[Analysis of accidental falls and the integration in the chronicity programs of patients with amyotrophic lateral sclerosis]. / Análisis de las caídas accidentales y la integración en los programas de cronicidad de los pacientes con esclerosis lateral amiotrófica.

INTRODUCTION: Amyotrophic lateral sclerosis (ALS) is the most common degenerative motor neuron disease. There is no curative treatment available, and these patients require multidisciplinary support to promote their comfort and quality of life. PATIENTS AND METHODS: Longitudinal descriptive study in patients registered in primary care (PC), Costa de Ponent-Barcelona Institut Catala de la Salut to analyse emergency hospital visits, use of support devices and their integration into the primary care chronicity program. Variables were sex, age and evolution time, emergency visits, patients with percutaneous gastrostomy (PEG), non-invasive or invasive ventilation (NIV/VI), integration in the primary care chronicity program. RESULTS: 81 patients, 49.4% male, mean age 65.6 years (±11.7), evolution time less than 2 years or equal to or greater than 2 years (42 and 58%, respectively). Of them, 47 (58.5%) made 107 consultations. The most frequent reasons for consultation were falls (26.8%), respiratory difficulties (23.3%), comorbidity (16.7%), eating problems (11%) and pain (10.2%) without differences by age or sex. Greater frequency (p < 0.001) was observed in patients with less than two years of evolution and significant increases in the use of NIV and PEG up to 51.9 and 35.8% respectively, as well as integration in primary care chronicity program of 61.7%. CONCLUSIONS: Accidental falls were the most frequent and potentially avoidable reason for hospital emergency visits in patients with ALS, especially in the first two years of the disease. Significant increases are detected in the use of support devices and in primary care chronicity program integration. It is necessary to increase home resources, especially in physiotherapy and occupational therapy.

TITLE: Análisis de las caídas accidentales y la integración en los programas de cronicidad de los pacientes con esclerosis lateral amiotrófica.Introducción. La esclerosis lateral amiotrófica (ELA) es la enfermedad degenerativa de las motoneuronas más frecuente. No dispone de tratamiento curativo y estos pacientes requieren un soporte multidisciplinar para favorecer su confort y calidad de vida. Pacientes y métodos. Estudio descriptivo longitudinal en pacientes registrados en atención primaria, Costa de Ponent-Barcelona, Institut Català de la Salut, para analizar las visitas urgentes hospitalarias, la utilización de dispositivos de soporte y su integración en el programa de atención a la cronicidad. Las variables fueron sexo, edad y tiempo de evolución, visitas urgentes, portadores de gastrostomía percutánea (PEG), ventilación no invasiva o invasiva (VNI/VI) e integración en el programa de atención a la cronicidad. Resultados. Se incluyó a 81 pacientes, un 49,4% varones, con una edad media de 65,6 años (±11,7), y un tiempo de evolución menor de 2 años o igual o mayor de 2 años (42 y 58%, respectivamente). De ellos, 47 (58,5%) realizaron 107 consultas. Los motivos de consulta más frecuentes fueron: caídas (26,8%), dificultades respiratorias (23,3%), comorbilidad (16,7%), problemas en la alimentación (11%) y dolor (10,2%), sin diferencias por edad o sexo. Se observó una mayor frecuentación (p menor de 0,001) en pacientes con menos de dos años de evolución e incrementos significativos en la utilización de la VNI y la PEG hasta el 51,9 y el 35,8%, respectivamente, así como integración en el programa de atención a la cronicidad del 61,7%. Conclusiones. El motivo más frecuente de consulta a urgencias hospitalarias de pacientes con ELA y potencialmente evitable fueron las caídas accidentales, especialmente en los primeros dos años de enfermedad. Se detectan incrementos significativos en la utilización de dispositivos de soporte y en la integración en el programa de atención a la cronicidad. Es necesario incrementar los recursos domiciliarios, especialmente en fisioterapia y terapia ocupacional.

[Benefits of treatment to eradicate Helicobacter pylori infection in patients with ulcer at a primary care center]. / Beneficios del tratamiento erradicador de la infección por Helicobacter pylori en pacientes ulcerosos en un centro de atención primaria.

OBJECTIVES: To evaluate the clinical evolution and the use of Primary Care health resources one year after treatment to eradicate Helicobacter pylori (Hp) infection in patients with peptic ulcers and Hp infection. DESIGN: Retrospective study on the effect of an intervention. SETTING: Urban, reformed primary care centre. PATIENTS: 102 patients with peptic ulcers and Hp infection. INTERVENTION: Treatment to eradicate Hp. MEASUREMENTS AND MAIN RESULTS: a) Total medical attendance; b) attendance for dyspepsia; c) number of ulcerous outbreaks; d) medicines taken to treat dyspepsia. 79.4% of the patients treated were male. Overall mean age was 47.8 +/- 12.4. After the intervention, total attendance (from 8.3 to 6.6, p < 0.001), attendance for dyspepsia (from 3.1 to 1.1, p < 0.00001), and ulcerous outbreaks (from 1.2 to 0.06, p < 0.00001) all dropped sharply. The mean number of medicines prescribed for dyspepsia per patient fell from 1.24 to 0.43, p < 0.0001. Ranitidine prescription fell from 72.7 to 13.8 days (p < 0.001); and omeprazol from 35.1 to 12.2 days (p < 0.03). Estimated total saving per patient was 26,792 pesetas at 1998 values. CONCLUSIONS: Treatment in primary care to eradicate Hp(+) in ulcerous patients reduced the needs of attendance and the prescription of drugs for ulcers. Just in the first year this supposed a clinical benefit for these patients and important economic savings for the public health service.

[The demand for care and systems of access in primary health care]. / Demanda asistencial y sistemas de acceso en la Atención Primaria de Salud.

The aim of the investigation was to assess variations in the demand for medical care in the primary care centre of Ciudad Badia (Barcelona, Spain). The records of attendance were analysed over a period of seven years. During this period, some changes were made which affected the way the centre was used by patients, such as the creation of systems which required notice of medical and nursing appointments, the reduction of spontaneous attendance, and the introduction of a card for medication for the chronically sick. These changes were accompanied initially by a decrease, then a stabilisation, and afterwards a slight increase in total number of visits. All visits (with notice) rose from 5.3% in 1983 to 45.2% in 1989. Similarly, nursing visits (with notice) increased from 4% to 9.5 of total activity. Emergency visits in the same period rose from 3.4% to 8%. It is concluded that changes that were introduced raised the level of commitment of the staff to medical work-both preventive and therapeutic, as well as the improvement of the organisation of attendance at the centre and a higher satisfaction of users of the centre and the medical staff.

[Follow-up of the quality of drug prescriptions: the Primary Care Center of Badia City (1986-1990)]. / Seguimiento en la calidad de la prescripción de medicamentos: el CAP de Ciudad Badía (1986-1990).

OBJECTIVE: To determine the variation in the quality of prescription of medicines in Primary Attention Centre in two different periods, 1986 and 1990. DESIGN: Longitudinal, retrospective study with direct intervention. SITE. Primary Attention Centre, Ciudad Badía. PARTICIPANTS: 1986: 9 general practitioners in medicine (GPs) and 7 pediatricians. 1990: 9 Gps, 7 pediatricians, and 7 residential doctors (MFC based) who were not included in the earlier evaluation. INTERVENTION: Once the 1986 prescriptions had been analysed qualitatively, the results were made available to and discussed with the doctors who made out the prescriptions (passive feedback). As ongoing intervention the periodic clinical sessions should be considered. MAIN MEASUREMENTS AND RESULTS: Increase in the substances included in Index/Guide: MG 6.5% and P 13% (p < 0.00001). Increase in the number of substances with an active principle and in the combinations accepted: MG 2.3% and P 9% (p < 0.00001). Increase in the percentage of specialties with high V1: MG 1% (p = 0.12) and P 10% (p < 0.00001). CONCLUSIONS: There has been an increase in the quality of medical prescriptions according to the indicators analysed. There are other external factors that effect prescriptions that are difficult to measure. This type of study allows one to pinpoint the excessive or wrong use of intrinsically not very valuable sub-groups of therapeutic substances, and will serve as a base for indication-prescription studies.