Continuidad asistencial: rol de la enfermera de enlace / Continuity of care: role of the link nurse

Objetivo. Evaluar el programa de enfermera de enlace a los 2 años de funcionamiento. Diseño. Estudio descriptivo. Emplazamiento. Atención primaria de los municipios de Sant Boi de Llobregat y Sant Vicenç dels Horts (Barcelona) y el Hospital Comarcal de Sant Boi. Pacientes. Pacientes dados de alta del hospital (entre octubre de 2000 y octubre 2002) y que necesitaban cuidados de continuidad en el equipo de atención primaria o domicilio. Intervenciones. Visitas conjuntas entre la enfermera de enlace y la supervisora de la unidad hospitalaria para elaborar el plan de cuidados previo al alta hospitalaria. Se comunica al equipo de atención primaria del traspaso del enfermo y su plan de cuidados. Las visitas posteriores al domicilio las realiza la enfermera de enlace, el equipo de atención primaria, o conjuntamente. Resultados. Se ha estudiado a 854 pacientes (57,6% mujeres); media de edad en mujeres 69,82 ± 14,7 años y en varones de 61,7 ± 19,6 años (p < 0,0001). La enfermera de enlace ha realizado 2.241 visitas hospitalarias, 81 domiciliarias y 434 llamadas telefónicas. También se han hecho 636 coordinaciones. El diagnóstico de enfermería más frecuente ha sido trastorno de la movilidad física (61% de los pacientes). Conclusiones. Se ha creado un mecanismo que mejora la continuidad desde el alta hospitalaria hasta el contacto con el equipo de atención primaria. La enfermera de enlace coordina y gestiona los casos antes de que el paciente sea traspasado al ámbito de la atención primaria

Objective. To evaluate the link nurse programme after 2 years of operation. Design. Descriptive study. Setting. Primary vare in the towns of Sant Boi de Llobregat and Sant Vicenç dels Horts (Barcelona) and the County Hospital of Sant Boi, Spain. Patients. Patients discharged from the hospital (October 2000-October 2002) and who needed ongoing care in the primary care centre or at home. Interventions. Joint visits of the link nurse and the hospital unit's supervisor to work out the care plan before discharge. The PC team was informed of the transfer of the patient and his/her care plan. Subsequent home visits were by the link nurse, the primary care team or both together. Results. 854 patients (57.6% women) were studied. Women's mean age was 69.82 (SD, 4.7) and men's was 61.7 (SD, 9.6) (P<.0001). The link nurse made 2241 hospital visits, 81 home visits, and 434 phone calls. There were 636 co-ordinations. The most common nursing diagnosis made was physical mobility disorder (61% of patients). Conclusions. A mechanism was created to improve continuity from hospital discharge to contact with the PC team. The link nurse coordinates and manages patients before they are handed over to PC

[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

[Breast-feeding: can health staff positively affect its duration?]. / Lactancia materna: puede el personal sanitario influir positivamente en su duración?

INTRODUCTION: Mother's milk is the ideal meal for the baby during the first six months of life. A good health education (before and after birth) helps to prolong breastfeeding (BF). OBJECTIVE: To know the prevalence of BF among a group of women and to study the relationship with health education. DESIGN: Observational and analytic study. SETTING: Dr. Pujol i Capsada Primary Health Center (El Prat de Llobregat); Casagemes CAD's afterbirth group in Badalona, and Alba Lactancia Women's group. SUBJECTS OF THE STUDY: 135 women with babies born between the 1st of March 2002 and the 28th of February 2003. METHOD: Mother's motivation for breast-feeding and the type of information she has got were evaluated. Breast-feeding period was measured from the second month of baby's life by means of a survey passed by nursing staff. RESULTS: The average BF period was of 160 days, 22% breastfed their babies for less than a week, and 14% between a week and a month. The main variables in relation with the increase of BF are: to want to breast-feed (P=.05); mother sleeping with the baby (P=.03); to receive assistance from nursing staff while in hospital (P=.01); not to receive additional meals in hospital (P=.02); no problems during the first month of life (P<.0001); to receive information from health center (P=.009). If the first contact mother-baby (bringing the baby close to the breast) lasts more than 30 minutes 51% give up BF before the first month; but if the first contact is before of 30 minutes only give up 20.8% (P=.002). CONCLUSIONS: The prevalence of BF increases among the women that got health education and support from the health professionals.

Lactancia materna: ¿puede el personal sanitario influir positivamente en su duración? / Breast-feeding: can health staff positively affect its duration?

Introducción. La leche materna es el alimento ideal para el niño durante los 6 primeros meses de vida. Una buena educación sanitaria preparto y posparto favorece la duración de la lactancia materna (LM). Objetivo. Conocer la prevalencia de LM en un grupo de mujeres y estudiar si guarda relación con la educación sanitaria. Diseño. Estudio observacional, analítico. Emplazamiento. Centro de Salud Dr. Pujol i Capsada (El Prat de Llobregat); grupo de posparto del Centro de Atención a la Mujer Casagemes (Badalona), y grupo de mujeres de Alba Lactancia. Participantes. Se incluyó a 135 mujeres con hijos nacidos entre el 1 de marzo de 2002 y el 28 de febrero de 2003. Mediciones principales. Se valoraba la información recibida, el tipo de información y la motivación de la madre para dar LM. Se midió la prevalencia de LM mediante una encuesta realizada por el personal de enfermería. Resultados. La media de días de LM fue de 160; un 22% dio el pecho menos de 1 semana y un 14% entre 1 semana y 1 mes. Las variables significativas relacionadas con la LM a los 3 meses son: deseo de dar el pecho (p = 0,05), disponer de un alojamiento conjunto (p = 0,03), recibir ayuda de los profesionales de enfermería durante la estancia en el hospital (p = 0,01), no recibir suplementos en el hospital (p = 0,02), no tener problemas durante el primer mes de vida del niño (p 30 min, el 51% abandona la LM antes del primer mes, pero si el tiempo del primer contacto es < 30 min, el abandono antes del primer mes es del 20,8% (p = 0,002). Conclusiones. La prevalencia de LM aumenta en las mujeres que recibieron educación sanitaria y apoyo por parte del personal sanitario

Introduction. Mother's milk is the ideal meal for the baby during the first six months of life. A good health education (before and after birth) helps to prolong breastfeeding (BF). Objective. To know the prevalence of BF among a group of women and to study the relationship with health education. Desing. Observational and analytic study. Setting. Dr. Pujol i Capsada Primary Health Center (El Prat de Llobregat); Casagemes CAD's afterbirth group in Badalona, and Alba Lactancia Women's group. Subjects of the study. 135 women with babies born between the 1st of March 2002 and the 28th of February 2003. Method. Mother's motivation for breast-feeding and the type of information she has got were evaluated. Breast-feeding period was measured from the second month of baby's life by means of a survey passed by nursing staff. Results. The average BF period was of 160 days, 22% breastfed their babies for less than a week, and 14% between a week and a month. The main variables in relation with the increase of BF are: to want to breast-feed (P=.05); mother sleeping with the baby (P=.03); to receive assistance from nursing staff while in hospital (P=.01); not to receive additional meals in hospital (P=.02); no problems during the first month of life (P<.0001); to receive information from health center (P=.009). If the first contact mother-baby (bringing the baby close to the breast) lasts more than 30 minutes 51% give up BF before the first month; but if the first contact is before of 30 minutes only give up 20.8% (P=.002). Conclusions. The prevalence of BF increases among the women that got health education and support from the health professionals

[Continuity of care: role of the link nurse]. / Continuidad asistencial: rol de la enfermera de enlace.

OBJECTIVE: To evaluate the link nurse programme after 2 years of operation. DESIGN: Descriptive study. SETTING: Primary vare in the towns of Sant Boi de Llobregat and Sant Vicenç dels Horts (Barcelona) and the County Hospital of Sant Boi, Spain. PATIENTS: Patients discharged from the hospital (October 2000-October 2002) and who needed ongoing care in the primary care centre or at home. INTERVENTIONS: Joint visits of the link nurse and the hospital unit's supervisor to work out the care plan before discharge. The PC team was informed of the transfer of the patient and his/her care plan. Subsequent home visits were by the link nurse, the primary care team or both together. RESULTS: 854 patients (57.6% women) were studied. Women's mean age was 69.82 (SD, 4.7) and men's was 61.7 (SD, 9.6) (P<.0001). The link nurse made 2241 hospital visits, 81 home visits, and 434 phone calls. There were 636 co-ordinations. The most common nursing diagnosis made was physical mobility disorder (61% of patients). CONCLUSIONS: A mechanism was created to improve continuity from hospital discharge to contact with the PC team. The link nurse coordinates and manages patients before they are handed over to PC.

Actividades preventivas y esquizofrenia. ¿Lo hacemos bien? / Preventive activities and esquizofreny. Do we do it well?

Fundamento : los esquizofrénicos son grandes frecuentadores en Atención Primaria, ¿aprovechamos para realizar actividades preventivas o se convierten en visitas burocráticas ? Objetivo : conocer si se practican las mismas actividades preventivas en esquizofrénicos que en población general.Diseño : estudio casos-controles .Material y métodos: casos (n=36): esquizofrénicos >15 años. Controles (n=72): extracción aleatoria de la base de datos, apareados por edad sexo .Variables: registro en HCAP de datos de filiación, frecuentación, actividades preventivas (peso, talla, vacuna antigripal, vacuna antitetánica, presión arterial, colesterolemia, alcohol y tabaco, según recomendaciones PAPPS) durante 1993-1998; recogida datos mayo-junio 1999.Explotación estadística: SPSS, estadística descriptiva de variables, Chi cuadrado o análisis de la varianza para análisis bivariante, odds ratio para medidas de asociación.Resultados : en el registro de actividades preventivas no hay diferencias estadísticamente significativas entre casos y controles, excepto mejor registro del hábito enólico (p=0,04) en los controles . Las actividades preventivas registradas, excepto hábito tabáquico, presentan mejores resultados en mujeres. Mejor registro de peso (p=0,01), talla (p=0,07), hábito alcohólico (p=0,04), mejor vacunadas de la gripe (p=0,006) y tétanos (p=0,03), y mejores resultados de cribado de colesterol (p=0,09) y presión arterial (p=0,005). Las mujeres son más frecuentadoras (6,8; DE:9,8) que los hombres (2,8; DE:3,2) (p=0,02). La mayor frecuentación se relaciona con un mejor re g i s t ro de vacuna antigripal (p=0,01), cribaje de c o l e s t e rol (p=0,05), peso (p=0,02), talla (p=0,04) y hábito enólico (p=0,03).Conclusiones : no se observan diferencias en la práctica de actividades preventivas entre esquizofrénicos y población general, siendo en ambos muy bajo el registro (AU)

[The diagnostic situation with prostatic cancer in primary care]. / Situación diagnóstica del cáncer de próstata en atención primaria.

OBJECTIVES: To evaluate the quality of diagnosis in primary care (PC) of prostate cancer (CP) and to analyse the factors linked to late diagnosis. DESIGN: Retrospective, cross-sectional study. SETTING: Five PC centres and a hospital (covering about 130,000 inhabitants). PATIENTS: All CP diagnosed in PC between April 1989 and October 1996. MEASUREMENTS AND MAIN RESULTS: PC clinical history, hospital records and request for specialist consultation in 41 cases were reviewed. In cases coming from PC (71%), the most frequent clinical picture was mixed prostate syndrome (44.8%). PSA (20.7%) and urine sediment (17.2%) were the most commonly requested investigations. Rectal touch (RT) occurred in one case (3.4%) and four cases were diagnosed as CP. In the urology service, RT occurred in 68% of cases, with PSA determined in 59% of those who had not had it. After the first visit, 44% were diagnosed as CP. Two time intervals in common between PC and hospital were studied: referral-specialist visit and specialist visit-diagnosis. In PC there were mean delays of 50 days (SD, 53; percentile [P] 25 = 14; P50 = 35; P75 = 75) and 420 days (SD, 595; P25 = 72; P50 = 194; P75 = 490), respectively. In the hospital the times were 6 days for the first (SD, 6; P25 = 2; P50 = 5; P75 = 8.5), and 168 for the second (SD, 176; P25 = 34; P50 = 130; P75 = 271). The differences were statistically significant: p = 0.0006 and p = 0.05. CONCLUSIONS: Doing RT and PSA determination in primary care would favour diagnosis in the cases of CP. The creation of training programmes and rapid referral routes to hospital could reduce the delays looked at.

Situación diagnóstica del cáncer de próstata en atención primaria / Diagnostic situation of prostate cancer in primary care

Objetivo. Valorar la calidad diagnóstica en atención primaria (AP) del cáncer de próstata (CP) y analizar factores asociados al posible retraso diagnóstico. Diseño. Estudio transversal retrospectivo. Emplazamiento. Cinco centros de AP y centro hospitalario (CH) (población aproximada, 130.000 habitantes). Pacientes. Todos los CP diagnosticados en el CH entre abril de 1989 y octubre de 1996. Mediciones y resultados principales. Se revisaron: historia clínica de AP, hospitalaria y petición de consulta especializada de los 41 casos. En los casos procedentes de AP (71 por ciento) la clínica más frecuente fue el síndrome prostático mixto (44,8 por ciento). El PSA (20,7 por ciento) y sedimento de orina (17,2 por ciento) fueron las exploraciones más solicitadas. Se realizó tacto rectal (TR) en un caso (3,4 por ciento) y 4 casos fueron orientados como CP. En el servicio de urología, el TR se realizó en un 68 por ciento de los casos, determinándose el PSA en el 59 por ciento de los que no lo tenían. Tras la primera visita, un 44 por ciento fue orientado como CP. Se estudiaron 2 intervalos de tiempos comunes: derivación-visita especializada y visita especializada-diagnóstico. En AP se obtuvo una media de 50 días (DE, 53; percentil [P] 25 = 14; P50 = 35; P75 = 75) y 420 (DE, 595; P25 = 72; P50 = 194; P75 = 490), respectivamente. Los resultados en el CH fueron de 6 días (DE, 6; P25 = 2; P50 = 5; P75 = 8,5) para el primero y 168 (DE, 176; P25 = 34; P50 = 130; P75 = 271) en el segundo. Las diferencias resultaron estadísticamente significativas: p = 0,0006 y p = 0,05. Conclusiones. La realización del TR y determinación del PSA desde AP favorecería la orientación diagnóstica en los casos de CP. La creación de programas formativos y vías de derivación rápida al CH permitiría reducir los intervalos estudiados Objetivo. Valorar la calidad diagnóstica en atención primaria (AP) del cáncer de próstata (CP) y analizar factores asociados al posible retraso diagnóstico. Diseño. Estudio transversal retrospectivo. Emplazamiento. Cinco centros de AP y centro hospitalario (CH) (población aproximada, 130.000 habitantes). Pacientes. Todos los CP diagnosticados en el CH entre abril de 1989 y octubre de 1996. Mediciones y resultados principales. Se revisaron: historia clínica de AP, hospitalaria y petición de consulta especializada de los 41 casos. En los casos procedentes de AP (71 por ciento) la clínica más frecuente fue el síndrome prostático mixto (44,8 por ciento). El PSA (20,7 por ciento) y sedimento de orina (17,2 por ciento) fueron las exploraciones más solicitadas. Se realizó tacto rectal (TR) en un caso (3,4 por ciento) y 4 casos fueron orientados como CP. En el servicio de urología, el TR se realizó en un 68 por ciento de los casos, determinándose el PSA en el 59 por ciento de los que no lo tenían. Tras la primera visita, un 44 por ciento fue orientado como CP. Se estudiaron 2 intervalos de tiempos comunes: derivación-visita especializada y visita especializada-diagnóstico. En AP se obtuvo una media de 50 días (DE, 53; percentil [P] 25 = 14; P50 = 35; P75 = 75) y 420 (DE, 595; P25 = 72; P50 = 194; P75 = 490), respectivamente. Los resultados en el CH fueron de 6 días (DE, 6; P25 = 2; P50 = 5; P75 = 8,5) para el primero y 168 (DE, 176; P25 = 34; P50 = 130; P75 = 271) en el segundo. Las diferencias resultaron estadísticamente significativas: p = 0,0006 y p = 0,05. Conclusiones. La realización del TR y determinación del PSA desde AP favorecería la orientación diagnóstica en los casos de CP. La creación de programas formativos y vías de derivación rápida al CH permitiría reducir los intervalos estudiados (AU)

[The prevalence of infection by the hepatitis B, C and human immunodeficiency viruses in drug users]. / Prevalencia de la infección por los virus de la hepatitis B, C e inmunodeficiencia humana en usuarios de drogas.

OBJECTIVE: Estimate the prevalence of the hepatitis B (HBV) infection, hepatitis C (HCV) and human immunodeficiency virus (HIV) and its coexistence in intravenous drug users, in order to start afterwards a vaccination and sanitary training programmes. PATIENTS AND METHODS: Intravenous drug users attended in a health centre and in the drugs addition deshabitation centre of reference located in a marginal urban quarter. Patients were detected from the health centre. During one year (June 1995-1996) facts were collected. The age, sex, consumption, type, administration mechanism and also the described serologies were analysed. It has been carried out descriptive statistics and applied the chi-square [correction of square-ji] test. RESULTS: A study of 355 patients, 295 (83.1%) males and 60 (16.9%) females was carried out. The average age was 28.6 years (SD = 6.5). All serologies in 113 (31.8%) were available. The positive serologies for HIV, 64.6% for HBV and 64.4% had 71.1% for HCV. The three of them coexisted in a 35.4% between HIV, 39.1% of them were VHB and 88% VHC. 49.1% were VHB and VHC. The infection from any of the three virus was related with intravenous administration mechanism, but not with sex or drug type. CONCLUSION: The infection caused from the virus above mentioned is frequent in drug users. A not negligible percentage of patients could benefit from the hepatitis B vaccine administration (67.6%) or other preventive measures.

[Criteria for the development of a formulary of drugs in a basic health area and impact on prescription]. / Criterios de elaboración de un formulario de medicamentos en un área básica de salud e impacto sobre la prescripción.

OBJECTIVE: To promote rational prescription in Primary Care by elaborating a restricted list of medicines in a PC, the implementation of the list and the evaluation of its influence. DESIGN: Controlled intervention study. SETTING: Intervention group: Castelldefels Health Centre. CONTROL GROUP: Molí Nou HC in same health sector. PARTICIPANTS: Doctors from the PC teams of both centres. INTERVENTIONS: Initially the prescription for 1992 of the intervention group was analysed. The main therapeutic groups prescribed for on the initiative of the General Practitioners (GP) of the Castelldefels HC were identified and the intervention was then carried out on them. The PC team from the intervention group, chose the drugs by consensus, on the basis of pharmaceutical advice. MEASUREMENTS AND MAIN RESULTS: Castelldefels HD presented worse indicators than the rest of the Sector's. It was observed that the GPs decided 63.4% +/- 3.9% of their therapeutic prescriptions. The groups most prescribed for on GP initiative were systemic (J) and respiratory apparatus (R) anti-infection therapies. The intervention was verified with Macrolids, Beta-lactamics (excluding Cephalosporins) and Quinolones. In neither of the two HDs were statistically significant differences (p < 0.05) in the consumption of the selected antibiotics between the two periods observed. CONCLUSIONS: This process is aimed at altering GPs' attitudes, it is essential that they participate in the choice of medicines in order to keep them involved; and that the ongoing records of the chosen drugs are verified, with the evaluation of their influence then being just one more tool in this process.

[The law of "inverse care" in the detection of arterial hypertension and tobacco addiction]. / Ley del "cuidado inverso" en la detección de la hipertensión arterial y el tabaquismo.

OBJECTIVE: To identify the characteristics of the physician, of the demand for care, of the reason for the clinical consultation, of the patient's pathology and of the case's length of time under care, all of these in connection with the assessment by the Primary Care physician or nurse of both arterial tension (AT) and of the tobacco habit (TH) in the general population aged between 20 and 65. DESIGN: Descriptive study of a selection of clinical histories. SITE. Primary Care Centre in Castelldefels (Barcelona). PATIENTS OR OTHERS PARTICIPANTS: Random sample of 200 clinical histories of people, aged between 20 and 65, who requested treatment. MAIN MEASUREMENTS AND RESULTS: In 71 histories (36%) there was AT. In 62 (31.5%) TH had been recorded. There was a statistically significant link between both risk factors. Detection was linked to the feminine sex, being older, greater attendance and the presence of disease. Lack of continuity was accompanied by a higher recording of TH. There were considerable disparities, not explicable in terms of the variables studied, among professionals as to their habits in making an on-the-spot investigation. The existence of the sheet of basic data about closed items appears to favour detection. CONCLUSIONS: If there is a will to use primary Care centres for effective preventive action in the population as a whole, motivation of the professionals involved and organisational changes will be necessary so as not to perpetuate the law of inverse care.