ABSTRACT
BACKGROUND AND AIM: undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. PATIENTS AND METHODS: an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. RESULTS: the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). CONCLUSIONS: in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain
No disponible
Subject(s)
Humans , Male , Female , Middle Aged , Hepatitis C/diagnosis , Hepatitis C/therapy , Referral and Consultation/statistics & numerical data , Mass Screening , Retrospective Studies , Prospective Studies , SpainABSTRACT
Introducción. La evaluación de la práctica médica en grupos seleccionados de pacientes puede ser útil para mejorar la calidad de la asistencia y disminuir la variabilidad en la práctica clínica. El objetivo de este estudio es evaluar la adecuación de la asistencia y el grado de adecuación con las guías establecidas en pacientes diagnosticados de meningitis mediante indicadores previamente elaborados. Métodos. Basado en las guías de práctica clínica, mediante reuniones de consenso se seleccionaron indicadores de calidad y se diseñó un protocolo de datos que se utilizó de forma retrospectiva en las historias clínicas de los pacientes diagnosticados de meningitis entre 1987 y 2004 en un hospital general básico de 280 camas. Resultados. Se incluyeron 99 episodios. Se comprobó registro de antibioterapia previa en el 94%, antigüedad de los síntomas en el 65%, exploración de fondo de ojo en el 21%, presión del líquido cefalorraquídeo (LCR) en el 5%; el estudio bioquímico y microbiológico de LCR fue adecuado (93-99%) pero no los hemocultivos (73%). De forma global, la realización de tomografía computarizada (TC) craneal fue adecuada en el 52% de los pacientes, pues en muchos casos se realizó sin haber indicación. El tratamiento de los pacientes se realizó según el protocolo del momento en el 53,6% en meningitis bacterianas y el 79,5% en linfocitarias. Fallecieron el 3% de los pacientes. Conclusión. Se observa una infrautilización del fondo de ojo y una sobreutilización de la TC craneal. El tratamiento se ajustó a los protocolos establecidos en algo más de la mitad de las meningitis bacterianas. Este tipo de auditorías son útiles para identificar la variabilidad de la práctica clínica según las guías y diseñar estrategias dirigidas a corregirlas (AU)
Objectives. Medical practice assessments for a specific patient population can be useful for improving health care quality and decreasing the variations in clinical practice. Our aim was to assess compliance with clinical practice guidelines established for patients with meningitis using previously formulated indicators. Methods. The indicators of quality were based on clinical practice guidelines and selected through consensus meetings. A data protocol was designed and applied retrospectively to the medical records of all patients with a diagnosis of meningitis between 1987 and 2004 in a 280-bed general hospital. Results. A total of 99 episodes were included. Information on pre-treatment was recorded in 94%, duration of symptoms in 65%, funduscopic examination in 21%, and cerebrospinal fluid (CSF) pressure in 5% of patients. Biochemical and microbiological CSF study was adequate (93%-99%), but blood culture (73%) was not. Cranial CT scan was adequate in 52% of patients, since in many cases it was performed without an indication for this study. Treatment was given according to the local protocol in 53.6% of patients with suspected bacterial meningitis and 79.5% of those with suspected viral meningitis. Three patients died due to meningitis. Conclusions. The use of funduscopic examination was poor, whereas the use of cranial CT scanning was excessive. Treatment of bacterial meningitis adhered to the established local antibiotic protocol in half the patients. This type of auditing is useful for determining compliance with guidelines and designing strategies to improve health care quality (AU)
Subject(s)
Child , Adolescent , Adult , Middle Aged , Humans , Meningitis, Bacterial/diagnosis , Clinical Protocols , Quality of Health Care/statistics & numerical data , Meningitis, Bacterial/drug therapy , Patient Satisfaction/statistics & numerical data , Quality Indicators, Health Care , Hospitals, General/statistics & numerical data , Professional Practice/statistics & numerical dataABSTRACT
Fundamento y objetivo. El objetivo es determinar la tendencia en cobertura vacunal antigripal en trabajadores sanitarios. Método. Estudio epidemiológico transversal. Período 1990-2005. Proporciones globales y por categorías profesionales anuales. Análisis: test χ² y test de tendencia lineal Mantel-Haenszel. Resultados. Las mayores coberturas fueron: 2003-2004, 15,9% (IC 95%: 14,8-17) y 2005-2006, 16,3% (IC 95%: 15,3-17,4). Médicos y MIR tienen mayores coberturas, 30,09%. La tendencia fue creciente durante todo el período. Conclusiones. Tendencia creciente de inmunización antigripal en personal sanitario (AU)
Background and objective. The aim of this study was to determine the trends in yearly vaccination coverage in healthcare workers. Method. Cross-sectional epidemiological study over fifteen seasons (1990-2005). Overall vaccination coverage and coverage by professional category was estimated annually. The chi-square test and Mantel-Haenszel test for linear trend were used for the statistical analysis. Results. The greatest vaccination coverage was in the 2003-04 season (15.9%; 95% CI: 14.8-17) and the 2005-06 season (16.3%; 95% CI: 15.3-17.4). The medical staff and residents showed the highest coverage (30.1%). A positive trend was observed along the period. Conclusions. An increasing trend in influenza vaccination coverage has been observed in healthcare workers (AU)
Subject(s)
Humans , Mass Vaccination/statistics & numerical data , Health Personnel , Influenza, Human/prevention & control , Infection Control/methods , Cross-Sectional Studies , Preventive Medicine/methods , Hospital Bed Capacity, 500 and over , Influenza, Human/epidemiologyABSTRACT
INTRODUCCIÓN. Describir las características clínicas y epidemiológicas de la hepatitis aislada en una cohorte de 109 pacientes con fiebre Q.RESULTADOS. La hepatitis aislada representó el 55 por ciento. En el 96 por ciento de los casos se manifestó como un cuadro febril sin síntomas focales y cistólisis hepática. No se ha encontrado ninguna diferencia en las características epidemiológicas entre los pacientes con y sin hepatitis. CONCLUSIÓN. Debería considerarse la fiebre Q en del diagnóstico diferencial de los síndromes febriles adquiridos en la comunidad (AU)
Subject(s)
Middle Aged , Adolescent , Adult , Male , Female , Humans , Spain , Coxiella burnetii , Q Fever , Retrospective Studies , Antibodies, Bacterial , Hepatitis , Hospitals, General , FeverABSTRACT
No disponible
