[Failure Mode and Effects Analysis (FMEA) method applied to anticoagulation of patients with non-valvular atrial fibrillation]. / El método AMFE (Análisis Modal de Fallos y Efectos) aplicado a la anticoagulación de pacientes con fibrilación auricular no valvular.

OBJECTIVES: To contribute to the improvement of the process of anticoagulation in patients with nonvalvular atrial fibrillation (NVAF) through awareness and training activities for Primary Care Physicians. MATERIALS AND METHODS: A total of 38 focus groups, sequenced according to an adaptation of the Failure Mode and Effects Analysis (FMEA) method. Each meeting was driven by «brainstorming¼ methodology. The geographical representation was homogeneous, with a total of 482 national. physicians (444 Primary Care Physicians, and 38 cardiologists). The meetings were held between March 28 and June 20, 2017. RESULTS: The main unsafe actions that can lead to a haemorrhagic or thrombotic event are incorrect anticoagulation or lack of patient follow-up. These events are mainly caused by training deficiencies in the management of NVAF, or by not taking into account possible interactions with vitamin K antagonist drugs. The main recommendations to alleviate these failures were focused on a good follow-up of patients with NVAF, on creating or updating the protocols or clinical practice guidelines, and on promoting the continuous training of physicians who usually manage patients with non-valvular AF treated with oral anticoagulants. CONCLUSIONS: A significant percentage of patients with NVAF are not correctly anticoagulated. Specific actions are required to alleviate this problem. Among them, the importance of a general anticoagulation training was emphasised, and particularly, the use of direct oral anticoagulants.

[Evaluation of the capacity of elderly patients to make decisions about their health]. / Evaluación de la capacidad de toma de decisiones sobre su salud en pacientes ancianos.

OBJECTIVE: To assess the decision-making capacity and variables related to this, in elderly patients in a home care program. MATERIAL AND METHODS: A cross-sectional study was conducted on 130 patients assigned to home care program or in social welfare residences of an urban health centre. Demographic variables, as well as comorbidities, social support, institutionalisation, number of drugs used, degree of dependence (Barthel Index), cognitive function (Pfeiffer) were collected. The primary endpoint was the capacity for decision-making about their health assessed using the Aid to Capacity Evaluation (ACE) tool. RESULTS: There was a prevalence of 58.5% capacity. There was an association between ability and independence for activities of daily living (odds ratio (OR): 12.214; Confidence interval 95% (95% CI): 3.90 to 32.29, P <.0001) and function intellectual intact (OR: 282.750, 95% CI 34.0 to 2351.2, P <.0001). Numeric variables associated with the capacity for decision-making that had a more important effect size were the Barthel index (d: -1.398) and Pfeiffer index (d: 3.084). CONCLUSIONS: The prevalence of incapacity to make decisions about their health in elderly patients who are cared for in their homes is high. The level of dependence in activities of daily living and the deterioration of intellectual function are factors associated with the presence of this capacity.

[Use of specific immunotherapy in the Basic Health Area of Campiña Sur (Moguer-Huelva)]. / Utilización de inmunoterapia específica en la Zona Básica de Salud Campiña Sur (Moguer-Huelva).

OBJECTIVE: To analyse the appropriateness of specific immunotherapy treatment (IT) to indications based on scientific evidence. DESIGN: Cross-sectional, descriptive study. SETTING: Primary care in a health district of about 12,000 inhabitants. PATIENTS: 166 patients for whom IT was prescribed in the period between January 1998 and June 1999 were included. The full evaluation covered 65 patients whose allergy report was available in their clinical records. MEASUREMENTS AND RESULTS: IT prescription was considered adequate in patients with single sensitivity to respiratory allergy or anaphylaxis to insect poison, in whom well-standardised single-component "vaccines" were used. IT was only used adequately in 36.4% of cases (71.4% in asthma, 46.1% in naso-bronchial allergy, and 18.7% in rhinitis). The high prescription of accompanying medication should be highlighted: oral H1 anti-histamines (81.8%), inhaled steroids for asthma (42.4%) and nasal steroids for rhinitis (72.4%). CONCLUSIONS: Use of IT in our health district is poorly suited to the indications based on contrasted scientific evidence. Clinical practice guidelines must be agreed at all care levels so as to improve the quality of care for all allergy patients.