Seguimiento de las recomendaciones en prevención secundaria cerebrovascular en atención primaria / Compliance with recommendations in secondary prevention of stroke in primary care

OBJETIVO: Conocer el grado de seguimiento de las recomendaciones en prevención secundaria cerebrovascular en atención primaria e identificar factores asociados. DISEÑO: Transversal multicéntrico. Emplazamiento: Centros de salud de atención primaria de un área metropolitana (944.280 habitantes). PARTICIPANTES: Pacientes mayores de 18 años con diagnóstico de enfermedad cerebrovascular antes de 6 meses del estudio. Mediciones principales: Extracción de historia clínica informatizada de variables demográficas, factores de riesgo y comorbilidad cardiovascular, fármacos, valores de presión arterial (PA), colesterolLDL y visitas por medicina y enfermería posteriores al episodio. Se consideró buen control: PA < 140/90mmHg, colesterolLDL < 100mg/dl, abstención tabáquica y prescripción de fármacos preventivos (antiagregantes/anticoagulantes, estatinas e IECA/ARAII o diurético) en los últimos 18 meses. RESULTADOS: Un total de 21.976 sujetos, media de edad 73,1 años (DE: 12,1), 48% mujeres, el 72,7% con accidente vascular cerebral establecido. Comorbilidad: 70,8% HTA, 55,1% dislipidemia, 30,9% DM, 14,1% fibrilación auricular, 13,5% cardiopatía isquémica, 12,5% insuficiencia renal crónica, 8,8% insuficiencia cardiaca, 6,2% arteriopatía periférica, 7,8% demencia. Sin registro de: hábito tabáquico 3,7%, PA 3,5% y colesterolLDL 6,5%. Grado de control: 75,4% abstención tabáquica, 65,7% PA < 140/90 y 41,0% colesterolLDL< 100mg/dl. Tratamiento: 86,2% antiagregantes/anticoagulantes, 61,3% estatinas y 61,8% IECA/ARAII o diurético. El registro/grado de control fue superior en el grupo de 66-79 años e inferior en el de 18-40 años. CONCLUSIONES: El seguimiento de las recomendaciones de las guías clínicas para la prevención de la enfermedad cerebrovascular en atención primaria es mejorable, especialmente en los más jóvenes. Son necesarios cambios organizativos e intervención más activa de los profesionales, así como estrategias para combatir la inercia terapéutica

OBJECTIVE: Knowing compliance with secondary prevention recommendations of stroke in primary care and to identify factors associated with compliance. DESIGN: Multi-centre cross-sectional. SETTING: Health primary care centres in a metropolitan area (944,280 inhabitants). PARTICIPANTS: Patients aged 18 years and over with ischemic brain disease diagnosis prior to 6months before the study. MAIN MEASUREMENTS: Clinical history records of demographic variables, risk factors and cardiovascular comorbidity, drugs, blood pressure values (BP), LDL-cholesterol and medical visits by doctor and nurses after the event. Good adherence was considered when BP < 140/90 mmHg, LDL-cholesterol < 100 mg/dL, smoking abstention and preventive drugs prescription (anti-platelet/anticoagulants, statins and angiotensin-converting-enzyme inhibitors/angiotensin-receptor-antagonists or diuretics) during the last 18 months. RESULTS: A total of 21,976 patients, mean age 73.12 years (SD: 12.13), 48% women, 72.7% with stroke. Co-morbidity: hypertension 70.8%, dyslipidemia 55.1%, DM 30.9%, atrial fibrillation 14.1%, ischemic heart disease 13.5%, chronic renal failure 12.5%, heart failure 8.8%, peripheral arterial disease 6.2%, dementia 7.8%. No record was found for smoking in 3.7%, for BP in 3.5% and for LDL in 6.5%. Optimal control: abstention smoking in 3.7%, BP < 140/90 in 65.7% and LDL < 100 mg/dL in 41.0%. Treatment: 86.2% anti-platelet/anticoagulants, 61.3% statins and 61.8% angiotensin-converting-enzyme inhibitors, angiotensin-receptor-antagonists or diuretic. Registration and risk factors control was higher in 66-79 years aged and lower in 18-40 years aged. CONCLUSIONS: The implementation of clinical guidelines recommendations for stroke prevention in primary care must be improved, especially among younger population. Organizational changes and more active involvement by professionals and strategies against therapeutic inertia must be taken

[Compliance with recommendations in secondary prevention of stroke in primary care]. / Seguimiento de las recomendaciones en prevención secundaria cerebrovascular en atención primaria.

OBJECTIVE: Knowing compliance with secondary prevention recommendations of stroke in primary care and to identify factors associated with compliance. DESIGN: Multi-centre cross-sectional. SETTING: Health primary care centres in a metropolitan area (944,280 inhabitants). PARTICIPANTS: Patients aged 18years and over with ischemic brain disease diagnosis prior to 6months before the study. MAIN MEASUREMENTS: Clinical history records of demographic variables, risk factors and cardiovascular comorbidity, drugs, blood pressure values (BP), LDL-cholesterol and medical visits by doctor and nurses after the event. Good adherence was considered when BP <140/90 mmHg, LDL-cholesterol <100 mg/dL, smoking abstention and preventive drugs prescription (anti-platelet/anticoagulants, statins and angiotensin-converting-enzyme inhibitors/angiotensin-receptor-antagonists or diuretics) during the last 18months. RESULTS: A total of 21,976 patients, mean age 73.12 years (SD: 12.13), 48% women, 72.7% with stroke. Co-morbidity: hypertension 70.8%, dyslipidemia 55.1%, DM 30.9%, atrial fibrillation 14.1%, ischemic heart disease 13.5%, chronic renal failure 12.5%, heart failure 8.8%, peripheral arterial disease 6.2%, dementia 7.8%. No record was found for smoking in 3.7%, for BP in 3.5% and for LDL in 6.5%. Optimal control: abstention smoking in 3.7%, BP <140/90 in 65.7% and LDL <100 mg/dL in 41.0%. TREATMENT: 86.2% anti-platelet/anticoagulants, 61.3% statins and 61.8% angiotensin-converting-enzyme inhibitors, angiotensin-receptor-antagonists or diuretic. Registration and risk factors control was higher in 66-79years aged and lower in 18-40years aged. CONCLUSIONS: The implementation of clinical guidelines recommendations for stroke prevention in primary care must be improved, especially among younger population. Organizational changes and more active involvement by professionals and strategies against therapeutic inertia must be taken.

Demencia y género: una perspectiva desde la atención primaria / No disponible

Objetivo. Describir las características de las demencias en atención primaria (AP) en función del sexo de paciente y cuidador. Material y métodos. Estudio observacional transversal de 227 casos, con diagnóstico de demencia según criterios del CIE-10 (en cualquiera de sus variantes), en junio de 2009 en un centro de AP, recogiendo variables sociodemográficas, clínicas y asistenciales. Resultados. Encontramos edad mayor (83 frente a 78; p < 0,001) y escolarización menor en mujeres que en hombres (16,7 % de analfabetismo frente a 6,8 %). La enfermedad de Alzheimer fue el subtipo más frecuente, aunque con predominio mayor en mujeres (55,4 % frente a 39 %). La institucionalización (51,1 % frente a 32,2 %; p = 0,01), polifarmacia (7,6 frente a 6,1; p = 0,02) y uso de psicofármacos son mayores en mujeres, mientras que la frecuentación de AP y urgencias hospitalarias (UH) es inferior (p = 0,033). El cuidador más habitual es una mujer (64,8 %; p < 0,001). Los pacientes cuidados por hijas frecuentan menos las UH (p = 0,017) y reciben con mayor probabilidad tratamiento específico. Conclusiones. El perfil de las demencias en AP presenta diferencias entre hombres y mujeres. El paciente tipo sería una mujer, más añosa que en el caso de los hombres, menos escolarizada, con una demencia más evolucionada, más «medicalizada », más institucionalizada y menos frecuentadora. Las mujeres parecen generar menor sobrecarga asistencial directa, pero mayor impacto farmacológico y sociosanitario. El cuidador principal suele ser una mujer. Los pacientes cuidados por hijas frecuentan menos servicios hospitalarios y siguen con mayor probabilidad tratamiento específico(AU)

Objective. To describe the characteristics of dementia in primary care (AP) depending on the sex of patient and caregiver. Material and methods. Observational transversal study in a Primary Care (PC) center of 227 cases with diagnosis «dementia» ICD-10 (including all subtypes) in 2009, June, collecting socio-demographic, clinical and care-related variables. Results. We find women older (83 vs 78;p < 0.001) and with lower levels of schooling (16.7 % illiteracy vs 6.8 % men). Alzheimer’s disease was the most frequent diagnosis with higher prevalence in women (55,4 % vs 39 %). Institutionalization (51.1 % vs 32.2 %; p = 0.01), polypharmacy (7.6 vs 6.1; p = 0.02) and use of psychoactive drugs is higher in women, while PC and emergency units (EU) attendance is lower (p = 0,033). The most usual caregiver is a woman (64.8%; p < 0.001). Patients cared for by her daughters have less frequentation in EU (p = 0, 017) and follow most likely specific treatments. Conclusions. Dementia in PC presents valuable differences between men and women. The profile type would be a woman, most aged than men, with lower academic level, with a more evolved dementia, more exposed to drugs, more institutionalized and less frequenter. Women seem to generate less direct care overload, but greater pharmacological and social impact. Primary caregiver is usually a woman. Patients cared for his daughters present lower frequentation of hospital services and higher use of specific treatment(AU)