Recursos disponibles para el manejo de la agudización de la enfermedad pulmonar obstructiva crónica en España / Available resources for the management of chronic obstructive pulmonary disease exacerbations in Spain

Objetivo: Las agudizaciones de la enfermedad pulmonar obstructiva crónica (AEPOC) generan un elevado consumo de recursos. El presente estudio evalúa recursos asistenciales y organizativos disponibles para el manejo de las AEPOC en servicios de atención primaria (AP), neumología, medicina interna y urgencias españoles, y los compara con las recomendaciones vigentes. Material y métodos: Estudio observacional mediante encuestas telefónicas a médicos de AP, neumólogos, internistas y de urgencias. Resultados: Se entrevistaron 284 médicos. Según su opinión, los centros de AP tienen elevada disponibilidad de pulsioximetría (98,9%) y electrocardiografía (100,0%), y baja disponibilidad de radiología de tórax (19,1%) o analítica urgente (17,0%) en el mismo centro. El 76,1% de las salas de hospitalización disponen de equipos de monitorización de ventilación mecánica no invasiva (VMNI), aunque solo el 69,7% del personal de enfermería está adecuadamente formado para manejarlos. El 18,3% de hospitales públicos disponen de unidades de cuidados respiratorios intermedios (UCRI) frente al 41,7% de los privados. El 47,9% de médicos de urgencias recibieron formación de manejo de las AEPOC en el último año. Solo el 31,9% de centros de AP tienen protocolos específicos de derivación a atención especializada. Algo más del 35% de centros de AP y hospitales refieren no disponer de historia informatizada integrada con otros niveles asistenciales. Conclusiones: En líneas generales, los recursos disponibles son adecuados. Sin embargo, se detectan áreas de mejora como el inadecuado nivel de integración de la historia informatizada entre niveles asistenciales, baja dotación de UCRI en hospitales públicos o deficiencias en formación específica del manejo de la VMNI

Objective: Chronic obstructive pulmonary disease exacerbations (COPDE) lead to a high use of healthcare resources. This study assesses the healthcare and organisational resources of Spanish health care centres for the management of COPDE at different care levels (Primary Care (PC), Respiratory Diseases, Internal Medicine, and Emergency Departments), and compare with current recommendations. Material and methods: An observational study was carried out through telephone interviews to General Practitioners, Chest Diseases, Internal Medicine, and Emergency Department doctors. Results: A total of 284 doctors were interviewed. According to their responses, at PC centres there is a high availability of pulse oximetry (98.9%) and electrocardiograph (100%), and a low availability of Chest X-Ray (19.1%), or urgent laboratory tests (17.0%) in sites. In hospital wards, non-invasive mechanical ventilation (NIV) availability was 76.1%, with only a 69.7% of nursing staff properly trained in its use. Respiratory intermediate care units (RICUs) were available in 18.3% of public hospitals versus 41.7% of private hospitals. Specific training for COPDE management was received by 47.9% of Emergency Department doctors in the previous year. Only 31.9% of PC centres had specific protocols for referring patients to specialists. More than 35% of PC centres and hospitals do not have their electronic medical records integrated with other healthcare levels. Conclusions: In general terms, there are sufficient resources available in Spanish healthcare centres. However, several areas of improvement were identified, such as an insufficient level of electronic medical record integration between healthcare levels, limited implementation of RICUs in public hospitals, and deficiencies related to specific training in NIV management

[Available resources for the management of chronic obstructive pulmonary disease exacerbations in Spain]. / Recursos disponibles para el manejo de la agudización de la enfermedad pulmonar obstructiva crónica en España.

OBJECTIVE: Chronic obstructive pulmonary disease exacerbations (COPDE) lead to a high use of healthcare resources. This study assesses the healthcare and organisational resources of Spanish health care centres for the management of COPDE at different care levels (Primary Care (PC), Respiratory Diseases, Internal Medicine, and Emergency Departments), and compare with current recommendations. MATERIAL AND METHODS: An observational study was carried out through telephone interviews to General Practitioners, Chest Diseases, Internal Medicine, and Emergency Department doctors. RESULTS: A total of 284 doctors were interviewed. According to their responses, at PC centres there is a high availability of pulse oximetry (98.9%) and electrocardiograph (100%), and a low availability of Chest X-Ray (19.1%), or urgent laboratory tests (17.0%) in sites. In hospital wards, non-invasive mechanical ventilation (NIV) availability was 76.1%, with only a 69.7% of nursing staff properly trained in its use. Respiratory intermediate care units (RICUs) were available in 18.3% of public hospitals versus 41.7% of private hospitals. Specific training for COPDE management was received by 47.9% of Emergency Department doctors in the previous year. Only 31.9% of PC centres had specific protocols for referring patients to specialists. More than 35% of PC centres and hospitals do not have their electronic medical records integrated with other healthcare levels. CONCLUSIONS: In general terms, there are sufficient resources available in Spanish healthcare centres. However, several areas of improvement were identified, such as an insufficient level of electronic medical record integration between healthcare levels, limited implementation of RICUs in public hospitals, and deficiencies related to specific training in NIV management.

Percepción de los médicos de Atención Primaria en el manejo clínico de la osteoporosis. Influencia de los planes de salud / Primary care perception of clinical management of osteoporosis. The influence of healthcare policies

Introducción: El objetivo es conocer el manejo clínico de la osteoporosis y la influencia de los planes de salud en la práctica clínica. Material y métodos: Se realizó una encuesta transversal dirigida a 465 médicos de Atención Primaria (MAP) de España y una revisión sistemática de 15 planes de salud (PS) autonómicos. En la encuesta se evaluó el uso de escalas de valoración de factores de riesgo (FR) de osteoporosis, el uso de pruebas diagnósticas, su accesibilidad en AP y tratamiento farmacológico. Resultados y Conclusión: La revisión de los PS determinó tres grupos de comunidades autónomas (CCAA) según cómo consideraban a la osteoporosis: (1) formulación explícita, (2) formulación implícita como problema de salud y (3) sin referencia a la osteoporosis. El 49% de los MAP utilizaban escalas de valoración de FR. El 98% de los MAP creían que el diagnóstico inicial de osteoporosis debía realizarse en AP, y más del 50% afirmaron que las mujeres diagnosticadas eran tratadas y seguidas en AP. El acceso a la densitometría ósea es más sencillo en las CCAA del grupo 1. El tratamiento más utilizado son los bifosfonatos y el calcio con la vitamina D, sin diferencias por CCAA. Conclusión: Los MAP consideran que la Atención Primaria es un marco inmejorable para la atención preventiva, terapéutica y rehabilitadora de la osteoporosis. A pesar de ello existen ciertas barreras para la utilización de escalas de valoración de FR. Los MAP de las CCAA con PS para la osteoporosis tienen mejor acceso a la densitometría ósea (AU)

Introduction: This study aims to assess the clinical management of osteoporosis and the influence of the health care plans in the clinical practice. Material and methods: A cross-sectional survey was made of 465 general practitioners (GP) from Spain. The survey included the following information: osteoporosis risk factors (RF) scales, diagnostic tests and their accessibility from primary care, and pharmacological treatment. In addition, a systematic review of 15 regional healthcare plans (RHP) was performed. Results and conclusions: The RHP review determined 3 autonomous region (AR) groups according to how they considered osteoporosis: (1) explicit formulation, (2) implicit as a health problem and (3) without any reference to osteoporosis. Forty-nine percent of the GP used risk factor scales. A total of 98% of the GPs thought that the initial diagnosis of osteoporosis should be made in PHC, and over 50% stated that the women diagnosed were treated and followed-up in PHC. Access to bone densitometry is easier in those belonging to group 1 AR. The most used treatments were bisphosphonates and calcium plus D vitamin, there being no differences among AR groups. Conclusions: The GPs consider that primary health care is an excellent framework for prevention, therapeutic attention and osteoporosis rehabilitation. In spite of this, there are still some barriers regarding the use of RF scales. In those ARs with specific osteoporosis health plans, the GPs have easier accessibility to bone densitometry (AU)

[Quality of life, time commitment and burden perceived by the principal informal caregiver of Alzheimer's patients]. / Calidad de vida, tiempo de dedicación y carga percibida por el cuidador principal informal del enfermo de Alzheimer.

OBJECTIVE: To evaluate the impact in Health Related Quality of Life (HRQoL), the time commitment and the burden perceived by the principal informal caregiver (PIC) of Alzheimer's patients (AP) in Spain, as well as the type and amount of external help received. DESIGN: Multicentric descriptive cross-sectional study. PATIENTS: A randomised sample of 268 PIC were included from 19 Alzheimer's Patient Family Associations (APFA) randomly selected from all Spanish regions. MEASURES: Data were collected using a structured telephone interview with the CATI system. HRQoL was measured using the questionnaire EuroQoL-5D. Information was also collected on the health problems of the PIC, the burden perceived (using the specific Zarit scale), the time commitment of PICs (hours per day), type of activity, as well as the amount and type of external help received. RESULTS: The HRQoL of the PIC showed to be worse than the general population in the EQ-5D, except in the self-care dimension. A total of 84% of PIC had physical problems related to the care given to the AP and 94.4% had psychological problems. The Zarit scale showed that 46.5% of caregivers had a level of burden between severe and moderated, while in 34.7% was severe. Time commitment was more than 8 hours per day in 72.1% of them and more than 20 hours per day in 39.6%. Only 26.9% of the PIC received some sort of socio-sanitary help and 76.5% received help from the APFA. CONCLUSIONS: Caregivers of AP suffer a negative impact on their health state and HRQoL; the time they dedicate to the patient is very high.

Calidad de vida, tiempo de dedicación y carga percibida por el cuidador principal informal del enfermo de Alzheimer / Quality of life, time commitment and burden perceived by the principal informal caregiver of Alzheimer´s patients

Objetivo. Evaluar el impacto en la calidad de vida relacionada con la salud (CVRS), el tiempo de dedicación y la carga percibida por los cuidadores principales informales (CPI) de los enfermos de Alzheimer (EA) en España, así como el tipo y la cantidad de ayuda recibida. Diseño. Estudio transversal multicéntrico mediante encuesta. Participantes. Se seleccionó aleatoriamente a 268 CPI afiliados a alguna de las 19 asociaciones de enfermos de Alzheimer (AFA) de España aleatoriamente seleccionadas. Mediciones principales. Los CPI fueron entrevistados telefónicamente mediante un cuestionario estructurado utilizando el sistema CATI. Se valoraron la CVRS de los CPI (EuroQoL-5D), los problemas de salud del CPI, la carga percibida (escala de Zarit), el tipo y el tiempo de dedicación de los cuidadores, y la cantidad y el tipo de ayudas externas recibidas. Resultados. Los CPI presentaron una peor CVRS en el cuestionario EuroQoL-5D que la población general, excepto en la dimensión de cuidado personal. El 84 por ciento de los CPI presentaban problemas de salud físicos y el 94,4 por ciento, psicológicos. Según la escala de Zarit, el 46,5 por ciento de los CPI tenían una carga entre moderada y severa, y el 34,7 por ciento, una sobrecarga severa. El tiempo de dedicación fue de más de 8 h al día en el 72,1 por ciento de los casos y más de 20 h al día en el 39,6 por ciento de ellos. Sólo el 26,9 por ciento recibió alguna ayuda sociosanitaria y el 76,5 por ciento, algún tipo de ayuda de las AFA. Conclusiones. Los cuidados prestados por el CPI afectan negativamente a su estado de salud y su CVRS y les requieren un elevado tiempo de dedicación (AU)

[Effect of type-2 diabetes mellitus on the quality of life of patients treated at primary care consultations in Spain]. / Impacto de la diabetes mellitus tipo 2 en la calidad de vida de los pacientes tratados en las consultas de atención primaria en España.

OBJECTIVES: To evaluate the impact of type-2 diabetes mellitus (DM2) on the health-related quality of life (HRQL) of patients and to analyse the impact of social-demographic and clinical variables and of resource use. DESIGN: Cross-sectional study with retrospective and prospective information gathering (HRQL questionnaire). Setting. 29 primary care centres from the whole of Spain. PARTICIPANTS: 1041 patients diagnosed with DM2 after the age of 30, chosen at random from patients' records at participating centres. Main measurements. HRQL evaluated through the general questionnaire EQ-5D, which enabled HRQL of patients to be compared with that of the general Spanish population, obtained from a sample of 8963 people. RESULTS: Patients with DM2 had worse HRQL (mean EVA index of 0.71) than people in the general population of the same age and gender (mean EVA index of 0.81). Women, older patients and obese patients had worse HRQL. In clinical terms, patients with some DM2-related complication, deficient glycaemic control and in receipt of insulin treatment had worse HRQL than patients without complications, acceptably controlled patients or those receiving non-pharmacological or oral anti-diabetes treatment. CONCLUSIONS: DM2 is associated with worse HRQL for patients, and more so for patients with complications, poor control of glucaemia or under insulin treatment.

Impacto de la diabetes mellitus tipo 2 en la calidad de vida de los pacientes tratados en las consultas de atención primaria en España / Effect of type-2 diabetes mellitus on the quality of life of patients treated at primary care consultations in Spain

Objetivo. Evaluar el impacto de la diabetes mellitus tipo 2 (DM2) en la calidad de vida relacionada con la salud (CVRS) de los pacientes y analizar la influencia de las variables sociodemográficas, clínicas y de uso de recursos. Diseño. Estudio transversal con recogida de información retrospectiva y prospectiva (cuestionario de CVRS).Emplazamiento. Un total de 29 centros de atención primaria de todo el territorio español. Participantes. Participaron en el estudio 1.041 pacientes diagnosticados de DM2 después de los 30 años de edad, seleccionados aleatoriamente de los registros de pacientes de los centros participantes. Mediciones principales. CVRS valorada mediante el cuestionario genérico EQ-5D, lo que permitió comparar la CVRS de los pacientes con la de la población general española, obtenida de una muestra de 8.963 sujetos. Resultados. Los pacientes con DM2 presentaron peor CVRS (media índice EVA de 0,71) que los sujetos de la población general de la misma edad y género (media índice EVA de 0,81). Los pacientes de género femenino, de mayor edad y obesos presentaron peor CVRS. En términos clínicos, los pacientes que presentaban alguna complicación relacionada con la DM2, un deficiente control glucémico y que recibían tratamiento con insulina presentaban peor CVRS que los pacientes sin complicaciones, aceptablemente controlados o que recibían tratamiento no farmacológico o antidiabéticos orales. Conclusiones. La DM2 se asocia con una peor CVRS de los pacientes, y de forma más importante en los pacientes con complicaciones, con bajo control glucémico y tratados con insulina (AU)

[Validation of the quality of life questionnaire in arterial hypertension (HQALY) for its use in Spain. Relationship between clinical variables and quality of life. Investigator Group of the HQALY study]. / Validación del cuestionario de calidad de vida en hipertensión arterial (CHAL) para su uso en España. Relación entre variables clínicas y calidad de vida. Grupo de Investigadores del Estudio CHAL.

OBJECTIVE: To evaluate the measurement properties of the Hypertension Quality of Life (HQALY) questionnaire, under normal clinical practice conditions, and the relationship between quality of life and clinical variables in patients with hypertension. DESIGN: Observational, prospective and multi-centred study. SETTING: 92 primary care centres in Spain. PARTICIPANTS: 269 patients, of both sexes and over 17, with hypertension, stratified by age (18-44, 45-64 and over 64), sex and organic complaint. 106 individuals over 17 with normal tension were chosen at random. INTERVENTIONS: Intensification of treatment in hypertense patients. MEASUREMENTS: Administration of the HQALY and the EuroQol-5D at every attendance (patients, basal and at a month; controls, basal). In addition, at the basal attendance social-demographic and clinical features were recorded, and at the attendance at a month the clinical features and changes in health status. MAIN RESULTS: Mean time of administration was 28 (23) minutes. VALIDITY: factor analysis showed two dimensions, state of mind and somatic manifestations, which correlated most closely with the dimensions of anxiety/depression (0.64) and pain/discomfort (0.55) on the EQ-5D, respectively. HQALY scores were higher (worse quality of life) in patients than in controls without hypertension (p < 0.01). Reliability: intraclass correlation coefficient was 0.88 in state of mind and 0.76 in somatic manifestations. Cronbach's alpha was 0.96 and 0.89, respectively. Sensitivity: the "size of the effect" at a month from starting treatment for hypertension was 0.40. Hypertension for over 10 years, more organs affected, gravity and morbid obesity were associated with worse quality of life, especially in the state-of-mind dimension. Cardiac frequency correlated closer with state of mind than somatic manifestations. CONCLUSIONS: The HQALY is the first specific hypertension questionnaire developed in Spain which has been shown valid, reliable and sensitive to changes. However, the number of items on it must be reduced for routine use in clinical practice.

Validación del cuestionario de calidad de vida en hipertensión arterial (CHAL) para su uso en España. Relación entre variables clínicas y calidad de vida / Validation for use in spain of the quality of life questionnaire on hypertension. relationship between clinical variables and quality of life

Objetivo. Evaluar las propiedades de medición del cuestionario de calidad de vida en hipertensión arterial (CHAL), en condiciones de práctica clínica habitual, así como la relación existente entre calidad de vida y variables clínicas en pacientes con HTA. Diseño. Estudio observacional, prospectivo y multicéntrico. Emplazamiento. Noventa y dos centros de atención primaria de España. Participantes. Doscientos sesenta y nueve hipertensos de ambos sexos, mayores de 17 años, estratificados según edad (18-44, 45-64 y más de 64 años), sexo y afectación orgánica. Ciento seis individuos normotensos mayores de 17 años, seleccionados de forma aleatoria. Intervenciones. Intensificación del tratamiento en los pacientes hipertensos. Mediciones. Administración del CHAL y el EuroQol-5D en todas las visitas (pacientes: basal y al mes; controles: basal). Adicionalmente, se registraron en la visita basal las características sociodemográficas y clínicas, y en la visita al mes las características clínicas y los cambios en el estado de salud. Resultados principales. El tiempo medio (DE) de administración fue de 28 (23) minutos. Validez: el análisis factorial mostró dos dimensiones: estado de ánimo (EA) y manifestaciones somáticas (MS) que presentaron una correlación máxima con las dimensiones de ansiedad/depresión (0,64) y dolor/malestar (0,55) del EQ-5D, respectivamente. Las puntuaciones del CHAL fueron superiores (peor CV) en pacientes que en controles sin HTA (p < 0,01). Fiabilidad: el coeficiente de correlación intraclase fue de 0,88 en EA y de 0,76 en MS; el alfa de Cronbach de 0,96 y 0,89, respectivamente. Sensibilidad: el 'tamaño del efecto' al mes de iniciar el tratamiento antihipertensivo fue de 0,40. La HTA de más de 10 años, mayor afectación orgánica, gravedad y obesidad mórbida se asociaron a una peor calidad de vida, especialmente en la dimensión de EA. La frecuencia cardíaca se correlacionó más con el EA que con las MS. Conclusiones. El CHAL es el primer cuestionario específico para la HTA desarrollado en España que ha mostrado ser válido, fiable y sensible a los cambios. Sin embargo, debe reducirse el número de ítems para su uso rutinario en la práctica clínica (AU)

[The development and preliminary validation of the IU-4 questionnaire for the clinical classification of urinary incontinence]. / Elaboración y validación preliminar del cuestionario para la clasificación clínica de la incontinencia urinaria IU-4.

RATIONALE: To prepare and validate a simple and self-administered questionnaire for the clinical rating of patients with urinary incontinence (UI) for use in the clinical practice. METHODS: The questionnaire was prepared based on a review of the literature on urinary incontinence and the views of 7 urodynamic urologists. The initial questionnaire UI-5 included 5 items related to UI symptoms that divided patients into three categories: stress incontinence (UEI), urge incontinence (UUI) or mixed urinary incontinence (MUI). An additional question evaluates the impact of UI type on the quality of life. The of construct validity was analyzed correlating the responses to UI-5 items and the question on quality of life. The area under the ROC curve was calculated for each UI type correlating the UI-5 scores and the results of the urodynamic test. The cut-off values for each scale were determined based on sensitivity (SE) and specificity (SP). RESULTS: The study included 188 females with UI (73.4% with UEI, 13.3% with UUI and 13.3% with MUI; based on the urodynamics). Only 4.3% patients did not answer some UI-5 items. One item related to the protective material used was excluded as it was not related to UI types, and so the final questionnaire included only 4 items (UI-4). The results show that UI-4 discriminates the different types of incontinence: UEI (SE: 0.69/SP: 0.76; 1 item), UUI (SE: 0.83/SP: 0.65; 2 items), MUI (SE: 0.72/SP: 0.65; 1 item). 100% patients with MUI, 84% with UUI and 59.9% with UEI report some impact on their quality of life. CONCLUSIONS: UI-4 is simple, valid and easy to administer, and can be particularly valuable in the clinical rating of UI in settings where urodynamic testing is not easily available such is primary health care.

[Prevalence of mental disorders in the general population of Catalonia. Team of the Health Survey of Catalonia]. / Prevalencia de trastornos mentales en la población general de Catalunya. Equipo de la Encuesta de Salud de Catalunya.

OBJECTIVE: The objective of the study is to estimate the prevalence of mental disorders in the general population of Catalonia. METHODS: Data comes from the Health Interview Survey of Catalonia (Enquesta de Salut de Catalunya, ESCA) and from an epidemiological study of Tres Cantos (Madrid). The General Health Questionnaire (GHQ-12) was administered to all the individuals older than 14 years (n: 12,455). The prevalence was estimated according to the GHQ score obtained and its correspondence to the probabilities score of the Madrid study. This study determined the probability of being a psychiatric case in a logistic regression using the Present State Examination (PSE) as gold standard. Morbidity Comparative Index (MCI) was used to compare the prevalences between health regions. The population of reference was the population of Catalonia. RESULTS: The 17.42% (CI 95%: 17.02-17.82) of the population of Catalonia older than 14 years suffered a probable mental disorder, the 18.66% (CI 95%: 18.07-19.25) in women and the 15.77% (CI 95%: 15.26-16.28) in men. The prevalence was higher in women with regard to men in all age groups. The MCI was lower in the Health Regions of Lleida and Girona and it was higher in the Health Regions of Tarragona and Tortosa, both in men and women. CONCLUSIONS: The figures are at intermediate level with respect others Spanish and Anglo-Saxon published studies based on population data and lower than the obtained for primary care users in Spain and in other international settings.