Efectividad a medio plazo de una intervención educativa grupal dirigida al cuidado de los pies en pacientes con diabetes tipo 2 / Medium-term effectiveness of a group educational intervention on foot care in patients with type 2 diabetes

Objetivo. Evaluar la efectividad a medio plazo de una intervención educativa grupal en atención primaria, dirigida a mejorar las habilidades en el autocuidado de los pies en pacientes con diabetes tipo 2 y determinar el momento más adecuado para una nueva intervención. Método. Estudio intervención antes-después con seguimiento tras 24 meses. Muestra de 76 pacientes con diabetes 2 que asistieron a 2 talleres de educación grupal. Se midieron variables sociodemográficas y variables relacionadas con el estado neurovascular del pie y con los hábitos de higiene y cuidado. Para la comparación de resultados se usó la prueba de McNemar para datos apareados. Resultados. Edad media 66 años, 51% varones. Evolución de hábitos antes-después (8 meses) de la intervención: higiene correcta 41-86%, hidratación buena-regular 80-97%, lavado de pies diario 42-68%, utensilios correctos 41-79%, calzado adecuado 9-33%, uñas correctas 26-74%, todas estas diferencias con p < 0,001. Entre los pacientes que mejoraron a raíz del taller, el 76% mantuvo la variable higiene correcta (intervalo de confianza [IC] del 95%, 61-90%) a los 24 meses, hidratación el 100%, lavado diario el 70% (IC del 95%, 51-90%), utensilios adecuados el 74% (IC del 95%, 58-90%), calzado adecuado el 55% (IC del 95%, 34-77%) y uñas correctas el 81% (IC del 95%, 68-94%). Conclusiones. La intervención ha mejorado todas las variables relacionadas con el cuidado del pie diabético estudiadas. El efecto del taller se mantiene a 24 meses en al menos el 70% de los participantes para todas las variables, excepto en el calzado adecuado. La educación grupal favorece el cambio de hábitos. Creemos indicada una intervención educativa cada 24 meses

Aim. To evaluate the medium-term effectiveness of a group educational intervention in primary care aimed at improving attitudes and skillsin self-care of the feet in patients with type 2 diabetes, and to determine the optimal time for reintervention. Method. We performed a before-after intervention study with a 24-month follow-up. The sample consisted of 76 patients with type 2 diabetes who underwent two group education sessions. Sociodemographic variables and variables related to the neurovascular statusof the foot and with hygiene and self-care habits were measured. To compare the results, McNemar’s test for paired data was used.Results. The mean age was 66 years and 51% were men. Skills performance before-after (8 months) the intervention were as follows:correct hygiene 41%-86%, good-medium hydration 80%-97%, daily foot washing 42%-68%, proper tools use 41%-79%, proper shoes 9%-33%, proper nails 26%-74% (all differences with p < 0.001). Among patients that improved due to the sessions, skills were stillcorrect at 24 months in 76% (95% CI: 61%-90%) for hygiene, 100% for hydration, 70% for daily foot washing (95% CI: 51%-90%), 74% for proper tools use (95% CI: 58-90%), 55% for proper shoes (95% CI: 34%-77%) and 81% for proper nails (95% CI: 68%-94%).Conclusions. The intervention improved all the skills studied. The effects of the sessions were still evident after 24 months in more than 70% of patients for all the variables studied except proper shoe use. Group education favors skills improvement. We suggest repeating the intervention every 24 months

[Study of use of psychiatric drugs in primary care]. / Estudio de utilización de psicofármacos en atención primaria.

OBJECTIVE: To get to know the profile of use of antidepressants (AD) and tranquilizers-hypnotics (T-H) in primary care in Catalonia. DESIGN: Transversal, observational, epidemiological study of prescription-indication. LOCATION: Health centres in Catalonia, Spain. PARTICIPANTS: Included, using consecutive sampling, patients on treatment with AD and/or T-H. MEASUREMENTS: The variables studied were: age, sex, type and number of drugs, treatment schemes, reason for prescribing, and the health professional who initiated it. RESULTS: 1613 drugs were evaluated: 43% were AD and 57% were T-H. The sub-groups most prescribed were: selective serotonin reuptake inhibitors (SSRI) (31.6%) and short half-life (32.9%) and long half-life (19.8%) benzodiazepines (BZD). We included 998 patients, 76% of the participants were women. The average age was 52.24 years (range, 16-96). 19.9% (n=199) received treatment with AD only, 34.3% (n=342) with T-H only, and 45.8% (n=457) combined treatment. The mean number of drugs per patient was 1.6. The main reasons for prescribing were: major depression or dysthymia (60.2%; n=417) for AD and generalised anxiety (33.3%; n=306) and insomnia (23.9%; n=220) for T-H. 39.8% (n=268) of the AD and 51.0% (n=441) of T-H had been prescribed for more than 1 year. CONCLUSION: The described profile of the use of psychiatric drugs suggests the need to reconsider the over-prescribing of BDZ and improve coordination between psychiatrists and primary care doctors.

Estudio de utilización de psicofármacos en atención primaria / Study of use of psychiatric drugs in primary care

Objetivo. Conocer el perfil de utilización de antidepresivos (AD) y ansiolíticos/hipnóticos (A/H) en atención primaria (AP) en Cataluña. Diseño. Estudio epidemiológico, observacional, transversal de prescripción-indicación. Emplazamiento. Centros de salud de Cataluña. Participantes. Se incluyó, mediante muestreo consecutivo, a pacientes en tratamiento con AD y/o A/H. Mediciones. Las variables estudiadas fueron: edad, sexo, tipo y número de fármacos, pautas de tratamiento, motivo de la prescripción y profesional que la inició. Resultados. Se evaluaron 1.613 fármacos: el 43% fue AD y el 57% A/H. Los subgrupos más prescritos fueron: inhibidores selectivos de la recaptación de serotonina (ISRS) (31,6%), y benzodiacepinas (BZD) de vida media corta (32,9%) y larga (19,8%). Se incluyeron 998 pacientes. El 76% de los participanetes eran mujeres. La edad media era de 52,24 años (rango, 16-96). El 19,9% (n = 199) de los pacientes recibía sólo tratamiento con AD; el 34,3% (n = 342), sólo con A/H, y el 45,8% (n = 457), tratamiento combinado. La media de fármacos por paciente fue de 1,6 ± 0,91. Los motivos principales de prescripción fueron: depresión mayor o distimia (60,2%; n = 417) para los AD y ansiedad generalizada (33,3%; n = 306) e insomnio (23,9%; n = 220) para los A/H. El 39,8% (n = 268) de los AD y el 51,0% (n = 441) de los A/H se habían prescrito hacía más de 1 año. Conclusión. El perfil de utilización de psicofármacos descrito nos plantea la necesidad de reconducir la hiperprescripción de BZD y mejorar la coordinación entre psiquiatras y médicos de AP

Objective. To get to know the profile of use of antidepressants (AD) and tranquilizers-hypnotics (T-H) in primary care in Catalonia. Design. Transversal, observational, epidemiological study of prescription-indication. Location. Health centres in Catalonia, Spain. Participants. Included, using consecutive sampling, patients on treatment with AD and/or T-H. Measurements. The variables studied were: age, sex, type and number of drugs, treatment schemes, reason for prescribing, and the health professional who initiated it. Results. 1613 drugs were evaluated: 43% were AD and 57% were T-H. The sub-groups most prescribed were: selective serotonin reuptake inhibitors (SSRI) (31.6%) and short half-life (32.9%) and long half-life (19.8%) benzodiazepines (BZD). We included 998 patients, 76% of the participants were women. The average age was 52.24 years (range, 16-96). 19.9% (n=199) received treatment with AD only, 34.3% (n=342) with T-H only, and 45.8% (n=457) combined treatment. The mean number of drugs per patient was 1.6. The main reasons for prescribing were: major depression or dysthymia (60.2%; n=417) for AD and generalised anxiety (33.3%; n=306) and insomnia (23.9%; n=220) for T-H. 39.8% (n=268) of the AD and 51.0% (n=441) of T-H had been prescribed for more than 1 year. Conclusion. The described profile of the use of psychiatric drugs suggests the need to reconsider the over-prescribing of BDZ and improve coordination between psychiatrists and primary care doctors