[Costs of spirometry as a screening test for chronic obstructive pulmonary disease in primary care]. / Costes de la espirometría como prueba de cribado en atención primaria de la enfermedad pulmonar obstructiva crónica.

OBJECTIVE: To calculate the costs of COPD screening by simple spirometry, conducted in primary care, in smokers and ex-smokers over 40 years old. DESIGN: Descriptive study. Cost analysis. SETTING: Semi-rural health district covering some 6000 inhabitants. PARTICIPANTS: Randomised sample of 350 smokers and ex-smokers over 40 allocated to the centre. 73 were excluded on SEFAR criteria. INTERVENTIONS AND MEASUREMENTS: Simple spirometry was conducted with an automatic, portable, dry spirometer. Costs were calculated from the time needed, the material, human resources and the number of valid spirometer readings. RESULTS: 85% of 277 had a spirometry test. 18% of the spirometry readings were not valid. 3 spirometries an hour could be done: at least 1 was pathological and a bronchodilator test was needed. The cost of a spirometry, if a professional devotes 2 hours a day for 5 years, was 10.57 euros or 8.54 euros, for doctor or nurse, respectively. Modifying the number of spirometries per year or the number of professionals trained for such a technique causes only minor changes in cost. CONCLUSIONS: Optimal cost: 9000 spirometries a year by a single nurse. However, this would entail one nurse's almost exclusive dedication. Two trained professionals raises the cost slightly and distributes the work load better, enabling more hours to be covered. Before advising any COPD screening, its costs and its real possibility of affecting active smokers (the sole preventive possibility) should be carefully assessed.

Costes de la espirometría como prueba de cribado en atención primaria de la enfermedad pulmonar obstructiva crónica / Costs of spirometry as a screening test for chronic obstructive pulmonary disease in primary care

Objetivo. Estimar los costes del cribado de la enfermedad pulmonar obstructiva crónica (EPOC) mediante espirometría simple realizada en asistencia primaria en fumadores y ex fumadores de más de 40 años. Diseño. Estudio descriptivo. Análisis de costes. Emplazamiento. Área básica de salud semirrural que atiende a unos 6.000 habitantes. Participantes. Muestra aleatoria de 350 individuos fumadores y ex fumadores > 40 años asignados al centro. Según los criterios de la SEPAR, se excluyó a 73. Intervenciones y mediciones. Se realizó una espirometría simple con un espirómetro seco, portátil y automático. Se estimaron los costes a partir del tiempo necesario, el material, los recursos humanos y el número de espirometrías válidas. Resultados. En el 85% de los 277 individuos se realizó una espirometría. El 18% de las espirometrías realizadas no fue válido. Se pueden realizar 3 espirometrías/h: al menos una será patológica y deberá realizarse una prueba broncodilatadora. El coste de una espirometría si un profesional dedica 2 h diarias durante 5 años es de 10,57 o 8,54e, según sea un médico o una enfermera. Modificar el número de espirometrías/año o el número de profesionales entrenados para esta técnica conlleva una menor modificación en los costes. Conclusiones. El coste óptimo es de 9.000 espirometrías/año realizadas por una sola enfermera; sin embargo, esto obligaría a que tuviera una dedicación casi exclusiva. Su realización por 2 profesionales preparados conlleva un moderado aumento del coste y distribuye mejor la carga, permitiendo acceder a un horario más amplio. Antes de aconsejar cualquier cribado de la EPOC se deberían valorar cuidadosamente sus costes y las posibilidades de influir en los fumadores activos (única posibilidad preventiva)

Objective. To calculate the costs of COPD screening by simple spirometry, conducted in primary care, in smokers and ex-smokers over 40 years old. Design. Descriptive study. Cost analysis. Setting. Semi-rural health district covering some 6000 inhabitants. Participants. Randomised sample of 350 smokers and ex-smokers over 40 allocated to the centre. 73 were excluded on SEFAR criteria. Interventions and measurements. Simple spirometry was conducted with an automatic, portable, dry spirometer. Costs were calculated from the time needed, the material, human resources and the number of valid spirometer readings. Results. 85% of 277 had a spirometry test. 18% of the spirometry readings were not valid. 3 spirometries an hour could be done: at least 1 was pathological and a bronchodilator test was needed. The cost of a spirometry, if a professional devotes 2 hours a day for 5 years, was 10.57 euros or 8.54 euros, for doctor or nurse, respectively. Modifying the number of spirometries per year or the number of professionals trained for such a technique causes only minor changes in cost. Conclusions. Optimal cost: 9000 spirometries a year by a single nurse. However, this would entail one nurse's almost exclusive dedication. Two trained professionals raises the cost slightly and distributes the work load better, enabling more hours to be covered. Before advising any COPD screening, its costs and its real possibility of affecting active smokers (the sole preventive possibility) should be carefully assessed

[Management of osteoporosis at a primary care center]. / Abordaje de la osteoporosis en un centro de atención primaria.

OBJECTIVES: To find how suitable a semFYC guide is for the indication of bone densitometry in menopausal women; and how appropriate their Osteoporosis treatment is. DESIGN: Cross-sectional study.Setting. Girona-3 Health District. PARTICIPANTS: Women between 50 and 80 allocated to the Girona-3 Health District. Suffering a grave psychiatric disorder or a terminal illness were considered criteria for exclusion. 409 out of the 420 women envisaged were included, to achieve a 5% accuracy and a 0.05% alpha error. MAIN MEASUREMENTS: Whether bone densitometry took place or otherwise, other diagnostic tests, risk factors for osteoporosis recorded and drug treatment prescribed. RESULTS: Of the 125 women with risk factors for osteoporosis, 12 (9.6%) had had a bone densitometry. 20% of all bone densitometries done showed pathology. Only in 3 cases (0.7%) of the pathological cases was any recommendation on life-style recorded. 19.8% of the women took drug treatment. In 8% this was justified. The most common treatment prescribed was calcium, on its own or linked to vitamin D. 20% of cases had a bone densitometry to monitor them after 2 years. CONCLUSIONS: The indication for bone densitometry is low and its use could be improved. In those cases in which bone densitometry is requested, a pharmacological intervention is more common than a life-style one.

¿Son directamente aplicables las tablas de framingham a la población mediterránea? / Are the Farmingham tables directly applicable to the Mediterranean population?

No disponible

Enfermedad de las vacas locas: la ausencia de evidencia no significa evidencia de ausencia / Mad cow disease: absence of evidence is not evidence of absence

No disponible

[Tackling mental health problems from primary care: relationship with specialized support services]. / Abordaje de los problemas de salud mental desde atención primaria. Relación con los servicios de apoyo especializados.

OBJECTIVES: To find the relationship between primary care (PC) and mental health (MH) by evaluating: 1) perception of MH problems in PC: training of professionals and doctor-patient relationship, and 2) relationship between PC and specialist support services: coordination meetings and reasons for referrals. DESIGN: Descriptive study. SETTING: Seven PC centres that share the same mental health centre in the Girona Health Region. PARTICIPANTS: All the PC doctors from the 7 centres (n = 66). MEASUREMENTS AND MAIN RESULTS: Specific, anonymous and self-administered survey, with 71 Likert-type items, distributed in 14 fields. 51 replies (77.2%). 60.4% valued positively their MH training. 100% thought that a good doctor-patient relationship improves adherence to treatment, and 76.5% saw this hindered by lack of time. Aggressive and manipulative patients caused a higher level of tension (70.6% and 66.7%). The point most highly valued of their relationship with the MH centre was its support in patient follow-up (69.6%) and the agreement to share responsibilities for treatment of mental disorders (71.1%). The forms of support most valued were: inter-clinical meetings (80.4%) and inter-clinic telephone consultations (78.4%). The factors most conditioning referral to the MH centre were ideas of suicide (96.1%) and the seriousness of the symptoms (94%). CONCLUSIONS: Greater MH training should be offered to PC doctors. PC doctors think they have little time available to devote to their psychiatric patients. Availability of a specialist PC support team is essential.

Abordaje de los problemas de salud mental desde atención primaria. Relación con los servicios de apoyo especializados / Tackling mental health problems from primary care: relationship with specialist support services

Objetivos. Conocer la relación entre asistencia primaria (AP) y salud mental (SM), valorando: a) percepción de los problemas de SM en AP: formación de los profesionales y relación médicopaciente, y b) relación entre AP y los servicios de soporte especializados: reuniones de coordinación y motivos de las derivaciones. Diseño. Estudio descriptivo. Emplazamiento. Siete centros de AP que comparten el mismo centro de salud mental (CSM) de la Regió Sanitària Girona. Participantes. Todos los médicos de AP de los 7 centros (n = 66).Mediciones y resultados principales. Encuesta específica, anónima y autoadministrada, que consta de 71 ítems tipo Likert, distribuidos en 14 campos; 51 respuestas (77,2 por ciento); un 60,4 por ciento valora positivamente su formación en SM; un 100 por ciento considera que una buena relación médico-paciente mejora la adhesión al tratamiento, y un 76,5 por ciento la ve dificultada por falta de tiempo. Los pacientes agresivos y manipuladores provocan un mayor grado de tensión (70,6 y 66,7 por ciento). Lo más valorado de la relación con el CSM es su apoyo en el seguimiento de los pacientes (69,6 por ciento) y el acuerdo en la división de responsabilidades en el tratamiento de los trastornos mentales (71,1 por ciento). Las formas de apoyo más valoradas son las reuniones de interconsulta (80,4 por ciento) y las interconsultas telefónicas (78,4 por ciento). Los factores que más condicionan la derivación al CSM son las ideas de suicidio (96,1 por ciento) y la gravedad de la sintomatología (94 por ciento). Conclusiones. Sería necesario ofrecer mayor formación al médico de AP sobre SM. Los médicos de AP consideran escaso el tiempo que pueden dedicar a sus enfermos psiquiátricos. La disponibilidad de un equipo de apoyo especializado es indispensable en AP (AU)

[Prevalence of Helicobacter pylori infection in primary health care]. / Prevalencia de la infección por Helicobacter pylori en atención primaria de salud.

OBJECTIVES: To find the prevalence of Helicobacter pylori (Hp) infection in the population as a whole. To assess its relationship with the associated factors described in other studies. DESIGN: Transversal study of an urban population of 20,000. PARTICIPANTS: Between 14 and 80 years old. Randomised sampling of the computerised records (640 clinical histories). Necessary sample n = 384 (alpha = 0.05, prior prevalence = 50%, precision 0.05). MEASUREMENTS: Breath test with urea marked (13C), age, sex, alcohol and tobacco consumption, social class and dyspepsia and/or gastro-duodenal pathology. RESULTS: 123 exclusions. 122 losses (23%). 397 people screened, 43.6% male. Average age: 42.6. 41.6% consumed alcohol. 30.5% smoked. Prevalence of dyspepsia, gastritis, gastric ulcer and duodenal ulcer, 14%, 2.8%, 2.8% and 2.0%, respectively. Hp prevalence: 56.1% (95% CI, 51.2-60.1). There were no significant differences between prevalence of Hp+ and sex, dyspepsia, peptic ulcer history, gastritis, alcohol consumption and tobacco consumption. Greatest prevalence of Hp+ in over-70s (73%). Significant linear tendency between presence of Hp+ and age (p < 0.05) and low social class (p < 0.05). The logistic regression analysis found a statistically significant relationship only between the presence of H. pylori and age and social class. CONCLUSIONS: Prevalence was similar to that in other studies. The relationship between low social class and age and greater Hp prevalence was confirmed. Dyspepsia is not a justification for empirical treatment of Hp. Patients with and without the infection must be followed to evaluate morbidity longitudinally.

Prevalencia de la infección por Helicobacter pylori en atención primaria de salud / Prevalence of helicobacter pylori infection in primary health care

Objetivos. Conocer la prevalencia de infección por Helicobacter pylori (Hp) en población general. Valorar la relación con los factores asociados descritos en otros ámbitos. Diseño y ámbito. Estudio transversal. Población urbana: 20.000 personas. Sujetos. Edad de 14-80 años. Muestreo aleatorio del registro informatizado (640 historias clínicas). Muestra necesaria, 384 (alfa, 0,05; prevalencia previa, 50 por ciento; precisión, 0,05). Mediciones. Prueba del aliento con urea marcada (13C), edad, sexo, consumo de alcohol y tabaco, clase social y dispepsia y/o patología gastroduodenal. Resultados. Exclusiones, 123; pérdidas, 122 (23 por ciento); cribados, 397; varones, 43,6 por ciento; edad media, 42,6 años; consumía alcohol, 41,6 por ciento; fumaba, 30,5 por ciento. Prevalencia de dispepsia, gastritis, ulcus gástrico y duodenal, respectivamente, 14, 2,8, 2,8 y 2,0 por ciento. Prevalencia Hp, 56,1 por ciento (IC del 95 por ciento, 51,2-60,1). No hay diferencias significativas entre prevalencia de Hp+ y sexo, dispepsia, antecedentes de ulcus péptico, gastritis, consumo de alcohol y consumo de tabaco. Máxima prevalencia de Hp+ en mayores de 70 años (73 por ciento). Tendencia lineal significativa entre presencia de Hp+ y edad (p < 0,05) y clase social baja (p < 0,05). El análisis de regresión logística sólo encuentra relación estadísticamente significativa entre presencia de Hp y edad y clase social. Conclusiones. La prevalencia es similar a la de otros estudios. Se confirma la relación entre clase social baja y edad y mayor prevalencia de Hp. La dispepsia no justificaría el tratamiento empírico de Hp. Es necesario el seguimiento de los pacientes con y sin infección para evaluar la morbilidad longitudinalmente (AU)

[User satisfaction in primary care]. / Satisfacción de los usuarios en atención primaria.

OBJECTIVES: To find user satisfaction and assess the usefulness of an analogue scale in measuring satisfaction. DESIGN: Multi-centre, descriptive and crossover study. SETTING: Four primary care centres in Girona. PARTICIPANTS: All those users who happened to attend on a certain day (n = 1349). MEASUREMENTS AND MAIN RESULTS: A multi-dimensional, self-administered and anonymous 33-item questionnaire on satisfaction, which had already been validated in primary care, was used. An analogue scale, running from 0 to 10, on overall satisfaction was added. The mean age was 48.5; 33% were men, 62% women. 84.2% replied; 37.3% needed help to reply. Mean satisfaction on the questionnaire was 85%, with lower ratings given to organisational questions, and the highest to personal treatment. The analogue scale achieved 7.34 average. The correlation between the two was r = 0.63 (p < 0.001). CONCLUSIONS: The satisfaction level was similar to that found in other studies. The analogue scale correlated closely with the questionnaire, but was quicker and more simple. As such, it could be used to monitor user satisfaction along with open questions for a supplementary qualitative evaluation.

[Overattendance at primary care: a study of psychosocial factors]. / Hiperfrecuentación en atención primaria: estudio de los factores psicosociales.

OBJECTIVE: To determine the effect of various psychological and social factors--family function, social support, psychological malaise and social class--on frequency of attendance. DESIGN: Study with cases and controls. SETTING: Health Districts Girona-3 and La Bisbal. PARTICIPANTS: Criteria for inclusion: being older than 14, being on a list as a user, and having been seen at least once during the study period. The person over-attending is defined as someone attending 7 or more times in a year. The normal attender attends less than 7 times. The sample was 441 patients (209 cases and 232 controls). MEASUREMENTS AND MAIN RESULTS: The Smilkestein family Apgar and the DUKE-UNC social support questionnaires, and the Goldberg anxiety and depression scale, were administered. Social class was defined according to the job of the head of the family. Statistical analysis was undertaken in two steps: firstly, bivariate analysis; and second, multivariate. The social support and age variables were related to frequency of attendance: they explained 8.1% of it (through multiple regression). Depression increased by between 1.21 and 2.58 the risk of over-attending and explained 10.53% of the variability of over-attendance, in line with the logistical regression analysis. CONCLUSIONS: The psychological and social variables studied fail to explain most of the variability. We should demystify the importance of psychological and social factors in the use of health resources.