Efectividad a corto y largo plazo de un programa tutelado de formación en espirometrías para profesionales de atención primaria

Introduction

Despite the importance of spirometry, its use and quality are limited in the Primary Care setting. There are few accredited training programs that have demonstrated improvement in the quality of spirometric studies. In this paper, we analyze the short- and long-term effectiveness of a supervised training program for performing and interpreting spirometries.

Methodology

Ours is an intervention study with before and after measurements. The target population included teams of physicians and nursing staff at 26 health-care centers in the area of Vigo (Galicia, Spain). The structured training program involved 2 theoretical and practical training sessions (that were 2 months apart), an intermediate period of 30 supervised spirometries performed in the respective centers and weekly e-mail exercises. Effectiveness was evaluated using exercises at the beginning (test 1) and the end (test 2) of the 1 st day, 2 nd day (test 3) and one year later (test 4), as well as the analysis of spirometries done in month 1, month 2 and one year later. Participants also completed a survey about their satisfaction.

Results

74 participants initiated the program; 72 completed the program, but only 45 participated in the one-year evaluation. Mean test scores were: 4.1 ± 1.9 on test 1; 7.5 ± 1.6 on test 2; 8.9 ± 1.3 on test 3, and 8.8 ± 1.4 on test 4. During month 1, the percentage of correctly done/interpreted tests was 71%, in month two it was 91% and after one year it was 83% (P < .05).

Conclusions

A training program based on theoretical and practical workshops and a supervised follow-up of spirometries significantly improved the ability of Primary Care professionals to carry out and interpret spirometric testing, although the quality of the tests diminished over time.     

Retraso diagnóstico de la hipertensión arterial en pacientes diabéticos atendidos en atención primaria

Introduction and objectives

Delayed diagnosis of hypertension may result in inadequate blood pressure control and increased cardiovascular risk. The aim of this study was to estimate the delay in hypertension diagnosis in patients with type 2 diabetes and the likelihood of a diagnosis within a suitable period (first 6 months), and to analyze the patient and physician characteristics associated with delayed diagnosis.

Methods

Retrospective dynamic cohort study, with a 7-year follow-up in primary care, of 8074 adult patients with diabetes who met the diagnostic criteria for hypertension. Two thresholds were considered: 140/90 mmHg and 130/80 mmHg. The time elapsed between meeting these criteria and recording the diagnosis was estimated; the time course of the likelihood of a missed diagnosis and the variables associated with correct diagnosis were assessed by Kaplan-Meier survival analysis and logistic regression analysis, respectively.

Results

The mean diagnostic delay was 8.9 (15.4) months in patients with blood pressure≥140/90 mmHg compared to 15.2 (19.6) months for those with <140/90 mmHg (P<.001). The main variables associated with correct diagnosis were baseline blood pressure ≥140/90 mmHg (odds ratio=2.77; 95% confidence interval, 2.44-3.15), no history of acute myocardial infarction (odds ratio=2.23; 95% confidence interval, 1.67-2.99), obesity (odds ratio=1.70; 95% confidence interval, 1.44-1.99), absence of depression (odds ratio=1.63; 95% confidence interval, 1.27-2.08), female sex (odds ratio=1.29; 95% confidence interval, 1.14-1.46), older age, and taking more intensive antidiabetic therapy. There was an inverse relationship with the age of physicians and a direct relationship with their professional stability.

Conclusions

The mean diagnostic delay in hypertension among diabetic patients was greater than 6 months and varied according to the diagnostic threshold used. Patients with baseline blood pressure≥140/90 mmHg were more likely to receive a timely diagnosis.Full English text available from:www.revespcardiol.org/en     

Factores asociados con el control del asma en pacientes de atención primaria en España: el estudio CHAS

Background

Asthma control is inadequate in all populations studied to date, leading to a major part of the cost of the disease. The aim of our study was to evaluate the prevalence of uncontrolled asthma in primary care patients and identify the associated factors.

Methods

We carried out a cross-sectional study of the population of primary care asthmatic patients over 18 years old in Spain (n=2159). Asthma control was measured with the Asthma Control Questionnaire (ACQ). The sociodemographic variables and treatment compliance were measured using a questionnaire. We built logistic-regression models using Asthma control, a dichotomous variable generated from ACQ score.

Results

The prevalence of uncontrolled asthma was 63.9%. Treatment with oral corticosteroids (OCS) (OR=6.55), greater asthma severity (OR=3.11), presence of a distressing event (OR=2.44), lower significance given to treatment compliance (OR=1.66) and living in a rural area (OR=1.29) are associated with uncontrolled asthma. On the contrary, sex, age, obesity, smoking, alcohol intake and educational level had no effect on asthma control.

Conclusions

In Spain asthma is still uncontrolled and some factors leading to this situation appear to be modifiable by the health system.     

Comportamiento de la calidad de vida (SGRQ) en pacientes con EPOC según las puntuaciones BODE

IntroductionTo evaluate if the association between the BODE index and deterioration in health-related quality of life is linear. To determine possible associations between the BODE index and health status evaluated by the Saint George's Respiratory Questionnaire (SGRQ) at all levels of disease severity in COPD.MethodsA cross-sectional study was carried out on 253 patients from two Latin American respiratory centers (Brazil and Chile) with a clinical diagnosis of COPD, based on GOLD criteria. Assessment included the BODE index and the SGRQ questionnaire.ResultsPatients had a BODE index of 3.1 ± 2.0; FEV₁ (%) of 49 ± 19.2; BMI (kg/m²) of 24.7 ± 5.1; 6MWT distance (meters) of 444 ± 96. Significant correlations were found between the BODE index and SGRQ total scores (r = 0.5; < 0.001), impact (r = 0.45; < 0.001) and activity (r = 0.5; < 0.001). From BODE score zero, HRQOL was already compromised in all SGRQ domains. SGRQ scores (total and domain) increased progressively for individual components of the BODE index, with the decrease in airflow limitation (< 0.05), BMI (< 0.002) and 6MWT (< 0.05), and with the increase in the Modified Medical Research Council (MMRC) score (< 0.05).ConclusionThere is an association between health-related quality of life, as assessed by the SGRQ and the BODE index within the entire spectrum of COPD severity. Even in early disease stages and BODE index zero, health-related quality of life is already impaired.     

Indicadores de calidad asistencial para la atención de personas que viven con el virus de la inmunodeficiencia humana,adaptados a la edad pediátrica

Introduction

Since infection with human immunodeficiency virus (HIV) was first described, there have been many advances in its diagnosis, monitoring and treatment. However, few contributions are related to the area of health care quality.In this sense, the Spanish Study Group on AIDS (GESIDA) has developed a set of quality care indicators for adult patients living with HIV infection that includes a total of 66 indicators, 22 of which are considered to be relevant. Standards were calculated for each of them in order to reflect the level of the quality of care offered to these patients. Similar documents for pediatric patients are currently lacking.

Methods

Preparation of a set of quality care indicators applicable to pediatric patients based on the GESIDA document and the Spanish Guidelines for monitoring of pediatric patients infected with HIV. Each indicator was analysed with respect to the required standards in all patients under 18 years of age followed-up in our Unit, with the aim of evaluating the quality of care provided.

Results

A total of 61 indicators were collected (51 from the GESIDA document and 10 from currently available pediatric guidelines), 30 of which were considered to be relevant. An overall compliance of 81%-83% was obtained when assessing the relevant indicators.

Conclusion

The availability of health care quality standards is essential for the care of pediatric HIV-infected patients. The assessment of these indicators in our Unit yielded satisfactory results.     

Utilidad de la ecografía en la evaluación de las entesis periféricas en las espondiloartritis

Enthesitis is one of the characteristic etiopathogenic manifestations of spondyloarthritis. However, in clinical practice, its presence often goes unnoticed because of the lack of precision and sensitivity of physical examination to detect it. Viable, valid and reliable imaging tests are needed for early diagnosis, as well as a good sensitivity to change to monitor therapeutic response. In this paper we review the most relevant aspects of current knowledge of the enthesis and discusses the validity of ultrasound for assessing enthesitis in spondyloarthritis and its sensitivity to change to monitor therapeutic response.     

Papel de las tecnologías de la información y la comunicación en la medicina actual

In the last few years there has been has been an explosion in information and communication technologies (ICT) both worldwide and in the health sector, mainly due to access to personal computers and internet expansion, which has facilitated access among health professionals and the public (whether patients, users, or citizens) to increasing information and communication on health. The spectrum of ICT is extremely wide and, in the last few years, has included electronic health (e-Health), defined as the set of techniques and devices used for treatment and the transmission of health information. Within e-Health, new fields are expanding, such as the electronic medical record and telemedicine.Digital medicine has transformed the traditional medical record into the electronic medical record and has shifted ways of gaining medical knowledge to searches of literature databases and new knowledge management tools, such as clinical practice guidelines or systematic reviews. Moreover, health organizations require computerization of their support processes, which has transformed these organizations. Telemedicine represents another revolutionary change by allowing off-site diagnosis and treatment, as well as education and continuing medical training (e-learning).Health professionals currently play an essential role in educating patients in the appropriate use of internet health resources. The doctor-patient relationship has become a «triadic» one, in which the computer plays an increasingly important role. ICT tend to improve patient safety but paradoxically also pose certain risks. In the next decade, there will be an unprecedented increase in health information, which will require enhanced measures to reduce the possible risks. These measures include the adoption of common standards, the development of better information systems, and greater training of users of the new ICT. Health professionals should be able to meet the challenge posed by this transformation.