[Quality and characteristics of antibiotics prescriptions in an emergency hospital service]. / Calidad y características de la prescripción de antibióticos en un servicio hospitalario de urgencias.

BACKGROUND: To assess the quality of the prescribing of antibiotics to patients treated at a hospital emergency department (HED). METHODS: Retrospective study of the 8600 patients treated and released from a HED throughout the January-April 1996 period. Those patients for whom antibiotics were prescribed as stated on the release form were included. The parameters employed for assessing the prescribing quality were: illness subject to being treated with antibiotics, proper antibiotic, dosage, proper frequency and length of time over which the antibiotic is to be taken. Each one of these parameters was assigned a mark affording the possibility of quantifying quality on a 0-100 point scale. The assessment of the extent to which proper treatment was prescribed was made based on the recommendations described on four guides to the use of antibiotics. RESULTS: Antibiotics were prescribed to 609 (7.1%) of the patients, basically for treating urinary tract infections (17.7%), the prevention of wound infection (13.1%) and for the treatment of repeated attacks of chronic obstructive pulmonary disease (COPD) (10.3%). The antibiotic most often prescribed was cloxacillin (22.5%), followed by ciprofloxacin (13.4%) and clarithromycin (13.2%). Of all of the patients treated with antibiotics, 10.8% had no illness or any indication subject to being treated with these medications, and 32% of those patients who did indeed meet these requirements were prescribed an unsuitable antibiotic. Pneumonia was the illness for which the best quality of treatment was provided. The average mark for the prescriptions did not total 80 points in any of the guides. CONCLUSIONS: Antibiotics are medications frequently prescribed in HED's. Major errors are found to exist with regard to the indication, selection and length of the treatments initiated with these medications, as a result of which it is advisable that sustained educational measures be taken.

[Do physicians' strikes influence the utilization profile of hospital emergency services?]. / Influyen las huelgas de médicos en el perfil de utilización de los servicios de urgencias hospitalarios?

BACKGROUND: To assess the differences in appropriateness of consultations and demographic outline of people attended in a hospital emergency facility (HEP) along the hospital physicians strike period in spring 1995. METHODS: Observational cross-sectional study in Health Area 1 in the province of Badajoz. 8964 patients assisted along the strike period were compared with 8024 attended in the same period of 1994 (no strike). RESULTS: The patients average was 169.13 (SD 27.35) a day in the strike period, during the control period this mean was 151.39 (SD 19.78) patients a day (p < 0.001). Demographic variables of patients were similar in both groups, with similar mean ages and gender proportion in all age and residence site groups. Most of patients went to the HEF self-promoted (70.1% and 65.8%) and without ambulance (92% and 90.8%) in both periods (strike and control). The outcome of medical care was home discharge in 85.35% during the strike period and 83.81% in the control period, with admission rates of 13.1% and 14.15% (p < 0.01). CONCLUSIONS: There are no significant differences in the HEF use features completely explained by the physicians strike.

[Drug savings and the outpatient monitoring of arterial pressure in a group of hypertensive patients]. / Ahorro farmacológico y monitorización ambulatoria de la presión arterial en un grupo de pacientes hipertensos.

OBJECTIVE: To evaluate whether the introduction of out-patient blood pressure monitoring (OBPM) to follow up patients diagnosed with light hypertension (HT) decreases the use of medicines and so saves money. DESIGN: An observational study. SETTING: Urban health centre. PATIENTS AND OTHER PARTICIPANTS: Patients with light HT not being treated with medication, with two or less cardiovascular risk factors and who had type 0 or 1 curves in OBPM and a mean daily blood pressure < 135/85 mm Hg. MEASUREMENTS AND MAIN RESULTS: OBPM over 24 hours with a Spacelabs 90202 oscillometer. 23 patients (15 women), average age 38.6 +/- 8, were studied. Savings generated ranged from 153,628 pesetas, when the cheapest thiazide diuretic was prescribed, to 5,208,258 pesetas, when the dearest ACEI was chosen. CONCLUSIONS: Monitoring HT with OBPM led to a decrease in the use of medicines to combat hypertension, with considerable savings. These findings cannot be generalised. We believe that Primary Care must have access to OBPM in order to manage hypertension, apart from the savings involved.