Epidemiología de los trastornos del equilibrio en atención primaria / Epidemiology of balance disorders in primary care

ANTECEDENTES Y OBJETIVO: Actualmente, no existen series de pacientes que hayan descrito la incidencia de cada una de las enfermedades que causan alteraciones del equilibrio (AE) en atención primaria. El objetivo de este estudio es calcular la incidencia de cada una de ellas para proponer medidas formativas específicas. MATERIALES Y MÉTODO: Estudio transversal prospectivo. Se obtuvieron los datos de los pacientes de cinco cupos de médicos en cinco centros diferentes de atención primaria de nuestra área hospitalaria. Durante un año se reclutaron todos los pacientes que acudieron a consultas por cualquier tipo de vértigo, inestabilidad o mareo como motivo principal de consulta. Mediante un algoritmo diagnóstico-terapéutico los pacientes fueron diagnosticados y tratados en atención primaria o derivados para su estudio en atención hospitalaria. RESULTADOS: La población estudiada fue de 7.896 personas. Se detectó una incidencia anual de AE del 2,2%. El 56,1% de los casos pudo ser diagnosticado y tratado en atención primaria. El 53,8% de los pacientes fue diagnosticado de algún tipo de vértigo posicional. Los siguientes tres diagnósticos más frecuentes fueron migraña vestibular, isquemia del sistema nervioso central y efectos secundarios de medicamentos. Estos cuatro grupos sumaron un 87,9% de la población. CONCLUSIONES: La incidencia de las AE en atención primaria requiere un abordaje en el que se incluya formación en el diagnóstico y tratamiento del vértigo posicional paroxístico benigno, la cefalea, los factores de riesgo cardiovascular y de farmacología, no siendo necesario prescribir sedantes vestibulares en la mayoría de los casos

BACKGROUND AND OBJECTIVE: In our country, there are no series of patients that have described the incidence of the different diseases which cause balance disorders (BD) in primary care. The objective of this study is to calculate the incidence of each disease to propose specific training measures. MATERIALS AND METHOD: Prospective cross-sectional study. Patient data of five primary care physicians in five different primary care centres in our hospital area were collected. All patients who attended consultations for any type of vertigo, imbalance or dizziness over one year as the main reason for consultation were recruited. Using a diagnostic-therapeutic algorithm, patients were diagnosed and treated in primary care or referred for study in hospital care. RESULTS: The population studied was 7,896 people. An annual incidence of BD of 2.2% was detected. Of the cases, 56.1% could be diagnosed and treated in primary care. Of the patients, 53.8% were diagnosed with some type of positional vertigo; the next three most frequent diagnoses were vestibular migraine, central nervous system ischaemia and medication side effects. These four groups accounted for 87.9% of the population. CONCLUSIONS: The incidence of BD in primary care requires an approach that includes training in the diagnosis and treatment of benign paroxysmal positional vertigo, headache, cardiovascular risk factors and pharmacology. It is not necessary to prescribe vestibular suppressants in most patients

Epidemiology of balance disorders in primary care. / Epidemiología de los trastornos del equilibrio en atención primaria.

BACKGROUND AND OBJECTIVE: In our country, there are no series of patients that have described the incidence of the different diseases which cause balance disorders (BD) in primary care. The objective of this study is to calculate the incidence of each disease to propose specific training measures. MATERIALS AND METHOD: Prospective cross-sectional study. Patient data of five primary care physicians in five different primary care centres in our hospital area were collected. All patients who attended consultations for any type of vertigo, imbalance or dizziness over one year as the main reason for consultation were recruited. Using a diagnostic-therapeutic algorithm, patients were diagnosed and treated in primary care or referred for study in hospital care. RESULTS: The population studied was 7,896 people. An annual incidence of BD of 2.2% was detected. Of the cases, 56.1% could be diagnosed and treated in primary care. Of the patients, 53.8% were diagnosed with some type of positional vertigo; the next three most frequent diagnoses were vestibular migraine, central nervous system ischaemia and medication side effects. These four groups accounted for 87.9% of the population. CONCLUSIONS: The incidence of BD in primary care requires an approach that includes training in the diagnosis and treatment of benign paroxysmal positional vertigo, headache, cardiovascular risk factors and pharmacology. It is not necessary to prescribe vestibular suppressants in most patients.

Balance disorders as potential confounders associated with an increased risk of acute cerebrovascular accidents.

PURPOSE: There is a higher risk of stroke after suffering from balance disorders (BDs) such as vertigo or dizziness. The causal relationship remains unclear due to the limited scope of the existing studies and the high prevalence of cardiovascular risk factors (CVRFs) in BD patients. The objective of this study is to clarify the role that BDs seem to have in the development of acute cerebrovascular accidents (ACAs). METHODS: This is an observational prospective study. The CVRFs and demographic factors of a sample of our population were noted. Five clusters of patients were tracked over the course of 2 years to detect and diagnose BDs and ACAs. The causal relationships between the CVRFs, BDs and ACAs were analyzed in a univariate analysis. A logistic regression multivariant analysis was performed on those variables that reached statistical significance. RESULTS: The sample included 7886 participants and 31 ACAs were recorded. CVRFs that reached statistical significance included age ≥ 60, hypertension, diabetes mellitus, dyslipidemia, ischemic heart disease, atrial fibrillation and previous ACAs. The relationship between BDs and ACAs always reached statistical significance, regardless of how the BD variable was defined. Five different multivariate analyses were performed, but in none of them did the BD variables significantly reduce the deviance and thus, they were not taken into account when building the final model. CONCLUSION: This study shows that BDs are probably confounders that are closely linked to other CVRFs and they are also useful red flags to identify patients at a higher risk of suffering from ACAs.

Eficacia de una estrategia para mejorar los indicadores de calidad del Proceso Asistencial Integrado Diabetes Mellitus 2 en el Centro Avanzado de Diabetes Macarena / Efficacy of the strategy to improve the quality indicators of Diabetes Mellitus 2 Care Process in Advanced Diabetes Centre Macarena

Introducción: La evaluación del Proceso Asistencial Integrado de Diabetes Mellitus 2 (PAI-DM2) mediante el instrumento para la evaluación de modelos de atención ante la cronicidad (IEMAC-Diabetes) permite el diseño de intervenciones para la mejora de la atención. Objetivo: Analizar la calidad de la atención sanitaria prestada a los pacientes con DM2. Diseño: Estudio cuasiexperimental de tipo antes-después con grupo control no aleatorizado. Emplazamiento: Distritos sanitarios de atención primaria de Sevilla. Participantes: Un total de 12 cupos médicos, 5 centros de atención primaria, seleccionados de manera discrecional. Intervención: Los profesionales de medicina y enfermería de los 12 cupos experimentales participaron en un programa formativo, incluida una estancia externa en el Hospital de Día de Diabetes. Mediciones principales: Número de pacientes incluidos, hemoglobina glucosilada (HbA1c), exploración de pies (EP) y fondo de ojo (FO). Resultados: Se analizaron 1.475 pacientes con DM2. La proporción de pacientes incluidos por cupo fue del 8,3%, siendo mujeres el 45,4%. Al inicio del estudio, la proporción de pacientes con HbA1c < 7% fue del 38,9% en 2013 frente al 47,7% en 2014, disminuyendo al 40,2% en 2016. El 33,3% de los pacientes tenía en 2013 realizado un FO frente al 41,77% en 2014. El 51,6% en 2013 tenía una EP frente al 54,7% en el 2014. Tras la intervención se alcanzaron diferencias estadísticamente significativas en el número de HbA1c (p = 0,01) y de retinografías (p = 0,01) solicitadas. Conclusiones: La herramienta IEMAC-Diabetes permite detectar áreas de mejora en el PAI-DM2. La ausencia de diferencias significativas puede deberse a un fenómeno de contaminación y/o al efecto Hawthorne

Introduction: The assessment of the Diabetes Mellitus 2 Care Process (PAI-DM2) through the assessment tool for the chronic illness’ care models (IEMAC-Diabetes) allows the design of health interventions for the improvement of medical care. Objective: Analysing the quality of healthcare provided to DM2 patients. Design: Quasiexperimental study before and after intervention with a not randomised control group. Location: Health care district of primary care Sevilla. Participants: 12 groups of ascribed patients, 5 Primary Care Healthcenter, chosen in a discretionary way. Intervention: Physicians and nurses from the 12 intervention groups took part in a training program, including an external rotation in the Diabetes Daycare Hospital. Main measurements: Number of included patients, glycated hemoglobin, feet exploration (FE), and ocular fundus (OF). Results: 1,475 DM-2 patients were analysed. The proportion of included patients per group was 8.5%, 45.5% were women. At the beginning of the study, the rate of patients with HbA1c < 7% were 38.9% in 2013 against 47.7% in 2014 and 40.2% in 2016; 33% of the patients had an OF in 2013 against 41.77% in 2014; 51.6% of patients had an EF against 54.7% in 2014. After the intervention, statistically significant differences were reached in HbA1c (p = 0.01) and retinography requested (p = 0.01). Conclusions: IEMAC-Diabetes allows spotting improvement areas in the PAI-DM2. The absence of statistically significant differences may be the result of contamination in the sample and/or Hawthorne effect

[Efficacy of the strategy to improve the quality indicators of Diabetes Mellitus 2 Care Process in Advanced Diabetes Centre Macarena]. / Eficacia de una estrategia para mejorar los indicadores de calidad del Proceso Asistencial Integrado Diabetes Mellitus 2 en el Centro Avanzado de Diabetes Macarena.

INTRODUCTION: The assessment of the Diabetes Mellitus 2 Care Process (PAI-DM2) through the assessment tool for the chronic illness' care models (IEMAC-Diabetes) allows the design of health interventions for the improvement of medical care. OBJECTIVE: Analysing the quality of healthcare provided to DM2 patients. DESIGN: Quasiexperimental study before and after intervention with a not randomised control group. LOCATION: Health care district of primary care Sevilla. PARTICIPANTS: 12 groups of ascribed patients, 5 Primary Care Healthcenter, chosen in a discretionary way. INTERVENTION: Physicians and nurses from the 12 intervention groups took part in a training program, including an external rotation in the Diabetes Daycare Hospital. MAIN MEASUREMENTS: Number of included patients, glycated hemoglobin, feet exploration (FE), and ocular fundus (OF). RESULTS: 1,475 DM-2 patients were analysed. The proportion of included patients per group was 8.5%, 45.5% were women. At the beginning of the study, the rate of patients with HbA1c<7% were 38.9% in 2013 against 47.7% in 2014 and 40.2% in 2016; 33% of the patients had an OF in 2013 against 41.77% in 2014; 51.6% of patients had an EF against 54.7% in 2014. After the intervention, statistically significant differences were reached in HbA1c (p=0.01) and retinography requested (p=0.01). CONCLUSIONS: IEMAC-Diabetes allows spotting improvement areas in the PAI-DM2. The absence of statistically significant differences may be the result of contamination in the sample and/or Hawthorne effect.