Consenso multidisciplinar sobre el manejo individualizado de la diabetes en atención primaria. Estudio ICANDAP / Delphi consensus on the individualised management of diabetes in primary care. ICANDAP study

Introducción. Se trata de explorar el grado de aceptación y consenso en el abordaje individualizado y determinadas recomendaciones sobre el manejo clínico-terapéutico de la diabetes mellitus de tipo 2 (DM2) entre los médicos de Atención Primaria (AP) españoles y explorar las diferentes barreras que pueden interferir en su implementación en la práctica clínica habitual. Material y métodos. Estudio nacional en el ámbito de la AP, de carácter exploratorio, de acuerdo con la metodología Delphi modificada, con 2 rondas de consenso. Evaluación por parte de un panel homogéneo formado por 152 médicos de AP a través de un cuestionario dividido en 6 áreas temáticas y constituido por 27 ítems. Resultados. De manera global, se consiguió el consenso en 19 (70,4%) de los 27 ítems: 12 de acuerdo (44,4%) y 7 de desacuerdo (25,9%). No se alcanzó consenso en 8 de los ítems (29,6%). Conclusiones. Aunque hay aspectos que reflejan un aceptable consenso sobre el manejo de la diabetes de tipo 2 con base en el perfil individualizado del paciente, como el establecimiento de los objetivos de control o la selección de los fármacos antidiabéticos, persiste una amplia diversidad de opiniones entre los médicos de AP en nuestro medio (AU)

Introduction. To determine the level of acceptance of the message of individualised management of type 2 diabetes mellitus among Spanish Primary Care (PC) physicians, and to evaluate the factors that may interfere with its implementation in clinical practice. Material and methods. National study in the field of PC, exploratory, and following a two-round modified Delphi method. Evaluation by a homogeneous panel of 152 physicians using a 27-items questionnaire divided into 6 thematic areas. Results. Overall, consensus was achieved in 19 (70.4%) of the 27 items, 12 in agreement (44.4%), and 7 in disagreement (25.9%). There was no consensus in 8 (29.6%) of the items. Conclusions. Although there are certain aspects indicating the good acceptance of the message of diabetes management based on the individual patient profile, such as in the establishment of targets or the selection of antidiabetic drugs, the message has not been assimilated by all Spanish PC physicians. Further studies, involving a large number of physicians, are required to corroborate these results, and identify more factors that may be interfering with the implementation in clinical practice (AU)

Casos clínicos / Clinical cases

No disponible

[Delphi consensus on the individualised management of diabetes in primary care. ICANDAP study]. / Consenso multidisciplinar sobre el manejo individualizado de la diabetes en atención primaria. Estudio ICANDAP.

INTRODUCTION: To determine the level of acceptance of the message of individualised management of type 2 diabetes mellitus among Spanish Primary Care (PC) physicians, and to evaluate the factors that may interfere with its implementation in clinical practice. MATERIAL AND METHODS: National study in the field of PC, exploratory, and following a two-round modified Delphi method. Evaluation by a homogeneous panel of 152 physicians using a 27-items questionnaire divided into 6 thematic areas. RESULTS: Overall, consensus was achieved in 19 (70.4%) of the 27 items, 12 in agreement (44.4%), and 7 in disagreement (25.9%). There was no consensus in 8 (29.6%) of the items. CONCLUSIONS: Although there are certain aspects indicating the good acceptance of the message of diabetes management based on the individual patient profile, such as in the establishment of targets or the selection of antidiabetic drugs, the message has not been assimilated by all Spanish PC physicians. Further studies, involving a large number of physicians, are required to corroborate these results, and identify more factors that may be interfering with the implementation in clinical practice.

Control de la presión arterial en una población hipertensa diabética asistida en atención primaria: estudio PRESCAP-Diabetes 2010 / Blood pressure control in a population of hypertensive diabetic patients treated in primary care: PRESCAP-Diabetes Study 2010

Objetivos. Conocer el grado de control de la presión arterial (PA) en los pacientes hipertensos diabéticos atendidos en atención primaria y determinar los factores asociados al mal control. Material y métodos. Estudio transversal, multicéntrico que incluyó a hipertensos diabéticos, reclutados mediante muestreo consecutivo por médicos de familia de toda España en junio de 2010. Se consideró buen control de la hipertensión arterial al promedio de PA inferior a 140/90 mmHg. Se evaluó también el porcentaje de pacientes con PA< 130/80 mmHg, 140/80 mmHg y 140/85 mmHg. Se registraron datos sociodemográficos, clínicos, factores de riesgo cardiovascular y tratamientos farmacológicos. Resultados. Se incluyeron 3.993 pacientes (50,1% mujeres) con una edad media (desviación típica) de 68,2 (10,2) años. El 73,9% recibía terapia combinada. Presentaron cifras de buen control de ambas cifras tensionales (< 140/90 mmHg) el 56,4% (IC 95%: 54,3-58,4) de los casos; el 58,5%(IC 95%: 57-60) solo de la PA sistólica y el 84,6% (IC 95%: 83,2-85,8) únicamente de la PA diastólica. Las variables con mayor fuerza de asociación con el mal control fueron la presencia de albuminuria, el colesterol total elevado, el sedentarismo y no tomar la medicación el día de la entrevista. Conclusiones. Los resultados del estudio PRESCAP-Diabetes 2010 indican que el 43,6% de los hipertensos diabéticos asistidos en atención primaria tiene mal controlada la PA, fundamentalmente la PA sistólica (AU)

Objectives. To determine the level of blood pressure (BP) control in hypertensive diabetic patients treated in primary care and to determine the factors associated with poor control. Material and methods. A cross-sectional, multicentre study that enrolled hypertensive diabetics recruited by consecutive sampling by family doctors in Spain in June 2010. A mean BP of less than 140/90 mmHg was considered as good control of arterial hypertension. The percentages of patients with < 130/80 mmHg PA, 140/80 mmHg, and 140/85 mmHg, respectively, were also determined. Sociodemographic, clinical, cardiovascular risk factors, and pharmacological treatments were recorded. Results. A total of 3,993 patients were enrolled (50.1% female) with a mean age (standard deviation) of 68.2 (10.2) years, of whom 73.9% received combination therapy. The figures showed good control of both blood pressure values (< 140/90 mmHg) in 56.4% (95% CI: 54.3 to 58.4) of the cases, with 58.5% (95% CI: 57.0-60.0) only in systolic BP, and 84.6% (95% CI, 83.2 to 85.8) only in diastolic BP. The variables with strongest association with poor control were the presence of albuminuria, elevated total cholesterol, physical inactivity, and not taking the medication on the day of the interview. Conclusions. The PRESCAP-Diabetes 2010 study results indicate that 43.6% of diabetics with hypertension seen in primary care have a poorly controlled BP, in particular, systolic BP (AU)

[Blood pressure control in a population of hypertensive diabetic patients treated in primary care: PRESCAP-Diabetes Study 2010]. / Control de la presión arterial en una población hipertensa diabética asistida en atención primaria: Estudio PRESCAP-Diabetes 2010.

OBJECTIVES: To determine the level of blood pressure (BP) control in hypertensive diabetic patients treated in primary care and to determine the factors associated with poor control. MATERIAL AND METHODS: A cross-sectional, multicentre study that enrolled hypertensive diabetics recruited by consecutive sampling by family doctors in Spain in June 2010. A mean BP of less than 140/90mmHg was considered as good control of arterial hypertension. The percentages of patients with<130/80mmHg PA, 140/80mmHg, and 140/85mmHg, respectively, were also determined. Sociodemographic, clinical, cardiovascular risk factors, and pharmacological treatments were recorded. RESULTS: A total of 3,993 patients were enrolled (50.1% female) with a mean age (standard deviation) of 68.2 (10.2) years, of whom 73.9% received combination therapy. The figures showed good control of both blood pressure values (<140/90mmHg) in 56.4% (95% CI: 54.3 to 58.4) of the cases, with 58.5% (95% CI: 57.0-60.0) only in systolic BP, and 84.6% (95% CI, 83.2 to 85.8) only in diastolic BP. The variables with strongest association with poor control were the presence of albuminuria, elevated total cholesterol, physical inactivity, and not taking the medication on the day of the interview. CONCLUSIONS: The PRESCAP-Diabetes 2010 study results indicate that 43.6% of diabetics with hypertension seen in primary care have a poorly controlled BP, in particular, systolic BP.

[An analysis of the referrals of primary care physicians to a hospital hypertension unit]. / Análisis de la derivación de médicos de atención primaria a una unidad de hipertensión hospitalaria.

OBJECTIVES: To describe the referral of hypertense patients from primary care to a hospital arterial hypertension unit, the quality of the information sent and the profile of the referred patients. DESIGN: A descriptive crossover study. SETTING: The Hospital Clínico of San Carlos in Madrid. PATIENTS AND OTHER PARTICIPANTS: A simple random sample of 368 clinical records belonging to patients attended at the unit over the last 3 years. MEASUREMENTS AND MAIN RESULTS: 54.6% of patients were referred from primary care. 48.9% of the interclinical (IC) notes were high-quality, with 28.7% acceptable. 36.8% of referrals were considered incorrect, 30.3% because of false unresponsiveness to treatment. Good or acceptable IC notes were associated with 94.1% of correct referrals and only 65.4% of incorrect referrals. CONCLUSIONS: A high proportion of referrals which were incorrect by the consensus criteria were detected and were caused by inadequate or insufficient medical treatment. There was a statistically significant relationship found between correct referrals and the quality of information sent in the IC note.