Impacto de la administración del cuestionario Asthma Control Test en atención primaria sobre la puntuación de control del asma

ObjectiveTo compare the score indicative of asthma control obtained using the Asthma Control Test (ACT^®) questionnaire administered by primary health care physicians, habitual users of the questionnaire, and those were not.DesignA multicentre, prospective, epidemiological study.SettingPrimary health care centres in Spain.ParticipantsTwo study populations were defined: «ACT^® users» and «non-ACT^® users», according to the use of the ACT^® questionnaire by their respective primary health care physicians.Main measurementsThe patients completed the ACT^® questionnaire during a baseline visit, and in another follow-up visit at 8 weeks. The primary outcome was the percentage of patients with an ACT^® score ≥ 20. The change in the ACT^® score was analysed if there was a change in treatment.ResultsThere was a higher percentage of patients with well-controlled asthma in the ACT^® users group after 8 weeks (68.5% vs. 55.6%; P=.01). A significant increase in the ACT^® score was observed in the follow-up visit compared to the baseline visit, when there was a change in treatment in both groups (2.5 and 3.8 points, ACT^® users and non-ACT^®-users, respectively, P=.001 and P<.0001).ConclusionsThe administering of the ACT^® questionnaire improved the score indicative of asthma control in both populations of the study, with a higher score being obtained in those patients attended by physicians with previous experience in the use of ACT^®. The administering of the ACT^® questionnaire could contribute to improving the long-term outcome of the patient, and favouring the appropriateness of the treatment.     

Accesibilidad y utilización de la espirometría en los centros de atención primaria de Cataluña

ObjectiveExamine the accessibility and use of forced spirometry (FS) in public primary care facilities centers in Catalonia.DesignCross-sectional study using a survey.ParticipantsThree hundred sixty-six Primary Care Teams (PCT) in Catalonia. Third quarter of 2010.MeasurementsSurvey with information on spirometers, training, interpretation and quality control, and the priority that the quality of spirometry had for the team. Indicators FS/100 inhabitants/year, FS/month/PCT; FS/month/10,000 inhabitants.Main resultsResponse rate: 75%. 97.5% of PCT had spirometer and made an average of 2.01 spirometries/100 inhabitants (34.68 spirometry/PCT/month). 83% have trained professionals. > 50% centers perform formal training but no information is available on the quality. 70% performed some sort of calibration. Interpretation was made by the family physician in 87.3% of cases. In 68% of cases not performed any quality control of exploration. 2/3 typed data manually into the computerized medical record. > 50% recognized a high priority strategies for improving the quality.ConclusionDespite the accessibility of EF efforts should be made to standardize training, increasing the number of scans test and promote systematic quality control.     

Impacto en los resultados de salud cardiovascular de la implantación del contrato de Dirección Clínica en atención primaria de Tarragona

ObjetivoLos objetivos del presente estudio son: a) determinar la mejora en la salud cardiovascular de una población tras la implantación del contrato de Dirección Clínica en los profesionales de los Equipos de Atención Primaria de Tarragona-Reus y Terres de l’Ebre (provincia de Tarragona), y b) identificar los factores predictivos que determinan una mejor salud cardiovascular tras la implantación del contrato de Dirección Clínica. La implantación del contrato de Dirección Clínica (basada en el liderazgo profesional, feedback de la información asistencial, control de los indicadores de riesgo cardiovascular basados en la evidencia científica concretadas en guías de práctica clínica) mejorará los resultados de salud cardiovascular de la población de referencia.DiseñoSe trata de un estudio antes-después y multicéntrico.EmplazamientoAtención primaria de salud.ParticipantesParticipan 30 centros de salud (totalidad de los centros de salud del ámbito de atención primaria del Institut Català de la Salut).Mediciones principalesCaracterísticas del centro. Variables de proceso: indicadores de buena práctica asistencial, cálculo del riesgo cardiovascular, aplicación de la guía de práctica clínica (hipertensión arterial, diabetes, dislipemia, tabaquismo y factores de riesgo cardiovascular), estándares de calidad de la prescripción farmacológica. Variables de resultados: cifras de riesgo cardiovascular, número de visitas en atención continuada, urgencias hospitalarias e ingresos por angina, infarto agudo de miocardio y accidente cerebrovascular, y cribados poblacionales de factores de riesgo.DiscusiónEste estudio es útil, ya que la dirección clinica pretende ser un motor para que los profesionales lideren la gestión asistencial y, mediante el control de indicadores y la «retroalimentación» de estos resultados a los profesionales, se mejore la calidad asistencial. Con este trabajo se pretende demostrar que una estrategia de gestión puede mejorar la salud cardiovascular de la población. La originalidad de este proyecto se basa en el desarrollo de una nueva herramienta de evaluación basada en una novedosa estrategia de gestión para medir resultados en salud cardiovascular.Palabras clave: Contrato dirección clínica, Atención primaria, Enfermedad cardiovascular     

Utilidad diagnóstica del cuestionario STOP-Bang en la apnea del sueño moderada en atención primaria

ObjectiveWe aimed to compare the diagnostic utility of the STOP-Bang questionnaire for moderate apnoea against the gold standard (type I polysomnography) in a primary care setting.MethodStudy of diagnostic utility in primary care. Estimated sample: 85 cases and 85 healthy controls. In convenience sampling, 203 patients were recruited by their physicians at six health centres. Twenty-five were excluded, and 57 women and 121 men, of whom 74 had apnoea-hypopnoea index (AHI) ≥15, were analyzed. STOP-Bang was validated by comparing scores in the same patient with the apnoea-hypopnoea index observed in polysomnography, as a gold standard. Sample size, ROC curve analysis and optimal cut-off points were identified with the easyROC, pROC, and OptimalCutpoints packages.ResultsThe area under the curve in moderate apnoea (AHI ≥15) of the STOP-Bang was 0.777 (0.667-0.808), with optimal cut-off points different by sex (4 in women and 6 in men). In the cross-validation with k = 10, the area under the curve for the STOP-Bang was 0.678.ConclusionsThe STOP-Bang presents a diagnostic moderate utility for AHI≥15, but superior to other scales, in a community population. Its performance is more appropriate in women.     

Aplicación de The Community Assessment Risk Screen en centros de atención primaria del Sistema Sanitario Valenciano

ObjectiveApplication of The Community Assessment Risk Screen (CARS) tool for detection of chronic elderly patients at risk of hospital readmission and the viability study for its inclusion in health information systems.DesignRetrospective cohort study.LocationHealth Departments 6, 10, and 11 from the Valencia Community.ParticipantsPatients of 65 and over seen in 6 Primary Care centres in December 2008. The sample consisted of 500 patients (sampling error = ± 4.37%, sampling fraction = 1/307).VariablesThe CARS tools includes 3 items: Diagnostics (heart diseases, diabetes, myocardial infarction, stroke, COPD, cancer), number of prescribed drugs and hospital admissions or emergency room visits in the previous 6 months. The data came from SIA-Abucasis, GAIA and MDS, and were compared by Primary Care professionals. The end-point was hospital admission in 2009.ResultsCARS risk levels are related to future readmission (P < .001). The value of sensitivity and specificity is 0.64; the tool accurately identifies patients with low probability of being hospitalized in the future (negative predictive value = 0.91, diagnostic efficacy = 0.67), but has a positive predictive value of 0.24.ConclusionsCARS does not properly identify the population at high risk of hospital readmission. However, if it could be revised and the positive predictive value improved, it could be incorporated into the Primary Care computer systems and be useful in the initial screening and grouping of chronic patients at risk of hospital readmission.     

Impacto de los grupos socioeducativos de atención primaria en la salud mental de las mujeres

ObjectiveTo present part of the results of the evaluation of this strategy.MethodLongitudinal (pre-post) and quasi-experimental (experimental and control group) design, collecting information from 228 women (114 each group) in four moments (one month before the program; one month after the end of the program; six months and a year and a half). Among the instruments used are the Anxiety and Depression Scale and the Rosenberg Self-Esteem Scale.ResultsWomen in the experimental group reduce their symptoms of depression and anxiety and improve their self-esteem after participating in the program, and this improvement is maintained until a year and a half after the end of it. On the contrary, women in the control group do not present pre-post differences in almost none of the variables analyzed (except in anxiety symptoms).ConclusionThese results support GRUSE as a non-medical intervention, and it is considered that they can serve as a stimulus to maintain the strategy and even extend it to other population groups that also experience psychosocial discomfort.     

Investigación y protección de datos personales en atención primaria

Research is one of the fundamental functions that have to be carried out in Primary Care. The clinical information stored in different records arising from medical care is a basic tool for this activity. The use of personal data for the purposes of research is legitimate according to our laws; however, this information must be treated confidentially at all times. Two alternatives are available for this. One is to obtain the informed consent of the patient, and the other is to dissociate the handling of the information. But in some situations, the compliance to legal demands when obtaining data for research is not easy, there being a series of obstacles which in many cases makes it impossible to carry out research. In this article, we will give guidance on how to access the information contained in records while respecting the rights of the patient and the current legislation.