[Suitability of antibiotic prescription in primary care in the Basque Autonomous Community]. / Idoneidad de la prescripción antibiótica en atención primaria en la Comunidad Autónoma Vasca.

OBJECTIVE: To study the variability and suitability of antibiotic prescription in primary care in the Basque Country. DESIGN: Prospective, descriptive study. SETTING: Basque Country health care centres both within and not in the reformed network. MEASUREMENTS AND MAIN RESULTS: 3182 infections from consultations for infectious disease were studied through sampling stratified by health area during February, March and April 1998. The appropriateness of antibiotics (ATB) prescription was compared with some standards after an extensive bibliographic review. 68.6% of consultations were infections not needing ATB (infections of respiratory airways, acute bronchitis, flu and gastro-enteritis). ATB were used in 28.5% of these cases (CI: 26.6-30.5), especially in acute bronchitis (90.7%) (CI: 87.3-93.4). Unnecessary prescription supposes 39.7% of total antibiotic prescription (CI: 37.2-42.1%), which means unnecessary annual expenditure of 1155 million pesetas. In 31.4% of the infections that require ATB treatment, in 23.7% inappropriate treatment was chosen (CI: 21-26.7%). Overall appropriateness of treatment was 72.2% (CI: 70.6-73.8). Working in the reformed system was linked to better prescription in all cases. Paediatricians prescribed better in the case of infections not susceptible to ATB treatment. CONCLUSIONS: ATB prescription is not consistent with the available scientific evidence. Incorrect treatments occur especially in benign and self-limiting processes. A local policy of ATB use that includes multi-disciplinary collaboration and effective ongoing training is necessary.

Idoneidad de la prescripción antibiótica en atención primaria en la Comunidad Autónoma Vasca / The suitability of antibiotic prescription in primary care in the basque autonomous community

Objetivo. Estudiar la variabilidad e idoneidad de la prescripción antibiótica en atención primaria en la Comunidad Autónoma Vasca (CAV).Diseño. Estudio descriptivo, prospectivo. Emplazamiento. Centros de atención primaria de la red reformada y no reformada de la CAV. Mediciones y resultados principales. Se estudiaron 3.182 infecciones obtenidas de consultas sobre enfermedad infecciosa mediante muestreo estratificado por área sanitaria durante febrero, marzo y abril de 1998. La idoneidad de la prescripción de antibióticos (ATB) se comparó con unos patrones elaborados tras una extensa revisión bibliográfica. Un 68,6 por ciento de las consultas son infecciones que no requieren ATB (catarro de vías altas [IRA], bronquitis aguda, gripe y gastroenteritis). Se utilizan ATB en un 28,5 por ciento de estos casos (IC, 26,6-30,5). Destaca la bronquitis aguda, con un 90,7 por ciento (IC, 87,3-93,4). La prescripción innecesaria supone un 39,7 por ciento de la prescripción total antibiótica (IC, 37,2-42,1 por ciento), suponiendo un gasto anual innecesario de 1.155 millones de pesetas. En el 31,4 por ciento de las infecciones que requieren tratamiento con ATB, se opta por uno no adecuado en un 23,7 por ciento (IC, 21-26,7 por ciento). En total, la idoneidad del tratamiento global fue del 72,2 por ciento (IC, 70,6-73,8). El hecho de trabajar en la red reformada se asoció a una mejor prescripción en todos los casos. Los pediatras prescriben mejor en el caso de las infecciones no susceptibles de tratamiento con ATB. Conclusiones. La prescripción de ATB no se realiza conforme a la evidencia científica disponible. Los tratamientos incorrectos tienen lugar sobre todo en procesos benignos y autolimitados. Es necesaria una política local de uso de ATB que incluya colaboración multidisciplinaria y formación continuada efectiva (AU)

[The health problems and needs of chronic home-bound patients]. / Problemas y necesidades de salud de los pacientes crónicos domiciliarios.

AIM: In light of the progressive ageing of the population and the consequent inability of a section of the population to attend health service facilities on their own, this study aims to establish the proportion of this population which could enter a programme of longterm home treatment, to identify their health problems and to assess what services they might require. DESIGN: Descriptive study of a crossover type. SITE. Four Sections of the Primary Care Centre in Andoain (Guipúzcoa). PATIENTS: Criteria of mobility, social and family support, mental state and limitations on daily activities were those considered when including patients in the study. The selection was made by examining clinical histories, long-treatment cards, the number of home alerts and by contacting institutions. MEASUREMENTS AND MAIN RESULTS: A survey of 68 patients in their homes was undertaken. The average age was 81, with a 76.47% majority of women. 41.06% were bed-ridden or in a wheel-chair and 50% suffered severe invalidity. We noted an average of 2.9 pathologies per patient; with cardiovascular problems (26.6%) accounting for the largest number. The average consumption of medicines was 2.83 per patient. CONCLUSIONS: The chronic home-bound patient presents several characteristics: advanced age, little mobility and a high level of invalidity. She/he suffers several pathologies and takes a large number of medicines, which require some level of primary care control. Both this control and any improvement in the quality of life and satisfaction for this type of patient crucially depend on nursing care.

[The diagnosis of basic sanitation in the Erniobea region]. / Diagnóstico del saneamiento básico en la comarca Erniobea.

The aim of this report was to identify the basic sanitary situation and that of a series of health markers, in the area of influence of our health centre. The population studied have all come from places under the census and the measuring system used was a prepared survey and also, direct observation. The information collected was verified by revising all the clinical notes of the affected people. The results found are presented, referring to the characteristics of the houses and the stables, the sanitary situation of the livestock, water supply and excrement removal, rubbish removal methods and health markers. The high number of houses without adequate installation maintenance (water, excrement...) and the high incidence of infectious diseases should be highlighted.