Síndrome de Bouveret. A propósito de un caso / A Bouveret syndrome. A case -report

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Variables explicativas del gasto evitable generado por la no prescripción de la especialidad equivalente de menor precio / Explanatory variables of avoidable cost produced by not prescribing a cheaper equivalent drug

Objetivo: Identificar las variables explicativas del gasto evitable por la no prescripción de la especialidad de menor precio. Métodos: Se diseñó un estudio transversal sobre la población de médicos generales de atención primaria de Galicia (n = 1.500). Se seleccionó una muestra de 405 sujetos. Se recogieron las siguientes variables independientes a través de cuestionario postal: especialidad del médico, percepción de la calidad de las distintas fuentes de información de medicamentos, integración en equipos de atención primaria y número de pacientes. Las características del entorno fueron obtenidas a través de fuentes secundarias. Se generaron dos modelos de regresión múltiple utilizando como variables dependientes dos indicadores basados en el gasto evitable generado por la no prescripción de la especialidad esencialmente similar de menor precio. Resultados: El porcentaje de respuesta fue del 77,4 por ciento. La eficiencia de la prescripción no se encontró asociada con el nivel de formación del médico ni con las variables de utilización y de calidad atribuida a la información comercial o institucional. Tampoco la variable modelo sanitario resulta significativa. Únicamente el número de cartillas y el porcentaje de cartillas de pensionista muestran significación estadística. Conclusiones: Los resultados del estudio sugieren la escasísima importancia que los médicos conceden a la eficiencia en la prescripción. Así, con el fin de disminuir el gasto evitable por la no prescripción de la especialidad esencialmente similar de menor precio se debería reorientar los planes de estudios en la línea de asegurar que sus contenidos reflejen las prioridades sanitarias nacionales y los recursos existentes (AU)

One-to-one versus group sessions to improve prescription in primary care: a pragmatic randomized controlled trial.

OBJECTIVES: The objective of the study was to evaluate the effectiveness of 2 educational strategies aimed at improving prescribing standards in primary care. METHODS: A pragmatic controlled trial was designed; the study population included general and family practitioners in Galicia (northwestern Spain) divided into 3 study groups: a one-to-one education group (n = 98), a by-group education group (n = 92), and a control group (n = 405). The educational intervention included explicit recommendations for selecting nonsteroidal anti-inflammatory drugs (NSAIDs) for inflammation signs. Some of the subjects were given reminders. Mixed-effect linear models were applied to data analysis. Analyses were done by intention-to-treat. The dependent variable is a rate with a numerator that is the number of prescribed units of the NSAIDs recommended during intervention; the denominator is the total number of prescribed units of the NSAID total. RESULTS: One-to-one education obtained an average prescribing behavior improvement of 6.5% (P < 0.001) in the 9 months after intervention. In the education group, the average improvement was 2.4% (P < 0.05) for the same period. Statistically significant differences were observed between the group intervention and one-to-one groups. The reminder increased significantly the effectiveness of the one-to-one intervention. CONCLUSIONS: A single, short educational session to primary care doctors can improve their prescribing standards during long periods of > or = 9 months. Of the 2 strategies followed in the trial, one-to-one education has shown to be the most effective. Results also show that the effectiveness of these interventions increases when presented together with written material.

[Explanatory variables of avoidable cost produced by not prescribing a cheaper equivalent drug]. / Variables explicativas del gasto evitable generado por la no prescripción de la especialidad equivalente de menor precio.

OBJECTIVE: To identify the explanatory variables of avoidable cost produced by not prescribing a cheaper equivalent drug. METHODS: We conducted a cross-sectional study of 1,500 primary care physicians in Galicia (northwest Spain). The sample consisted of 405 primary care physicians. The following independent variables were collected through a postal questionnaire physicians' training and specialty, physicians' perception of the quality of available drug information sources, type of practice, and number of patients. The environmental characteristics of the practice were obtained from secondary sources. Multiple regression models were constructed using as dependent variables two indicators based on unnecessary cost produced by not prescribing cheaper equivalents. RESULTS: The response rate was 77,4%. No association was found between prescription efficiency and the level of the physician's training, or with the variables of utilization or the quality of commercial and institutional information. The variable of health model was not significant. The only statistically significant variables were the number of identification cards and the percentage of pensioners' identification cards. CONCLUSIONS: The results of this study suggest that physicians attach little importance to prescription efficiency. Thus, to decrease avoidable cost produced by not prescribing a cheaper equivalent drug, the medical curriculum should be modified to ensure that is contents reflect national health priorities and current resources.

¿Es legítimo el uso de placebo en atención primaria? / Is it legitimate to use placebos in primary care?

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[Self-medication: concept and "users'" profile]. / La automedicación: concepto y perfil de sus "usuarios".

Self-medication constitutes one of the most modern expressions of the always present need of men and women for care of their health. However, in contrast to other expressions of selfcare, the self-medication includes, for a good part of population and the most of the doctors, negative connotations. Contrary to this vision, the WHO marks the existence of a valid role for self-medication in developed societies. This article has two objectives: to revise the different concepts of self-medication proposed in literature; and to revise the socio-demographic and socio-medical factors connected with the practice of self-medication.

La automedicación: concepto y perfil de sus 'usuarios' / Self-medication: concept and "users" features

La automedicación constituye una de las expresiones más modernas de la siempre presente necesidad de hombres y mujeres de velar por su propia salud. Sin embargo, y a diferencia de otras expresiones de los autocuidados, la automedicación tiene, para buena parte de la población y para la mayoría de los médicos, connotaciones negativas. Contrariamente a esta visión, la OMS señala la existencia de un lugar válido para la automedicación en las sociedades desarrolladas. Este trabajo tiene como objetivos: revisar los distintos conceptos de automedicación propuestos en la literatura, y revisar los factores sociodemográficos y sociomédicos asociados a la práctica de la automedicación (AU)

Sociodemographic factors related to self-medication in Spain.

To identify the sociodemographic factors associated to self-medication (i.e. use of non-prescription medicines) and undesirable self-medication, a cross-sectional study was carried out using a sample (n = 20,311) representative of the population of adults of 16 years of age and older in Spain. Multivariate Cox's regression was used. The prevalence of self-medication in the sample was 12.7% during the two weeks preceding the interview. Self-medication is more prevalent among women, persons who live alone, and persons who live in large cities. For persons who reported acute disorders, self-medication prevalence was higher among those with higher educational levels. The prevalence of undesirable self-medication in the sample was 2.5% during the two weeks previous to the interview. Undesirable self-medication is twice as common among persons older than 40 years, as compared to persons younger than 27 years. Undesirable self-medication prevalence is 53.0% higher among those who live alone as compared to those who live with their partner (95% confidence interval (CI): 15.2-103.2) and 36.8% higher among students as compared to full-time workers (95% CI: 1.9-83.5). People over 40 years of age, people living alone, and students should be the priority target populations for public health education programs aimed at improving the quality of self-medication behavior.

Influence of physician's education, drug information and medical-care settings on the quality of drugs prescribed.

OBJECTIVE: To identify factors associated with low prescription quality in primary care. METHODS: We carried out a cross-sectional study on a sample of 405 primary care physicians in Galicia (Northwest Spain). The following independent variables were collected through a mail questionnaire survey: physician's education and speciality, physician's perception of the quality of available drug information sources, type of practice and number of patients. We constructed multiple regression models using as dependent variables four indicators of the quality of drugs prescribed. RESULTS: The response rate was 75.2%. The quality of drugs prescribed was found to be associated with regulated physician training (P = 0.001), perceived credibility of information sources (P = 0.013) and environmental characteristics of the practice (reform model and number of patients' cards). CONCLUSION: Study results suggest that in order to improve the quality of drugs prescribed, physician education and training must be improved and the role of pharmaceutical companies in physician training should be limited, emphasising more objective sources of information, such as therapeutic guidelines. Our results also underline the need to complete the reform of our primary care system and promote better relationships among physicians and between physicians and patients.