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Josep Montserrat-Capdevila Pere Godoy Josep Ramon Marsal Marta Ortega Ferran Barbé Maria Teresa Castañ María Asunción Seminario Jesús Pujol Miquel Alsedà 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(10):602-609
ObjectiveThe objective of the study was to know the profile of patients diagnosed with chronic obstructive pulmonary disease (COPD) and who have never been smokers.DesignA transversal study.LocationPrimary Care Centre of Pla d’Urgell (Primary care setting in Lleida, Spain).Participants512 patients older than 40 years with COPD from Primary Care Centre of Pla d’Urgell with a compatible spirometry [forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) ratio < 0.7) to the beginning of the study.Main measurementsThe dependent variable was de COPD in non-smokers and the independents were variables collected from the information on the respiratory clinical history, the risk factors of the patients and on quality of life. We designed a predictor model of COPD in non-smokers compared to smokers.Results33.2% of COPD patients had never been smokers, 59.4% of whom were women. The average FEV1 for non-smokers was 70.5 (SD = 17.1), higher than 62.6 (SD = 18.5) for smokers/former smokers (p < 0.001). The coverage of pneumococcal vaccination 23V was better in non-smokers (75.3%), p < 0.001. COPD in non-smokers (compared to smokers/former smokers) were: mostly women (OR = 16.46), older (OR = 1.1), with better FEV1 (OR = 1.1), better perception of quality, EuroQoL-5D (OR = 0.8), with lower prevalence of diabetes (OR = 0.5), lower level of studies (OR = 0.2), and with fewer previous hospitalizations (OR = 0.3).ConclusionsThe study evidences a high proportion of non-smokers in COPD patients. Our study aims that older women with less severity would be associated with an increased risk of COPD in non-smokers. It seems to indicate that COPD in non-smokers would appear at later ages and would be milder than smoking-related COPD. 相似文献
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Cristina Blánquez Moreno Cristina Colungo Francia M. Carme Alvira Balada Belchin Kostov Luis González-de Paz Antoni Sisó-Almirall 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(9):539-546
Aim
To determine the impact of an educational program to improve the management of chronic obstructive pulmonary disease (COPD) that contributes to an increase of the quality of life, exercise capacity, level of dyspnoea, and clinical risk.Design
Intervention study without controls.Location
Primary Healthcare Centre.Participants
193 patients with COPD were invited, 73 accepted and 55 participated in the educational program.Interventions
Respiratory rehabilitation educational program with basic concepts of pulmonary and respiratory pathophysiology, respiratory physiotherapy exercises, practical workshop on the use of the most frequent inhalation devices, understanding of chronic disease and self-care measures in case of exacerbation.Main measurements
The quality of life (the COPD assessment test), exercise tolerance (the Six-Minute Walk Test), rating of perceived exertion (Borg Dyspnoea Score) and clinical risk (BODE index) were assessed by means of validated questionnaires in Spanish.Results
A total of 43 (78.2%) participants completed the program. An improvement in the quality of life by a mean of 3.3 points was observed (95%CI; 1.76-4.84). Just over half (53.5%) of the participants obtained a clinically relevant improvement. Participants also improved their physical exercise capacity at post-intervention by increasing the distance that they walked in 6 min by a mean of 20.76 m (95%CI; 2.57-38.95). Improvements in the level of dyspnoea and clinical risk were also observed.Conclusions
The educational program shows a statistically significant and clinically relevant improvement in the quality of life, fatigue, symptomatology, exercise capacity, level of dyspnoea, and clinical risk. The program is adaptable to the health care routine of healthcare centres. 相似文献6.
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Sergio Minué-Lorenzo Carmen Fernández-Aguilar 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2018,50(2):114-129
The detailed analysis of the chronic care plans developed by the Spanish regional health services show a surprising level of uniformity in their design and deployment, despite differences between these services. The reviews about theoretical models that support it and tools they develop does not provide conclusive evidence to support the chronic care models achieve better results than another alternatives of care.Although the whole Spanish chronic care plans includes assessment proposals no rigorous studies on their effect have been published to date.Given that, on the contrary, there is a strong and repeated evidence that health systems with Primary Care high performance obtains better outcomes, it is necessary to ask about the need to look for alternative models, when the proposed goals could be reached strengthen Primary Care. 相似文献
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Miguel Ángel Royo-Bordonada Pedro Armario José María Lobos Bejarano Juan Pedro-Botet Fernando Villar Álvarez Roberto Elosua Carlos Brotons Cuixart Olga Cortés Benilde Serrano Miguel Camafort Babkowski Antonio Gil Núñez Antonio Pérez Antonio Maiques Ana de Santiago Nocito Almudena de Castro Eduardo Alegría Ciro Baeza María Herranz Pilar Campos 《Gaceta sanitaria / S.E.S.P.A.S》2017,31(3):255-268
The VI European Guidelines for Cardiovascular Prevention recommend combining population and high-risk strategies with lifestyle changes as a cornerstone of prevention, and propose the SCORE function to quantify cardiovascular risk. The guidelines highlight disease specific interventions, and conditions as women, young people and ethnic minorities. Screening for subclinical atherosclerosis with noninvasive imaging techniques is not recommended. The guidelines distinguish four risk levels (very high, high, moderate and low) with therapeutic objectives for lipid control according to risk. Diabetes mellitus confers a high risk, except for subjects with type 2 diabetes with less than <10 years of evolution, without other risk factors or complications, or type 1 diabetes of short evolution without complications. The decision to start pharmacological treatment of arterial hypertension will depend on the blood pressure level and the cardiovascular risk, taking into account the lesion of target organs. The guidelines don’t recommend antiplatelet drugs in primary prevention because of the increased bleeding risk. The low adherence to the medication requires simplified therapeutic regimes and to identify and combat its causes. The guidelines highlight the responsibility of health professionals to take an active role in advocating evidence-based interventions at the population level, and propose effective interventions, at individual and population level, to promote a healthy diet, the practice of physical activity, the cessation of smoking and the protection against alcohol abuse. 相似文献
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Chronic kidney disease (CKD) is an important global health problem, involving to 10% of the Spanish population, promoting high morbidity and mortality for the patient and an elevate consumption of the total health resources for the National Health System. This is a summary of an executive consensus document of ten scientific societies involved in the care of the renal patient, that actualizes the consensus document published in 2007. The central extended document can be consulted in the web page of each society. The aspects included in the document are: Concept, epidemiology and risk factors for CKD. Diagnostic criteria, evaluation and stages of CKD, albuminuria and glomerular filtration rate estimation. Progression factors for renal damage. Patient remission criteria. Follow-up and objectives of each speciality control. Nephrotoxicity prevention. Cardio-vascular damage detection. Diet, life-style and treatment attitudes: hypertension, dyslipidaemia, hyperglycemia, smoking, obesity, hyperuricemia, anemia, mineral and bone disorders. Multidisciplinary management for Primary Care, other specialities and Nephrology. Integrated management of CKD patient in haemodialysis, peritoneal dialysis and renal transplant patients. Management of the uremic patient in palliative care. We hope that this document may be of help for the multidisciplinary management of CKD patients by summarizing the most updated recommendations. 相似文献
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J. Blad-Creixenti I. Pascual-Moron A. Gmez-Sorribes J. Daniel-Diez J.L. Piol-Moreso grupo de estudio Direccin Clínica y Enfermedad Cardiovascular 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2006,37(1):51-55
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 相似文献
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Jordi Coderch Xavier Pérez-Berruezo Inma Sánchez-Pérez Elvira Sánchez Pere Ibern Marc Pérez Marc Carreras José M. Inoriza 《Gaceta sanitaria / S.E.S.P.A.S》2018,32(1):18-26