Tendencias y variables predictoras de hospitalización, reingreso y duración de la estancia hospitalaria en los pacientes ambulatorios con insuficiencia cardíaca / Trends and predictors of hospitalization, readmissions and length of stay in ambulatory patients with heart failure

Objetivos. En los pacientes ambulatorios con insuficiencia cardiaca crónica apenas se conocen las variables pronósticas de hospitalización, y es posible que las variables conocidas no sean aplicables a la población de los países mediterráneos. El objetivo del presente estudio es documentar las tendencias longitudinales en las hospitalizaciones e identificar las variables predictoras de ingreso, reingreso y duración de la estancia hospitalaria en la población objeto del estudio. Métodos. Estudio de cohorte retrospectivo, poblacional, efectuado en Cataluña (noreste de España). Se incluyeron a 7.196 pacientes ambulatorios (58,6% mujeres, edad media: 76 años). Se seleccionaron los pacientes elegibles a partir de la historia clínica electrónica de los centros de atención primaria y se les controló durante 3 años. Resultados. A los 3 años del seguimiento, en conjunto, 645 (9,0%) pacientes fueron ingresados por una causa cardiovascular, el 37% presentó un reingreso, y la duración mediana de la estancia hospitalaria fue de 9 (límites intercuartil:5-17) días. La insuficiencia renal crónica (odds ratio [OR]:1,98 [1,62-2,43]), la cardiopatía isquémica (OR:1,72; intervalo de confianza [IC] del 95%:1,45-2,04), la diabetes mellitus (DM) (OR:1,50; IC 95%:1,27-1,78) y la enfermedad pulmonar obstructiva crónica (OR:1,43; IC 95%:1,16-1,77) aumentaron el riesgo de hospitalización. La DM (OR:1,70; IC 95%:1,22-2,38), la cardiopatía isquémica (OR:1,85; IC 95%:1,33-2,58) y la hipertensión arterial (OR:1,66; IC 95%:1,11-2,46) aumentaron el riesgo de reingreso. La insuficiencia renal crónica (OR:2,21; IC 95%:1,70-2,90), la cardiopatía isquémica (OR:2,19; IC 95%:1,73-2,77), la DM (OR:1,70; IC 95%:1,34-2,15), la hipertensión arterial (OR:1,51; IC 95%:1,13-2,01) y la enfermedad pulmonar obstructiva crónica (OR:1,37; IC 95%:1,02-1,83) aumentaron el riesgo de duración prolongada de la estancia hospitalaria. Conclusiones. El presente estudio identificó las variables predictoras de hospitalización, los reingresos y la duración prolongada de la estancia hospitalaria que pueden ayudar a los médicos y gestores hospitalarios a identificar a los pacientes en alto riesgo, que deben ser los destinatarios de la planificación de los servicios y de las acciones preventivas establecidas(AU)

Objectives. Little is known on predictors of hospitalisation in ambulatory patients with chronic heart failure, and known predictors may not apply to Mediterranean countries. Our aim was to document longitudinal trends in hospitalisations and identify patient-related predictors of hospital admission, re-admission and length of stay in the targeted population. Methods. Population-based retrospective cohort study in Catalonia (North-East Spain), including 7196 ambulatory patients (58.6% women; mean age 76 years). Eligible patients were selected from the electronic patient records of primary care practices, and followed for 3 years. Results. At 3 years of follow up overall 645 (9.0%) patients had cardiovascular hospitalisation, 37% were readmitted, and median length of stay was 9 (interquartile range 5–17) days. Chronic kidney disease [odds ratio (OR)=1.98 (1.62–2.43)], IHD [OR=1.72 (1.45–2.04)], DM [OR=1.50 (1.27–1.78)] and chronic obstructive pulmonary disease [OR=1.43 (1.16–1.77)] increased the risk for hospitalisation. DM [OR=1.70 (1.22–2.38)], IHD [OR=1.85 (1.33–2.58)] and HTA [OR=1.66 (1.11–2.46)] increased the risk for readmissions. Chronic kidney disease [OR of 2.21 (1.70–2.90)], IHD [OR of 2.19 (1.73–2.77)], DM [OR=1.70 (1.34–2.15)], HTA [OR=1.51 (1.13–2.01)], chronic obstructive pulmonary disease [OR=1.37 (1.02–1.83)] increased the risk for long length of stay in hospital. Conclusions. Our study identified predictors of hospitalisation, readmissions and long length of stay which can help clinicians and managers to identify high risk patients which should be targeted on service planning and when designing preventive actions(AU)

Trends and predictors of hospitalization, readmissions and length of stay in ambulatory patients with heart failure.

OBJECTIVES: Little is known on predictors of hospitalisation in ambulatory patients with chronic heart failure, and known predictors may not apply to Mediterranean countries. Our aim was to document longitudinal trends in hospitalisations and identify patient-related predictors of hospital admission, re-admission and length of stay in the targeted population. METHODS: Population-based retrospective cohort study in Catalonia (North-East Spain), including 7196 ambulatory patients (58.6% women; mean age 76 years). Eligible patients were selected from the electronic patient records of primary care practices, and followed for 3 years. RESULTS: At 3 years of follow up overall 645 (9.0%) patients had cardiovascular hospitalisation, 37% were readmitted, and median length of stay was 9 (interquartile range 5-17) days. Chronic kidney disease [odds ratio (OR)=1.98 (1.62-2.43)], IHD [OR=1.72 (1.45-2.04)], DM [OR=1.50 (1.27-1.78)] and chronic obstructive pulmonary disease [OR=1.43 (1.16-1.77)] increased the risk for hospitalisation. DM [OR=1.70 (1.22-2.38)], IHD [OR=1.85 (1.33-2.58)] and HTA [OR=1.66 (1.11-2.46)] increased the risk for readmissions. Chronic kidney disease [OR of 2.21 (1.70-2.90)], IHD [OR of 2.19 (1.73-2.77)], DM [OR=1.70 (1.34-2.15)], HTA [OR=1.51 (1.13-2.01)], chronic obstructive pulmonary disease [OR=1.37 (1.02-1.83)] increased the risk for long length of stay in hospital. CONCLUSIONS: Our study identified predictors of hospitalisation, readmissions and long length of stay which can help clinicians and managers to identify high risk patients which should be targeted on service planning and when designing preventive actions.

El modelo de acreditación del Departament de Salut de Catalunya: un modelo para atención primaria / Accreditation model of the Health Department of Catalonia: a model for primary care

Existen pocas experiencias de modelos de acreditación validados para atención primaria. El Departament de Salut de Catalunya revisó los modelos propuestos por la European Foundation for Quality Management, la Joint Commission International y el Institut Català de la Salut y consensuó estándares para acreditar equipos de atención primaria. Se realizó una prueba piloto para validar contenidos e identificar evidencias. Se pasó una encuesta para valorar aceptación y validación. Se consensuaron 414 estándares de los que la prueba piloto seleccionó 379. La media de cumplimiento de los estándares fue 70,4%. Los estándares con peor porcentaje fueron los correspondientes a criterios de resultados. La encuesta objetivó que el 83% de los equipos lo encontró útil y el 78% encontró adecuado el contenido del manual de acreditación como herramienta para evaluar la calidad e identificar oportunidades de mejora. Aspectos negativos: complejidad y laboriosidad. El modelo es de fácil comprensión y se ajusta a la realidad de atención primaria, contempla aspectos relevantes para la calidad, de fácil aplicación a otros equipos que desarrollen sus actividades en atención primaria (adaptando estándares de criterios 5 y 9 a los específicos de cada ámbito) (AU)

Few accreditation models have been validated for primary care. The Catalan Department of Health reviewed the models proposed by the European Foundation for Quality Management, the Joint International Commission and the Institut Català de la Salut, and standards for the accreditation of primary care teams were agreed. A pilot study was carried out to validate contents and identify evidence. A survey was conducted to evaluate acceptability and validation. A total of 414 standards were agreed, of which 379 were selected after the pilot test. The mean compliance with the standards was 70.4%. Standards with the lowest percentage of compliance were those corresponding to results criteria. The survey showed that 83% of the teams thought the pilot test was useful and 78% found the contents of the accreditation manual were appropriate to evaluate quality and identify areas for improvement. Negative features were the manual´s complexity and the workload involved. The model is easy to understand, fits the reality of primary care, includes relevant issues for quality and is easy to apply to other teams working in primary care (by adapting the standards for criteria 5 and 9 to the specific features of each setting) (AU)

Gestión de la hipertensión arterial en Atención Primaria / Management of hypertension in Primary Care

No disponible

[Type 2 diabetes mellitus: incidence and diagnosis at a primary care center]. / Diabetes mellitus tipo 2: incidencia y diagnóstico en un centro de atención primaria.

OBJECTIVE: To find the annual incidence and reasons for type-2 Diabetes Mellitus (DM2), and the methods used to diagnose it, on the basis of the validation of a computerised record for 1991-1995. DESIGN: Retrospective, longitudinal study. SETTING: Primary care centre. MEASUREMENTS AND MAIN RESULTS: Of the 387 diabetics registered as new cases in the 1991-1995 period out of 17031 people over 14 who were seen, 21 were not diabetics, 60 were cases of late diagnosis or late recording, 75 came from another centre and 9 were type-1. All these were excluded. The mean age of the 222 (57.4%) real new cases was 59 (ED 11.4). 53% were women. The most common causes of diagnosis were the existence of previous with diagnostic hiperglycemia (50.9%) and the application of protocols for other cardiovascular risk factors (19.8%). The diagnostic methods were two basal glucaemias > or = 140 mg/dl (70.7%), 1 glucaemia > or = 200 mg/dl with typical clinical picture (6.7%) and oral overload of glucose (23%). 97% of cases were diagnosed at the centre itself. The density of annual incidence was 30.1 per 10,000 inhabitants. Prevalence at start and end of the study was 4.4 and 4.9%. CONCLUSIONS: The incidence and prevalence described are greater than described in other studies. The most common reasons for diagnosis were the existence of previous nondiagnostic hyperglycemia and the application of protocols for other risk factors.

Diabetes mellitus tipo 2: incidencia y diagnóstico en un centro de atención primaria / Type-2 diabetes mellitus: incidence and diagnosis at a primary care centre

Objetivos. Conocer la incidencia anual, los motivos y los métodos utilizados para el diagnóstico de diabetes mellitus tipo 2 (DM2) en el período 1991-1995 a partir de la validación de un registro informatizado. Diseño. Estudio longitudinal retrospectivo. Emplazamiento. Centro de atención primaria. Mediciones y resultados principales. De los 387 diabéticos registrados como nuevos casos en el período 1991-1995 de una población atendida de 17.031 personas mayores de 14 años, 21 no eran diabéticos, 60 eran retrasos en el diagnóstico o en su registro, 75 provenían de otro centro y 9 eran tipo 1, por lo que fueron excluidos. La edad media de los 222 (57,4 por ciento) nuevos casos verdaderos fue de 59 (DE, 11,4) años, siendo un 53 por ciento mujeres. Los motivos de diagnóstico más frecuentes fueron la existencia de hiperglucemias no diagnósticas previas (50,9 por ciento) y la aplicación de protocolos de otros factores de riesgo cardiovascular (19,8 por ciento). Los métodos diagnósticos fueron 2 glucemias basales >= 140 mg/dl (70,7 por ciento), una glucemia >= 200 mg/dl con clínica típica (6,7 por ciento) y la sobrecarga oral de glucosa (23 por ciento). El 97 por ciento de casos se diagnosticó en el propio centro. La densidad de incidencia anual fue de 30,1 por 10.000 habitantes. La prevalencia al principio y al final del estudio fue del 4,4 y 4,9 por ciento. Conclusiones. La incidencia y la prevalencia observadas son superiores a las descritas en otros estudios. Los motivos de diagnóstico más frecuentes fueron la hiperglucemia no diagnóstica previa y la aplicación de protocolos de otros factores de riesgo (AU)

[Estimation of the prevalence of cognitive impairment according to the test used]. / Estimaciones de la frecuencia de déficit cognitivo según el test empleado.

OBJECTIVES: The aim of the study was to compare the findings of Folstein's Mini Mental Test (MMT), Lobo's Cognitive Mini Exam (CME) and the Isaacs Set test, in their detection of cognitive deficit in over-64 year olds; and to analyse the factors associated with variability in the scores obtained with these tests. DESIGN: An observational crossover study. SETTING: An urban Primary Care center. PATIENTS: Among the total of 1096 patients aged over 64 registered on 5 lists and with medical records, a random sample of 329 was chosen. INTERVENTIONS: The MMT, CME and Set test were administered to each patient in the same interview. Information on associated morbidity and social and demographic variables was gathered. MAIN RESULTS: 211 women (64%) and 118 men (36%) completed the tests. Women were older (73.0 +/- 6 against 71.2 +/- 6; p = 0.02) and had had less schooling (3.2 +/- 3.6 years against 4.2 +/- 3.7; p = 0.019). A higher percentage of women were illiterate (47.1% against 24.3%; p = 0.008). The MMT showed CD at 60.8%, the CME at 28% and the Set test at 11.3%. CONCLUSIONS: Estimated prevalence of CD varies depending on the test used. Variability in the MMT and CME is basically due to years of schooling, whereas in the Set test it is because of age.

[Ongoing improvement in the quality of chronic prescriptions at a primary care center: a 5-year follow-up]. / Mejora continua de la calidad de la prescripción crónica en un centro de atención primaria: seguimiento de 5 años.

OBJECTIVE: To find how the indicators for prescriptions for the chronically ill during the 1988-1992 period evolved, based on the analysis of the repeat prescription archive; and to assess the persistence of the effect of the 1989 corrective intervention. DESIGN: A retrospective and longitudinal evaluation study. SETTING: Primary Care Centre. PATIENTS AND OTHER PARTICIPANTS: Four representative samples of patients with an ongoing prescription card for 1988 (n = 549), 1989 (n = 211), 1990 (n = 193) and 1992 (n = 126). MEASUREMENTS AND RESULTS: Indicators used were: percentage of patients in treatment with some medication of low intrinsic value (LIV), benzodiazepines, peripheric vasodilators (PV), oral non-steroidal anti-inflammatories (NSAID), external NSAID and the percentage of each one of these out of the prescription total. A progressive decrease in the percentage of LIV medication in the 1988-1992 period was detected. There were significant differences, both for oral anti-diabetes drugs of high intrinsic value (HIV) (24.4 and 12.7%), and of LIV (26.6 and 16.9%) (p < 0.001 in both cases). Benzodiazepines went down from 5.4 to 1.2% (p = 0.0006), PVs from 4.4 to 1.2% (p = 0.003) and oral NSAID from 4.7 to 2.4% (p = 0.049). The percentage of patients treated with LIV medication went down from 46.1 to 29.4% (p < 0.001) and from 52.4 to 38.1% (p = 0.004), for HIV and LIV oral anti-diabetes drugs, respectively. Patients treated with benzodiazepines went down from 14.7 to 4.0% (p = 0.0017), with PV from 12.0 to 3.2% (p = 0.005) and with oral NSAID from 12.7 to 7.9% (ns). CONCLUSION: A continuous improvement in the quality of prescription for the chronically ill has been observed over the last 5 years and can be attributed to the primary care team.

[Functional classification of chronic alcoholic hepatopathy in primary care]. / Clasificación funcional de la hepatopatía crónica alcohólica en atención primaria.

OBJECTIVE: To evaluate the use of Pugh's Classification in assessing patients with diffuse alcoholic Chronic Hepatopathy in the out-patient context. DESIGN: Descriptive-retrospective study. SITE. The Base Health Area of "La Mina" in Barcelona. PATIENTS OR OTHER PARTICIPANTS: 143 patients over the age of 14 diagnosed as suffering diffuse chronic Hepatopathy were identified. 37 of these were excluded because of lack of data. MAIN MEASUREMENTS AND RESULTS: The following data were gathered: those relating to semeiology, anamnesis, quantifying alcoholic intake, where the original diagnosis was made, how rapidly the condition evolved, laboratory and complementary explorations' parameters. Out of the 106 patients studied 71 (67%) were classified in group A; 22 (21%) in B and 13 (12%) in C. No significant differences were found in relation to age or sex. Significant differences concerning the speed of the condition's evolution and the average intake in grammes of alcohol per day were observable. The number of hospital admissions increased as the patient's functional stage became worse and complications increased. CONCLUSIONS: Pugh's test was shown to be useful in the out-patient context for classifying patients suffering chronic diffuse Hepatopathy in line with the severity of their condition.