 7- 20). HRQL explained 5,2% of utilization variability, living in high-income areas an additional 2.4%, age a 7.4%, incomes a 1.0% and «need factors» (chronic illnesses or a hospital admission in the last year) explained an additional 4.1% of the variability. Each increase of the tercile in the perception of HRQL was associated with a decrease of 13,8% of the number of visits/year. Living in high-income areas, and each increase of 1000 in the incomes decreased the percentage of annual visits 17.5 % and 9.5% respectively. Age is associated with an increase of 8.0% of annual visits per decade. Suffering from chronic illnesses or a hospital admission in the last year increased the average number of visits/year to 51.9 and 26.5%. Conclusions: HRQL is independently associated with the variability of the demand for the family physician after adjusting by « health need» factors as the «behavioral model» proposes(AU)