[Quasi-experimental study of an intervention on the pharmacological management of non-oncological chronic pain in Primary Care]. / Estudio cuasi experimental de una intervención sobre el manejo farmacológico del dolor crónico no oncológico en atención primaria.

OBJECTIVE: To analyse the impact of a formative / informative intervention on the treatment of non-oncological chronic pain in Primary Care. DESIGN: Quasi-experimental study before-after, and follow-up of the patient cohort. LOCATION: 64 Primary Care teams/centres (770 physicians). PARTICIPANTS: Patients≥14 years without an oncological diagnosis on: 1) fentanyl citrate, 2) major opioids and≥2 anxiolytics-hypnotics, 3) long-term major and minor opioids, 4) transdermal lidocaine, out of indication. INTERVENTION: Dissemination of recommendations for the treatment of non-oncological chronic pain and the reporting of the incidents of their patients to each doctor. MAIN MEASUREMENTS: Number of incidents in 2 cross sections (June 2017 and June 2018). Number of incidents in June 2017, which were maintained in June 2018 (prospective cohort). RESULTS: Of the 2,465 incidents detected in 2017, there was a 21.1% reduction after the intervention. The reduction was higher (61.8%, p<.001) in the prospective cohort. In absolute values, the most important reduction was in incidences of lidocaine patches outside of indication (1,032 incidences). The approved indication was found in less than 8% of the treated patients. CONCLUSIONS: The intervention reduced the number of patients with incidences, and this reduction was higher in the prospective cohort, confirming the efficacy of sending information about patients with incidences to their physicians. The incorporation of new treatments during the follow-up year was significant, so these interventions should be perpetuated over time.

[Adequacy of treatment for osteoporosis in primary prevention. Quantitative and qualitative study]. / Adecuación del tratamiento de la osteoporosis en prevención primaria. Estudio cuantitativo y cualitativo.

OBJECTIVE: Quantitative study: To assess the prevalence of inadequacy of treatment for osteoporosis in primary prevention (OPP) in women aged 60-74years. Qualitative study: To evaluate the diagnostic and treatment criteria of the OPP and it's variability in primary care physicians (PC) and specialists. MATERIAL AND METHODS: Quantitative study: observational, cross-sectional and retrospective study. POPULATION: women aged 60-74years with active treatment for OPP (n=424) in May 2012. Inadequacy if they had ≤2 risk factors with a DXA or DXA T-score ≥-2.4. Qualitative study: Delphi technique (15items) and two rounds of consultation. PERIOD: March-April 2014. POPULATION: PC physicians, rheumatologists and orthopaedic surgeons (n=251). Random sampling. RESULTS: Quantitative study: degree of inadequacy is 63.4%. In 43.2% isn't mention a diagnosis of osteoporosis. In 82.3% there isn't mention of risk factors. TREATMENT: bisphosphonate 40.3% and calcium +vitaminD 47.9%. Qualitative study: 23% respond to the first round, and of these 67% the second round. Items with higher agreement were the important of the evaluation of risk factors for diagnosis and bisphosphonates for treatment. Items with fewer consensuses were using the FRAX and densitometry and treatment with only calcium +vitaminD. CONCLUSIONS: The percentage of inadequacy is high. The degree of registration in medical history is low. The Delphi method is useful for detecting discrepancies between recommendations of clinical practice guidelines and results.

[Experiencia en la vacunación frente a la COVID-19 en personas con antecedentes de alergia.] / Experience in vaccination against covid-19 in people with a history of allergy.

OBJECTIVE: A common consultation since the beginning of the vaccination campaign against COVID-19 was related to people with a history of allergy to drugs or other vaccines. The objective of the study was to describe what happened after the administration of the vaccine against COVID-19 in people with a history of moderate and severe allergy, vaccinated against COVID-19 in a Primary Care Emergency Center (PCEC). METHODS: Observational descriptive study with sixty-four people with a history of moderate and severe allergy was carried out, vaccinated in PCEP, between May and October 2021, in the Barcelonés Nord and Maresme (Barcelona province), after assessment by primary care pharmacologists and pharmacists. The percentage of people with adverse events that occurred after vaccination during their stay in the PCEP, the types detected and severity were calculated. Subsequently, a telephone survey was conducted to determine patient satisfaction. A descriptive analysis (calculation of proportions) was performed. RESULTS: The mean age of 49.7 years (from twelve to ninety-four years) and 90.6% were women. 87.5% of the administered vaccines were Comirnaty®. Adverse events occurring after vaccination were detected in fifteen patients (23.4%), of whom four (6.25%) were manifestations of hypersensitivity, all classified as mild. The reasons for vaccination were a history of allergy to NSAIDs (45.3%), antibiotics (32.8%), analgesics (17.2%), vaccines (28.1%), other substances (40.6%) and anaphylaxis (26.6%). The degree of general satisfaction was 9.11 (out of 10). CONCLUSIONS: The percentage of patients with a history of anaphylaxis and allergic drug reactions who present hypersensitivity reactions to COVID-19 vaccines is 6.25% and all are mild.

OBJETIVO: Una consulta habitual desde el inicio de la campaña de vacunación frente a la COVID-19 fue la relacionada con personas que tienen antecedentes de alergia a fármacos u otras vacunas. El objetivo del estudio fue describir lo ocurrido tras la administración de la vacuna frente a la COVID-19 en personas con antecedentes de alergia moderada y grave, en un Centro de Urgencias de Atención Primaria (CUAP). METODOS: Se realizó un estudio observacional descriptivo con sesenta y cuatro personas que tenían antecedentes de alergia moderada y grave, vacunadas en CUAP, entre mayo y octubre de 2021, en el Barcelonés Nord i Maresme (provincia de Barcelona), previa valoración por farmacólogos y farmacéuticos de Atención Primaria. Se calculó el porcentaje de personas con acontecimientos adversos ocurridos tras la vacunación en el transcurso de su estancia en el CUAP, los tipos detectados y la gravedad. Posteriormente, se realizó una encuesta telefónica para conocer la satisfacción de los pacientes. Se realizó un análisis descriptivo (cálculo de proporciones). RESULTADOS: La media de edad de las personas participantes fue de 49,7 años (de doce a noventa y cuatro años) y el 90,6% fueron mujeres. El 87,5% de las vacunas administradas fue Comirnaty®. Se detectaron acontecimientos adversos ocurridos tras la vacunación en quince pacientes (23,4%), de los que en cuatro casos (6,25%) fueron manifestaciones de hipersensibilidad, todas catalogadas como leves. Los motivos de vacunación fueron antecedentes de alergia a AINE (45,3%), antibióticos (32,8%), analgésicos (17,2%), vacunas (28,1%), otras sustancias (40,6%) y anafilaxia (26,6%). El grado de satisfacción general fue de 9,11 (sobre 10). CONCLUSIONES: El porcentaje de pacientes con antecedentes de anafilaxia y reacciones alérgicas a medicamentos que presentan reacciones de hipersensibilidad a las vacunas frente a la COVID-19 es del 6,25% y todas son leves.

A quality improvement plan for hypertension control: the INCOTECA Project (INterventions for COntrol of hyperTEnsion in CAtalonia).

BACKGROUND: Different studies have shown insufficient blood pressure (BP) control in hypertensive patients. Multiple factors influence hypertension management, and the quality of primary care is one of them. We decided therefore to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT) with the aim to achieve a better control of hypertension. The hypothesis of the study is that the implementation of a quality improvement plan will improve the control of hypertension. The primary aim of this study will be to evaluate the effectiveness of this plan. DESIGN: multicentric study quasi-experimental before - after with control group. The non-randomised allocation of the intervention will be done at PHCT level. SETTING: 18 PHCT in the Barcelona province (Spain). SAMPLE: all patients with a diagnosis of hypertension (population based study). EXCLUSION CRITERIA: patients with a diagnosis of hypertension made later than 01/01/2006 and patients younger than 18 years. INTERVENTION: a quality improvement plan, which targets primary health care professionals and includes educational sessions, feedback to health professionals, audit and implementation of recommended clinical practice guidelines for the management of hypertensive patients. MEASUREMENTS: age, sex, associated co-morbidity (diabetes mellitus type I and II, heart failure and renal failure). The following variables will be recorded: BP measurement, cardiovascular risk and antihypertensive drugs used. Results will be measured before the start of the intervention and twelve months after the start of the study. Dependent variable: prevalence of hypertensive patients with poor BP control. ANALYSIS: Chi-square test and Student's t-test will be used to measure the association between independent qualitative and quantitative variables, respectively. Non-parametric tests will be used for the analysis of non-normally distributed variables. Significance level (alpha) will be set at < 0.05. Outcomes will be analysed on an intention-to-treat basis. DISCUSSION: The implementation of a quality improvement plan might benefit the coordination of different professionals of PHCTs and may also improve blood pressure control. TRIAL REGISTRATION: This protocol has been registered at clinicaltrials.gov with the ID number MS: 1998275938244441.

Intervention for control of hypertension in Catalonia, Spain (INCOTECA Project): results of a multicentric, non-randomised, quasi-experimental controlled intervention study.

OBJECTIVE: The purpose of this study was to assess the effectiveness of a quality improvement (QI) plan aimed at primary healthcare teams (PHCTs) to optimise hypertension control and to compare it with standard clinical care. METHODS: Design Multicentric, non-randomised, quasi-experimental controlled intervention study. Setting 5 PHCTs in the intervention and 13 in the standard care group in the province of Barcelona, Catalonia, Spain. Participants This is a population-based study in which all patients over 18 years of age with a diagnosis of hypertension before 1 January 2006 were included (n=9877 in the intervention group and n=21 704 in the control group). Intervention A QI plan that targeted primary care professionals. The plan included training sessions, implementation of recommended clinical practice guidelines for the management of hypertensive patients and audit and feedback to health professionals. Main outcome measure Prevalence of hypertensive patients with an adequate blood pressure (BP) control. RESULTS: The adjusted difference between intervention and standard care groups in the odds of BP control was 1.3 (95% CI 1.1 to 1.6, p=0.003). Results of the mixed model on repeated measures showed that, on average, an individual in the intervention group had an increase of 92% in the odds of BP control (OR 1.9, 95% CI 1.7 to 2.1). CONCLUSIONS: The implementation of a QI plan can improve BP control. This strategy is potentially feasible for up-scaling within the existing PHCTs. TRIAL REGISTRATION: ClinicalTrials.gov MS: 1998275938244441.