[Oral anti-coagulants in an urban health centre. The first years results]. / Anticoagulación oral en un centro de salud urbano. Resultados del primer año.

OBJECTIVES: To assess the management of oral anti-coagulation treatment (OAT) by family doctors and nurses from a health centre (HC) during its first year. DESIGN: Descriptive cross-sectional study.Setting. La Chana, an urban HC in Granada, covering 19,362 inhabitants in family care units. PARTICIPANTS: 220 patients with acenocumarol prescribed during the year 2000. The criterion for inclusion was to have at least 3 OAT check-ups a year. 24 people were excluded.Interventions. Recruitment by personal invitation at the clinic. Capillary blood analyses and dose adjustments by the 10 nurses and 10 family doctors of the HC. Internationally recognised therapeutic ranges. MAIN MEASUREMENTS: Prevalence of OAT: prescriptions of acenocumarol. Recruitment: patients monitored at the HC. INDICATIONS: those found in the clinical records. Monitoring: % of patients with INR within range in final annual check-up. COMPLICATIONS: rate of haemorrhages, thrombo-embolic accidents and other secondary effects. RESULTS: 196 patients followed OAT, a prevalence of 10.12 per thousand, with 19.6 patients per family doctor. The HC monitored 122 (62.24%); and the hospital, 74 (37.76%). The HC carried out 1,224 check-ups, 208 in the homes of 21 patients. There were 70.5% within the therapeutic range. Only 13% were in a situation of dose adjustment. Most common indications: non-rheumatic auricular fibrillation 65, TVP/TEP 27, mechanical cardiac prostheses 22. There were no fatal haemorrhages. Major haemorrhages ran at 2.22% of patients a year; and minor ones, at 6.68%. There were no thrombo-embolic accidents. There were two skin allergies. CONCLUSIONS: The study showed good results, in line with the findings of other studies.

[Thyroid function tests and their use by the general practitioner]. / Pruebas de función tiroidea y su utilización por el médico general.

OBJECTIVE: We aimed to discover how thyroid function tests (TFTs) were used in general practice (GP) consultations. We would evaluate how many TFTs were requested, their efficiency, cost and their impact on referrals to endocrinology. DESIGN: This was a longitudinal, retrospective and observational study. SITE. At the Primary Care level, in the La Chana Health Centre, Granada. PATIENTS: 69 patients with possible Thyroid Disease, and who had a TFT performed by their GP, were surveyed. The test comprised parallel TSH, free T4 and free T3. MAIN MEASUREMENTS AND RESULTS: 2.46 TFTs per GP per year were requested. 14 showed positive (20.28%) and a definite diagnosis of Thyroid Function Disease (TFD) was made in 11 cases (15.94%). The cost per test was 1,718 pesetas; and per diagnosis, 8,467 pesetas. 78.26% of the cases were resolved by the GP without need of referral. CONCLUSIONS: The GPs carried out few FTFs; but those they did were very efficient. Cost was low and patients benefited from the fact that their GPs were able to use this technique. Endocrinology referrals were reasonable. All general practitioners should have use of TFTs.