[Effectiveness of a quality improvement intervention in blood pressure control in Primary Care]. / Efectividad de una intervención de mejora de calidad en el control de la presión arterial en Atención Primaria.

INTRODUCTION AND OBJECTIVES: To evaluate the effectiveness of a quality improvement intervention on professionals sanitary in blood pressure control in hypertensive patients. METHODS: Quality improvement trials with cuasi-experimental design. Two primary care health centres. One centre was assigned intervention group (7 family doctors and 419 patients) and the other was control group (7 family doctors and 419 patients). The quality improvement intervention consisted of a combined program comprising audit, feedback, training sessions about main hypertension clinical guidelines during 6 months. The main measurement were blood pressure, lipid levels, diabetes, smoking and body index mass, antihypertensive drugs and record treatment adherence and therapeutic plan in march 2002 the baseline measurement and march 2004 the post intervention. RESULTS: In study group blood pressure systolic and diastolic decreased 8.16/3.71 mmHg and control group increased 1.56/0.13 mmHg, respectively. The intervention effect was a drop of 9.72 mmHg (IC 95%: 7.50-11.94) and diastolic blood pressure in 3.84 mmHg (IC 95%: 2.40-5.28). The rate of hypertensive patients with blood pressure < 140/90 mmHg increased from 37.5% to 68.8% in study group, without changes in control group (p < 0.05). The drugs and combination drugs prescribed increased in both group, while the records of therapeutics plans and adherence increased only in intervention group (p < 0.05). CONCLUSIONS: The quality improvement intervention was associated to a systolic and diastolic blood pressure reduction and a increase of rate patients with blood pressure controlled.

[The follow-up of pregnancy in the province of Salamanca]. / Control de gestación en la provincia de Salamanca.

AIM: To discover the level of health care accorded to pregnant women, the type of professional who attends them, and to what extent guidelines proposed for monitoring pregnancies are carried through. DESIGN: A transversal, retrospective, observational study: without a control and with a random sample. SITE. The data were obtained in a Public Hospital and came from women who had been monitored at all levels of health care, whether public or private. PATIENTS: The study was of all the women who gave birth in the General Hospital over a period of three months. MEASUREMENTS AND MAIN FINDINGS: An interview was administered to 500 pregnant women. It was found that the number of pregnancies attended to at the Primary Care level is small (9% in Health Centre consultations and 6% by the General Practitioner). The entry of pregnant women into the Health System is late: 48% from the fourth mont. In a high percentage of cases, no explorations of the neck of the womb are made; nor are certain analytic tests (e.g. renal and liver function tests and urinary cultures) and various complementary checks made. CONCLUSIONS: 1) Health Education programmes must be initiated at the Primary Care level, in order to draw in at an early stage the pregnant woman. 2) There is a need to use guidelines for pregnancy and develop programmes of ongoing training for Primary Care professionals, in order to improve the quality of health care during pregnancy.