[Evaluation of the system of direct purchase and distribution of urinary incontinence pads in primary care centers]. / Evaluación del sistema de compra y dispensación directa de pañales absorbentes de orina en los centros de atención primaria.

OBJECTIVE: To evaluate the impact of the pilot experience of direct purchase and distribution of incontinence diapers in primary health care centres of the Balearic Islands after 10 months of implementation. DESIGN: Comparison of diapers's public expenditures and use during 10 months of pilot experience (9/1/1994-6/30/1995: POSTC) to a same length period prior to pilot experience implementation (11/1/1993-8/31/1994: PREC). SETTING: Primary health care centres of the Balearic Islands (Spain). MEASUREMENTS AND RESULTS: Monthly mean of packages used in the PREC period was 3,246 packages/month, whereas monthly mean of packages used in POSTC period was 4,541 packages/month. It means an increase of 1,295 packages/month. The mean price per package got by public tender was 4,426 ptas., nearly half of mean unit price per package paid through the usual dispensing system of medical prescription (8,583 ptas.), thus producing a saving of 4,157 ptas. per package. A decreasing trend to the monthly mean of diapers use of the PREC period was observed in the last months of the experience. The monthly expenditures in diapers was 27,790 milions ptas. in the PREC period and 21,024 milions ptas. during the POSTC period. CONCLUSIONS: The expected increase in diapers use during the first year of implementation of this measure was 34.86%. Of this increase, 70.5% is attributed to development of stock in centres and the undergoing trend of diapers demand increase observed throughout the country.

[Identification and recording of risk factors both at reformed and non-reformed primary care centers]. / Identificación y registro de factores de riesgo en centros reformados y no reformados de atención primaria.

OBJECTIVE: To identify factors associated with carrying out preventive activities in primary care. DESIGN: A crossover study through a self-administered questionnaire. SETTING: Reformed and non-reformed centres of the primary care sub-division of the Barcelona Health Region, Catalan Health Institute. PARTICIPANTS: 134 doctors from reformed centres (primary care teams) and 138 from non-reformed primary care centres (PCC). MEASUREMENTS AND MAIN RESULTS: Doctors from the reformed centres used records to a much greater extent (75.3% as against 26.3% for tobacco consumption; 76.2% as against 27.9% for alcohol consumption). Together with the type of centre, some professional characteristics were linked to the likelihood of carrying out preventive activities. These included, in particular, professionals' high valuation of their own effectiveness and professional practices such as the habitual use of a safety belt and anti-flu injections. CONCLUSIONS: In the reformed centres preventive activities are much more integrated. To optimise their use other important aspects, such as training in skills and improving professionals' perception of their own effectiveness, will have to be considered.

[Vaccination against hepatitis B in health workers and other staff in Barcelona]. / Vacunación contra el virus de la hepatitis B del personal sanitario y no sanitario en el área de Barcelona ciudad.

OBJECTIVE: To analyse the results of a hepatitis B vaccination programme, in order to find the levels of acceptance of the programme and adherence to it, as well as the immunological response and the impact of age, gender and the index of corporal mass (ICM). DESIGN: This was a retrospective study. SETTING: Primary Care. PATIENTS AND OTHER PARTICIPANTS: 2,055 Primary Care professionals considered at risk (43.3% of the Area total). MEASUREMENTS AND MAIN RESULTS: Out of the total number of professionals at risk, 1,294 (63%) agreed to have the serological markers. The prevalence of markers of the hepatitis B virus (HBV) was 16.07% (208), which increased with age (p < 0.0001). 87% had three doses (961/1,106). 863 (89.8%) of these went through the post-vaccination controls and levels of HB antibodies above 10 IU/ml were found in 790 (91.5%). The fourth dose produced favorable results (66.7%) in individuals with HB antibodies between 10 and 100 IU/ml and unfavorable ones (3.8%) where the HB antibodies were below 10 IU/ml. CONCLUSIONS: The hepatitis B vaccination programme has not enjoyed total acceptance by Primary Care professionals, although a satisfactory level of adherence has been reached. Age is the variable linked most closely to the risk of a poor immunological response, though ICM and gender should not be ignored.

[A tumor registry at a primary care center]. / Registro de tumores en un centro de asistencia primaria.

AIM: We analysed the data obtained from a tumor register kept in a Primary Care Centre (PCC) to find out the variables which contribute to the diagnostic and therapeutic evolution of our patients. DESIGN: Retrospective study on every Neoplasia registered in the Centre. PATIENTS: 293 malignant Neoplasias were recorded in the period between June 1984 and June 1990 (184 in males--62.8%; and 109 in women--37.2%). MEASUREMENTS AND MAIN RESULTS: The intervals between symptom and consultation (ISC), between consultation and referral (ICR), between referral and diagnosis (IRD) and between diagnosis and treatment (IDT) were evaluated. The average age at the moment of diagnosis was 59 (SD:13). There were 3.9% double neoplasias. The most frequent type was lung cancer with 41 cases (14%). This also occupied first place among men, whereas breast cancer did so among women. 10 tumours were diagnosed by screening: 4 breast, 5 cervix and 1 endometrium, which represent 16%, 50% and 14.3% respectively of these cancers. For all neoplasias taken together, the average time of ISC was 44.09 days (SD 73.48) and of IDT 25.75 days (SD:61.55). Given the wide variations, we assessed the most common types of tumour. CONCLUSIONS: The usefulness of keeping a tumour register in a Primary Care Centre, which could identify the factors which affect diagnostic delays and find possible corrective measures to reduce the delays, was appraised.

[The evaluation of different methods for rapid diagnosis in the detection of asymptomatic bacteriuria in pregnant women]. / Evaluación de diferentes métodos de diagnóstico rápido en la detección de bacteriuria asintomática en la gestante.

We compared the effectiveness of different methods of rapid diagnosis in the detection of asymptomatic bacteriuria in 74 females during the first trimester of pregnancy. The sensitivity, specificity and negative predictive value for the visual reading of nitrites, leukocyte sterase, bacteriuria and leukocyturia in the sediment and bacteria in Gram stain were 77%, 22%, 33%, 22% and 88%, 98%, 85%, 82%, 91% and 86%, and 97%, 89%, 90% and 90%, with and accuracy of 96%, 77%, 76%, 82% and 86%, respectively. The combination of visual readings of nitrites and Gram stain showed a sensitivity and negative predictive value of 100%. We conclude that if the reading of the reactive strip is negative, the likelihood of a positive culture is very small, and it is minimal when combined with Gram stain.

[Ischemic cardiopathy in primary care. A descriptive study]. / La cardiopatía isquémica en atención primaria. Estudio descriptivo.

A descriptive study of ischemic heart disease in a primary care center is reported. From the recording systems 112 patients with IHD (9 of them dead) were identified. The calculated incidence and prevalence rates were 1.9/1000 and 10.9/1000, respectively. There were remarkably high rates of cardiovascular risk factors. The most common forms of presentation were myocardial infarction in males and angina in females. The physicians of the primary care center played a role in the diagnosis in 17% of patients. In addition, the disease was exclusively managed in the primary care center in 29% of patients, most of them over 65 years of age. The role of the primary care physician in the diagnosis and control of this condition is emphasized.

[A drug prescription study in chronic pathology at a primary care center]. / Estudio de la prescripción de fármacos por patologías crónicas en un centro de asistencia primaria.

To evaluate the characteristics of the drug used for the therapy of chronic diseases, 1588 prescriptions from a sample of 549 continued drug prescription forms were evaluated. Every patient had a mean number of 2.9 drugs, 2.14 diagnoses and 1.41 drugs per diagnosis. The patients over 65 years had a higher number of drugs and diagnoses. A smaller number of diagnoses but a higher number of drugs per diagnoses was found for males. The drug subgroups with higher prescription rates were cardiac drugs (12.3%), diuretics (11.2%) and analgesics (9.9%). The most common diagnoses were hypertension and osteoarthritis, with 17.6% and 13.6% of prescriptions, respectively. A high rate of patients receiving vasodilators (12%) and benzodiazepines (14.7%) was found. The usefulness of the continued prescription forms for the control of chronic treatments is emphasized.

[Request for a hemogram as a marker of the quality of health care]. / La solicitud del hemograma como indicador de calidad del proceso asistencial.

The evaluation of markers of the health care activity, such as the reason for requesting a peripheral blood count in everyday practice and its inclusion in the clinical record, constitutes an estimate of the quality of care. To this end, we have reviewed the requests of 160 peripheral blood counts in our center during one month. It was found that the request itself and/or its cause had not been mentioned in the clinical record in 32.5% of instances. In the cases where the indication could be ascertained, it was not justified in 58.4%. Overall 72.5% of peripheral blood counts were normal. It was concluded that peripheral blood count is an over-utilized test, while its request is insufficiently recorded. This makes diagnostic decisions and the evaluation of the quality of care difficult.