Clinical applicability and cost-effectiveness of DIABSCORE in screening for type 2 diabetes in primary care.

AIMS: To evaluate the applicability and cost-effectiveness of a clinical risk score (DIABSCORE) to screen for type 2 diabetes in primary care patients. METHODS: Multicenter cross-sectional study of 10,508 adult no previously diagnosed with diabetes, in 2 Spanish regions (Canary Islands and Valencian Community). The variables comprising DIABSCORE were age, waist to height ratio, family history of diabetes and gestational diabetes. ROC curves were obtained; the diabetes prevalences odds ratios (HbA1c ≥6.5%) between patients exposed and not exposed to DIABSCORE ≥100, and to fasting blood glucose ≥126mg/dL were calculated. The opinions of both the professionals and the patients concerning DIABSCORE were collected, and a cost-effectiveness analysis was performed. RESULTS: In both regions, the valid cut-off point for diabetes (DIABSCORE=100), showed an area under the curve >0.80. The prevalences odds ratio of diabetes for DIABSCORE ≥100 was 9.5 (3.7-31.5) in Canarian and 18.3 (8.0-51.1) in Valencian; and for glucose ≥126mg/dL it was, respectively, 123.0 (58.8-259.2) and 303.1 (162.5-583.8). However, glucose ≥126mg/dL showed a low sensitivity (below 48% in both communities) as opposed to DIABSCORE ≥100 (above 90% in both regions). Professionals (100%) and patients (75%) satisfaction was greater when using DIABSCORE rather than glucose measurement for diabetes screening. The cost of each case of diabetes identified was lower with DIABSCORE ≥100 (7.6 € in Canarian and 8.3 € in Valencian) than glucose ≥126mg/dL (10.8 € and 10.5 €, respectively). CONCLUSIONS: DIABSCORE is an applicable and cost-effective screening method for type 2 diabetes in primary care.

[The PROPRESE trial: results of a new health care organizational model in primary care for patients with chronic coronary heart disease based on a multifactorial intervention]. / El estudio PROPRESE: resultados de un nuevo modelo organizativo en atención primaria para pacientes con cardiopatía isquémica crónica basado en una intervención multifactorial.

OBJECTIVE: Comparison of the results from the EUROASPIRE I to the EUROASPIRE III, in patients with coronary heart disease, shows that the prevalence of uncontrolled risk factors remains high. The aim of the study was to evaluate the effectiveness of a new multifactorial intervention in order to improve health care for chronic coronary heart disease patients in primary care. METHODS: In this randomized clinical trial with a 1-year follow-up period, we recruited patients with a diagnosis of coronary heart disease (145 for the intervention group and 1461 for the control group). An organizational intervention on the patient-professional relationship (centered on the Chronic Care Model, the Stanford Expert Patient Programme and the Kaiser Permanente model) and formative strategy for professionals were carried out. The main outcomes were smoking control, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP). A multivariate analysis was performed. RESULTS: The characteristics of patients were: age (68.4±11.8 years), male (71.6%), having diabetes mellitus (51.3%), dyslipidemia (68.5%), arterial hypertension (76.7%), non-smokers (76.1%); LDL-C < 100mg/dL (46.9%); SBP < 140mmHg (64.5%); DBP < 90 (91.2%). The multivariable analysis showed the risk of good control for intervention group to be: smoking, adjusted relative risk (aRR): 15.70 (95% confidence interval [95%CI], 4.2-58.7); P < .001; LDL-C, aRR: 2.98 (95%CI, 1.48-6.02); P < .002; SPB, aRR: 1.97 (95%CI, 1.21-3.23); P < .007, and DBP: aRR: 1.51 (95%CI, 0.65-3.50); P < .342. CONCLUSIONS: An intervention based on models for chronic patients focused in primary care and involving patients in medical decision making improves cardiovascular risk factors control (smoking, LDL-C and SBP). Chronic care strategies may be an efficacy tool to help clinicians to involve the patients with a diagnosis of CHD to reach better outcomes.

El estudio PROPRESE: resultados de un nuevo modelo organizativo en atención primaria para pacientes con cardiopatía isquémica crónica basado en una intervención multifactorial / The PROPRESE trial: results of a new health care organizational model in primary care for patients with chronic coronary heart disease based on a multifactorial intervention

OBJETIVO: Comparando los resultados obtenidos en los estudios EUROASPIRE I y EUROASPIRE III en pacientes con cardiopatía isquémica se muestra que el grado de control de los factores de riesgo mayores es mejorable. El objetivo de este estudio es evaluar la eficacia de una intervención multifactorial orientada a la mejora del grado de control en estos pacientes en el ámbito de la atención primaria. MÉTODOS: En este estudio de intervención aleatorizado, con 1 año de seguimiento, se reclutó a pacientes con diagnóstico de cardiopatía isquémica (145 en el grupo de intervención y 1.461 en el grupo control). Se aplicó una intervención organizativa mixta basada en la mejora de la relación profesional sanitario-paciente (de acuerdo a los modelos del Chronic Care, el Stanford Expert Patient Programme y el Kaiser Permanente) y en la formación profesional continuada. Los principales resultados fueron el efecto sobre el tabaquismo, el colesterol unido a lipoproteínas de baja densidad (cLDL), la presión arterial sistólica (PAS) y la presión arterial diastólica (PAD) a través de un análisis multivariable. RESULTADOS: Las características de los pacientes fueron: edad (68,4 ± 11,8 años), varones (71,6%), diabetes mellitus (51,3%), dislipemia (68,5%), hipertensión arterial (76,7%), no fumadores (76,1%); cLDL < 100 mg/dl (46,9%); PAS < 140 mmHg (64,5%); PAD < 90 (91,2%). El análisis multivariable mostró que el riesgo para el buen control en el grupo de intervención fue tabaquismo, riesgo relativo ajustado (RRa): 15,7 (intervalo de confianza del 95% [IC95%], 4,2-58,7); p < 0,001; cLDL, RRa: 2,98 (IC95%, 1,48-6,02); p < 0,002; PAS, RRa: 1.97 (IC95%, 1,21-3,23); p < 0,007, y PAD; RRa: 1,51 (IC95%, 0,65-3,50); p < 0,342. CONCLUSIONES: Una intervención multifactorial basada en el modelo de paciente crónico centrada en atención primaria y que facilite la toma de decisiones compartidas con los pacientes y la formación de los profesionales mejora el grado de control de los factores de riesgo cardiovascular (tabaquismo, cLDL y PAS). Las estrategias de mejora en la atención de la cronicidad pueden ser una herramienta eficaz para conseguir mejores resultados

OBJECTIVE: Comparison of the results from the EUROASPIRE I to the EUROASPIRE III, in patients with coronary heart disease, shows that the prevalence of uncontrolled risk factors remains high. The aim of the study was to evaluate the effectiveness of a new multifactorial intervention in order to improve health care for chronic coronary heart disease patients in primary care . METHODS: In this randomized clinical trial with a 1-year follow-up period, we recruited patients with a diagnosis of coronary heart disease (145 for the intervention group and 1461 for the control group). An organizational intervention on the patient-professional relationship (centered on the Chronic Care Model, the Stanford Expert Patient Programme and the Kaiser Permanente model) and formative strategy for professionals were carried out. The main outcomes were smoking control, low-density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP) and diastolic blood pressure (DBP). A multivariate analysis was performed. RESULTS: The characteristics of patients were: age (68.4 ± 11.8 years), male (71.6%), having diabetes mellitus (51.3%), dyslipidemia (68.5%), arterial hypertension (76.7%), non-smokers (76.1%); LDL-C < 100 mg/dL (46.9%); SBP < 140 mmHg (64.5%); DBP < 90 (91.2%). The multivariable analysis showed the risk of good control for intervention group to be: smoking, adjusted relative risk (aRR): 15.70 (95% confidence interval [95%CI], 4.2-58.7); P < 0.001; LDL-C, aRR: 2.98 (95%CI, 1.48-6.02);P <0 .002; SPB, aRR: 1.97 (95%CI, 1.21-3.23); P < 0.007, and DBP: aRR: 1.51 (95%CI, 0.65-3.50); P < 0.342. CONCLUSIONS: An intervention based on models for chronic patients focused in primary care and involving patients in medical decision making improves cardiovascular risk factors control (smoking, LDL-C and SBP). Chronic care strategies may be an efficacy tool to help clinicians to involve the patients with a diagnosis of CHD to reach better outcomes

Indicadores de calidad en hiperplasia benigna de próstata. Un estudio cualitativo / Quality of care indicators for benign prostatic hyperplasia. A qualitative study

OBJETIVO: Valorar posibles indicadores de calidad de la atención a la hiperplasia benigna de próstata (HBP) y sus fortalezas y debilidades para su incorporación a los sistemas de información sanitaria. DISEÑO: Reunión de expertos, estructurada siguiendo procedimientos adaptados de las técnicas de grupo nominal y método de consenso Rand. Emplazamiento: Escuela Valenciana de Estudios de la Salud. Participantes y/o contextos: Participaron 40 panelistas (74% médicos, 70% del ámbito de la atención primaria) con experiencia en el manejo de la HBP pertenecientes a 15 Departamentos de la Agencia Valenciana de Salud. MÉTODO: Se realizaron 3 talleres simultáneos (exploración y diagnóstico, tratamiento farmacológico y adecuación y resultados) en los que se valoraron los 15 indicadores seleccionados por el grupo coordinador. RESULTADOS: Once de los 15 indicadores obtuvieron puntuaciones en el rango de alta relevancia. Los 5 mejor valorados fueron: el uso de alfabloqueante + inhibidores de la 5 alfa-reductasa a partir de determinado nivel de gravedad, el tacto rectal en la valoración inicial, el seguimiento con el Índice Internacional de Síntomas Prostáticos (IPSS), la tasa de sondaje urgente en urgencias hospitalarias, la valoración inicial con el IPSS y el uso de alfabloqueante previo a la retirada de sonda por retención aguda de orina. CONCLUSIONES: Parte de los indicadores valorados pueden ser útiles para su incorporación a los sistemas de información sanitaria

OBJECTIVE: To assess quality of care indicators for benign prostatic hyperplasia (BPH), and to evaluate their strengths and weaknesses for incorporation into health information systems. DESIGN: Structured expert meeting, using procedures adapted from the nominal group techniques and the Rand consensus method. Setting: Valencian School of Health Studies. Participants and/or contexts: Forty panel lists (74% doctors, 70% from primary care settings)with experience in the management of BPH from 15 departments of the Valencia Health Agency. METHOD: Three workshops were held simultaneously (examination and diagnosis, drug therapy, and appropriateness and results), and the 15 quality indicators selected by the coordination group were assessed. RESULTS: Eleven of the 15 indicators scored in the range of high relevance. The 5 best rated were: the use of alpha-blockers + 5-alpha reductase inhibitor from certain severity level, digital rectal examination in the initial assessment, follow-up with the International Prostate Symptoms Score (IPSS), the rate of urgent catheterization in Hospital Accident & Emergency Units, initial assessment with the IPSS and the use of alpha-blockers prior to catheter removal for acute retention of urine. CONCLUSIONS: Some of the assessed indicators can be useful for incorporation into health information systems

[Quality of care indicators for benign prostatic hyperplasia. A qualitative study]. / Indicadores de calidad en hiperplasia benigna de próstata. Un estudio cualitativo.

OBJECTIVE: To assess quality of care indicators for benign prostatic hyperplasia (BPH), and to evaluate their strengths and weaknesses for incorporation into health information systems. DESIGN: Structured expert meeting, using procedures adapted from the nominal group techniques and the Rand consensus method. SETTING: Valencian School of Health Studies. PARTICIPANTS AND/OR CONTEXTS: Forty panellists (74% doctors, 70% from primary care settings) with experience in the management of BPH from 15 departments of the Valencia Health Agency. METHOD: Three workshops were held simultaneously (examination and diagnosis, drug therapy, and appropriateness and results), and the 15 quality indicators selected by the coordination group were assessed. RESULTS: Eleven of the 15 indicators scored in the range of high relevance. The 5 best rated were: the use of alpha-blockers + 5-alpha reductase inhibitor from certain severity level, digital rectal examination in the initial assessment, follow-up with the International Prostate Symptoms Score (IPSS), the rate of urgent catheterization in Hospital Accident & Emergency Units, initial assessment with the IPSS and the use of alpha-blockers prior to catheter removal for acute retention of urine. CONCLUSIONS: Some of the assessed indicators can be useful for incorporation into health information systems.

Effectiveness of a new health care organization model in primary care for chronic cardiovascular disease patients based on a multifactorial intervention: the PROPRESE randomized controlled trial.

BACKGROUND: To evaluate the effectiveness of a new multifactorial intervention to improve health care for chronic ischemic heart disease patients in primary care. The strategy has two components: a) organizational for the patient/professional relationship and b) training for professionals. METHODS/DESIGN: Experimental study. Randomized clinical trial. Follow-up period: one year. STUDY SETTING: primary care, multicenter (15 health centers). For the intervention group 15 health centers are selected from those participating in ESCARVAL study. Once the center agreed to participate patients are randomly selected from the total amount of patients with ischemic heart disease registered in the electronic health records. For the control group a random sample of patients with ischemic heart disease is selected from all 72 health centers electronic records. DISCUSSION: This study aims to evaluate the efficacy of a multifactorial intervention strategy involving patients with ischemic heart disease for the improvement of the degree of control of the cardiovascular risk factors and of the quality of life, number of visits, and number of hospitalizations. TRIAL REGISTRATION: NCT01826929.

Asma bronquial

Guía de actuación clínica en Atención Primaria que contiene los siguientes apartados : introducción, definición, diagnóstico, clasificación según la gravedad, tratamiento del asma, tratamiento de la crisis de asma, educación del paciente asmático, asma en situaciones especiales, criterios de interconsulta y/o derivación al especialista correspondiente y distribución de actividades en Atención Primaria. También incluye una guía de consulta rápida.