Risk factors associated with the family care of people with serious mental illness.

BACKGROUND: The aim of the present study is to analyse the variables associated with the family care of people diagnosed with serious mental illness. MATERIAL AND METHODS: A cross-sectional study was carried out involving caregivers of people with serious mental illness (SMI) who were known to the mental health services in Valencia (España) and associations for those with SMI. The sample comprised 417 caregivers who completed a sociodemographic questionnaire and the Zarit Burden Interview. Bivariate analyses (t-test, analysis of variance and Pearson correlation) were performed, as was a multiple linear regression model. Values of p < .05 were considered significant. The study was carried out in accordance with the recommendations of the ethics committees of the participating institutions. RESULTS: The statistical analyses showed significant associations between the sociodemographic and clinical variables of the caregivers and patients and the burden felt by caregivers of people with SMI. The importance of both formal and informal social support stands out as a protective factor against the consequences of the illness's impact on the main caregiver. CONCLUSIONS: The role of spaces of mutual support is crucial. The results suggest that family psychoeducational programmes should be created, applied and evaluated in all mental healthcare services so as to reinforce training in mental health matters and provide support and assessment to caregivers in order to ease their burden.

Changes in benign prostatic hyperplasia management in Valencia: a real-world evidence analysis.

INTRODUCTION AND OBJECTIVES: A training program was developed to increase general practitioners' engagement in the optimal management of Benign Prostatic Hyperplasia (BPH). The goal of this study was to evaluate changes in BPH management after the implementation of a training program. MATERIAL AND METHODS: This observational retrospective cohort study was conducted between 2019 and 2020. Aggregated data were analyzed in three evaluation periods (2010, 2012 and 2015), addressing quality indicators for diagnosis, treatment, and treatment outcomes. RESULTS: Overall, 118 795 patients who presented any data points were included. All quality indicators (number of IPSS and PSA determinations) increased between the first period and the last. Combination (α-blocker + 5-ARI) therapy was increasingly prescribed during the study periods whereas the proportion of prescriptions for single-agent α-blocker showed no significant differences among the periods analyzed. However, the total number of patients eligible for combination therapy who actually received this treatment was low in all periods (7.5%, 17.9%, and 20.1%, in 2010, 2012, and 2015, respectively). The outcome indicators revealed a decrease in referrals to the urology unit mostly among newly diagnosed patients. Even though the proportion of patients who underwent BPH-related surgeries increased significantly from the first to the second period, the number of surgeries remained stable between the second and third periods. CONCLUSIONS: The training program had a generally positive impact on the management of BPH patients in PC, but the overall study period may be insufficient to show an effect on some outcome indicators such as the number of surgeries.

Barriers associated with poor control in Spanish diabetic patients. A consensus study.

BACKGROUND: Delphi technique allows developing a multidisciplinary consensus to establish solutions. AIM: To identify barriers and solutions to improve control in patients with Type-2 Diabetes Mellitus (DM2). METHODS: An observational study using the 2-round Delphi technique (June-August 2011). A panel of 108 experts in DM2 from medical and nursing fields (primary care providers and specialists) from different regions completed via email a questionnaire with 41 Likert statements and 9 scores for each one. Level of agreement was assessed using measures of central tendency and dispersion. We analysed commonalities/differences between the two groups (Kappa index and McNemar chi-square). RESULTS: Response rate: 65%. Degree of agreement: 63.4% (95% CI 48.7-78.1%) in medicine, and 78.1% (95% CI 65.4-90.8) in nursing (p > 0.05). Overall level of agreement: Kappa = 0.43, (χ(2) = 2.5 p > 0.05). Regarding non-compliance with therapy, it improves with: the information to the partner/family/caregiver, patient education degree in diabetes, patient motivation and ability to share and agree on decisions with the patient. Clinical inertia improves with: motivation degree of healthcare professionals and the calculation of cardiovascular risk; and gets worse with: the shortage of time in consultation, absence of data in medical record, border high limits measurements accepted as normal readings, lack of a treatment goals, lack of teamwork (Physician/Nurse), scarcity of resources and lack of alarm systems in the electronic medical record on goals to achieve. CONCLUSION: The participants achieved an agreement in interventions in non-therapeutic compliance and clinical inertia to improve DM2 control.

[Bibliometric analysis of International Scientific production on primary care]. / Análisis Bibliométrico de la producción Científica Internacional sobre atención primaria.

OBJECTIVE: To present an international view of the scientific production in the field of primary care in the period 1985-2004. DESIGN: Retrospective, observational study. Bibliometric analysis. LOCATION: Medline database. WebSPIRS access through version 4.3. We analysed two periods: 2000-2004 (cross-sectional) and 1985-2004 (developmental). Search based on "MeSH Major" with descriptors: Primary Care or Primary Health Care, Family Practice, Family Physicians, Nurse Practitioners, and Entry Terms associated with these. KEY MEASURES: We analysed the bibliometric indicators of production, circulation, dispersion, and visibility. RESULTS: In 2000-2004, published 20911 articles were published, 0.73% of total production. There was a growth rate (1985-2004) of 221%, which was 2.4 times more than average. Transience rate was 83.17%. The English language is predominant (88.81%) over 34 languages, with Spanish being the next (2.6%). Sixteen countries produce 95.67% of the articles. Spain occupies the 7th place. Universities (52%) are the most productive institutions. There are 1074 different journals with the 10 most productive being: Br J Gen Pract, Adv Nurse Pract, Aust Fam Physician, Fam Pract, Fam Med, BMJ, Aten Primary Health Serv J, Can Fam Physician, J Fam Pract. The proportion of trials (5.43%) in PC is similar to other disciplines and has increased by 453% (1985-2004). CONCLUSIONS: The production of Primary care is about 1% of the total scientific output, with a noticeable and higher than average growth over 20 years. The proportion of clinical trials is similar to other disciplines. Although Anglo-Saxon countries and journals are the highest producers, Spain and the journal Aten Primaria is among those highlighted.

[Restless legs syndrome: detection, diagnosis, impact on health and utilization of health care resources]. / El síndrome de piernas inquietas: detección, diagnóstico, consecuencias sobre la salud y utilización de recursos sanitarios.

INTRODUCTION: Despite the high prevalence of Restless Legs Syndrome (RLS) reported, little information is available about this disorder in Spain. The present study was conducted to obtain information on this condition from patients identified by a simple screening questionnaire and subsequent diagnostic confirmation by the Primary Care Practitioner (PCP). MATERIALS AND METHODS: Three-stage, cross-sectional and retrospective (resource utilization), observational study in a sample of adult patients (2,047 subject) attending 10 outpatient Primary Care centers in Madrid, Barcelona and Valencia. A screening questionnaire containing the 4 RLS diagnostic criteria was used. Clinical assessment and RLS diagnosis confirmation was performed using a structured questionnaire. Other variables assessed were quality of life by SF-36 questionnaire scoring; sleep by the MOS sleep scale; symptom severity of RLS symptoms by the IRLS scales; health care resource utilization in the previous 12 months by completion of questionnaire following patient chart review. The diagnosis made by the PCP was confirmed in a small sample of patients by a neurologist expert in Movement Disorders. RESULTS: A total of 19.7% (404 out of 2,047) subjects positively answered the 4 diagnostic questions of the RLS screening questionnaire. Of these, 185 (9.0%) reported moderate to severe symptoms at least twice weekly. The PCP made a diagnosis of RLS in 79 of 154 patients completing the diagnostic interview. Thus, prevalence of RLS estimated in this adult population was 4.6%. The predictive value of the screening RLS questionnaire was 51.3%. Average age of symptom onset was 42 years (range: 20 - over 80 years). RLS symptoms were moderately (50.6%) or extremely (38%) distressing and 73.4% of RLS patients slept poorly at least two nights a week. This diagnosis represents 9.4% of all patients presenting to PCP and experiencing poor sleep. Mean score in the IRLS scale (0 - 40) was 19.4. Average score of SF-36 questionnaire (0-100) was 54.6, lower than the Spanish general reference population (61.4). About one third of the RLS patients had seen a physician because of RLS symptoms. However, a diagnosis was made in only 48% of these and only 5% the diagnosis was RLS. CONCLUSIONS: The DECODE RLS - Spain study shows that many patients with classical RLS symptoms frequently see their PCP without being adequately diagnosed and treated. Screening tools such as that used in this study may contribute to the detection of these patients.

Control of diabetes and cardiovascular risk factors in patients with type 2 diabetes in primary care. The gap between guidelines and reality in Spain.

To evaluate the level and factors affecting control of diabetes and cardiovascular risk factors in type 2 diabetes (TYPE 2 DM) patients. Multicentre cross-sectional study: a sample of 430 primary care practices across Spain selected 1907 type 2 diabetic patients. The first five consecutive ambulatory patients with TYPE 2 DM were eligible for the inclusion into the survey. Patients were free of known cardiovascular disease (CVD). Control criteria were defined based on 2002 American Diabetes Association (ADA) clinical practice recommendations. A total of 1907 patients (51% women) aged 63 +/- 9 years. Smoking prevalence was 22.6%, 50.6% had levels of A1c < 7%. Mean blood pressure (BP) was 148 +/- 17/86 +/- 10 mmHg. Only 7.8% have achieved the target of BP < 130/80 mmHg. Among the 1180 patients (65%) treated for hypertension, this target was attained in only 4.4% of patients. A measurement for low-density lipoprotein (LDL) cholesterol was available in 1669 patients (88%). Only 5.9% of patients achieved the target of LDL < 100 mg/dl. Among the 638 patients (41.6%) on drug treatment for dyslipidaemia, this target was attained in only 5.6% of patients. Among type 2 diabetic patients in Spain the prevalence of cardiovascular risk factors is high. Control of glycaemia, smoking, BP and LDL are far from optimal despite the widespread use of guidelines for the management of diabetes and CVD. The application of published recommendations needs to be reinforced.

[Helicobacter pylori: 6-day triple therapy in duodenal ulcer]. / Helicobacter pylori: triple terapia de 6 días en el ulcus duodenal.

OBJECTIVES: To find the effectiveness of short-term eradication treatment of Helicobacter pylori in the duodenal ulcer. DESIGN: Intervention study, open controlled, randomised with parallel groups. SETTING: Three Health Centres in the city of Valencia. PATIENTS: Patients with a duodenal ulcer diagnosis and a Helicobacter pylori infection who attended the Primary Care physician. INTERVENTION: The study group (48 patients) was treated for six days with the triple therapy: Amoxycillin, Clarithromycin and Omeprazole. The control group (40 patients) was treated with Omeprazole for six weeks. MEASUREMENTS AND MAIN RESULTS: The observance period lasted a year, after which the Elisa test was conducted. Eradication was successful for 65% of those treated with the triple therapy, but for only 30% of those treated with monotherapy. The consumption of medication for the ulcer during the year of observance was almost three times greater in the group treated with monotherapy than in the triple-therapy group. CONCLUSIONS: Eradicative triple therapy was shown to be more effective and efficient than monotherapy. It is feasible to use it in Primary Care. Eradicative triple therapy is not advisable within six days: a longer treatment period should be employed with this recommendable therapy.

[Description of costs and effectiveness of a hypertension control program in primary care]. / Descripción de los costes y la efectividad de un programa de control de hipertensos en atención primaria.

OBJECTIVE: To find the control degree of a population of hypertension patients. To evaluate the cost effectiveness of health services. SETTING: EAP Salvador Pau. Valencia (Spain). PATIENTS: 200 patients diagnosed of hypertension included in the health center file. MEASUREMENTS AND RESULTS: Items studied were age, sex, diagnosis and program inclusion year, number of visits, other explorations and its cost, TAS and TAD, drugs and its cost, personnel cost. We established different well control levels and we obtained the cost of each of them. Twenty six point five per cent of patients had TA values below 140/90 mmHg; Sixty four point five per cent had values below 160/90 mmHg. And sixty six point nine had values below 90 mmHg. Monthly medium cost per patient was 3242 pts. Monthly medium cost per patient well controlled was 12234 pts. CONCLUSIONS: Only a third of our patients are well controlled according the current standards. Efficiency decreases noteworthy when control levels are lower.

[An episode of the prevention of cardiovascular risk factors by age and sex in the Community of Valencia]. / Episodio de prevención de factores de riesgo cardiovascular por edad y sexo en la Comunidad Valenciana.

OBJECTIVE: To typify the episodes of early detection of cardiovascular risk factors (CRF) and to calculate their frequency by age and sex groups. DESIGN: An observational, prospective and multi-centred study. SETTING: Twenty health centres distributed in the three provinces of the Community of Valencia. PATIENTS: Episodes of prevention of CRF in users of both sexes aged between 18 and 64 who, in the three years prior to the study, had undergone no CRF early diagnosis protocol. They were included by means of consecutive proposal with informed consent. MEASUREMENTS AND RESULTS: The diagnostic protocol of the Plan for Prevention of Cardiovascular Diseases (PPCVD) was applied. The variables analysed were: age, sex, number and duration of consultations, CRF diagnosed previously, and CRF diagnosed at the intervention. 632 episodes were analysed, with a mean 1.44 (CI: 1.39-1.49) consultations per episode and a mean duration of 10 minutes 53 seconds. At the start of the study 60.3% of the population did not have CRF, but after the intervention only 17.2% had no CRF diagnosed. CRF frequency after the intervention was: diabetes 4.5% (CI: 3.2-12.2), alcohol consumption 5.5% (CI: 2.2-13.1), hypertension 14.9% (CI: 7.7-22.2), obesity 30.8% (CI: 24.3-37.3), tobacco habit 33.2% (CI: 26.8-39.6), lipaemia 42.5% (CI: 36.6-48.5), and sedentary life-style 54.9% (CI: 49.6-60.2). CONCLUSIONS: CRF diagnosed most often after the intervention were: sedentary life-style, tobacco habit and obesity; and the least commonly diagnosed was alcohol consumption. The application of the PPCVD protocol was most effective in the youngest age-groups and women. The "episode" as a unit of analysis is a useful and feasible instrument for investigating the procedures and results of primary care preventive activities.