Análisis de la prescripción inducida en una comarca de atención primaria / Analysis of the induced prescription in a primary care region

Objetivos. Conocer la prevalencia, el origen y el gasto atribuible de la prescripción inducida (PI) en atención primaria (AP) en la Comarca Oeste de Gipuzkoa, determinar el grado de acuerdo de los médicos de AP con respecto a la PI y analizar la adecuación de la PI a los indicadores del contrato de gestión clínica de la AP. Material y métodos. Diseño: estudio descriptivo, transversal y multicéntrico. Ámbito: AP, 38 médicos pertenecientes a 17 unidades de AP de la Comarca Oeste de Gipuzkoa. Participantes: prescripciones farmacéuticas financiables realizadas durante 2 días en consulta a demanda y crónicas generadas por el programa informático Osabide. Variables analizadas: tipo de prescripción, origen, especialidad del prescriptor, diagnóstico, precio y grado de acuerdo. Resultados. Se realizaron 6.919 prescripciones y el 44% fueron PI (intervalo de confianza del 95%: 42,8–45,1). El 62,2% del gasto total se atribuyó a la PI, con un precio medio por receta de 22,3€ para la PI y de 10,6€ para la prescripción propia. Los subgrupos terapéuticos de mayor gasto fueron los hipolipidemiantes y los broncodilatadores. Resultados. El grado de desacuerdo de los médicos participantes con la PI fue del 28,8%. La adecuación de los indicadores de calidad de la prescripción fue mayor en la prescripción propia que en la PI. Conclusiones. Existe un porcentaje elevado de PI asociado a un gasto elevado que se atribuye a la AP. El porcentaje de desacuerdo en AP con respecto a la PI es importante. Se observa una influencia elevada de la PI en la evaluación de los indicadores de calidad establecidos en la AP(AU)

Objectives. To find out the prevalence, origin and cost associated with Induced Prescription (IP) in Primary Health Care (PHC) in the West of Gipuzkoa (WG). To find out the extent to which PHC doctors agree with IP. To analyse the adaptation of IP to PHC clinical management contract indicators. Materials and methods. Design descriptive multi-centre cross-study. Location. Primary Health Care, 38 doctors from 17 WG PHC units. Participants. Pharmaceutical prescriptions eligible for finance over a period of two days in outpatients and chronic diseases generated by the Osabide computer application. Participants. Variables analysed: type of prescription, origin, prescriber, diagnosis, price and level of agreement. Results. A total of 6.919 prescriptions were made out, with 44% (95% CI: 42.8–45.1) being IP. Of the total cost, 62.2% was put down to IP, with an average price per prescription of €22.3,and in non-induced prescription (NIP) it was €10.62. The therapeutic subgroups with the highest cost were lipid lowering and bronchodilator drugs. The level of disagreement of the doctors taking part in IP was 28.8%. The adaptation to the quality indicators of the prescription was higher in NIP than in IP. Conclusions. There is a high percentage of IP associated with high costs attributed to PHC. The percentage of disagreement in PHC with regard to IP is significant. There is a high influence of IP on the evaluation of the quality indicators established in PHC(AU)

[Analysis of the induced prescription in a primary care region]. / Análisis de la prescripción inducida en una comarca de atención primaria.

OBJECTIVES: To find out the prevalence, origin and cost associated with Induced Prescription (IP) in Primary Health Care (PHC) in the West of Gipuzkoa (WG). To find out the extent to which PHC doctors agree with IP. To analyse the adaptation of IP to PHC clinical management contract indicators. MATERIALS AND METHODS: Design descriptive multi-centre cross-study. LOCATION: Primary Health Care, 38 doctors from 17 WG PHC units. PARTICIPANTS: Pharmaceutical prescriptions eligible for finance over a period of two days in outpatients and chronic diseases generated by the Osabide computer application. Variables analysed: type of prescription, origin, prescriber, diagnosis, price and level of agreement. RESULTS: A total of 6.919 prescriptions were made out, with 44% (95% CI: 42.8-45.1) being IP. Of the total cost, 62.2% was put down to IP, with an average price per prescription of €22.3,and in non-induced prescription (NIP) it was €10.62. The therapeutic subgroups with the highest cost were lipid lowering and bronchodilator drugs. The level of disagreement of the doctors taking part in IP was 28.8%. The adaptation to the quality indicators of the prescription was higher in NIP than in IP. CONCLUSIONS: There is a high percentage of IP associated with high costs attributed to PHC. The percentage of disagreement in PHC with regard to IP is significant. There is a high influence of IP on the evaluation of the quality indicators established in PHC.

[Relation between food habits and nutritional status of preschool children in a rural community]. / Relación de los hábitos de alimentación y el estado nutricional de niños preescolares en una comunidad rural.

Food habits in regard to the nutritional status of preschool children and their socioeconomic situation were analyzed in this research. The study was carried out in Cuetzalan, State of Puebla; all families were studied and, besides the presence of a preschool child in the home, both father and mother should also be living in the same house. Forty children considered as well nourished and 40 malnourished in the opposite case, were selected, taking the limits of the Gómez classification. In order to define socioeconomic differences between the two groups, the sample population was divided into different levels, with the following results. The socioeconomic level of the well-nourished children did correlate with a good living standard of their families; in the other case, families with a low socioeconomic status, presented more nutritional problems. A questionnaire was applied to every mother selected. This included two items: a) In the first case, we tried to assess the mother's attitude towards food habits and children's illnesses. b) In the second case, the mother's knowledge concerning pregnancy, breast feeding, feeding of the child during the first year of life, taboos, beliefs and other aspects which could be related to nutrition. On the whole, the main objective of this study was attained, because significant differences were found between these two groups. Firstly, a good relationship between food habits and good nutritional status of the children was found. Secondly, mother with well-nourished children had better food habits and better socioeconomic status than mothers having children with poor health status, and therefore, of a lower socioeconomic status.

[Relation of socioeconomic and environmental indicators to the nutritional status of preschool children in a community of Sierra Norte de Puebla, México]. / Relación entre indicadores socioeconómicos y ambientales con el estado nutricional de preescolares en una comunidad de la Sierra Norte de Puebla, México.

A brief discussión on "the social" approach in nutritional research is presented. The relevance that socioeconomic factors have acquired in recent years for this type of studies, is also discussed. The main purpose of our communication was to identify and validate some socioeconomic and environmental indicators and their association with the nutritional status of preschool children in a Mexican indigenous community (Sierra Norte de Puebla). A total of 89 children below five years of age were studied and classified according to their nutritional status. A socioeconomic questionnaire was applied to their parents. Results revealed ample correlation between the degree of malnutrition of the preschool child and the following indicators: housing conditions, father's main occupation, land tenure, income, etc. It is argued that the analysis of these indicators is relevant, emphasizing the importance that the combination of anthropometrical, food consumption and socioeconomic data have for detecting population groups vulnerable to malnutrition. The obtention of these indicators is therefore highly recommended, but should not imply great obstacles; on the contrary, they should be highly sensitive and easy to detect.

[Differentiation of the nutritional status of preschool children, according to socioeconomic levels, in a marginal zone]. / Diferenciación de la situación nutricional del preescolar, segun niveles socioeconomicos, en una zona marginal.

This article informs of a study carried out in an attempt to validate a new methodology to differentiate socioeconomic levels in a low income urban population group, as well as to correlate each level with the degree of malnutrition of preschool children, using the Gómez and Waterlow classifications. The socioeconomic indicators selected were: housing, main occupational activity and educational level of the head of the family, number of members per room, food expenditure per capita, per week, and ownership of a few household articles. A scale was constructed on the basis of the afore-mentioned indicators, and values were assigned on a point system, resulting in three levels: high, medium and low. Weight and height were determined in preschool children. In order to establish correlation of anthropometric data with socioeconomic levels, and to determine if such levels permitted to differentiate the degree of malnutrition, two types of nutritional classifications were used. Of the total of 187 families selected, 46 were evaluated as of high level, 72 medium and 69, low. Analysis of the weight-for-age and weight-for-height in children 24 to 47 months of age, and total preschool children, that is, from 12 to 59 months, revealed significant differences in both classifications, p less than 0.001. The authors conclude that the point scale applied to determine socioeconomic levels, was sufficiently sensitive in distinguishing the degree of malnutrition in preschool children, especially when analyzing the total population; though not significant in a few age groups, this was probably due to the reduced number of same. It is recommended that the Gómez classification be used permanently, particularly in cross-sectional surveys, and the Waterlow classification, because of its rapid diffusion in the world.