Demora en el diagnóstico y tratamiento de 5 tipos de cáncer en 2 centros de salud urbanos / Delay in the diagnosis and treatment of five types of cancer in two urban health centres

Objetivos: Evaluar los intervalos de diagnóstico (ID) y tratamiento (IT) de los cánceres más prevalentes en pacientes adscritos a 2 centros de salud, y analizar la influencia de factores sociodemográficos, clínicos y de organización del sistema sanitario (SS).DiseñoEstudio observacional de cohortes, retrospectivo y analítico.LocalizaciónAtención primaria. Dos centros de salud urbanos.ParticipantesTrescientos sesenta y cinco pacientes diagnosticados de cáncer colorrectal (CCR), mama, pulmón, próstata o vejiga entre el 1/1/2012 y el 31/12/2017.Medidas principalesSe comparan las medianas de ID e IT y el riesgo (OR) de ID e IT superiores a esas medianas según los factores mencionados. Se analiza la contribución de cada etapa del proceso al ID.ResultadosLa mediana del ID fue 92 días, máxima en cáncer de próstata (395 días) y mínima en pulmón (54 días). Factores relacionados con ID prolongado (OR>92 días) fueron sexo femenino, localización CCR o prostática, estadío localizado, consulta índice en atención primaria (AP) y ruta diagnóstica ambulatoria. Un IT prolongado (OR>56 días) se relacionó con la localización de CCR o prostática y ruta diagnóstica ambulatoria. Componentes del ID con mayor influencia en la demora fueron: intervalo de atención primaria (IAP), demora de atención secundaria (DAS) y demora de la prueba complementaria de atención secundaria (DPCAS). La contribución del IAP fue mayor en pacientes con CCR, pulmón y vejiga.ConclusionesLos ID e IT fueron 92 y 56 días, respectivamente. Los componentes del ID con mayor contribución a la demora fueron IAP, DAS y DPCAS. Aumentar la capacidad diagnóstica en AP y organizar itinerarios específicos de diagnóstico y tratamiento, acortaría dichos intervalos y permitiría una detección más temprana.

Objectives: To assess the diagnostic (ID) and treatment (IT) intervals of the most prevalent cancers in patients attached to two health centres and to analyse the influence of sociodemographic, clinical and health system (HS) organisational factors.DesignObservational, retrospective, analytical cohort study.SitePrimary care. Two urban health centres.ParticipantsThree hundred sixty-five patients diagnosed with colorectal cancer (CRC), breast, lung, prostate or bladder cancer between 1/1/2012 and 31/12/2017.Main measuresThe medians of ID and IT and the risk (OR) of ID and IT above those medians according to the above factors are compared. The contribution of each process step to ID is analysed.ResultsMedian ID was 92 days, maximum in prostate cancer (395 days) and minimum in lung (54 days). Factors associated with prolonged ID (OR>92 days) were female sex, CRC or prostate location, localised stage, index primary care (AP) consultation and outpatient diagnostic pathway. Prolonged IT (OR>56 days) was related to CRC or prostate location and outpatient diagnostic route. ID components with the greatest influence on delay were: Primary Care Interval (IAP), Secondary Care Delay (DAS) and Secondary Care Adjunctive Test Delay (DPAS). The contribution of IAP was highest in patients with CRC, lung and bladder.ConclusionsID and IT were 92 and 56 days respectively. The ID components with the highest contribution to delay were IAP, DAS and DPAS. Increasing diagnostic capacity in PC and organising specific diagnostic and treatment pathways would shorten these intervals and allow earlier detection.

[Delay in the diagnosis and treatment of five types of cancer in two urban health centres]. / Demora en el diagnóstico y tratamiento de 5 tipos de cáncer en 2 centros de salud urbanos.

OBJECTIVES: To assess the diagnostic (ID) and treatment (IT) intervals of the most prevalent cancers in patients attached to two health centres and to analyse the influence of sociodemographic, clinical and health system (HS) organisational factors. DESIGN: Observational, retrospective, analytical cohort study. SITE: Primary care. Two urban health centres. PARTICIPANTS: Three hundred sixty-five patients diagnosed with colorectal cancer (CRC), breast, lung, prostate or bladder cancer between 1/1/2012 and 31/12/2017. MAIN MEASURES: The medians of ID and IT and the risk (OR) of ID and IT above those medians according to the above factors are compared. The contribution of each process step to ID is analysed. RESULTS: Median ID was 92 days, maximum in prostate cancer (395 days) and minimum in lung (54 days). Factors associated with prolonged ID (OR>92 days) were female sex, CRC or prostate location, localised stage, index primary care (AP) consultation and outpatient diagnostic pathway. Prolonged IT (OR>56 days) was related to CRC or prostate location and outpatient diagnostic route. ID components with the greatest influence on delay were: Primary Care Interval (IAP), Secondary Care Delay (DAS) and Secondary Care Adjunctive Test Delay (DPAS). The contribution of IAP was highest in patients with CRC, lung and bladder. CONCLUSIONS: ID and IT were 92 and 56 days respectively. The ID components with the highest contribution to delay were IAP, DAS and DPAS. Increasing diagnostic capacity in PC and organising specific diagnostic and treatment pathways would shorten these intervals and allow earlier detection.

Ensayo clínico aleatorio para evaluar la eficacia de una intervención educativa desarrollada en atención primaria sobre asmáticos adultos / A randomised clinical trial to evaluate the effectiveness of an educational intervention developed for adult asthmatics in a primary care centre

OBJETIVO: Evaluar el efecto de una intervención educativa específica sobre el control del asma y la calidad de vida. DISEÑO: Ensayo clínico con asignación aleatoria de pacientes asmáticos, a un grupo de intervención educativa (GI) y otro de control (GC). Se midió el nivel de control del asma y de calidad de vida, al inicio y trimestralmente durante un año. El cegamiento solo fue posible en la recogida y análisis de datos. Emplazamiento: Dos centros de atención primaria urbanos. Participantes: Se incluyeron 163 asmáticos, de 18 a 55 años, asignados aleatoriamente 84 al GI y 79 al GC. Finalizaron el seguimiento 104 (GI: 55; GC: 49). Intervención: GI: Tres sesiones educativas, grupales, impartidas por médicos de familia. primera al inicio de la primavera, segunda a los 15 días, y tercera, de refuerzo, a los 6 meses. GC: asistencia habitual. Mediciones principales: Nivel de control del asma y de calidad de vida mediante el Asthma Control Test (ACT) y el Asthma Quality of life Questionnaire (AQLQ). RESULTADOS: Al tercer mes, hubo diferencia significativa en el porcentaje de pacientes con buen control (p = 0,002), 75% en el GI y 48,5% en el GC, RR = 1,6 [1,2 a 2,1], NNT = 3,8 [2,4 a 9,4] y una mejoría con respecto al inicio en los niveles de calidad de vida (p = 0,005); RR = 2,3 [1,3 a 4,1], NNT = 4,3 [2,6 a 12,4]. Sin diferencias en los trimestres restantes. CONCLUSIONES: Estos talleres son efectivos para mejorar el control y la calidad de vida a corto plazo, lo que nos puede orientar en la elección del momento más adecuado para realizarlos

OBJECTIVE: To assess the effect of an educational intervention on asthma control and quality of life. DESIGN: A randomised clinical trial of patients with asthma, with an intervention group (IG) and a control (GC). Asthma control and quality of life was measured in both groups at baseline and every three months for one a year. Blinding was only possible in the collection and analysis of data. Location: Two urban Primary Care Health Centres. Participants: A total of 163 patients aged 18 to 55 years were included: 84 were assigned to the IG and 79 to the CG. The follow-up was completed by 104 patients (GI: 55 and GC 49). Intervention: GI: Three educational sessions in small interactive groups. The first session was at the beginning of spring, the second 15 days later, and the third 6 months later, to recall the knowledge. Main measurements: Asthma control level and quality of life using ACT(Asthma Control Test)and the AQLQ (Asthma Quality of life Questionnaire). RESULTS: In the third month, statistically significant differences were detected in the percentage of patients with good control [(p = 0.0002), 75% in the GI, and 48.5% in the GC, Relative Risk (RR)=1.6 [1.2 to 2.1], Number Needed to Treat (NNT)=3.8 [2.4 to 9.4], and an improvement in levels of quality of life from baseline (p = 0.005), RR=2.3 [1.3 to 4.1], NNT: 4.3 [2.6 to 12.4]. No differences were detected in the remaining sessions. CONCLUSIONS: These interventions are effective in improving the control and quality of life in short-term, which can guide us in choosing the best time to do it

[A randomised clinical trial to evaluate the effectiveness of an educational intervention developed for adult asthmatics in a primary care centre]. / Ensayo clínico aleatorio para evaluar la eficacia de una intervención educativa desarrollada en atención primaria sobre asmáticos adultos.

OBJECTIVE: To assess the effect of an educational intervention on asthma control and quality of life. DESIGN: A randomised clinical trial of patients with asthma, with an intervention group (IG) and a control (GC). Asthma control and quality of life was measured in both groups at baseline and every three months for one a year. Blinding was only possible in the collection and analysis of data. LOCATION: Two urban Primary Care Health Centres PARTICIPANTS: A total of 163 patients aged 18 to 55 years were included: 84 were assigned to the IG and 79 to the CG. The follow-up was completed by 104 patients (GI: 55 and GC 49). INTERVENTION GI: Three educational sessions in small interactive groups. The first session was at the beginning of spring, the second 15 days later, and the third 6 months later, to recall the knowledge. MAIN MEASUREMENTS: Asthma control level and quality of life using ACT(Asthma Control Test) and the AQLQ (Asthma Quality of life Questionnaire). RESULTS: In the third month, statistically significant differences were detected in the percentage of patients with good control [(P=.0002), 75% in the GI, and 48.5% in the GC, Relative Risk (RR)=1.6 [1.2 to 2.1], Number Needed to Treat (NNT)=3.8 [2.4 to 9.4], and an improvement in levels of quality of life from baseline (P=.005), RR=2.3 [1.3 to 4.1], NNT: 4.3 [2.6 to 12.4]. No differences were detected in the remaining sessions. CONCLUSIONS: These interventions are effective in improving the control and quality of life in short-term, which can guide us in choosing the best time to do it.