[Assessment of a chronic care program in Gerona (CRONIGICAT)]. / Evaluación de un programa de atención a la cronicidad en Girona (CRONIGICAT).

OBJECTIVE: To determine the utility and viability of a chronic care program. DESIGN: Cross-sectional descriptive study with qualitative and quantitative evaluation. SETTING AND PARTICIPANTS: 26 primary care teams (PCT) from the Catalan health service of Gerona. INTERVENTIONS: 20 projects within the program. Start 2011. MAIN OUTCOME MEASURES: The degree of development of the program, consensus indicators for chronic care, and the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad [IEMAC]). RESULTS: Evaluation of the degree of development: 75% of projects were partially or fully implemented, with a high degree of development in 71% of the PCT. An increasing tendency was found in the consensus indicators for process (patients contacted 48 hours after hospital discharge, population attended in chronic care programs and with the highest risk stratification). There was a slight decrease in the consensus indicators for effectiveness (readmissions, mean length of hospital stay, avoidable hospital admissions, pharmaceutical expenditure, patients attended in the emergency department, and mortality). The dimensions receiving the highest scores on the IEMAC were those evaluating information systems and clinical decision support, while those receiving the lowest scores were community health and self-care. CONCLUSIONS: When assessing the utility of CRONIGICAT, we believe that progress has been made mainly in its implantation, which has acted as a catalyst for a self-directed shift to a better chronic care model and has identified areas for improvement. We believe that the CRONIGICAT is viable and sustainable, since its actions and projects are integrated within routine clinical practice.

[Prevalence of occult chronic kidney disease and associated variables in a population of patients with type 2 diabetes]. / Prevalencia de insuficiencia renal oculta y variables asociadas en una población de pacientes con diabetes tipo 2.

BACKGROUND AND OBJECTIVE: To determine the prevalence of occult chronic kidney disease (CKD) and the associated clinical variables in patients with type 2 diabetes mellitus (DM-2). PATIENTS AND METHOD: Observational, laboratory and cross-sectional study of patients with DM-2 from primary care settings. Demographic and anthropometric data, previous illnesses and measures of cardiovascular risk and kidney function were collected from electronic medical records. We determined the prevalence of occult CKD defined as patients with normal values of plasma creatinine (Cr) and reduced glomerular filtration rate (GFr) (< 60 ml/min/1,73 m(2)). The GFr was determined by the Modification of Diet in Renal Disease (MDRD) equation. RESULTS: The sample consisted of 3,197 patients, the mean age was 67.7 years (SD = 11.7) and 53.9% were men. The prevalence of CKD according to the MDMR values was 16.6% (n = 532), of which 60.3% (n = 321) corresponded to occult CKD. 6.6% (n = 211) of the participants had CKD with high Cr values. Multivariate analysis showed an association of occult CKD with female sex (OR = 2.7; CI 95% = 1,83-3,99). Occult CKD was associated with age, blood pressure higher than 150/100 mm/Hg and with a history of ischemic heart disease, heart failure, peripheral arterial disease and dyslipemia. CONCLUSIONS: The prevalence of CKD is 16.6%, of which 60.3% (n = 321) corresponds to occult CKD. Female sex is associated with the presence of occult CKD.

[Final results of a multifactorial and community intervention study for the prevention of falls in the elderly]. / Resultados finales de un estudio de intervención multifactorial y comunitario para la prevención de caídas en ancianos.

OBJECTIVE: To evaluate the effectiveness of a multifactorial and community intervention programme to decrease the number of falls and their complications in the >or=70 years population in a community. DESIGN: Multicentre, community intervention study, with no random assignment and with controls. SETTING: Two basic health areas in the province of Girona (Spain). PARTICIPANTS: Random sample of people >or=70 years, 2515 in the intervention group (IG) and 1212 in the control group (CG). The IG received multifactorial intervention with community activities, individual in the clinic or at home and by the professionals, for 2 years. The CG received routine health care. MEASUREMENTS AND PRIMARY OUTCOMES: The baseline situation of two representative random samples, IG (n=329) and CG (n=379) and post-intervention IG (n=292) and CG (n=310), usinn a survey. RESULTS: (People with falls): IG baseline 29% (95% confidence interval [CI]: 25.8-31.9) and post-intervention 31% (95% CI: 25.6-36.5). CG baseline 32% (95% CI: 28.8-35.2) and post-intervention 30% (95% CI: 24.9-35.4). Falls with fractures: IG baseline 10.4% (95% CI:6-16.3) and post-intervention 5.3% (95% CI:2-11,2); CG baseline 7% (95% CI:4-11.2) and post-intervention 10.7% (95% CI:5.8-17.7). Falls with medical care: IG baseline 45.4% (95% CI: 37-54) and post-intervention 43.8% (95% CI: 34.4-54.4). GC baseline 30.3% (95% CI: 24.3-36.8) and post-intervention 40.8% (95% CI: 31-51.2). CONCLUSIONS: A multifactorial community intervention programme in people >or=70 years did not reduce the number of falls at 2 years, but a tendency to reduce their consequences was observed, and could be integrated within routine care activities.

[Multidisciplinary intervention program for caregivers of patients in a home care program]. / Programa de intervención multidisciplinaria para cuidadores de pacientes en atención domiciliaria.

OBJECTIVES: To improve quality of life, anxiety and depression in caregivers of patients in home care. METHODS: We performed a randomized clinical trial in 79 main caregivers (39 control group and 40 intervention group) of patients in the home care program of a primary care health center between 2000 and 2001. Quality of life, anxiety and depression were measured by the COOP/WONCA and Goldberg questionnaires, respectively, at the beginning and at the end of the study. Interventions consisted of two medical visits to take a bio-psychosocial history of the caregiver and a nurse visit for health education. Two letters, adapted to each carer's needs, were sent and two telephone calls were made. RESULTS: The intervention group scored significantly better than the control group in relation to WONCA-feelings (p=0.03), WONCA-social activities (p=0.05), and WONCA-quality of life (p=0.02). CONCLUSIONS: A short multidisciplinary intervention program adapted to routine consultations could prevent deterioration in caregivers' quality of life.