[Detection of cardiovascular risk factors in the reformed primary care network in Catalonia. Comparison between the years 1995 and 2000]. / La detección de factores de riesgo cardiovascular en la red reformada de atención primaria en Cataluña. Comparación entre los años 1995 y 2000.

OBJECTIVES: To know if much the detection and control of cardiovascular risk factors (FRCV) have been incorporated in primary care settings (PCS) on 2000 and compare them with 1995 results. Design and participants. A descriptive cross-sectional study of a random sample of 5,875 of clinical histories (CH) of patients aged 15 and over attended during 2000 in PCS, which had been in operation for over three years. MEASUREMENTS AND MAIN RESULTS: Whether were recorded values, levels, diagnoses and control related to: blood pressure, cholesterol, glucose, weight, size, tobacco and alcohol consumption, in order to compare 1995 and 2000 results obtained with the same methodology. Cholesterol levels (57.3%), blood pressure values (52.9%) and glucose levels (51.3%) are the most recorded variables in CH. Obese diabetics and high blood pressure patients are the most studied with a mean of 3.6 records in the CH related others CRF. Smoking (41.7%) and hypertension (32.9%) are the most frequents diagnoses. The 32.3% of the high blood pressure patients have optimum control and 42.9% acceptable control. The 31.2% hyperlipaemia and the 34.1% diabetic patients are controlled. Compared with 1995, the main variations observed are: an increase of the records of cholesterol levels and glucose levels and a decrease of the others, especially in tobacco and alcohol consumption screening. Diabetes and obesity diagnosis decrease and smoking and excessive alcohol consumption increase have been also observed. Screening age and sex group differences are maintained. CONCLUSIONS: The results suggest that may be a change in CRF screening performance is happening and the influencial factors would be study.

[Health professionals' opinion of the Catalan Health Plan. Basis for a reflexion on the future]. / La opinión de los profesionales sanitarios sobre el Plan de Salud de Cataluña. Punto de partida para una reflexión orientada al futuro.

OBJECTIVES: To know health professional's opinion of the Health Plan for Catalonia (Spain) in order to get news elements for the formulation and management of new plans. DESIGN: Combination of quantitative and qualitative methodologies. Postal survey to doctors and nurses (multistage randomised sample). 3.223 questionnaires were obtained (response rate: 34,1%). Interview to a selected sample of 41 health care professionals and managers. MEASUREMENTS AND MAIN RESULTS: 78,8% (IC95%: 1,4) of health professionals are familiar with the Health Plan, and for most of them it is valued as important. 28,9% (IC95%: 1,7) of the professionals who know the Plan consider that it has repercussions in their daily work and 51,8% (IC95%: 1,9) declare that it doesn't have any repercussions. Different issues such as the planning process, the contents, the dissemination strategy, as well as a the poor impact on the health budget are critised. Differences by age group and sex, care setting and type of health professional are observed. CONCLUSIONS: The implication of health professionals in the discussion, formulation and implementation of the Health Plan proposals needs to be improved. It will be necessary to make progress in identifying health problems and needs, in setting priorities and in the allocation of resources. To increase the multisectorial involvement and to develop marketing strategies directed to politicians, managers and health professionals will also be needed in order to increase the impact of the Health Plan on both the Health System and the other sectors involved in health. The role to be played by the Health Plan in the health system must be redefined and this will lead to redesigning the planning process and the implementation of health strategies.

La opinión de los profesionales sanitarios sobre el Plan de Salud de Cataluña. Punto de partida para una reflexión orientada al futuro / Health professionals' opinion of the Catalan Health Plan. Basis for a reflexion on the future

Objetivos: Conocer la opinión de los profesionales sanitarios sobre el Plan de Salud (PS) de Cataluña y obtener nuevos elementos para la formulación y gestión de nuevos planes. Diseño: Combinación de metodología cuantitativa y cualitativa. Encuesta postal a personal médico y de enfermería, por muestreo aleatorio polietápico con estratificación. Se obtuvieron 3.223 cuestionarios (tasa de respuesta del 34,1 per cent). Entrevista a una muestra de conveniencia formada por 41 profesionales asistenciales y de la gestión. Mediciones y resultados principales: El PS es conocido por el 78,8 per cent (intervalo de confianza del 95 per cent: ñ 1,4) de los profesionales y es valorado positivamente por la mayoría de los consultados. Según el 28,9 per cent (IC del 95 per cent: ñ 1,7) de los encuestados que lo conocen, el PS ha tenido repercusiones favorables en su labor diaria, y el 51,8 per cent (IC del 95 per cent: ñ 1,9) opina que no ha tenido repercusiones. Se critican aspectos de su elaboración, contenido, difusión y la escasa asignación de recursos específicos. Se observan diferencias por edad, sexo, ámbito asistencial y colectivo profesional. Conclusiones: Es necesaria una mayor implicación de los profesionales en la discusión, diseño e implementación de las propuestas del PS. Se debe avanzar en la identificación de problemas, en el establecimiento de prioridades y en la asignación de recursos. También hay que lograr un mayor compromiso intersectorial y desarrollar estrategias de comunicación específicas para políticos, gestores y profesionales que permitan mejorar la proyección de los objetivos del PS en el sistema sanitario y otros sectores con responsabilidad en el ámbito de la salud. En definitiva, es necesario replantearse el papel del PS en el sistema y, de acuerdo con él, rediseñar los procesos para el establecimiento y aplicación de estrategias de salud (AU)

Objectives: To know health professional's opinion of the Health Plan for Catalonia (Spain) in order to get news elements for the formulation and management of new plans. Design: Combination of quantitative and qualitative methodologies. Postal survey to doctors and nurses (multistage randomised sample). 3.223 questionnaires were obtained (response rate: 34,1%). Interview to a selected sample of 41 health care professionals and managers. Measurements and main results: 78,8% (IC95%: ± 1,4) of health professionals are familiar with the Health Plan, and for most of them it is valued as important. 28,9% (IC95%: ± 1,7) of the professionals who know the Plan consider that it has repercussions in their daily work and 51,8% (IC95%: ± 1,9) declare that it doesn't have any repercussions. Different issues such as the planning process, the contents, the dissemination strategy, as well as a the poor impact on the health budget are critised. Differences by age group and sex, care setting and type of health professional are observed. Conclusions: The implication of health professionals in the discussion, formulation and implementation of the Health Plan proposals needs to be improved. It will be necessary to make progress in identifying health problems and needs, in setting priorities and in the allocation of resources. To increase the multisectorial involvement and to develop marketing strategies directed to politicians, managers and health professionals will also be needed in order to increase the impact of the Health Plan on both the Health System and the other sectors involved in health. The role to be played by the Health Plan in the health system must be redefined and this will lead to redesigning the planning process and the implementation of health strategies (AU)

La detección de factores de riesgo cardiovascular en la red reformada de atención primaria en Cataluña. Comparación entre los años 1995 y 2000 / Detection of cardiovascular risk factors in the reformed primary care network in Catalonia. Comparison between the years 1995 and 2000

Objetivo. Conocer la detección y el control de los factores de riesgo cardiovascular (FRCV) en las áreas básicas de salud (ABS) en el año 2000 y compararlos con resultados de 1995.Diseño y sujetos. Estudio descriptivo, transversal, de una muestra de 5.875 historias clínicas (HC) de la población de 15 y más años atendida en las ABS de Cataluña con más de 3 años de funcionamiento.Mediciones y resultados principales. Se estudia el registro en la HC de los valores, diagnóstico y control en relación con: tensión arterial, colesteremia, glucemia, talla, peso, hábito tabáquico y consumo de alcohol. Se comparan los resultados con los obtenidos en el estudio de 1995, realizado con la misma metodología.Las variables clínicas más anotadas son colesteremia (57,3 por ciento), tensión arterial (52,9 por ciento) y glucemia (51,3 por ciento). Los obesos diabéticos y los hipertensos son los pacientes más estudiados, con una media de 3,6 anotaciones en la HC sobre otros factores de riesgo. El tabaquismo (41,7 por ciento) y la hipertensión arterial (32,9 por ciento) son los diagnósticos más frecuentes.Se observa un control óptimo y aceptable en un 32,3 por ciento y 42,9 por ciento de los hipertensos, respectivamente. El 31,2 por ciento de los hipercolesterémicos y un 34,1 por ciento de los diabéticos se encuentran en situación de control. Respecto a 1995 se observa un aumento de la anotación de los valores de colesterolemia y glucemia y un descenso del resto, y es especialmente relevante el del cribado del hábito de fumar y consumo de alcohol. También se constata un descenso en el diagnóstico de diabetes y obesidad y un aumento del de tabaquismo y consumo excesivo de alcohol. Se mantienen las diferencias en el cribado según grupo de edad y sexo.Conclusiones. Los resultados sugieren que puede estar produciéndose un cambio en la práctica de la detección de FRCV y cabe plantearse los factores que pueden influir en él (AU)

[Health self-perception in men and women among the elderly]. / Percepción del estado de salud en varones y mujeres en las últimas etapas de la vida.

OBJECTIVES: To analyze the differences in health self-perception between men and women in the later stages of life and to assess their association with sociodemographic and health variables. METHODS: Data on 1,459 men and 1,993 women aged 60 or older from the 1994 Catalan Health Survey, were collected and an analysis of health self-perception according to age, gender, social class, reporting of chronic disease and handicaps was performed. Multivariate logistic regression analysis was used, taking into account the survey design. RESULTS: Of the women aged 60 and older, 57.3% reported poor health compared with 43.6% of men of the same age. The proportion of women with one or more handicaps was also greater (41.2%) than that of the men (28.7%), as was the case with chronic disease (92.2% in women and 85.6% in men). The multivariate model also revealed that health self-perception was poorer among women than among men. Other explanatory factors were the number of chronic diseases, having handicaps, and being a member of a lower social class. Age interacted with the number of chronic diseases to mitigate the effect of chronic diseases on perceived health status. CONCLUSIONS: In the elderly population, poor health self-perception was greater among women, even when other significant explanatory variable (social class, age, handicaps and chronic disease) were adjusted for. The most important explanatory factors in health self-perception were having chronic disease and/or handicaps. The impact of chronic disease on poor health self-perception decreased in older age groups.

Percepción del estado de salud en varones y mujeres en las últimas etapas de la vida / Health self-perception in men and women among the elderly

Objetivo: Analizar las diferencias en la percepción del estado de salud de los varones y mujeres en las últimas etapas de la vida y explorar su relación con variables sociodemográficas y de salud. Métodos: Datos procedentes de la Encuesta de Salud de Cataluña de 1994, de 1.459 varones y 1.993 mujeres de 60 y más años. Se realizó un análisis de la autovaloración del estado de salud según la edad, el sexo, la clase social, la declaración de enfermedades crónicas y la discapacidades y se aplicó un modelo de análisis multivariable de regresión logística teniendo en cuenta el diseño muestral. Resultados: El 57,3 por ciento de las mujeres de 60 y más años declaraba no tener buena salud, frente al 43,6 por ciento de los varones. También fue superior la proporción de mujeres que padecía una o más discapacidades (41,2 por ciento) respecto a los varones (28,7 por ciento), así como la de enfermedades crónicas, el 92,2 por ciento de las mujeres y el 85,6 por ciento de los varones. En el modelo de regresión logística multivariable continúa manteniéndose una percepción de mala salud superior en las mujeres y aparecen como factores explicativos el número de enfermedades crónicas, padecer discapacidades y pertenecer a las clases sociales más desfavorecidas. La edad en interacción con las enfermedades crónicas amortigua el efecto de éstas en la valoración del estado de salud. Conclusiones: Entre la población anciana, la percepción de mala salud fue superior en las mujeres incluso ajustando por otras variables explicativas significativas (clase social, edad, discapacidades y enfermedades crónicas). Padecer enfermedades crónicas y/o discapacidades constituyen los factores explicativos más importantes en la percepción del estado de salud. El impacto del padecimiento de enfermedades crónicas en relación con la percepción de mala salud disminuye a medida que los grupos son de mayor edad (AU)

[Health status and gender in Catalonia. An approach using the information sources available]. / Estado de salud y género en Cataluña. Una aproximación a través de las fuentes de información disponibles.

OBJECTIVE: To present health status differences between men and women in Catalonia across the main available data sources. METHODS: The main institutional health data sources of the Catalan population are presented. Mortality and morbidity differences by gender are studied. RESULTS: Men die before than women and present more frequently pathologies that require hospitalary care. Unhealthy behaviours are more frequent in men than in women. Women in general, in all social classes, present more frequently chronic disorders and disabilities and declare worse perception of health status than men of the same social class. CONCLUSIONS: Institutional sources of data available in Catalonia allow the description of gender differences in health, nevertheless new variables should be included to improve gender perspective analyse.

Estado de salud y género en Cataluña. Una aproximacióna través de las fuentes de información disponibles / Health status and gender in Catalonia. An approach using the information sources available

Objetivo: Presentar las diferencias en el estado de salud de varones y mujeres en Cataluña a través de las principales fuentes de información disponibles. Métodos: Se presentan las principales fuentes de información sanitaria institucionales referidas al ámbito catalán. Se hace una aproximación a la morbimortalidad según género. Resultados: Los varones mueren antes que las mujeres y presentan con mayor frecuencia patologías que requieren ingreso hospitalario. Las conductas poco saludables son más frecuentes en los varones que en las mujeres. Éstas, en general, cualquiera que sea la clase social a la que pertenecen, presentan más enfermedades crónicas y discapacidades y declaran peor percepción del estado de salud que los varones de la misma clase social. Conclusiones: Las fuentes de información institucionales en Cataluña permiten caracterizar el estado de salud según género,si bien deberían incorporar variables que facilitaran el análisis de la información desde la perspectiva de género (AU)

Objective: To present health status differences between men and women in Catalonia across the main available data sources. Methods: The main institutional health data sources of the Catalan population are presented. Mortality and morbidity differences by gender are studied. Results: Men die before than women and present more frequently pathologies that require hospitalary care. Unhealthy behaviours are more frequent in men than in women. Women in general, in all social classes, present more frequently chronic disorders and disabilities and declare worse perception of health status than men of the same social class. Conclusions: Institutional sources of data available in Catalonia allow the description of gender differences in health, nevertheless new variables should be included to improve gender perspective analyse (AU)

[Practice of preventive activities in primary care and objectives of the 1993-1995 Health Plan of Catalonia]. / La práctica de actividades preventivas en la atención primaria y los objectivos del Plan de Salud de Cataluña 1993-1995.

OBJECTIVES: To find how much the detection of two factors of cardiovascular risk, over-consumption of alcohol and anti-tetanus vaccination, has been incorporated into clinical practice in the treatment of adults in the primary care reform; and to what extent the objectives on these questions of the Health Plan for Catalonia 1993-1995 were met. DESIGN: A descriptive crossover study of a sample of primary care clinical histories (PCCHs). PATIENTS: A random sample of 3000 PCCHs of patients aged 15 and over attended during 1995 in the Health Districts in Catalonia which had been in operation for over three years. MEASUREMENTS AND MAIN RESULTS: The following data were obtained from the PCCHs: patients' age and sex, whether blood pressure values were recorded, cholesterol levels, glucose levels, weight, size, tobacco habit, alcohol consumption, antitetanus vaccination and explicit documentation of diagnoses in relation to risk factors studied. The results showed that recording was above the level established in the Plan for cholesterol levels (64.4%), glucose levels (72.1%) and tobacco habit (66.5%); and slightly below, for blood pressure (57.8%) and alcohol consumption (9.6%). Among the youngest of the target population, detection was less common, especially for tobacco habit and alcohol consumption. Antitetanus vaccinations were recorded in 24.3% of the PCCHs. CONCLUSIONS: In general the objectives set in the plan have been reached. The detection of cardiovascular risk factors and over-consumption of alcohol was adequate for the target population groups established. Antitetanus vaccination is the preventive activity with the least compliance.

Drug prescribing and use among elderly people in Spain.

As a result of the lack of an adequate regulation, the supply and the use of medicines is irrational in Spain. In order to know the characteristics of the prescription and use of drugs among the elderly, two drug utilization studies were carried out. The first study was an analysis of 981 prescriptions from an outpatient clinic of the Spanish Social Security. The results show that a high proportion of fixed-dose combinations were prescribed and that drugs without any demonstrated therapeutic value are often prescribed for the elderly. The second study was a survey of 389 individuals randomly chosen among people affiliated with a pensioners' club. The results show that drug use is highly prevalent among the elderly, that many medicines without any demonstrated benefit are being taken, and that potentially harmful drugs were being used by a high proportion of patients without medical follow-up. The prevalence of the use of some particular groups of drugs is also presented.