Promoción de la investigación clínica en atención primaria de salud / Promotion of clinical research in primary health care

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[Induced prescription from reference hospital Universitari Vall d'Hebron to general practitioners]. / Prescripción inducida a médicos de atención primaria procedente del hospital de referencia, Hospital Universitari Vall d'Hebron.

OBJECTIVES: Our objectives were to describe proportion of patients with induced prescription (IP) from reference hospital, the information about diagnosis and treatment that GP get as well as their agreement with the prescription. We also analyzed the quality of IP assessed by GP's quality of prescription criteria. DESIGN: Cross-sectional study. SETTING: Six urban health care centers. PARTICIPANTS: Patients and drugs prescribed from the reference hospital and derivated to health care center to get treatments. MEASUREMENTS: Origin of patients, diagnosis, treatment and the GP's agreement with it, and whether that information was enough to allow patient's control. MAIN RESULTS: Thirty six GP collected data from 323 patients and 844 drugs from reference hospital. 52% (95% CI, 47-58) of IP came from the emergency room. Medical conditions more frequently associated with IP were chronic obstructive pulmonary disease, lumbosciatica and traumatism. The most prescribed drugs were analgesics and NSAIDs. GP's agreement with IP reached 63% (95% CI, 60-67). Most frequent disagreement cause was drug selection (61 drugs; 7.2% of IP). In some 20% (95% CI, 16-25) of patients information wasn't sufficient enough to assume patient's control. CONCLUSIONS: A stronger relation between GP's and hospital doctors would be needed to establish common treatments for patients' frequent conditions and their follow-up.

Prescripción inducida a médicos de atención primaria procedentes del hospital de referencia, Hospital Universitari Vall d´Hebron / Induced prescription from Reference Hospital Universitari Vall d´Hebron to general practitioners

Objetivos. Describir el porcentaje de pacientes con prescripción inducida (PI) por el hospital de referencia, así como la información aportada sobre el diagnóstico y.el tratamiento, el grado de acuerdo del médico de familia con éstos y la evaluación de la PI según los criterios de calidad de prescripción de atención primaria. Diseño. Estudio descriptivo transversal. Emplazamiento. Un total de 6 equipos de atención primaria urbanos. Participantes. Pacientes derivados y fármacos indicados por el hospital de referencia y solicitados a los médicos de familia de atención primaria. Mediciones principales. Procedencia de los pacientes, diagnóstico, tratamiento, grado de acuerdo con éstos e información aportada para el control del paciente. Resultados. Un total de 36 médicos recogieron datos de 323 pacientes y 844 fármacos procedentes del hospital de referencia. El 52 por ciento (intervalo de confianza [IC] del 95 por ciento, 47-58) de la PI se originó en urgencias. Las enfermedades que originaron más PI fueron la enfermedad pulmonar obstructiva crónica, la lumbociatalgia y los traumatismos. Los fármacos más inducidos fueron analgésicos y antiinflamatorios no esteroideos. Los médicos de familia estuvieron de acuerdo con el 63 por ciento de la PI (IC del 95 por ciento, 60-67). La mayor discrepancia se produjo por la selección del fármaco (61 fármacos; 7,2 por ciento de la PI). En un 20 por ciento (IC del 95 por ciento, 16-25) de pacientes la información fue considerada insuficiente para su control. Conclusiones. Sería necesaria una mayor relación entre los médicos de familia y hospitalarios para establecer acuerdos en la selección de fármacos para el tratamiento de enfermedades frecuentes y en el seguimiento de los pacientes (AU)

[Evidence based medical treatment of heart failure]. / Tratamiento médico de la insuficiencia cardíaca basado en la evidencia.

INTRODUCTION AND OBJECTIVES: Recommendations for the treatment of heart failure were carried out by a systematic review of the available evidence of the different pharmacologic treatments. MATERIAL AND METHODS: The review focused on the treatment of chronic and systolic heart failure. All the studies published in english about the pharmacologic treatment of heart failure where identified. The evidence of every pharmacologic treatment was classified according to: a) efficacy variables (reduction of mortality and hospitalizations, improvement of functional class, ejection fraction and exercise tolerance), and b) the level of quality of the evidence according to an evaluation scale. The evidence was also reviewed for the comparisons and the combinations of the pharmacologic treatments, as well as for the toxicity and costs of treatments. RESULTS: The recommendations were defined according to the NYHA functional class and were classified in the A, B and C categories according to the level of quality of the available evidence. The evidence on mortality was considered the most important. First line drugs, the alternatives and other possible treatments were take into account. CONCLUSIONS: There is enough evidence based on information about some variables such as reduction of mortality or hospitalizations to carry out treatment recommendations in all stages of heart failure. This point out the interest ant the priority of used them in the evaluation and improvement of the results of heart failure.

[Variability of prescriptions in prevailing indications in primary care: a multicenter study. Study of Prescriptions in Primary Care (GEPAP)]. / Variabilidad de la prescripción en indicaciones prevalentes en atención primaria: un estudio multicéntrico. Estudio de la Prescripción en Atención Primaria (GEPAP).

OBJECTIVES: It seems convenient to have information on how drugs are used in everyday's practice in order to be able to make drug selection proposals. The aim of this study was to describe the prescription profile in a number of prevalent indications and its variability among the participating centres. DESIGN: Cross-sectional descriptive study. SETTING: Four Primary care centres. PARTICIPANTS: Each of the 32 participating physicians collected information on 200 consecutive patients who received a prescription between October 1994 and January 1995. MEASUREMENTS AND MAIN RESULTS: 5932 patients, with a mean age of 56 years (SD = 18 years) were included. We analysed the prescriptions they received for hypertension (988 patients), hyperlipidaemia (254), peptic ulcer (PU) (136), nonulcer dyspepsia (271), chronic obstructive lung disease (COLD) (293), asthma (134) and depression (261). We describe the number of different drugs used (range: 14 for PU-63 for hypertension), the number of drugs that accounted for 90% of the prescriptions (range: 5 for PU-20 for depression), the number of recently marketed drugs (range: 0 for PU-9 for hypertension) and the proportion of prescribed drugs they accounted for (range: 0% for PU-12.4% for depression). We found an important variability among the participating centres in all the considered indications; for instance, statins for hyperlipidaemia. CONCLUSION: A rather high variability in prescription habits among participating centres was found. Prescription was highly concentrated in a few number of drugs, and the use of recently marketed drugs accounted for less than 10% of all prescriptions, although data show variability according to the considered indications.