Mortalidad y factores asociados de los pacientes con enfermedades crónicas complejas del ámbito rural y zonas de transformación social en Andalucía / Mortality and associated factors of patients with complex chronic diseases in rural and social transformation areas in Andalusia

OBJETIVO: Determinar la mortalidad al año y los factores relacionados en pacientes crónicos complejos (PCC) de centros de salud rurales y zonas de necesidades de transformación social (ZNTS) de Atención Primaria (AP) de Andalucía. MATERIAL Y MÉTODO: Diseño: descriptivo longitudinal prospectivo abierto de un año. Ámbito: 40 centros de salud. Sujetos: PCC mayores de 18 años con criterios de pluripatología y consentimiento a participar. Muestra: 814 sujetos (intervalo de confianza del 95%; riesgo alfa 0,03; p 0,2; incremento del 20% por posibles pérdidas). Variables: Dependiente: Mortalidad al año. Independientes: sociodemográficas, sociofamiliares, clínicas, funcionales (índice de Barthel -IB-, índice de Lawton-Brody), cognitivas (test de Pfeiffer), fármacos prescritos, uso de recursos sociosanitarios y calidad de vida (EQ-5D). Recogida de datos: entrevista e historia clínica. RESULTADOS: 832 PCC fueron incluidos (48,8% mujeres). La mortalidad al año fue 17,8% (n=148). El modelo de regresión logística para mortalidad incluyó: edad mayor de 85 años, presencia de cuidador, hemoglobina menor de 10g/L, ingreso hospitalario en el último año, IB menor de 60 puntos y neoplasia activa. La calibración del modelo fue buena (p = 0,85 en el test de Hosmer-Lemeshow) con buen poder de discriminación (área bajo la curva ROC 0,72 [IC 95% 0,68 a 0,77]). CONCLUSIONES: La mortalidad al año en PCC atendidos en centros de salud rurales y ZNTS de AP fue del 17,8%. El conocimiento de los factores relacionados con la mortalidad en este grupo de pacientes contribuye al abordaje de necesidades y gestión de los recursos sociosanitarios

OBJECTIVE: To determine one-year mortality and associated factors in patients with complex chronic diseases (CCP) in rural health centres and social transformation needs areas (STNA) in Primary Health Care (PHC) in Andalusia. MATERIAL AND METHODS: Design: 1-Year longitudinal observational prospective open study. SETTING: 40 health centre. Subjects: consenting subjects over 18yr according multiple health condition criteria. Sample Size: 814 subjects (confidence interval 95%, alpha risk 0.03%, p=.2; 20% of sample increase due to possible losses). End-point: 1-year Mortality. Independent variables: socio-demographic, socio-familial, clinical, functional (Barthel Index -BI-, Lawton-Brody Index), cognitive (Pfeiffer Test), prescribed drugs, social healthcare resources consumption, and quality of life (EQ-5D). Data source: Interview and computerised clinical history. RESULTS: A total of 832 CCP were included (48.8% women). One-year mortality was 17.8% (n=148). Logistic regression model for mortality included: aged 85 and over, having a caregiver, haemoglobin level less 10g/L, hospital admission in last year, BI under 60 points, and active neoplasia. The calibration obtained from model was good (p=.85 in the Hosmer-Lemeshow goodness-of-fit test), and the discrimination power also good (AUC=0.772 [0.68-0.77] in ROC curve). CONCLUSIONS: 1-year mortality of CCP in rural centres and STNA in PHC was 17.8%. Knowledge of the factors related to the mortality of CCP helps to approach the needs and social-health resources management

[Mortality and associated factors of patients with complex chronic diseases in rural and social transformation areas in Andalusia]. / Mortalidad y factores asociados de los pacientes con enfermedades crónicas complejas del ámbito rural y zonas de transformación social en Andalucía.

OBJECTIVE: To determine one-year mortality and associated factors in patients with complex chronic diseases (CCP) in rural health centres and social transformation needs areas (STNA) in Primary Health Care (PHC) in Andalusia. MATERIAL AND METHODS: Design: 1-Year longitudinal observational prospective open study. SETTING: 40 health centre. SUBJECTS: consenting subjects over 18yr according multiple health condition criteria. SAMPLE SIZE: 814 subjects (confidence interval 95%, alpha risk 0.03%, p=.2; 20% of sample increase due to possible losses). End-point: 1-year Mortality. INDEPENDENT VARIABLES: socio-demographic, socio-familial, clinical, functional (Barthel Index -BI-, Lawton-Brody Index), cognitive (Pfeiffer Test), prescribed drugs, social healthcare resources consumption, and quality of life (EQ-5D). DATA SOURCE: Interview and computerised clinical history Results: A total of 832 CCP were included (48.8% women). One-year mortality was 17.8% (n=148). Logistic regression model for mortality included: aged 85 and over, having a caregiver, haemoglobin level less 10g/L, hospital admission in last year, BI under 60 points, and active neoplasia. The calibration obtained from model was good (p=.85 in the Hosmer-Lemeshow goodness-of-fit test), and the discrimination power also good (AUC=0.772 [0.68-0.77] in ROC curve). CONCLUSIONS: 1-year mortality of CCP in rural centres and STNA in PHC was 17.8%. Knowledge of the factors related to the mortality of CCP helps to approach the needs and social-health resources management.

Estudio descriptivo del manejo de la insuficiencia venosa crónica entre niveles asistenciales / Descriptive study of management of chronic venous insufficiency between levels of care

INTRODUCCIÓN: La coordinación entre niveles asistenciales constituye un elemento esencial para incrementar la eficiencia del sistema sanitario; en este sentido, la enfermedad vascular ocupa un lugar destacado por incluir entidades frecuentes, graves y vulnerables. Debido a la alta prevalencia de la enfermedad, hay actualmente un número desproporcionado de pacientes, que son derivados desde Atención Primaria (AP) a Especializada (AE), con el diagnóstico de sospecha de insuficiencia venosa crónica de miembros inferiores y que realmente no se confirma este diagnóstico. Lo cual lleva a colapsar las consultas de AE, retrasar el diagnóstico, pérdidas de días laborables y todas las repercusiones sanitarias, sociales y económicas. OBJETIVO: El objetivo de este estudio es valorar la realidad de esta patología en el distrito sanitario Huelva Costa. PACIENTES Y MÉTODOS: Para ello realizamos estudio descriptivo de los pacientes pertenecientes a esta área que acuden a médico de AP para consultar sobre patología venosa. Igualmente realizamos estudio descriptivo mediante encuestas, para conocer el grado de conocimiento sobre dicha patología del médico de AP, así como sobre la necesidad de realización de cursos de formación continuada, o bien, analizar si estos cursos transmiten las competencias necesarias a los profesionales para realizar una buena práctica diaria frente a esta entidad clínica. RESULTADOS: Los primeros datos obtenidos muestran que solo se deriva desde AP con acierto en un 42,4% de los casos. Existe una asociación estadísticamente significativa entre la certeza diagnóstica y síntomas como la cercanía a fuente de calor, antecedentes familiares de varices (AFV), pesadez de piernas, venas gruesas en MMII, hinchazón de piernas al final del día y el sexo femenino. CONCLUSIONES: Parece inadecuado el elevado número de paciente derivados desde la AP a la AE bajo la sospecha de IVC en los que no se confirma el diagnóstico

INTRODUCTION: The coordination between levels of care is an essential element to increase the efficiency of the health system. Vascular diseases, in particular would benefit from this due to its frequency, severity and vulnerability. Owing to the high prevalence of the disease, there is currently a disproportionate number of patients being referred from Primary Care (AP) to Specialist Units (AE), with a suspected diagnosis of chronic venous insufficiency of the lower limbs (IVC MMII) without really having this diagnosis confirmed. This leads to collapse in AE consultations, diagnostic delay, lost workdays, as well as all the public health, social and economic repercussions. OBJECTIVE: The aim of this study is to assess the reality of this disease in the Huelva Costa Health District. PATIENTS AND METHODS: A descriptive study was conducted on a population of Huelva Coast Area Health seen by a Primary Care doctor to consult on lower limb venous pathology. The study also included a questionnaire to determine the level of knowledge about this disease of the Primary Care physician, as well as the need for conducting continuing education courses and analyse whether these courses provide professionals with the necessary skills for a good daily practice against this clinical condition. RESULTS: The first data obtained show that only 42.4% of cases referred from Primary Care had a correct diagnosis. There is a statistically significant association between diagnostic accuracy and risk factors/symptoms, such as nearby heat source, a family history of varicose veins, heavy legs, thick veins in the lower limbs, swelling of the legs at the end of the day, and being female. CONCLUSION: There appears to be an inappropriately high number of patients referred from Primary Care to Specialists due to suspicion of IVC, in which the diagnosis is not confirmed

[Prevalence of hyperalphalipoproteinemia in the general population]. / Prevalencia de las hiperalfalipoproteinemias en población general.

BACKGROUND: Hypercholesterolemia is often incorrectly treated with no normal consensus being followed. The same occurs with hyperalphalipoproteinemias (HAL). The aim of the present was to know the prevalence of HAL in a sample of an adult general population and the theoretical percentage of the same which would be treated as hypercholesterolemia if the above cited entity is not appropriately diagnosed. METHODS: A transversal study (November 1991-March 1992) was performed selecting a randomized sample representative of the adult population (13,224 individuals) from a basic health area (municipal census of 1991), and was stratified by groups of age and sex. The final sample was of 802 individuals who underwent anamnesis and in whom total cholesterol (TC), total triglycerides (TG), cHDL and cLDL were determined. In agreement with the percentile 90 of the results of the Lipid Research Clinic Programs for each group of age and sex with normal number of cLDL (3.84 mmol/l, < 150 mg/dl) and TG (2.27 mmol/l, < 200 mg/dl) the percentage of the population with HAL was established. The theoretical percentage of the population which would be treated as hypercholesterolemia was found following the recommendations of the Spanish consensus without the cHDL and cLDL being calculated. RESULTS: The prevalence of HAL was 7.8%, 92% being primary and 7.9 secondary. By ages the greatest frequency appeared in the group of 20-29 years (15.8%) and 30-39 years (8.4%) with male predominance (9%) with respect to females (6.8%). 63.5% had hypercholesterolemia. Treatment would be recommended to 661 individuals without need. CONCLUSIONS: Hyperalphalipoproteinemia is a frequent entity in general population. Correct diagnosis would avoid unnecessary treatment in 5% of the population. The determination of cHDL is required before any hypolipemic treatment is initiated.