[Coordination between primary and cardiological care: the opinion of the family doctor]. / La coordinación entre asistencia primaria y cardiología. La opinión del médico de familia.

OBJECTIVE: To analyse the relationship between Primary and Cardiological Care from the perspective of family physicians. METHODS: A descriptive-crossover study was carried out by a questionnaire sent by mail to a sample of 384 doctors systematically selected from the database of the College of Physicians of Madrid. RESULTS: One hundred forty-eight physicians (38.5%) answered the questionnaire, 75% of whom saw more than 30 patients/week with cardiovascular risk factors and more than 10 patients/week with cardiac syndromes, in the following order: ischaemic heart disease, heart failure, arrhythmias, valvular disease, cor pulmonale and others. Ninety percent of the physicians refer less than 10 patients/month to cardiologists, with a time delay of greater than a month in 50% of the cases. The document used for referral is the consultation form (98%) that is always or frequently answered. The quality of the cardiologist's report is either good or excellent in 50% of the cases. Accessibility to electrocardiograms and thorax x-rays by family doctors is of 99.3%. Family physicians have a very positive opinion regarding the need for hospital collaboration in their continuous training and coordination with cardiologists.

[The combination of insulin and metformin in obese patients with type-2 diabetes mellitus]. / Asociación de insulina y metformina en pacientes obesos con diabetes mellitus tipo 2.

OBJECTIVES: Principal: to show that the addition of metformin to insulin treatment in type-2 DM obese patients with poor metabolic control (HbA1c > 7.5%) causes a 50% increase after one year in the number of patients with acceptable (HbA1c < or = 7.5%) or good (HbA1c < 6.5%) control, and to determine how many patients reduced their HbA1c by a point. Secondary: to determine the relationship between the BMI at the start of treatment and the difference between HbA1c values before and after treatment. DESIGN: Quasi-experimental before-and-after intervention study. SETTING: Diabetes clinic at the San Carlos Hospital, consisting of patients referred from primary care. PATIENTS: 31 obese people with type-2 DM and with poor metabolic control (HbA1c > 7.5%) in spite of insulin treatment were chosen by consecutive sampling as they attended for consultation. Three people left due to their intolerance of metformin. INTERVENTIONS: Metformin was added progressively over a year in total doses of 1.7 mg. All those parameters considered in diabetes control were measured, the main criterion of evaluation being the HbA1c figures. MEASUREMENTS AND RESULTS: Patients with poor metabolic control changed from 100% at the start of the study to 42.9% after a year (p = 0.0000). There was a 1.75% mean reduction of HbA1c. 78.57% of patients reduced their HbA1c by a point. The relationship between the BMI before the start of treatment and the HbA1c difference at the start and end gave a Pearson's correlation coefficient of r = -0.39 (p = 0.04). CONCLUSIONS: Adding metformin to the treatment of obese type-2 DM patients with poor metabolic control and on insulin treatment improved their control.

[Audit of clinical records: clinico-microbiologic study of urinary infections in a team of primary care]. / Auditoría de historias clínicas: estudio clinicomicrobiológico de infecciones urinarias en un equipo de atención primaria.

To carry out an audit of clinical records in our center for the evaluation of the quality of care before the introduction of protocols, several prevalent conditions were selected, and among them urinary tract infections (UTI). Another aim of the study was to evaluate the autochthonous flora responsible for UTI and its resistence to commonly used antimicrobials. A series of acceptable criteria and standards were set as quality controls, and the real index was found below the preselected one in all cases. The most commonly isolated organism was E. coli, followed by Proteus, which were resistent to trimetoprim-sulfamethoxazole in 56% and 71.4% of cases, respectively. Problems of organization and knowledge, and a high resistence rate to common antimicrobials were detected; the following were suggested as measures for improvement: introduction of a protocol, need for continuing education, reduction in the care demand, health education and improvement in the antibiotic policy.