Intervention for control of hypertension in Catalonia, Spain (INCOTECA Project): results of a multicentric, non-randomised, quasi-experimental controlled intervention study.

OBJECTIVE: The purpose of this study was to assess the effectiveness of a quality improvement (QI) plan aimed at primary healthcare teams (PHCTs) to optimise hypertension control and to compare it with standard clinical care. METHODS: Design Multicentric, non-randomised, quasi-experimental controlled intervention study. Setting 5 PHCTs in the intervention and 13 in the standard care group in the province of Barcelona, Catalonia, Spain. Participants This is a population-based study in which all patients over 18 years of age with a diagnosis of hypertension before 1 January 2006 were included (n=9877 in the intervention group and n=21 704 in the control group). Intervention A QI plan that targeted primary care professionals. The plan included training sessions, implementation of recommended clinical practice guidelines for the management of hypertensive patients and audit and feedback to health professionals. Main outcome measure Prevalence of hypertensive patients with an adequate blood pressure (BP) control. RESULTS: The adjusted difference between intervention and standard care groups in the odds of BP control was 1.3 (95% CI 1.1 to 1.6, p=0.003). Results of the mixed model on repeated measures showed that, on average, an individual in the intervention group had an increase of 92% in the odds of BP control (OR 1.9, 95% CI 1.7 to 2.1). CONCLUSIONS: The implementation of a QI plan can improve BP control. This strategy is potentially feasible for up-scaling within the existing PHCTs. TRIAL REGISTRATION: ClinicalTrials.gov MS: 1998275938244441.

Visita preoperatoria de enfermería: evaluación de la efectividad de la intervención enfermera y percepción del paciente / Pre-surgical nursing visit: evaluation of its effectiveness and patient perception

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A quality improvement plan for hypertension control: the INCOTECA Project (INterventions for COntrol of hyperTEnsion in CAtalonia).

BACKGROUND: Different studies have shown insufficient blood pressure (BP) control in hypertensive patients. Multiple factors influence hypertension management, and the quality of primary care is one of them. We decided therefore to evaluate the effectiveness of a quality improvement plan directed at professionals of Primary Health Care Teams (PHCT) with the aim to achieve a better control of hypertension. The hypothesis of the study is that the implementation of a quality improvement plan will improve the control of hypertension. The primary aim of this study will be to evaluate the effectiveness of this plan. DESIGN: multicentric study quasi-experimental before - after with control group. The non-randomised allocation of the intervention will be done at PHCT level. SETTING: 18 PHCT in the Barcelona province (Spain). SAMPLE: all patients with a diagnosis of hypertension (population based study). EXCLUSION CRITERIA: patients with a diagnosis of hypertension made later than 01/01/2006 and patients younger than 18 years. INTERVENTION: a quality improvement plan, which targets primary health care professionals and includes educational sessions, feedback to health professionals, audit and implementation of recommended clinical practice guidelines for the management of hypertensive patients. MEASUREMENTS: age, sex, associated co-morbidity (diabetes mellitus type I and II, heart failure and renal failure). The following variables will be recorded: BP measurement, cardiovascular risk and antihypertensive drugs used. Results will be measured before the start of the intervention and twelve months after the start of the study. Dependent variable: prevalence of hypertensive patients with poor BP control. ANALYSIS: Chi-square test and Student's t-test will be used to measure the association between independent qualitative and quantitative variables, respectively. Non-parametric tests will be used for the analysis of non-normally distributed variables. Significance level (alpha) will be set at < 0.05. Outcomes will be analysed on an intention-to-treat basis. DISCUSSION: The implementation of a quality improvement plan might benefit the coordination of different professionals of PHCTs and may also improve blood pressure control. TRIAL REGISTRATION: This protocol has been registered at clinicaltrials.gov with the ID number MS: 1998275938244441.

Hábitos higiénico-dietéticos respecto alconsumo de alimentos ricos en yodo duranteel primer trimestre de la gestación / Hygiene and dietary habits with respect to the consumption of iodine-rich foods

Objetivo: Conocer los hábitos higiénico-dietéticos de las mujeresembarazadas respecto al consumo de alimentos ricos en yodo duranteel primer trimestre de la gestación.Material y método: Estudio observacional, descriptivo, transversaly multicéntrico. Se estudiaron las mujeres embarazadas en el primertrimestre de la gestación que acudieron a la consulta de control delembarazo del programa de atención a la salud sexual y reproductiva(ASSIR) de la Región Sanitaria del Ámbito Centro del Instituto Catalánde la Salud durante el año 2006. Para la recogida de datos se utilizóun cuestionario que cumplimentó la matrona en una entrevistaindividual en la primera visita de control de embarazo.Resultados: Se recogieron 823 cuestionarios cumplimentados. El 6%(50) de las gestantes no consumía pescado y el 83% (683) lo hacíamenos de cuatro veces por semana. El 17% (138) no consumía lechey el 39% (324) bebía un vaso al día. El 42% (342) de las gestantesutilizaba sal yodada para la preparación y condimentación de los alimentos,frente al 50% (412) que no la empleaba. El 22% (184) delas gestantes tomaba algún tipo de suplemento de yodo, y el 18%(148) de la muestra manifestó ser fumadora.Conclusiones: Las mujeres embarazadas de nuestro ámbito de estudiotienen un consumo reducido de alimentos ricos en yodo. Además, tantoel consumo de sal yodada como la utilización de suplementos que contenganyodo durante el embarazo resultan también insuficientes (AU)

Objective: To evaluate hygiene and dietary habits with respect to theconsumption of iodine-rich foods by pregnant women during the firsttrimester of pregnancy.Material and method: A cross-sectional, descriptive, observational,multicenter study was carried out. In 2006, we studied the women inthe first trimester of pregnancy who came to the clinics for pregnancymanagement pertaining to the sexual and reproductive health program(ASSIR) of the Central Health Region of Catalonia, Spain. Informationwas gathered by means of a questionnaire created by the research teamand completed by the midwife during the first visit to the pregnancymanagement clinic.Results: A total of 823 questionnaires were completed. Six percent(50) of those polled did not consume any fish and 83% (683) ate it lessthan four times a week. Seventeen percent (138) did not drink any milkand 39% (324) drank one glass per day. Forty-two percent (342) of thepregnant women used iodized salt for cooking while 50% (412) didnot. Twenty-two percent (184) of them were taking some kind of iodinesupplement and 18% (148) were smokers.Conclusions: The pregnant women included in our study consumedlow amounts of iodine-rich foods. Moreover, the consumption of bothiodized salt and iodine supplements was also insufficient (AU)

Efectividad y seguridad del orto-ftalaldehído en la desinfección de alto nivel de material sanitario

Trabajo cuyos objetivos son: evaluar la efectividad y seguridad del orto-ftalaldehído al 0,55% en la desinfección de alto nivel de material sanitario y comparar el orto-ftalaldehído con otras alternativas disponibles para la desinfección de alto nivel, en términos de costes y/o coste-efectividad.