Results of a national system-wide quality improvement initiative for the implementation of evidence-based infection prevention practices in Brazilian hospitals.

BACKGROUND: Quality improvement (QI) methods are recommended to address healthcare-associated infections (HCAIs) in hospitals, but whereas internal initiatives have been widely studied, there is little evidence on the application and effect of a QI approach from an external system-wide perspective. AIM: To analyse the effect of a national system-wide QI initiative aimed at promoting HCAI prevention via regulatory interventions in Brazil. METHODS: A QI cycle approach designed and assessed with a before-and-after quasi-experimental design was implemented by the Brazilian Health Regulatory Agency (ANVISA), targeting 1869 hospitals. Eleven evidence-based quality indicators related to HCAI prevention and a composite measure were assembled, shared, and assessed; the intervention to improve was then based on participatory multifaceted regulatory actions. Absolute and relative improvements were estimated after the intervention. FINDINGS: In all, 563 hospitals (30.1% response) totalling 86,837 beds participated in the baseline assessment, and 681 hospitals (36.4% response) totalling 101,231 beds in the second. Ten of the 11 criteria improved (P < 0.05), as well as the composite indicator (P = 0.001) in all the regions of the country, particularly in the group of hospitals participating at baseline. 'Hand hygiene (HH) infrastructure' reached 100% (baseline: 97.9; P = 0.001), 'HH protocol' 96.9% (baseline: 92.9; P = 0.001), 'HH monitoring' 70% (baseline: 60.7; P < 0.001) and 'existence of antimicrobial prescription protocol' 80.7% (baseline: 73.2; P < 0.001), among others. The HCAI rates of the participating hospitals decreased after the intervention (P < 0.05). CONCLUSION: The QI cycle approach was useful in guiding system-wide interventions for patient safety. External regulation was feasible and effective in promoting internal HCAI prevention nationwide.

[Clinical approach to chronic lumbar pain: a systematic review of recommendations included in existing practice guidelines]. / Abordaje clínico del dolor lumbar crónico: síntesis de recomendaciones basadas en la evidencia de las guías de práctica clínica existentes.

This paper presents a systematic review of clinical practice guidelines based on evidence, with explicit recommendations on the treatment of chronic low back pain. The main objective was to analyze their content and provide a synthesis in order to improve the translation of this evidence into practice. The recommendations were analyzed and then classified by treatment; evidence level and strength of recommendation were identified and translated into our gradation system. Eight guidelines met the inclusion criteria. Exercise and back school treatment are shown as the best therapies. Pharmacotherapy is indicated during short periods of time. The guidelines analyzed show similar therapeutic approaches. The recommendations have been synthesized in order to allow clinical selection of the best treatment and avoid bad practices with their corresponding costs, providing a more efficient management of the patient.

[Formal quality assessment of informed consent documents in 9 hospitals]. / Evaluación de la calidad formal de los documentos de consentimiento informado en 9 hospitales.

INTRODUCTION: Informed consent forms are very important in the process of medical information. The aim of this study is to design reliable formal quality criteria of these documents and their application in the evaluation of those used in the hospitals of a regional health service. MATERIAL AND METHODS: Criteria have been designed from the analysis of existing regulations, previous studies and consultation with key experts. The interobserver concordance was assessed using the kappa index. Criteria evaluation was performed on 1425 documents of 9 hospitals. RESULTS: A total of 19 criteria used in the evaluation of the quality of informed consent forms have been obtained. Kappa values were higher than 0,60 in 17 of them and higher than 0,52 in the other 2. The average number of defects per document was 7.6, with a high-low ratio among hospitals of 1.84. More than 90% of the documents had defects in the information on consequences and contraindications, and in about 90% it did not mention the copy to the patient. More than 60% did not comply with stating the purpose of the procedure, a statement of having understood and clarified doubts, and the treatment options. CONCLUSIONS: A tool has been obtained to reliably assess the formal quality of the informed consent forms. The documents assessed have a wide margin for improvement related to giving a copy to the patient, and some aspects of the specific information that patients should receive.

Conocimiento de las preferencias de los pacientes terminales en los hospitales públicos de la Región de Murcia / Advanced knowledge of patient preferences for end-of-life care in national health service hospitals of the Murcia Region

Fundamento. Los cuidados terminales no deseados son un evento adverso evitable y sujeto a normativa legal. Una de las recomendaciones para la seguridad del paciente del National Quality Forum (NQF) es «Asegurar el conocimiento de preferencias del paciente para cuidados terminales». Nuestro objetivo es valorar el cumplimiento de esta recomendación y qué factores sociolaborales se asocian a él en los hospitales públicos de la Región de Murcia. Métodos. Estudio transversal en 8 hospitales. Medimos indicadores de estructura (existencia y características de los protocolos sobre instrucciones previas) y proceso (frecuencia con que se indagan las preferencias de pacientes terminales), construidos según la recomendación del NQF. El indicador de proceso se mide mediante un cuestionario distribuido a una muestra representativa de profesionales (n=3.141). Realizamos un análisis descriptivo de resultados de ambos indicadores. La asociación de variables sociolaborales con la indagación de preferencias del paciente (variable dependiente) se analiza mediante regresión logística. Resultados. Uno de los 8 hospitales tenía protocolo válido. El 12% (IC del 95%, 9,4-14,6) de los profesionales (n=607) respondió que en su servicio siempre se indagan las preferencias de los pacientes terminales. La existencia de protocolo se asoció significativamente (odds ratio [OR] = 18,1; IC del 95%, 2,28-143,83) a la respuesta positiva, y trabajar en servicios quirúrgicos (OR=0,15; IC del 95%, 0,04-0,65) a una respuesta negativa. Conclusiones. Se observa un escaso cumplimiento de la recomendación del NQF, evidenciado por una escasa protocolización sobre instrucciones previas y la baja frecuencia de consulta a pacientes terminales sobre sus preferencias. La implantación de protocolos puede ayudar a mejorar esta situación que es significativamente peor en servicios quirúrgicos(AU)

Background and objective. Provision of unwanted end-of-life care is an adverse event that can be avoided and is regulated by law. One of the Safe Practices recommended by the National Quality Forum (NQF) is «Ensure that patient preferences regarding end-of-life care are known». Our objective is to assess compliance with this recommendation, and the associated socio-professional factors, in the National Health Service hospitals in the Murcia Region (Spain). Methods. Cross-sectional study in 8 hospitals. We measured structure (existence and characteristics of guidelines about advance directives) and process (frequency with which healthcare providers enquire about the preferences of terminally ill patients) indicators, constructed according to the NQF recommendation. The process indicator was measured using a questionnaire distributed to a sample of clinical personnel (n=3141). A descriptive analysis of the results was performed. The association of socio-professional variables with asking patient's preferences (dependent variable) was analysed using multivariate logistic regression. Results. One of the eight assessed hospitals has valid guidelines. Only 12% of professionals (n=607), (95% confidence interval [CI], 9.4-14.6), responded that they always enquire about the preferences of terminally ill patients in their departments. The existence of guidelines is significantly associated with this response (odds ratio [OR]=18.1; 95% CI, 2.28-143.83) and working in surgical departments with a negative response (OR=0.15; 95% CI, 0.04-0.65). Conclusions. There is a very low compliance with the NQF recommendation, evidenced by the lack of guidelines and the low frequency in which terminally ill patients are asked about their preferences for life-sustaining treatment. Implementation of guidelines may help to improve this situation, which is significantly worse in surgical services(AU)

[Advanced knowledge of patient preferences for end-of-life care in national health service hospitals of the Murcia Region]. / Conocimiento de las preferencias de los pacientes terminales en los hospitales públicos de la Región de Murcia.

BACKGROUND AND OBJECTIVE: Provision of unwanted end-of-life care is an adverse event that can be avoided and is regulated by law. One of the Safe Practices recommended by the National Quality Forum (NQF) is "Ensure that patient preferences regarding end-of-life care are known". Our objective is to assess compliance with this recommendation, and the associated socio-professional factors, in the National Health Service hospitals in the Murcia Region (Spain). METHODS: Cross-sectional study in 8 hospitals. We measured structure (existence and characteristics of guidelines about advance directives) and process (frequency with which healthcare providers enquire about the preferences of terminally ill patients) indicators, constructed according to the NQF recommendation. The process indicator was measured using a questionnaire distributed to a sample of clinical personnel (n=3141). A descriptive analysis of the results was performed. The association of socio-professional variables with asking patient's preferences (dependent variable) was analysed using multivariate logistic regression. RESULTS: One of the eight assessed hospitals has valid guidelines. Only 12% of professionals (n=607), (95% confidence interval [CI], 9.4-14.6), responded that they always enquire about the preferences of terminally ill patients in their departments. The existence of guidelines is significantly associated with this response (odds ratio [OR]=18.1; 95% CI, 2.28-143.83) and working in surgical departments with a negative response (OR=0.15; 95% CI, 0.04-0.65). CONCLUSIONS: There is a very low compliance with the NQF recommendation, evidenced by the lack of guidelines and the low frequency in which terminally ill patients are asked about their preferences for life-sustaining treatment. Implementation of guidelines may help to improve this situation, which is significantly worse in surgical services.

[Factors linked to structural quality in the guidelines for clinical practice of physiotherapy]. / Factores asociados a la calidad estructural en las guías de práctica clínica de fisioterapia.

OBJECTIVE: To identify the characteristics associated with better structural quality of protocols.Design. Analytic and transversal.Setting. Health centres in Spain with physiotherapy protocols. PARTICIPANTS: Guidelines for physiotherapy practice or protocols worked out between 1990 and 1996, inclusive. MAIN MEASUREMENTS: The design quality of the documents was evaluated by using percentages of compliance with eight explicit validated criteria and the proportion of criteria complied with in each protocol out of the total possible. To identify the characteristics linked to structural quality, multiple and logistic regression multivariate analyses were performed. RESULTS: There was greater structural quality in documents worked out by teams of over five authors and after 1992. Variables that did not affect structural quality were the source of the protocol (Insalud or autonomous community with devolved powers) and the kind of professional (only physiotherapists or multi-disciplinary) who worked it out. CONCLUSIONS: The quality of the documents varies according to the date and the number of authors who work them out. There was significantly greater quality when this was after 1992 and there were over five authors. Therefore, under the opposite circumstances (few authors), there is greater risk of low-quality documents.

[What is the attitude of doctors to the current model of primary care?]. / Cuál es la actitud de los médicos hacia el actual modelo de atención primaria?

OBJECTIVES: To determine the attitude of doctors towards the current model of primary care and to calculate its relationship with social and demographic and/or work variables. DESIGN: Multi-centre cross-sectional study. SETTING: Health centres in Area II of the Murcia region. Participants. All general practitioners, family doctors and paediatricians in the health centres mentioned (54 in all). MAIN MEASUREMENTS: The "Scale of attitudes towards the contents of primary health care" by Ballesteros et al. was used as the tool of evaluation. This scale provides both a total score and a specific score for each of its 7 dimensions. RESULTS: In general, doctors' attitudes were favourable (4.1 points average out of 5). We found a less favourable attitude in the dimension "Inclusion of second-level professionals in primary care", with family doctors most in agreement. The professionals working in centres on the periphery and those without tenure had a more positive attitude towards the current model, for the remaining variables. CONCLUSIONS: Understanding professionals' attitudes and the variables related to them may serve as a basis for designing intervention strategies aimed at improving the quality of primary care and for the positive evolution of professionals working in PC.

[Evaluation and improvement of therapy adherence of hypertensive patients]. / Evaluación y mejora de la adhesión terapéutica en los pacientes hipertensos.

OBJECTIVES: First, to assess whether it is useful for a patient to take part in the analysis of the causes of non-compliance with therapy for hypertension. Second, to design a questionnaire to evaluate the causes and the degree of adherence to therapy and to construct indicators on the basis of this. Lastly, to determine the effectiveness of the feedback of the evaluation of these indicators to health professionals, as a method of improving hypertense patients' adherence to therapy. DESIGN: Qualitative study through the focus group technique; b) quasi-experimental design of independent samples between evaluation and re-evaluation with two study groups: experimental (3 PC health centres) and control (3 PC health centres). SETTING: PC health centres. PARTICIPANTS: Patients over 18 on medical hypertension treatment. MEASUREMENTS: First phase: analysis of the reasons for non-compliance with therapy through the group focus technique and design of the questionnaire to evaluate factors associated with non-compliance. Second phase: evaluation and pilot study of the questionnaire. For this, a questionnaire to assess therapy adherence and to determine the weight of related factors will be sent to a random sample of hypertense patients at each Health Centre. Third phase: intervention. A report with the results of the first assessment will be sent to the health professionals of the experimental group. Fourth phase: re-evaluation of the indicators of adherence, and analysis of the improvement achieved.

Evaluación y mejora de la adhesión terapéutica en los pacientes hipertensos / Evaluation and improvement of therapeutic adherence of hypertense patients

Objetivos. Primero, valorar la utilidad de la participación del usuario en el análisis de las causas del incumplimiento terapéutico en la hipertensión. Segundo, diseñar un cuestionario para evaluar las causas y el grado de adhesión terapéutica y construir indicadores a partir de él. Por último, determinar la efectividad del feedback de la evaluación de estos indicadores a los profesionales sanitarios como método de mejora de la adhesión terapéutica en los pacientes hipertensos. Diseño. a) Estudio cualitativo mediante la técnica del grupo focal, y b) diseño cuasiexperimental de muestras independientes entre la evaluación y la reevaluación con 2 grupos de estudio: experimental (3 centros de atención primaria salud) y control (3 centros de atención primaria de salud). Sujetos de estudio. Pacientes de más de 18 años con tratamiento farmacológico antihipertensivo. Emplazamiento. Centros de atención primaria de salud. Instrumentalización. Primera fase: análisis de las causas del incumplimiento terapéutico mediante la técnica del grupo focal y diseño del cuestionario de evaluación de los factores asociados a este fenómeno. Segunda fase: evaluación y pilotaje del cuestionario. Para ello, en cada centro de salud se enviará a una muestra aleatoria de sujetos hipertensos un cuestionario para valorar la adhesión terapéutica y determinar la magnitud de los factores relacionados con ésta. Tercera fase: intervención. Se enviará a los profesionales sanitarios del grupo experimental un informe con los resultados de la primera evaluación. Cuarta fase: reevaluación de los indicadores de adhesión y análisis de la mejora conseguida (AU)

Características de las guías clínicas de atención primaria que se asocian a una mayor calidad estructural / Characterstics of primary care clinical guidelines associated with greater structural quality of the document

Objetivo. Identificar las características que se asocian a una mayor calidad estructural de las guías clínicas. Diseño. Evaluación transversal. Emplazamiento. Centros de salud de la región de Murcia. Participantes. Documentos (y profesionales) de esos centros. Mediciones principales. Son objeto de estudio todas las guías de práctica o protocolos elaborados de enero de 1985 a enero de 1994, obteniéndose 470, de las que se evalúan 462 (se rechazan 8 por falta de datos). Se valora la calidad del diseño de los protocolos. Se calcula la ratio de cumplimiento de criterios para cada documento. Se identifican las características que se asocian a la calidad de los protocolos con dos análisis multivariantes: regresión múltiple (variable dependiente la ratio cumplimiento) y regresión logística (variable dependiente la ratio de cumplimiento en relación a la media).Resultados. En ambos análisis una mayor calidad estructural se asocia con una determinada área de salud, elaborados de manera multidisciplinaria (p < 0,001), referidos a un problema de salud crónico (p < 0,001), elaborados específicamente como tales (p < 0,001) y relacionados con la cartera de servicios (p < 0,001). En alguno de los análisis parece asociarse una mejor calidad con que el centro de salud sea docente, que la guía se refiera a la asistencia y del programa de salud de la mujer. Conclusiones. La calidad de los documentos varía significativamente según el área de salud, y determinadas características (problemas de salud crónicos, elaboración multidisciplinaria y específica, y relación con la cartera de servicios) se asocian a una superior calidad de los documentos. Las características de problemas agudos, elaboración uniprofesional, ser parte de un programa y no relacionados con la cartera de servicios se mostraron como de mayor riesgo para una baja calidad. (AU)

Factores que influyen en el uso de los protocolos clínicos, según la opinión de los fisioterapeutas de los centros de salud de la región de murcia / The factors that influence the use of clinical protocols according to the opinion of the physical therapist of health center in the Autonomous Community of Murcia

Objetivos: averiguar los factores que influyen en el uso de los protocolos de fisioterapia en Atención Primaria según la opinión de los fisioterapeutas de Atención Primaria, las razones de su poco uso y recoger sugerencias para mejora. Material y métodos: se realizó un estudio de opinión mediante encuesta telefónica. El ámbito de estudio corresponde a 18 Unidades de Fisioterapia del nivel de Atención Primaria de la Comunidad Autónoma de la región de Murcia. Los sujetos de estudio son 21 fisioterapeutas que desarrollan su labor en dichas Unidades. Se realizó una encuesta telefónica, estructurada, pilotada previamente, administrada por un entrevistador entrenado con dos preguntas abiertas: ¿por qué cree que los fisioterapeutas de su área no utilizan más los protocolos?, y ¿qué sugerencias propondría para que se utilizaran más? El trabajo de campo se realizó en enero de 2000. Resultados: El grado de respuesta ha sido del 90,9 por ciento. Respecto a la primera pregunta, los fisioterapeutas creen que el poco uso se explicaría por la asistencia mediatizada por criterios médicos, recomendaciones poco actualizadas y poca flexibilidad ante situaciones imprevistas (42,5 por ciento del total de respuestas). Respecto a la segunda pregunta, la sugerencia más señalada ha sido realizar sesiones de consenso para elaborar los protocolos (13,7 por ciento). Conclusiones: los fisioterapeutas asumen que los protocolos se usan poco y la clave para utilizarlos más es la mejora de la organización y de los documentos de los protocolos. (AU)

[Usefulness of patients' reports in monitoring rational use of medicines]. / Utilidad del informe del usuario en la monitorización del uso racional de medicamentos.

OBJECTIVES: To determine the usefulness of patients' reports in constructing indicators of the rational use of medicines and to analyse these reports' benefits and limitations in comparison with the medical records. DESIGN: Cross-sectional multi-centred study. SETTING: Eight primary care health centres. PATIENTS: For each centre a randomised sample, stratified by medical list, was selected of 125 subjects over 18 who had attended on some occasion the medical clinic in the previous 12 months (1000 subjects in all). MEASUREMENTS AND MAIN RESULTS: A <> questionnaire was designed and distributed (with questions referring to objective concrete experiences), in which information was gathered on various aspects of the use of medicines. In addition, these data were checked against the medical records of the subjects who answered the questionnaire. The reply rate was 43.7% for the questionnaire as a whole. It fluctuated between 92.0% and 46.0% in different specific items. The age of the patient, the number of consultations and suffering a chronic illness all affected the level of response to the questionnaire. Nevertheless, the users provided between 2 and 5 times more information than the medical record, with moderate-to-high reliability. Concordance between what was reported and what was recorded varied between 72.0% and 82.0%. CONCLUSIONS: The user's report can be useful, as a substitute for and as a complement to other sources of information, to construct indicators of the rational use of medication from an integrated perspective.

Utilidad del informe del usuario en la monitorización del uso racional de medicamentos / Usefulness of patients' reports in monitoring rational use of medicines

Objetivo. Determinar la utilidad del informe del usuario en la construcción de indicadores del uso racional de medicamentos y analizar sus ventajas y limitaciones en relación con la historia clínica. Diseño. Estudio multicéntrico, transversal. Emplazamiento. Ocho centros de atención primaria de salud. Pacientes. Para cada centro se ha seleccionado una muestra aleatoria y estratificada por cupo médico de 125 sujetos mayores de 18 años que habían acudido alguna vez a la consulta médica durante los últimos 12 meses (1.000 sujetos en total).Mediciones y resultados principales. Se ha diseñado y distribuido un cuestionario 'tipo informe' (con preguntas que hacen referencia a experiencias objetivas y concretas) en el que se recoge información sobre diversos aspectos del uso de medicamentos. Adicionalmente se han revisado estos datos en las historias clínicas de los sujetos que han respondido al cuestionario. La proporción de respuesta ha sido del 43,7 por ciento para el cuestionario global y ha oscilado entre un 92,0 por ciento y el 46,0 por ciento en los diferentes ítems específicos. Tanto la edad del paciente, como el número de consultas y presentar alguna enfermedad crónica han influido en el grado de respuesta al cuestionario. No obstante, el usuario proporciona 2-5 veces más información que la historia clínica, con una fiabilidad moderadaalta. Por otra parte, la concordancia entre lo informado y lo registrado varía en un 72,0-82,0 por ciento. Conclusiones. El informe del usuario puede ser útil, como sustituto y como complemento de otras fuentes de información, para construir indicadores del uso racional de medicamentos desde una perspectiva integral (AU)

[Characteristics of primary care clinical guidelines associated with greater structural quality of the document]. / Características de las guías clínicas de atención primaria que se asocian a una mayor calidad estructural.

AIM: To identify characteristics associated with greater structural quality of clinical guidelines. DESIGN: Cross-sectional study. SETTING: Health centers in the region of Murcia (southeastern Spain). MAIN OUTCOME MEASURES: All clinical practice guidelines and protocols developed between January 1985 and January 1994 were reviewed. Of the 470 documents originally obtained, 462 were evaluated and 8 were excluded because of missing data. The quality of document design was evaluated in all materials. The rate of criteria compliance was calculated for each document. The characteristics that were associated with protocol quality were identified in two types of multivariate analysis: multiple regression (with compliance rate as the dependent variable) and logistic regression (with compliance rate referred to the mean as the dependent variable). RESULTS: Both analyses showed that structural quality was associated with specific health care areas, multidisciplinary design (p < 0.001), reference to chronic health problems (p < 0.001), design of the document specifically as a clinical practice guideline (p < 0.001), and reference to the health services offered at a given center (p < 0.001). In some analyses, greater quality appeared to be associated with heath centers that were also teaching centers, reference in the document to health care, and womens health programs. CONCLUSIONS: Document quality varied significantly in different health care areas, and certain characteristics (chronic health problems, multidisciplinary design and specific design, reference to specific health services offered) were associated with greater document quality. Reference to acute health problems, design by only one type of professional (physicians or nurses), inclusion as part of a larger program, and lack of reference to specific health services offered at a given center were characteristics with a greater risk for low document quality.

[Local variability in the guidelines for hypertension screening, diagnosis and baseline assessment in 40 health centers]. / Variabilidad en la protocolización de la captación, diagnóstico y valoración inicial del paciente hipertenso en 40 centros de salud.

BACKGROUND: To identify and to compare the recommendations of the currently existing clinical protocols for arterial hypertension (HT) screening, diagnosis and baseline study in the Murcia Region, Spain, in order to assess their validity and reliability. MATERIAL AND METHODS: Structured comparative description of guidelines in Clinical Protocols for HT (n = 40) from all Health Centers in the Region. Comparative description of the Health Centers Clinical Protocols and national and international reference documents regarding HT screening, diagnosis and baseline assessment is performed. RESULTS: Target population for screening ranged from aged > or = 14 years (24 centers) to > 20 (1 center). Screening procedure was not described in 3 centers and screening periodicity varied from 6 months to 5 years, with differences by age and by concurrent risk factors in some protocols. Diagnosis norms differed by age in only 11 protocols; blood pressure (BP) exams for diagnosis varied from 3 to 5 and there were 12 different HT figures for immediate diagnosis and treatment. Baseline study varied greatly; we found a total of 7 recommended items for anamnesis, 11 for physical exam, 19 for blood tests, 4 for urine tests, and 7 for other tests; only the electrocardiogram was common to all protocols. There was also some disagreement in the national and international reference guidelines whose scientific evidence was not always explicitly considered. CONCLUSIONS: There is a wide local variation in norms for HT screening, diagnosis, and baseline study. If the Centers follow their own protocols, the same patient may be or may not be diagnosed depending on the Center he visits; additionally, there would be big differences in the process and resources needed for HT control. This variation casts doubt on the protocols validity and reliability at regional level and underscores the need for critically reviewing the validity of existing protocols.

[Diagnosis of dyslipidemia in primary care: a service to be improved. Results of a multicenter evaluation]. / El diagnóstico de las dislipemias en atención primaria: un servicio a mejorar. Resultados de una evaluación multicéntrica.

OBJECTIVE: The variability of the quality of care in the primary care procedures to diagnose lipaemia was evaluated. DESIGN: Observation, multi-centred and retrospective study. SETTING: Random sample of 10 primary care centres in the Murcia region. PATIENTS AND OTHER PARTICIPANTS: Patients over 19 with lipaemia detected over the previous twelve months in the general medical clinics at health centres. 500 cases in all were studied (50 per centre). MEASUREMENTS AND MAIN RESULTS: Compliance with criteria of good clinical practice was evaluated. These criteria were formulated by health centre doctors and included: adequate diagnosis, classification into primary or secondary, phenotype, recording of cardiovascular risk factors and assessment of cardiovascular (CV) risk. The differences between the centres studied and the effect of the centre's characteristics (teaching, location, existence of lipaemia programme) and of the patients' (age and gender) were also examined. We found that none of the cases evaluated satisfied the five quality criteria at the same time. Assessment of CV risk and the aetiopathogenic classification were the criteria least complied with (1.5% +/- 1.0). Centres varied considerably. Their characteristics affected the quality of the procedure evaluated, which in all centres had a lot of room for improvement. CONCLUSIONS: The quality of the procedures for diagnosing lipaemia can be considerably improved. It varies a lot from centre to centre.

El diagnóstico de las dislipemias en atención primaria: un servicio a mejorar. Resultados de una evaluación multicéntrica / The diagnosis of lipaemia in primary care: an improveable service. Results of a multi-centred evaluation

Objetivo. Se evalúa la variabilidad de la calidad asistencial del proceso diagnóstico de las hiperlipemias en atención primaria de salud. Diseño. Estudio observacional, multicéntrico y retrospectivo. Emplazamiento. Muestra aleatoria de 10 centros de atención primaria de salud de la región de Murcia. Pacientes u otros participantes. Sujetos de más de 19 años con hiperlipemia detectada durante los últimos 12 meses en las consultas de medicina general de los centros de salud. Se estudiaron 500 casos en total (50 por centro). Mediciones y resultados principales.Se evaluó el grado de cumplimiento de criterios de buena práctica clínica (diagnóstico adecuado, clasificación en primaria o secundaria, clasificación fenotípica, registro de factores de riesgo cardiovascular y valoración del riesgo cardiovascular) formulados por médicos de centros de salud, así como las diferencias entre los centros estudiados y la influencia de sus características (docencia, ubicación, existencia de programa de dislipemias) y las del paciente (edad y sexo). Encontramos que ninguno de los casos evaluados cumplía de forma simultánea los 5 criterios de calidad, siendo la valoración del riesgo cardiovascular y la clasificación etiopatogénica los que menos se cumplen (1,5 por ciento ñ 1,0).Hay asimismo una amplia variabilidad entre centros, cuyas características influyen en el nivel de calidad del proceso evaluado, que presenta un amplio margen para la mejora en todos ellos. Conclusiones. La calidad del proceso diagnóstico de las hiperlipemias presenta un amplio margen de mejora y se distribuye de forma eterogénea entre los diferentes centros de salud (AU)

Sistema de registro y evaluación de la guía de práctica clínica en los pacientes con cervicalgia / Registry system and evaluation of the guidelines for clinical practice in the patients with neck pain

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