Ecografía pulmonar en paciente con disnea y fiebre en atención primaria / Lung ultrasound in a patient with dyspnoea and fever in primary care

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Dispepsia con síntomas de alarma: endoscopia sí, pero también ecografía / Dyspepsia with alarm symptoms: Endoscopy yes, but ultrasound as well

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El medio rural: una visión mirando al futuro (II) / The rural world: a forward-looking view (and II)

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[Current status of oral anticoagulation control in primary care]. / Situación actual del control de la anticoagulación oral en atención primaria.

OBJECTIVE: To know the present situation about the follow-up of the patients with oral anticoagulant therapy (OAT) in primary care centers, the difficulties felt in its implantation and the professionals attitudes. DESIGN: Cross-sectional descriptive study. SETTING: All Spanish primary care centers. PARTICIPANTS: The study subjects are the managers of all primary care centers. We selected a sample of 227 centers (the total number is 1854), for prevalence of 50%, confidence at 95%, precision 7% and 30% loss. The sample is stratified by regions. MEASUREMENTS AND MAIN RESULTS: We sent a questionnaire by post to the managers of sample primary care centers. We sent a new mailing, after three months, to the "no answers". A rate of 72.7% answers were obtained. 23% of sample primary care centers do follow-up of OAT al less in a part of the patients. Reduced access to hospital is the only structural cause that it has influence significantly. The main problem to carry out this activity is coordination with Haematology reference service. CONCLUSIONS: One every four Spanish primary care centers make the follow-up of OAT, higher when primary care centers are far away from hospital. So, accessibility is the factor with more influence in the decision of carry out OAT follow-up. Coordination with haematology services is the main problem to solve.

[Therapeutic quality control of follow-up of oral anticoagulation in primary care: 4-year experience]. / Control de calidad terapéutico del seguimiento de la anticoagulación oral en atención primaria: cuatro años de experiencia.

OBJECTIVE: To find the rate of therapeutic control and the frequency of complications among patients receiving oral anticoagulant therapy, attending in a primary care center. DESIGN: Descriptive study over the last four years. SETTING: An urban primary care center. PATIENTS AND METHODS: We included all patients in oral anticoagulant treatment controlled in our center among 1989 and 1993, excluding that patients with less than three months in control, or discontinued control. The prothrombin time was measured by international normalized ratio (INR). To measure the therapeutic quality control, we used the method proposed by the International Society of Thrombosis and Haemostasis. The frequency of complications was measured in number of events/100 patients/year. RESULTS: In the 136 patients studied the average time in control was 23.57 months. The 68.37 percent of determinations were within satisfactory ranges. The frequency of minor hemorrhages was 13.36 by 100 patients/year, 1.08 of major hemorrhages, and 2.53 of thromboembolism events. CONCLUSIONS: The results obtained in this audit are similar to the communicated by other centers. The therapeutic control of oral anticoagulants can carry out in primary care with enough quality and some advantages: more facility to health education, better accessibility, and more integration of anticoagulation therapy in global care of patients.

[Role of the primary care physician in the diagnosis and treatment of thyroid diseases]. / Papel del médico de atención primaria en el diagnóstico y seguimiento de la patología tiroidea.

OBJECTIVE: To determine the participation of the primary care physician in the diagnosis and follow-up of thyroid pathology. DESIGN: A descriptive study of a crossover type. SETTING: The Isabel II Health centre at Parla (Madrid). PATIENTS: All those diagnosed with thyroid pathology registered with the two primary care teams at the Isabel II Health Centre up to august 1992. Data were obtained from the morbidity records and the District's Endocrinology Clinic. MAIN RESULTS: 196 patients, with 250 diagnoses overall, were located. The main ones were: hypothyroidism (27.6%), normally functioning goitres (24.4%) and hyperthyroidism (23.2%). The general practitioner was aware of the illness in 87% of cases, as against the specialist in 97%. The provisional diagnosis was carried out at the primary care level in 56% of cases; the final one only in 18%. With respect to patients' subsequent treatment, it was exclusively specialist in 72% of cases and joint in 19%. CONCLUSIONS: The primary care doctor is aware of the majority of his/her patients' thyroid illnesses, but not all. We recommend greater participation of primary care in the initial diagnostic approach to these conditions; and, in particular, a closer involvement in the treatment of these pathologies, which requires that the primary care doctor must have access to precise diagnostic methods.

[The coverage and quality of the follow-up in the prenatal care at a health center]. / Cobertura y calidad del seguimiento de la atención prenatal en un centro de salud.

OBJECTIVE: To discover the recruitment and follow-up coverage of Prenatal Care in Parla Health Center, derivation causes and quality control of follow-up. DESIGN: Descriptive and retrospective study. PATIENTS: We obtained 445 newborns (from May 1991 to April 1992) in pediatric records of Health Center, and encountered 412 women records (93%). MEASUREMENTS AND MAIN RESULTS: We measured general practitioner coverage, obstetric derivation and causes, and audit of 23 quality markers selected. General practitioner diagnosed pregnancy in 142 cases (32%). Of them, 63 were derivated at the beginning, 19 at the following-up, and 60 cases (13.5% of total newborns known) were completed in primary care. In these, 19 of 23 quality markers were fulfilled over 80%. CONCLUSIONS: We emphasized the poor capacity of primary care for recruiting pregnancies in the moment (most of them went straight to obstetric), and the excellent results of quality control markers. These situations can be as similar as many others Health Centers in urban areas. Coordination with Reference Obstetric Services is necessary as a strategy to increased the coverage of these programs.