[A multicenter primary care study on alcohol consumption]. / Estudio multicéntrico sobre el abordaje del consumo de alcohol en atención primaria.

OBJECTIVES: To find records of alcoholic drink consumption in general medical records and actions taken when at-risk drinkers were identified. DESIGN: A descriptive study using clinical auditing at 4 Health Centres. PARTICIPANTS: 399 Primary Care (PC) clinical records. MEASUREMENTS AND MAIN RESULTS: Only 24.8% of the clinical records included alcoholic drink consumption over the last two years. Only 11 (2.8%)-all for men-of the records examined fulfilled the criteria for the drinker being considered at-risk. Low recording of alcohol might be for different reasons: some related to the professionals, others to the internal organisation of the PC team, yet others due to the external support structure. Causes related to internal organisation and the professionals were considered priority, as it was harder to intervene from the team into external causes. CONCLUSIONS: The results show low recording of alcohol consumption and justify the design of specific interventions. The methodology of continual quality improvement helps us identify the causes, the possible solutions and to design the strategy for change.

[Infectious diseases in primary care]. / Patología infecciosa en atención primaria.

OBJECTIVE: To find the frequency and seasonal variability of the infectious diseases detected over a year. DESIGN: Observational prospective study. SETTING: Primary care centre. PATIENTS: Simple multi-stage random sampling of the patients over 14 seen on demand at general medical clinics and the Casualty department between June 1991 and May 1992. MEASUREMENTS AND MAIN RESULTS: Out of 49,193 attendances during the study period, the attendance sample was 2,523, of which 474 (18.8%; CI: 17.3-20.3%) were for infectious conditions. Average age of these 474 was 39 (SD: 19.17); 55% were women. Frequency of respiratory infections was 64.1% (CI: 59.8-68.5%). The correlation coefficient between respiratory infections and the total number of infections was 0.94 (R2 = 0.89). The frequency of infections oscillated between 29% (CI: 23-35%) in February and 10% (CI: 5.8-14.5%) in May. CONCLUSIONS: Infectious conditions account for a considerable percentage of the total number of primary care attendances. There is a seasonal variation in infections, which is mainly due to respiratory infections.

[Are antibiotics correctly prescribed in primary care?]. / Se prescriben correctamente los antibióticos en atención primaria?

OBJECTIVE: To identify the antibiotic prescriptions and evaluate their suitability for the infectious conditions treated at a Primary Care Centre. DESIGN: A prospective observation study. SETTING: La Mina Primary Care Centre. Sant Adrià de Besòs (Barcelona). PATIENTS AND OTHER PARTICIPANTS: The on-demand visits of patients over 14 to the General Medicine and Emergency clinics between June 1991 and May 1992 provided the data through a simple multi-stage random sample. MEASUREMENTS AND MAIN RESULTS: On the basis of the clinical notes, these variables were recorded: age, gender, diagnosis, the antibiotic prescribed and its manner of administration. The indication and choice of treatment was assessed in line with previously established criteria, as well as whether the antibiotic was first-choice in Primary Care. Infections treated in hospital or by specialists, non-bacterial cutaneous infections and Conjunctivitis were excluded. Out of 2,523 people examined, 474 presented infectious conditions (18.8%); the most common of these were infections of the upper respiratory tract (46.4%) and acute Bronchitis (17.3%). An antibiotic was prescribed in 206 cases (43.3%). The most used antibiotics were: Amoxicillin (41.5%), Penicillin (19.0%), Cloxacillin (11.2%), Erythromycin (10.2%) and Pipemidic Acid (7.8%). They were orally taken in 89.4% of cases. 92.3% of the antibiotics were first-choice. Overall fitness of treatment was 86.3% (56.5% unnecessary and non-prescribed treatment; and 29.7% necessary and using the recommended antibiotic). The least suitable treatment was observed for cases of acute Bronchitis without any risk factors. CONCLUSIONS: Prescriptions are adjusted to the recommendations on antibiotic policy in Primary Care, although less suitable treatment was observed for acute Bronchitis. The importance of applying a methodology based on objective criteria, in order to make a qualitative analysis in studies on the use of medication, is highlighted.