RESUMO
The current reality of the diagnosis and treatment of HIV infection justifies a multidisciplinary and coordinated approach between Primary Care and Hospital Care, contemplating bidirectionality and communication between the two care settings. The consensus document, coordinated by the AIDS Study Group of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC-GeSIDA) and the Spanish Society of Family and Community Medicine (semFYC), was born out of this need. Here, the recommendations of the four sections that comprise it are summarized: the first deals with aspects of prevention and diagnosis of HIV infection; the second contemplates the clinical care of people living with HIV; the third deals with social factors, including legal and confidentiality issues, quality of life, and the role of NGOs; finally, the fourth block addresses bidirectional and shared training/teaching and research.
Assuntos
Infecções por HIV , Humanos , Infecções por HIV/terapia , Infecções por HIV/tratamento farmacológico , Consenso , Qualidade de Vida , HospitaisRESUMO
Colonoscopy (CS) is an invasive diagnostic and therapeutic technique, allowing the study of the colon. It is a safe and well tolerated procedure. However, CS is associated with an increased risk of adverse events, insufficient preparation and incomplete examinations in the elderly or frail patient (PEA/F). The objective of this position paper was to develop a set of recommendations on risk assessment, indications and special care required for CS in the PEA/F. It was drafted by a group of experts appointed by the SCD, SCGiG and CAMFiC that agreed on eight statements and recommendations, between them to recommend against performing CS in patients with advanced frailty, to indicate CS only if the benefits clearly outweigh the risks in moderate frailty and to avoid repeating CS in patients with a previous normal procedure. We also recommended against performing screening CS in patients with moderate or advanced frailty.
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Fragilidade , Humanos , Idoso , Fragilidade/diagnóstico , Idoso Fragilizado , Colonoscopia/métodos , Medição de RiscoRESUMO
OBJECTIVE: The aim of this study was to assess the efficacy of an electronic reminder in primary healthcare in patients diagnosed with an indicator condition (IC) to improve HIV screening. METHODS: We developed a prospective interventional study in 51 primary healthcare centres in Barcelona randomly assigned into one of two study groups: control and alert. Between June 2018 and May 2019, an electronic reminder appeared in the electronic medical record each time a diagnosis of an IC in patients aged 16-65 years was registered in the alert group. We assessed HIV testing rates within 4 months following the diagnosis of an IC. RESULTS: In all, 13 000 patients were diagnosed with at least one IC. HIV testing was more likely in the alert group than in the control group. The electronic reminder multiplied the odds of being tested in men by 1.26 [95% confidence interval (CI): 1.04-1.52, p = 0.019], by 1.77 (95% CI: 1.33-2.38, p < 0.001) among patients aged < 50 years , and by 1.51 (95% CI: 1.20-1.92, p < 0.001) in diagnoses of IC other than a sexually transmitted infection (STI) or an AIDS-defining illness. Five (0.08%) cases of HIV were detected in the control group and 10 (0.17%) in the alert group. CONCLUSIONS: Implementing an electronic reminder had a positive impact on HIV screening rates in patients diagnosed with an IC. The alert was more effective among older patients, those living in less socioeconomically deprived neighbourhoods, and those with an IC other than an STI or an AIDS-defining illness.
Assuntos
Síndrome da Imunodeficiência Adquirida , Infecções por HIV , Infecções Sexualmente Transmissíveis , Adolescente , Adulto , Idoso , Eletrônica , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Teste de HIV , Humanos , Masculino , Programas de Rastreamento , Pessoa de Meia-Idade , Atenção Primária à Saúde , Estudos Prospectivos , Espanha/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: To estimate the prevalence of HIV testing among patients diagnosed with an indicator condition (IC) for HIV, seen in primary care (PC) in Catalonia, and to estimate the prevalence of HIV infection among those patients. DESIGN: Cross-sectional and population-based study in patients aged between 16 and 65 diagnosed with an IC within PC in Catalonia. METHODS: Data used in this study were extracted from a large population-based public health database in Spain, the Information System for the Development of Research in Primary Care (SIDIAP). All participants registered in SIDIAP from 1 January 2010 to 31 August 2012 and with a diagnosis of an IC were screened to identify those with an HIV test within the following 4â months. RESULTS: 99â 426 patients were diagnosed with an IC during the study period. In these patients, there were 102â 647 episodes in which at least one IC was diagnosed. An HIV test was performed within 4 months in only 18â 515 of the episodes in which an IC was diagnosed (18.5%). The prevalence of HIV infection was 1.46%. Women (OR 1.35, 95% CI 1.30 to 1.39), people aged 50 or over (OR 2.85, 95% CI 2.69 to 3.00) and patients having a single IC (OR 3.59. 95% CI 3.20 to 4.03) had the greatest odds of not having an HIV test. CONCLUSIONS: The study highlights the persistence of missed opportunities for HIV testing within PC in Catalonia. Urgent engagement with PC professionals is required in order to increase HIV testing and prevent late HIV diagnoses.
Assuntos
Diagnóstico Tardio/prevenção & controle , Infecções por HIV/diagnóstico , Pesquisa sobre Serviços de Saúde , Programas de Rastreamento/métodos , Atenção Primária à Saúde , Adolescente , Adulto , Distribuição por Idade , Idoso , Estudos Transversais , Dermatite Seborreica , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Hepatite B , Hepatite C , Herpes Zoster , Herpesvirus Humano 4 , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia , Vigilância da População , Prevalência , Fatores de Risco , Infecções Sexualmente Transmissíveis , Espanha , Trombocitopenia , Tuberculose , Adulto JovemRESUMO
OBJECTIVES: To describe the clinical practice of the General Practitioner (GP) in HIV and sexually transmitted infections (STIs) and the obstacles they face in diagnosing them. MATERIALS AND METHODS: An anonymous questionnaire was distributed online to members of two Spanish GP Societies. RESULTS: A total of 1.308 GP took part in the survey, which showed that 39.3% had received training on HIV/STI in the last three years, and 21.2% felt uncomfortable talking about sex with the patient. CONCLUSIONS: We identified important deficiencies in the resources needed for diagnosis of HIV/STI and in the circuits for referral.
Assuntos
Infecções por HIV/diagnóstico , Atenção Primária à Saúde , Infecções Sexualmente Transmissíveis/diagnóstico , Adulto , Estudos Transversais , Humanos , EspanhaRESUMO
INTRODUCTION: Colonoscopies are being requested with increasing frequency in the last few years, as they are used both as a diagnostic and therapeutic procedure in several gastrointestinal diseases. Our purpose is to describe the appropriateness of colonoscopy requests issued both from primary care centres and from hospitals, according to the EPAGE II guidelines (European Panel on the Appropriateness of Gastrointestinal Endoscopy). METHODS AND ANALYSIS: Cross-sectional study. Colonoscopy requests issued since January 2011 and received at the endoscopy units of all six reference hospitals serving the primary care centres of the South Metropolitan and Central Catalonia districts will be collected (total=1500 requests). Variables to be collected include gender, date of birth, origin of the request and reference hospital, priority of the procedure, type of clinician requesting the procedure, date and indication of request, abdominal examination performed, anal inspection examination performed, date of last colonoscopy if applicable, diagnosis and date of diagnosis. Using the available information and the EPAGE II website, colonoscopy requests will be assigned as an appropriateness score. The association between the variables collected and the EPAGE II scores will be assessed using a Student's t test and a χ(2) test. A multilevel logistic model will be generated on the factors associated with the appropriateness of the requests. ETHICS AND DISSEMINATION: Colonoscopy is a costly procedure and not free from complications. In order to increase cost effectiveness, reduce waiting lists and optimise resources, it is necessary to use tools such as the EPAGE II guidelines, which establish criteria to assess the appropriateness of colonoscopies. The purpose of this study is to describe the current situation and to discuss whether current clinical practice is appropriate. The results of the study will be published in the next few years. In consideration of the ethical principles and methods of the research study, approval was granted for the project.
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Colorectal cancer (CRC) is the most common malignant tumor in Spain, when men and women are considered together, and the second leading cause of cancer death. Every week in Spain over 500 cases of CRC are diagnosed, and nearly 260 people die from the disease. Epidemiologic estimations for the coming years show a significant increase in the number of annual cases. CRC is a perfectly preventable tumor and can be cured in 90% of cases if detected in the early stages. Population-based screening programs have been shown to reduce the incidence of CRC and mortality from the disease. Unless early detection programs are established in Spain, it is estimated that in the coming years, 1 out of 20 men and 1 out of 30 women will develop CRC before the age of 75. The Alliance for the Prevention of Colorectal Cancer in Spain is an independent and non-profit organization created in 2008 that integrates patients' associations, altruistic non-governmental organizations and scientific societies. Its main objective is to raise awareness and disseminate information on the social and healthcare importance of CRC in Spain and to promote screening measures, early detection and prevention programs. Health professionals, scientific societies, healthcare institutions and civil society should be sensitized to this highly important health problem that requires the participation of all sectors of society. The early detection of CRC is an issue that affects the whole of society and therefore it is imperative for all sectors to work together.
Assuntos
Neoplasias Colorretais/prevenção & controle , Promoção da Saúde/organização & administração , Disseminação de Informação , Organizações sem Fins Lucrativos/organização & administração , Colonoscopia/normas , Neoplasias Colorretais/epidemiologia , Comportamento Cooperativo , Detecção Precoce de Câncer , Saúde Global , Objetivos , Educação em Saúde/organização & administração , Prioridades em Saúde , Humanos , Incidência , Programas de Rastreamento , Sangue Oculto , Organizações/organização & administração , Guias de Prática Clínica como Assunto , Setor Privado , Setor Público , Grupos de Autoajuda/organização & administração , Sociedades Médicas/organização & administração , Sociedades Científicas/organização & administração , Espanha/epidemiologiaRESUMO
BACKGROUND: Preventive activities carried out in primary care have important variability that makes necessary to know which factors have an impact in order to establish future strategies for improvement. The present study has three objectives: 1) To describe the variability in the implementation of 7 preventive services (screening for smoking status, alcohol abuse, hypertension, hypercholesterolemia, obesity, influenza and tetanus immunization) and to determine their related factors; 2) To describe the degree of control of 5 identified health problems (smoking, alcohol abuse, hypertension, hypercholesterolemia and obesity); 3) To calculate intraclass correlation coefficients. DESIGN: Multi-centered cross-sectional study of a randomised sample of primary health care teams from 3 regions of Spain designed to analyse variability and related factors of 7 selected preventive services in years 2006 and 2007. At the end of 2008, we will perform a cross-sectional study of a cohort of patients attended in 2006 or 2007 to asses the degree of control of 5 identified health problems. All subjects older than 16 years assigned to a randomised sample of 22 computerized primary health care teams and attended during the study period are included in each region providing a sample with more than 850.000 subjects. The main outcome measures will be implementation of 7 preventive services and control of 5 identified health problems. Furthermore, there will be 3 levels of data collection: 1) Patient level (age, gender, morbidity, preventive services, attendance); 2) Health-care professional level (professional characteristics, years working at the team, workload); 3) Team level (characteristics, electronic clinical record system). Data will be transferred from electronic clinical records to a central database with prior encryption and dissociation of subject, professional and team identity. Global and regional analysis will be performed including standard analysis for primary health care teams and health-care professional level. Linear and logistic regression multilevel analysis adjusted for individual and cluster variables will also be performed. Variability in the number of preventive services implemented will be calculated with Poisson multilevel models. Team and health-care professional will be considered random effects. Intraclass correlation coefficients, standard error and variance components for the different outcome measures will be calculated.