Is a practice-based rural research network feasible in Europe?

Research in family medicine is a well-established entity nationally and internationally, covering all aspects of primary care including remote and isolated practices. However, due to limited capacity and resources in rural family medicine, its potential is not fully exploited yet. An idea to foster European rural primary care research by establishing a practice-based research network has been recently put forward by several members of the European Rural and Isolated Practitioners Association (EURIPA) and the European General Practice Research Network (EGPRN). Two workshops on why, and how to design a practice-based research network among rural family practices in Europe were conducted at two international meetings. This paper revisits the definition of practice-based research in family medicine, reflects on the current situation in Europe regarding the research in rural family practice, and discusses a rationale for practice-based research in rural family medicine. A SWOT analysis was used as the main tool to analyse the current situation in Europe regarding the research in rural family practice at both meetings. The key messages gained from these meetings may be employed by the Wonca Working Party on research, the International Federation of Primary Care Research Network and the EGPRN that seek to introduce a practice-based research approach. The cooperation and collaboration between EURIPA and EGPRN creates a fertile ground to discuss further the prospect of a European practice-based rural family medicine research network, and to draw on the joint experience.

[Arterial hypertension in immigrant patients in Spanish primary health care]. / Prevalencia de la hipertensión arterial en la población inmigrante asistida en atención primaria en España.

BACKGROUND AND OBJECTIVE: To evaluate the arterial hypertension (AHT) prevalence in a wide sample of immigrant patients. PATIENTS AND METHOD: A transversal and multicentric study that has included immigrant patients aged 18 years or more, consecutive sampling recruitment in primary healthcare consultations. The patient was defined with AHT hypertension when the average of 6 measurements in 3 visits (2 measurements per visit) was > or = 140 mmHg for the systolic blood pressure and/or 90 mmHg for diastolic blood pressure or if the patient had been previously diagnosed. RESULTS: 1,424 immigrants were followed-up (53.1% women) with average age (standard deviation) of 42.8 (13.1) years and mean stay in our country of 5.6 (5.7) years. Most of the patients' origin was Central and South America (40.2%) and Eastern Europe (21.9%). The prevalence of AHT was 31.4% (95% confidence interval [CI], 30.1-32.7%), of which the 62.1% where known patients. Patients coming from Asia showed a significant higher prevalence of AHT (40.0%; 95% CI, 38.7-41.3). CONCLUSIONS: Three of each 10 immigrant patients have AHT. There are significant differences according to the gender, the origin and period of residence of these patients.

Prevalencia de la hipertensión arterial en la población inmigrante asistida en atención primaria en España / Arterial hypertension in immigrant patients in Spanish primary health care

Fundamento y objetivo: Valorar la prevalencia de hipertensión arterial (HTA) en una amplia muestra de pacientes inmigrantes. Pacientes y método: Se ha realizado un estudio transversal y multicéntrico en pacientes inmigrantes de 18 años o más seleccionados consecutivamente en consultas de atención primaria de toda España. Se consideró que el paciente presentaba HTA cuando el promedio de 6 medidas de presión arterial en 3 visitas (2 tomas por visita) era igual o mayor de 140 mmHg para la sistólica y/o 90 mmHg para la diastólica, o cuando estaba diagnosticado de tal enfermedad. Resultados: Se estudió a 1.424 inmigrantes (un 53,1% mujeres) con una edad media (desviación estándar) de 42,8 (13,1) años y estancia media en nuestro país de 5,6 (5,7) años. La mayoría procedía de América Central y del Sur (40,2%) y Europa del Este (21,9%). La prevalencia de HTA fue del 31,4% (intervalo de confianza [IC] del 95%, 30,1-32,7%); de éstos, el 62,1% sabía que era hipertenso. Los individuos que procedían de Asia presentaban una prevalencia de HTA significativamente mayor (40,0%; IC del 95%, 38,7-41,3%). Conclusiones: Tres de cada 10 pacientes inmigrantes tienen HTA. Se observan diferencias según el sexo, la procedencia y el tiempo de estancia de los individuos

Background and objective: To evaluate the arterial hypertension (AHT) prevalence in a wide sample of immigrant patients. Patients and method: A transversal and multicentric study that has included immigrant patients aged 18 years or more, consecutive sampling recruitment in primary healthcare consultations. The patient was defined with AHT hypertension when the average of 6 measurements in 3 visits (2 measurements per visit) was >= 140 mmHg for the systolic blood pressure and/or 90 mmHg for diastolic blood pressure or if the patient had been previously diagnosed. Results: 1,424 immigrants were followed-up (53.1% women) with average age (standard deviation) of 42.8 (13.1) years and mean stay in our country of 5.6 (5.7) years. Most of the patients' origin was Central and South America (40.2%) and Eastern Europe (21.9%). The prevalence of AHT was 31.4% (95% confidence interval [CI], 30.1-32.7%), of which the 62.1% where known patients. Patients coming from Asia showed a significant higher prevalence of AHT (40.0%; 95% CI, 38.7-41.3). Conclusions: Three of each 10 immigrant patients have AHT. There are significant differences according to the gender, the origin and period of residence of these patients

Cumplimiento terapéutico y calidad de vida en pacientes crónicos / Therapeutic compliance and quality of life in chronic patients

Objetivo. Conocer el cumplimiento terapéutico y percepción de salud en dos Centros de Salud, en los que se utilizó un documento normalizado de tratamiento. Diseño. Ensayo clínico. Emplazamiento. Zonas de Salud de Sillería y Ocaña (Toledo). Participantes. Pacientes, de edad ≥ 18 años, en cartera de servicios que siguen tratamiento para la hipertensión, dislipemia y Diabetes Mellitus. Se realizó un muestreo aleatorio simple de los listados de estos pacientes. Mediciones principales. En los dos grupos se entregó un documento sobre medidas higiénico-dietéticas y consejos de cumplimentación farmacológica. En el grupo de intervención además del documento anterior se entregó una hoja de tratamientos crónicos. Se realizaron cuatro visitas bimensuales en un periodo de seguimiento de ocho meses. Para el estudio del cumplimento terapéutico se utilizó el recuento de comprimidos. En la primera y última visita se pasó la versión española del EuroQol-5D. Resultados. Se incluyeron en el estudio 309 pacientes con una edad media de 69,2 ± 10,7 años (55,3% eran mujeres). Un total de 156 pacientes fueron aleatorizados al grupo de intervención y 153 al grupo control. En la última visita 173 pacientes cumplieron adecuadamente el tratamiento (63,1%; IC 95%: 57,4 - 68,8), frente a 152 en la visita basal del estudio (55,5%; IC 95%: 49,6 - 61,4), Chi-cuadrado = 96,7 y p < 0,0001. Al analizar el número de pacientes cumplidores por grupo de estudio, en la visita fi nal, no se encontraron diferencias signifi cativas entre ambos grupos. Los grupos del estudio no mostraron diferencias en la percepción de su propia salud. Conclusiones. El documento normalizado de tratamiento no aportó una mejora en el cumplimiento terapéutico del grupo de intervención. La intervención realizada en ambos grupos y el seguimiento mejoró el cumplimiento terapéutico en ambos grupos (AU)

Objective. To determine treatment compliance and health perception at two Primary Health Centres, in which a standardized treatment protocol was used. Design. Clinical trial. Setting. Primary Health Centres at Sillería and Ocaña (Toledo). Subjects. Patients aged ≥ 18 years, in the portfolio services being treated for hypertension, dyslipidaemia and diabetes. A simple random sampling from the lists of these patients was made. Main measurement. Patients in both groups were given a sheet setting out health-dietary measures and advice on treatment compliance. The intervention group were also given a sheet of chronic treatments.. There were four two-monthly visits over a follow-up period of eight months. Pill count was used to determine treatment compliance. At the fi rst and last visit the Spanish version of the EuroQol- 5D was performed. Results. A total of 309 patients with an average age of 69.2 ± 10.7 years were included in the study (55.3% were women). Of these patients, 156 patients were randomised to the intervention group and 153 to the control group. At the final visit, 173 patients had good treatment compliance (63.1%; CI 95%, 57.4 - 68.8), as opposed to 152 at the baseline visit (55.5%; CI 95%, 49.6 - 61.4), Chi-square = 96.7 and p < 0,0001. At the final visit, no significant differences were found between the two groups as regards treatment compliance. There were no differences in health perception between the two study groups. Conclusions. The standardized treatment document did not contribute to an improvement in treatment compliance in the intervention group. Interventionand follow-up improved treatment compliance in both groups (AU)

Cost-effectiveness of ambulatory blood pressure monitoring in the follow-up of hypertension.

AIMS: To study the cost of the follow-up of hypertension in primary care (PC) using clinical blood pressure (CBP) and ambulatory blood pressure monitoring (ABPM), and to analyse the cost-effectiveness (CE) of both methods. MAJOR FINDINGS AND PRINCIPAL CONCLUSION: Good control of hypertension was achieved in 8.3% with CBP (95% CI 4.8-11.8) and in 55.6% with ABPM (95% CI 49.3-61.9). The cost of one patient with good control of hypertension is almost four times higher with CBP than with ABPM (Euro 940 vs Euro 238). Reaching the gold standard (ABPM) involved an after-cost of Euro 115 per patient. The results for a 5% discount rate showed a saving of Euro 68,883 if ABPM was performed in all the patients included in the study (n = 241, Euro 285 per patient). An analysis of sensitivity, changing the discount rate and life expectancy indicated that ABPM provides a better CE ratio and a lower global cost. ABPM is more cost-effective than CBP. However, if we include the new treatment cost of poorly monitored patients, it is less cost-effective. Excellent control of hypertension is still an important challenge for all healthcare professionals, especially for those working in PC, where most monitoring of hypertensive patients takes place.

Proposals for improvement of emergency rural health care.

Universal healthcare coverage is a right, and that includes emergency health care. The community expects such requirements to be within their reach, including all human and technological resources necessary for rapid and high-quality health assistance in an emergency. Access to and delivery of emergency care in rural areas is recognized as more difficult than that in urban areas. In this report, following the EURIPA meeting in June 2004, the authors determine the problems of dealing with emergencies in the rural healthcare context, and also make proposals for improvement.