[Effect of the Helicobacter pylori eradication in patients with functional dyspepsia: randomised placebo-controlled trial]. / Efecto del tratamiento erradicador en pacientes con dispepsia funcional e infección por Helicobacter pylori: ensayo clínico aleatorizado frente a placebo.

BACKGROUND AND OBJECTIVE: The Helicobacter pylori eradication in patients with functional dyspepsia has been the subject of controversy because trials come to contradictory conclusions. The objective of this trial was to evaluate the effect, compared with placebo, of the eradication treatment in patients with functional dyspepsia. PATIENTS AND METHOD: Randomized double blind placebo controlled trial. We included 158 patients attended by family physicians (Area 10 Primary Care, Health Institute of Madrid) with functional dyspepsia and Helicobacter pylori infection detected by the ureasa test in endoscopy. An OCA (ameprazole clarithromycin and amoxicillin group (n = 79) and a placebo group (n = 79) were randomized. During 7 days, patients at the OCA group received omeprazole (20 mg bid), clarithromycin (500 mg bid) and amoxicillin (1000 mg bid) daily, and patients at the control group received the placebo agent twice daily. Dyspepsia improvement according to a Likert scale (5 steps), and eradication of H. pylori by 13C-urea breath test were evaluated during one year. RESULTS: Both groups were homogeneous in relation to age, sex and dyspepsia degree. The average age (standard deviation) of studied patients was 41.99 (13.93) years. At one year of follow up, H. pylori was eradicated in 81.01% (64/79) of the OCA group and 5.06% (4/79) of the placebo group. The difference of dyspepsia improvement (22.78%; 95% confidence interval [CI], 7.62-37.79) between the OCA group (41.77%; 95% CI, 30.77-53.41), and the placebo group (18.99%; 95% CI 11.03-29.38) was significant (p = 0.0018). CONCLUSION: Eradication of Helicobacter pylori in patients with functional dyspepsia is more effective improving symptoms than placebo.

[Analysis of complaints in primary care using statistical process control]. / Análisis de las reclamaciones en atención primaria mediante el control estadístico de procesos.

OBJECTIVE: To analyze patient complaints in a Primary Health Care District (PHCD) using statistical process control methods compared to multivariate methods, as regards their results and feasibility of application in this context. MATERIAL AND METHOD: Descriptive study based on an aggregate analysis of administrative complaints. SETTING: Complaints received between January 2005 and August 2008 in the Customer Management Department in the 3rd PHCD Management Office, Madrid Health Services. Complaints are registered through Itrack, a computer software tool used throughout the whole Community of Madrid. MAIN VARIABLES: Total number of complaints, complaints sorted by Reason and Primary Health Care Team (PHCT), total number of patient visits (including visits on demand, appointment visits and home visits) and visits by PHCT and per month and year. STATISTICAL ANALYSIS: Multivariate analysis and control charts were used. RESULTS: 44-month time series with a mean of 76 complaints per month, an increasing trend in the first three years and decreasing during summer months. Poisson regression detected an excess of complaints in 8 out of the 44 months in the series. The control chart detected the same 8 months plus two additional ones. CONCLUSIONS: Statistical process control can be useful for detecting an excess of complaints in a PHCD and enables comparisons to be made between different PHC teams. As it is a simple technique, it can be used for ongoing monitoring of customer perceived quality.

Análisis de las reclamaciones en atención primaria mediante el control estadístico de procesos / Analysis of complaints in primary care using statistical process control

Objetivo: Analizar las reclamaciones de un área de atención primaria mediante técnicas de control estadístico de procesos, y compararlas con técnicas multivariables en cuanto a sus resultados y su factibilidad de aplicación en este medio. Material y método: Estudio descriptivo con análisis agregado de las reclamaciones administrativas. Período del estudio: reclamaciones recibidas desde enero de 2005 a agosto de 2008. Fuente de datos: la Unidad de Gestión de Usuarios de la Gerencia de Atención Primaria Área 3, Servicio Madrileño de Salud registra las reclamaciones en el programa track, utilizado en toda la Comunidad de Madrid. Mediciones principales: número total de reclamaciones, reclamaciones por motivo y por equipo de atención primaria, número de consultas totales (incluye consultas a demanda, concertadas y domicilio) y consultas por EAP, mes y año. Análisis estadístico: aplicación de técnicas multivariables y gráficos de control. Resultados: Serie temporal de 44 meses con una mediana de 76 reclamaciones/mes, una tendencia incremental en los primeros 3 años y descensos durante el verano. La regresión de Poisson permite detectar un exceso de reclamaciones en 8 de los 44 meses de la serie. El gráfico de control identifica los mismos puntos y 2 adicionales. Conclusiones: El control estadístico de procesos puede resultar útil para detectar excesos de reclamaciones en un área de salud y comparar entre unidades asistenciales. Su fácil aplicación permite realizar una monitorización continua de la calidad percibida por los usuarios (AU)

Objective: To analyze patient complaints in a Primary Health Care District (PHCD) using statistical process control methods compared to multivariate methods, as regards their results and feasibility of application in this context. Material and method: Descriptive study based on an aggregate analysis of administrative complaints. Setting: Complaints received between January 2005 and August 2008 in the Customer Management Department in the 3 rd PHCD Management Office, Madrid Health Services. Complaints are registered through track, a computer software tool used throughout the whole Community of Madrid. Main variables: Total number of complaints, complaints sorted by Reason and Primary Health Care Team (PHCT), total number of patient visits(including visits on demand, appointment visits and home visits) and visits by PHCT and per month and year. Statistical analysis: Multivariate analysis and control charts were used. Results: 44-month time series with a mean of 76 complaints per month, an increasing trend in the first three years and decreasing during summer months. Poisson regression detected an excess of complaints in 8 out of the 44 months in the series. The control chart detected the same 8 months plus two additional ones. Conclusions: Statistical process control can be useful for detecting an excess of complaints in a PHCD and enables comparisons to be made between different PHC teams. As it is a simple technique, it can be used for ongoing monitoring of customer perceived quality (AU)

Efecto del tratamiento erradicador en pacientes con dispepsia funcional e infección por Helicobacter pylori: ensayo clínico aleatorizado frente a placebo / Effect of the Helicobacter pylori eradication in patients with functional dyspepsia: reandomised placebo-controlled trial

Fundamento y objetivo: El tratamiento erradicador en pacientes con dispepsia funcional ha sido frecuentemente objeto de discusión porque los ensayos llegan a conclusiones contradictorias, por lo que son necesarios más estudios para aclarar este tema. El objetivo de este ensayo es valorar el efecto del tratamiento erradicador en pacientes con dispepsia funcional comparándolo con placebo. Pacientes y método: Se trata de un ensayo clínico aleatorizado, doble ciego y controlado con placebo. Se seleccionó a 158 pacientes atendidos por médicos de familia (Área 10 IMSALUD), con dispepsia funcional e infección por Helicobacter pylori detectado por test de ureasa en la endoscopia. Se asignaron aleatoriamente a un grupo de tratamiento activo con omeprazol, claritromicina y amoxicilina (OCA) (n = 79) y a un grupo que recibió placebo (n = 79). Durante 7 días, el grupo OCA recibió omeprazol (20 mg/12 h), claritromicina (500 mg/12 h) y amoxicilina (1000 mg/12 h), mientras que el grupo control recibió placebo 2 veces al día. Se evaluaron durante un año las variaciones de mejoría de dispepsia según una escala Likert (5 grados), y la erradicación de Helicobacter pylori mediante prueba del aliento con urea-13C. Resultados: Ambos grupos eran homogéneos con respecto a la edad, el sexo y el grado de dispepsia. La edad media (desviación estándar) de los pacientes estudiados fue de 41,99 (13,93) años. Al año de seguimiento, H. Pylori se erradicó en el 81,01% (64/79) del grupo OCA y en el 5,06% (4/79) del grupo placebo. La diferencia de mejora de dispepsia (22,78%; intervalo de confianza [IC del 95%, 7,62-37,79]) entre el grupo OCA (41,77%, [IC del 95%, 30,77-53,41]) y el grupo placebo (18,99%; [IC del 95%, 11,03-29,38]) fue significativa (p = 0,0018). Conclusión: El tratamiento erradicador de H. pylori en pacientes con dispepsia funcional es más efectivo que el placebo, tanto para la erradicación del germen como en la mejoría de la dispepsia

Background and objective: The Helicobacter pylori eradication in patients with functional dyspepsia has been the subject of controversy because trials come to contradictory conclusions. The objective of this trial was to evaluate the effect, compared with placebo, of the eradication treatment in patients with functional dyspepsia. Patients and method: Randomized double blind placebo controlled trial. We included 158 patients attended by family physicians (Área 10 Primary Care, Health Institute of Madrid) with functional dyspepsia and Helicobacter pylori infection detected by the ureasa test in endoscopy. An OCA (ameprazole clarithromycin and amoxicillin group (n = 79) and a placebo group (n = 79) were randomized. During 7 days, patients at the OCA group received omeprazole (20 mg bid), clarithromycin (500 mg bid) and amoxicillin (1000 mg bid) daily, and patients at the control group received the placebo agent twice daily. Dyspepsia improvement according to a Likert scale (5 steps), and eradication of H. pylori by 13C-urea breath test were evaluated during one year. Results: Both groups were homogeneous in relation to age, sex and dyspepsia degree. The average age (standard deviation) of studied patients was 41.99 (13.93) years. At one year of follow up, H. pylori was eradicated in 81.01% (64/79) of the OCA group and 5.06% (4/79) of the placebo group. The difference of dyspepsia improvement (22.78%; 95% confidence interval [CI], 7.62-37.79) between the OCA group (41.77%; 95% CI, 30.77-53.41), and the placebo group (18.99%; 95% CI 11.03-29.38) was significant (p = 0.0018). Conclusion: Eradication of Helicobacter pylori in patients with functional dyspepsia is more effective improving symptoms than placebo