Efectividad de la electrocardiografía fetal frente a la pulsioximetría para la determinación del bienestar fetal / Effectiveness of fetal electrocardiography versus pulse oximetry to determine fetal well-being

El parto supone un peligro potencial para el bienestar fetal. Se han desarrollado nuevos métodos de monitorización continua fetal intraparto como la pulsioximetría y el análisis del electrocardiograma fetal (STAN(R)). Nuestro objetivo es comparar los resultados clínicos del sistema STAN(R) con la pulsioximetría en la determinación del estado de bienestar fetal durante el trabajo de parto. Mediante el desarrollo de estructuras de búsqueda específicas en las principales bases de datos y la aplicación de criterios de inclusión y exclusión predefinidos se seleccionaron 2 estudios prospectivos y una revisión sistemática. La tasa de extracciones instrumentales fue mayor para el grupo analizado con STAN(R) frente al grupo analizado con pulsioximetría. La incidencia de acidosis metabólica, la tasa de encefalopatías neonatales y el número de determinaciones de pH fue menor en el grupo analizado con STAN(R) y RCTG de forma combinada en comparación con el grupo analizado con RTCG de forma aislada

Labor poses a potential risk for fetal well-being. New methods have been developed of continuous fetal pulse oximetry and fetal electrocardiogram analysis (STAN(R)). Our aim was to compare clinical outcomes after the STAN(R) system or pulse oximetry to determine fetal well-being during labor. We carried out specific searches in the major databases and applied predefined inclusion and exclusion criteria. Two prospective studies and a systematic review were selected. The instrumental delivery rate was higher with STAN® than with pulse oximetry. Metabolic acidosis rates, neonatal encephalopathy rates, and the number of pH determinations were lower when STAN(R) was used in combination with cardiotocography than when cardiotocography was used alone

Uso adecuado de la prótesis invertida de hombro mediante aplicación del método RAND/UCLA / Appropriateness of the indication for reverse shoulder replacement using the RAND/UCLA method

Objetivo: En las series de casos publicadas sobre artropatía del manguito rotador, tratadas con prótesis invertida de hombro, se analizan factores asociados que pueden influir en su evolución como dolor, edad, calidad ósea o limitación articular. En ningún trabajo se plantea una posible actitud de decisión médica partiendo de estas variables. El objetivo del presente estudio fue desarrollar criterios de uso adecuado de la prótesis invertida de hombro en pacientes con artropatía del manguito rotador a través de escenarios creados con dichas variables. Material y método: Se aplicó el método RAND/ UCLA para combinar la evidencia científica disponible con el juicio de 12 expertos en la materia. Los expertos expresaron su opinión de forma cuantitativa sobre cada situación clínica. Se calificaron como adecuadas, cuando los beneficios superaban con margen a los riesgos o consecuencias negativas, o inadecuadas, si los riesgos superaban a los beneficios. Resultados: El panel de expertos, tras dos rondas de puntuación, encontró que de 192 situaciones clínicas planteadas, 22 (11,4%) fueron consideradas adecuadas, 47 (24,5%) dudosas y 123 (64,1%) inadecuadas. El grado de desacuerdo bajó respecto al obtenido en la primera ronda, calificando con desacuerdo 5 indicaciones (2,6%), indeterminadas 82 (42,7%) y con acuerdo 105 (54,7%). Conclusiones: Los panelistas consideraron adecuadas aquellas indicaciones definidas por dolor severo y limitación funcional importante, combinada con lesión del manguito rotador no reparable y edad mayor a 65 años. Otras variables como la calidad ósea, la existencia de un defecto glenoideo o la reparabilidad de la lesión del manguito, podrían afectar la decisión

Purpose: The case series studies performed on rotator cuff arthropathy treated with reverse shoulder replacement (RSR) examine factors influencing the outcome, such as pain, age, bone quality or limited joint mobility. However, none of these studies examine how these variables influence the treatment choice. The aim of this study is to develop appropriateness criteria for the use of RSR in patients with rotator cuff tear arthropathy (RCTA) according to a variety of cases including the variables mentioned above. Material and methods: We applied the RAND/ UCLA appropriateness method to combine the available scientific evidence with the judgment of 12 experts in RCTA. Indication for RSR was considered appropriate when the benefits outweighed the associated risks or complications, and inappropriate when the risks outweighed the benefits. Results: After two rating rounds, the panel of experts found that out of the 192 cases analyzed, 22 (11.4%) were considered appropriate, 47 (24.5%) were uncertain and 123 (64.1%) were considered inappropriate. The level of disagreement was lower in the second rating round: there was agreement on 5 indications (2.6%), indeterminate on 82 (42.7%) and disagreement on 105 cases (54.7%). Conclusion: The experts agreed that appropriateness criteria for indication of reverse shoulder replacement were acute pain and severe functional limitation combined with irreparable rotator cuff dysfunction and older than 65 years. Other variables such as bone quality, the presence of a glenoid defect or the reparability of the cuff failure might affect the treatment choice

Indirect comparison for Anti-TNF drugs in moderate to severe ulcerative colitis / Fármacos anti-TNF en colitis ulcerosa moderada-grave: comparación indirecta

Objective: To compare the relative efficacy of infliximab, adalimumab and golimumab through adjusted indirect treatment comparisons (ITCs). Methods: An exhaustive search was performed until October 2013. Databases consulted were MEDLINE, EMBASE, the Cochrane Library, the Centre for Reviews and Dissemination and the Web of Science. Randomized control trials (RCTs) comparing the efficacy of infliximab, adalimumab or golimumab versus placebo, in terms of clinical remission, clinical response and mucosal healing, were included. In the case that more than one RCT fulfilled the inclusion criteria for the same drug, a metanalysis was undertaken using a fixed effects model. ITCs were carried out using the method proposed by Bucher et al. Results: 6 RCTs published in 5 papers were included: 2 for infliximab (ACT 1 and ACT 2), 2 for adalimumab (ULTRA 1 y ULTRA 2) and 2 for golimumab (PURSUIT-SC y PURSUIT-M).In these RTCs, each biological agent was superior in efficacy to placebo. The results of the adjusted ITC are the following. In relation to the clinical remission, in the induction and maintenance period, there are no statistically significant differences between the three anti-TNF drugs. In relation to the clinical response and mucosal healing, in the induction period, there are statistically significant differences between infliximab and adalimumab. Conclusion: In view of the results obtained, infliximab, adalimumab and golimumab appear to be similarly effective the rapeutic alternatives. Therefore, other considerations such as safety, tolerance and cost-effectiveness should be taken into account in order to select the most appropriate treatment (AU)

Objetivo: Comparar la eficacia relativa de infliximab, adalimumab y golimumab mediante comparaciones indirectas (CI) ajustadas. Métodos: Se realizó una búsqueda bibliográfica que abarcó hasta Octubre 2013. Las bases de datos consultadas fueron: MEDLINE, EMBASE, the Cochrane Library, the Centre for Reviews and Dissemination y the Web of Science. Se incluyeron ensayos clínicos aleatorizados (ECA) que compararan la eficacia de infliximab, adalimumab o golimumab frente a placebo en términos de remisión clínica, respuesta clínica y curación de la mucosa. En el caso de que se incluyera más de un ECA para un mismo fármaco se llevó a cabo un metanálisis utilizado el modelo de efectos fijos. Las CI se realizaron utilizando el mé- todo de Butcher et al. Resultados: Se incluyeron 6 ECA publicados en 5 artículos: 2 para infliximab (ACT 1 y ACT 2), 2 para adalimumab (ULTRA 1 y ULTRA 2) y 2 para golimumab (PURSUIT-SC y PURSUIT-M). Los tres agentes biológicos presentaron mayor eficacia que placebo. Los resultados de las CI fueron los siguientes: en relación a la remisión clínica, en el período de inducción y en el período de mantenimiento, no hubo diferencias estadísticamente significativas entre los tres fármacos anti-TNF. En relación a la respuesta clínica y a la curación de la mucosa, en el período de inducción hay diferencias estadísticamente significativas entre infliximab y adalimumab. Conclusiones: En base a los resultados obtenidos (eficacia similar), infliximab, adalimumab y golimumab parecen ser alternativas terapéuticas. Así, otras consideraciones como la seguridad, la tolerancia y el coste-efectividad deben considerarse a la hora de seleccionar el tratamiento más adecuado (AU)

Indirect comparison for Anti-TNF drugs in moderate to severe ulcerative colitis.

OBJECTIVE: To compare the relative efficacy of infliximab, adalimumab and golimumab through adjusted indirect treatment comparisons (ITCs). METHODS: An exhaustive search was performed until October 2013. Databases consulted were MEDLINE, EMBASE, the Cochrane Library, the Centre for Reviews and Dissemination and the Web of Science. Randomized control trials (RCTs) comparing the efficacy of infliximab, adalimumab or golimumab versus placebo, in terms of clinical remission, clinical response and mucosal healing, were included. In the case that more than one RCT fulfilled the inclusion criteria for the same drug, a metanalysis was undertaken using a fixed effects model. ITCs were carried out using the method proposed by Bucher et al. RESULTS: 6 RCTs published in 5 papers were included: 2 for infliximab (ACT 1 and ACT 2), 2 for adalimumab (ULTRA 1 y ULTRA 2) and 2 for golimumab (PURSUIT-SC y PURSUIT-M).In these RTCs, each biological agent was superior in efficacy to placebo. The results of the adjusted ITC are the following. In relation to the clinical remission, in the induction and maintenance period, there are no statistically significant differences between the three anti-TNF drugs. In relation to the clinical response and mucosal healing, in the induction period, there are statistically significant differences between infliximab and adalimumab. CONCLUSION: In view of the results obtained, infliximab, adalimumab and golimumab appear to be similarly effective therapeutic alternatives. Therefore, other considerations such as safety, tolerance and cost-effectiveness should be taken into account in order to select the most appropriate treatment.

Objetivo: Comparar la eficacia relativa de infliximab, adalimumab y golimumab mediante comparaciones indirectas (CI) ajustadas. Métodos: Se realizó una búsqueda bibliográfica que abarcó hasta Octubre 2013. Las bases de datos consultadas fueron: MEDLINE, EMBASE, the Cochrane Library, the Centre for Reviews and Dissemination y the Web of Science. Se incluyeron ensayos clínicos aleatorizados (ECA) que compararan la eficacia de infliximab, adalimumab o golimumab frente a placebo en términos de remisión clínica, respuesta clínica y curación de la mucosa. En el caso de que se incluyera más de un ECA para un mismo fármaco se llevó a cabo un metanálisis utilizado el modelo de efectos fijos. Las CI se realizaron utilizando el método de Butcher et al. Resultados: Se incluyeron 6 ECA publicados en 5 artículos: 2 para infliximab (ACT 1 y ACT 2), 2 para adalimumab (ULTRA 1 y ULTRA 2) y 2 para golimumab (PURSUIT-SC y PURSUIT-M). Los tres agentes biológicos presentaron mayor eficacia que placebo. Los resultados de las CI fueron los siguientes: en relación a la remisión clínica, en el período de inducción y en el período de mantenimiento, no hubo diferencias estadísticamente significativas entre los tres fármacos anti-TNF. En relación a la respuesta clínica y a la curación de la mucosa, en el período de inducción hay diferencias estadísticamente significativas entre infliximab y adalimumab. Conclusiones: En base a los resultados obtenidos (eficacia similar), infliximab, adalimumab y golimumab parecen ser alternativas terapéuticas. Así, otras consideraciones como la seguridad, la tolerancia y el coste-efectividad deben considerarse a la hora de seleccionar el tratamiento más adecuado.

Evaluación de la calidad de vida de la braquiterapia vs prostatectomia robotizada en pacientes con carcinoma prostático localizado. Revisión sistemática / Quality of life after brachytherapy or robot-assisted radical prostatectomy for localized prostate cancer

OBJETIVO: Efectuar una revisión sistemática de la literatura evaluando la calidad de vida y complicaciones de la prostatectomía robotizada (PR) frente a la braquiterapia permanente a bajas dosis (BPBD) en pacientes con cáncer de próstata (PCa) localizado. MÉTODOS: Se realizó una búsqueda sistematizada en Pubmed, EMBASE y Cochrane, Centre for Reviews and Dissemination, Emergency Care Research Institute, Web of Knowledge, Technology Evaluation Center, Clinical Evidence, Uptodate, Hayes y Drug Effectiveness Review Project. Se incluyeron las revisiones sistemáticas y estudios prospectivos que comparaban PR frente a BPBD en varones con PCa localizado y confirmado. La variable de resultado principal fue la calidad de vida y la variable secundaria, la tasa de complicaciones. RESULTADOS: Se incluyeron 3 revisiones sistemáticas y 4 estudios prospectivos. PR mostró mejores resultados vs BPBD para el dominio físico del cuestionario SF-12 (p <0,01) y una recuperación más rápida a las puntuaciones previas a la cirugía. BPBD mejoró las puntuaciones para la función urinaria y sexual medidas con el cuestionario UCLA-PCI vs PR durante los tres primeros años de seguimiento (p < 0,001). La tasa de pacientes con incontinencia urinaria en el primer año de seguimiento resultó a favor de BPBD (88,0% vs 84,5%, p < 0,001). No se encontraron diferencias en las puntuaciones para la función intestinal en los tres primeros años posintervención (p = 0,02). Las principales complicaciones de la BPBD fueron la toxicidad gastrointestinal (GI) y genitourinarias (GU), aunque la tasa de eventos ponderada de los estudios incluidos no fue analizada. CONCLUSIÓN: La BPBD ha mostrado una mejora en las puntuaciones para la calidad de vida relacionada con la función urinaria y sexual en pacientes con PCa localizado frente a la PR en los tres primeros años posintervención

OBJECTIVES: To perform a systematic bibliographic review of the literature assessing the quality of life and complications of robotic prostatectomy (RP) versus low-dose rate brachytherapy (LDR-BT) in patients with localized prostate cancer (PCa). METHODS: A systematic search was conducted in PubMed, EMBASE and Cochrane, Centre for Reviews and Dissemination, Emergency Care Research Institute, Web of Knowledge, Technology Evaluation Center, Clinical vidence, Uptodate, Hayes and Drug Effectiveness Review Project. Systematic reviews and prospective studies comparing RP to LDR-BT in men with localized PCa were included. The primary outcome was quality of life and the secondary endpoint complications rate. RESULTS: Three systematic reviews and four prospective studies were included. RP showed better results than LDR-BT for SF-12-physical domain (p <0.01) and faster recovery to pre-operative scores. LDR-BT improved scores for UCLAPCI questionnaire-urinary and sexual domains compared to RP during the first three years of follow-up (p <0.001). First postoperative year urinary incontinence rate was favorable for LDR-BT (88.0% vs 84.5%, p <0.001). No differences for intestinal function scores for the first three post-intervention years (p = 0.02) were found. Major complications of LDR-BT were gastrointestinal and genitourinary toxicity, although pooled weighted events rate of the studies was not analyzed. CONCLUSIONS: LDR-BT improves quality of life in terms of urinary and sexual function in patients with localized PCa vs RP during the first three years post-intervention

Comparison of the accuracy of CT colonography and colonoscopy in the diagnosis of colorectal cancer.

AIM: The available evidence was reviewed to compare the effectiveness of CT colonography with that of colonoscopy for colorectal cancer (CRC) screening. METHOD: An electronic search was conducted using PubMed, EMBASE, the Cochrane Library and Centre for Reviews and Dissemination databases, from inception to July 2009. Studies were included if investigations used CT colonography for CRC screening in asymptomatic populations. Studies were excluded if investigations were conducted for the diagnosis of CRC or in elderly, high-risk or symptomatic populations. RESULTS: Of the 213 references identified, nine studies were included. The specificity of CT colonography in screening for CRC was high, although it decreased with decreasing diameter of polyp to be detected. The sensitivity of CT colonography for the detection of polyps < 6 mm in diameter was low and heterogeneous, although it was higher for polyps > 10 mm. The main factors contributing to a greater sensitivity of CT colonography were the inclusion of only populations with an average CRC risk and colonic insufflation with CO2 . The incidence of adverse effects was very low for both tests. CONCLUSION: CT colonography has high specificity but heterogeneous sensitivity, although in most cases it is not as sensitive or specific as conventional colonoscopy. CT colonography could therefore be useful as a screening test for populations with an average risk of CRC.

Complicaciones y preservación nerviosa de la prostatectomía en relación con el intervalo de tiempo desde la biopsia diagnóstica / Complications and Nerve Preservation in Prostatectomy According to the Time Interval from Diagnostic Biopsy

Objetivos: Sintetizar la evidencia disponible sobre las complicaciones y la capacidad de preservación nerviosa bilateral de la prostatectomía radical en pacientes con cáncer próstatico en función del tiempo transcurrido de la biopsia diagnóstica (superior o inferior a las seis semanas). Material y métodos: Se identificaron los estudios relevantes utilizando estrategias de búsqueda estructuradas y específicas para cada una de las bases de datos consultadas sin ninguna limitación. Se evaluó la calidad metodológica de cada uno de los estudios incluidos y se extrajeron los datos de forma independiente. Resultados: Para la prostatectomía radical abierta, dos de los estudios concluyeron que el intervalo de tiempo transcurrido entre la realización de la biopsia prostática y la cirugía inferior a las 4 o 6 semanas no influye en la tasa de complicaciones posquirúrgicas y la capacidad de preservación nerviosa durante la cirugía. En cuanto a la prostatectomía radical laparoscópica asistida por robot el estudio incluido concluye que la realización de este tipo de intervenciones dentro de un periodo de tiempo inferior a las cuatro o seis semanas posteriores a la biopsia diagnóstica, se asocia a un mayor riesgo de sufrir complicaciones postquirúrgicas. No obstante, estos estudios contaban con importantes limitaciones metodológicas. Conclusiones: El intervalo de tiempo entre la realización de la biopsia diagnóstica y la cirugía abierta no influye en la tasa de complicaciones o preservación nerviosa. En cambio, un periodo de tiempo inferior a las cuatro semanas entre la biopsia diagnóstica y la cirugía laparoscópica se asocia con mayor riesgo de complicaciones quirúrgicas (AU)

Objectives: To summarize the available evidence on complications and bilateral nerve preservation in radical prostatectomy in patients according to the time interval from diagnostic biopsy (more or less than six weeks). Material and methods: Relevant studies were identified by using structured and specific search strategies for each of the databases consulted, without limitations. The methodological quality of each of the studies included was evaluated and the data were extracted independently. Results: For open radical prostatectomy, two of the studies concluded that a time interval of less than 4 or 6 weeks between prostate biopsy and surgery had no influence on the postsurgical complications rate or on nerve preservation during surgery. For laparoscopic robotic-assisted radical prostatectomy, the study included concluded that performing this type of intervention in an interval of less than 4 or 6 weeks after diagnostic biopsy was associated with a higher risk of postsurgical complications. However, all these studies had major methodological limitations. Conclusions: The time interval between diagnostic biopsy and open surgery has no influence on the complications rate or nerve preservations. In contrast, an interval of less than 4 weeks between diagnostic biopsy and laparoscopic surgery is associated with a higher risk of surgical complications (AU)

[Complications and nerve preservation in prostatectomy according to the time interval from diagnostic biopsy]. / Complicaciones y preservación nerviosa de la prostatectomía en relación con el intervalo de tiempo desde la biopsia diagnóstica.

OBJECTIVES: To summarize the available evidence on complications and bilateral nerve preservation in radical prostatectomy in patients according to the time interval from diagnostic biopsy (more or less than six weeks). MATERIAL AND METHODS: Relevant studies were identified by using structured and specific search strategies for each of the databases consulted, without limitations. The methodological quality of each of the studies included was evaluated and the data were extracted independently. RESULTS: For open radical prostatectomy, two of the studies concluded that a time interval of less than 4 or 6 weeks between prostate biopsy and surgery had no influence on the postsurgical complications rate or on nerve preservation during surgery. For laparoscopic robotic-assisted radical prostatectomy, the study included concluded that performing this type of intervention in an interval of less than 4 or 6 weeks after diagnostic biopsy was associated with a higher risk of postsurgical complications. However, all these studies had major methodological limitations. CONCLUSIONS: The time interval between diagnostic biopsy and open surgery has no influence on the complications rate or nerve preservations. In contrast, an interval of less than 4 weeks between diagnostic biopsy and laparoscopic surgery is associated with a higher risk of surgical complications.

Encuesta de la SEFAP sobre la Farmacia de Atención Primaria y la Ley 29/2006 de garantías y uso racional del medicamento y productos sanitarios / No disponible

Transcurrido un año desde la publicación de la «Ley 29/2006 de garantías y uso racional de los medicamentos yproductos sanitarios», la Sociedad Española de Farmacéuticos de Atención Primaria (SEFAP) quiere conocer lasituación de los servicios de farmacia de atención primaria (SFAP) en el territorio nacional. Material y método.Estudio descriptivo transversal llevado a cabo mediante una encuesta con 128 ítems. Se distribuyó mediante envíoelectrónico desde la web de la SEFAP a todos los socios, especificando que se cumplimentara una encuesta por SFAP.Resultados. Se recibieron un total de 84 encuestas, desestimándose 5 por repetición del mismo SFAP o por no trabajaren un SFAP, lo que representa el 58,1% de los posibles SFAP. El 52% de las estructuras de gestión de atenciónprimaria encuestadas disponen de SFAP autorizados según la normativa vigente y el 59% son los responsables de lagestión de medicamentos. El 99% tienen establecidos sistemas de información sobre gestión de la farmacoterapia(aspectos clínicos, de efectividad, seguridad y eficiencia de la utilización de los medicamentos) y proporcionan unacorrecta información y formación sobre medicamentos y productos sanitarios a los profesionales. El 40% de los SFAPparticipa en la elaboración de criterios de selección de medicamentos para el desarrollo de protocolos y guías farmacoterapéuticasque garanticen la correcta asistencia a los pacientes, y el 27% asesora sobre el historial farmacoterapéuticode los pacientes. El 46% de las estructuras de atención primaria participa en investigación clínica en farmacoterapiade calidad, y el 42% de los SFAP participan en comités éticos y de investigación. El 99% participan confarmacovigilancia y con programas que potencian el uso seguro de los medicamentos. El 41% de los SFAP impulsanprogramas de educación a la población sobre medicamento. Y casi la mitad, el 45% de los SFAP, están participandoya en los planes estratégicos de calidad en las estructuras de gestión de atención primaria. Discusión. Los serviciosde salud deben impulsar y velar por el desarrollo de los SFAP, no sólo regularizando la situación administrativa deéstos conforme a la Ley, sino también promoviendo el desarrollo de las funciones establecidas, favoreciendo la integracióndel farmacéutico de atención primaria en todos los procesos de la cadena terapéutica, y retornando al sistemala corresponsabilidad en la calidad asistencial y la farmacoterapéutica de los pacientes

One year after the publication of Law 29/2006 on the guarantees and rational use of medicines and healthcareproducts the Spanish Society of Primary Care Pharmacists (SEFAP) wishes to know the situation of the PrimaryCare Pharmacy Services (SFAP) in Spain. Material and method: a cross-sectional descriptive study carried outby means of a survey with 128 items. It was distributed to all the members via e-mail from the SEFAP’s web,specifying that one survey should be filled out per Primary Care Pharmacy Service. Results: a total of 84 surveyswere received, 5 of which were rejected because of repetitions of the same SFAP or for not working in a SFAP,representing 58.1% of all possible SFAPs. Of the primary care management structures polled, 52% have SFAPsauthorised according to current legislation and 59% are responsible for the management of medicines. Of the total,99% have established information systems on pharmacotherapy management (clinical aspects, aspects regardingefficacy, safety and the efficiency of the use of the medicines) and provide correct information and training onmedicines and healthcare products to healthcare professionals. Of the SFAPs, 40% participate in the definition ofmedicine selection criteria for the development of protocols and pharmacotherapeutic guides that guarantee thecorrect pharmacotherapeutic care of patients, and 27% provide advice on the patients’ pharmacotherapeutic history.Of the Primary Care structures, 46% participate in clinical research on quality pharmacotherapy, and 42%of the SFAPs participate in Ethical and Research Committees. Moreover, 99% participate with Pharmacovigilanceand with programmes that promote the safe use of medicines. Of the SFAPs 41% promote educational programmesfor the population on medication. Nearly half of the SFAPs, namely 45%, already participate in strategic plans forquality in the primary care management structures. Discussion: the Health Services should promote and watchover the development of the SFAPs, not only through the regularisation of the administrative situation of the SFAPsaccording to the Law, but also through the promotion of the development of the established functions, encouragingthe involvement of the primary care pharmacist in all the processes of the therapeutic chain, returning to thesystem joint responsibility in the quality of the care and pharmacotherapy of the patients (AU)

[Computer-aided prescribing: from utopia to reality]. / Receta electrónica: de la utopía a la realidad.

OBJECTIVE: To determine whether the introduction of computer-aided prescribing helped reduce the administrative burden at primary care centers. DESIGN: Descriptive, cross-sectional design. SETTING: Torreblanca Health Center in the province of Seville, southern Spain. From 29 October 2003 to the present a pilot project involving nine pharmacies in the basic health zone served by this health center has been running to evaluate computer-aided prescribing (the Receta XXI project) with real patients. PARTICIPANTS: All patients on the center's list of patients who came to the center for an administrative consultation to renew prescriptions for medications or supplies for long-term treatment. MEASURES: Total number of administrative visits per patient for patients who came to the center to renew prescriptions for long-term treatment, as recorded by the Diraya system (Historia Clinica Digital del Ciudadano, or Citizen's Digital Medical Record) during the period from February to July 2004. Total number of the same type of administrative visits recorded by the previous system (TASS) during the period from February to July 2003. MAIN RESULTS: The mean number of administrative visits per month during the period from February to July 2003 was 160, compared to a mean number of 64 visits during the period from February to July 2004. The reduction in the number of visits for prescription renewal was 60%. CONCLUSIONS: Introducing a system for computer-aided prescribing significantly reduced the number of administrative visits for prescription renewal for long-term treatment. This could help reduce the administrative burden considerably in primary care if the system were used in all centers.

Receta electrónica: de la utopía a la realidad / Computer-aided prescribing: from utopia to reality

Objetivo. Valorar si la introducción de la receta electrónica ayuda a desburocratizar las consultas de atención primaria. Diseño. Estudio descriptivo, transversal. Emplazamiento. Centro de Salud de Torreblanca, donde desde el 29 de octubre de 2003 se está pilotando, junto con las 9 oficinas de farmacia de la Zona Básica de Salud, la implantación de la Receta Electrónica de Andalucía (Receta XXI) con pacientes reales. Participantes. Todos los pacientes de un cupo médico que acuden a consulta administrativa para la renovación de tratamientos crónicos entre febrero y junio de 2004. Mediciones. Número total de consultas administrativas realizadas por todos los pacientes que acuden para la renovación de tratamientos crónicos registrados mediante el sistema operativo DIRAYA (Historia Clínica Digital del Ciudadano) y comparación con el mismo tipo de consulta administrativa registrado en TASS en el período comprendido entre febrero y julio de 2003. Resultados principales. La media mensual de consultas administrativas entre febrero y julio de 2003 fue de 160, frente a las 64 habidas entre febrero y julio de 2004, lo que supone una reducción de la frecuentación para la renovación de recetas del 60%. Conclusiones. La introducción de la receta electrónica reduce significativamente la frecuentación de consultas administrativas para la renovación de recetas de tratamientos crónicos, lo que ayudará a desburocratizar de forma importante las consultas de atención primaria cuando se generalice su uso

Objective. To determine whether the introduction of computer-aided prescribing helped reduce the administrative burden at primary care centers. Design. Descriptive, cross-sectional design. Setting. Torreblanca Health Center in the province of Seville, southern Spain. From 29 October 2003 to the present a pilot project involving nine pharmacies in the basic health zone served by this health center has been running to evaluate computer-aided prescribing (the Receta XXI project) with real patients. Participants. All patients on the center's list of patients who came to the center for an administrative consultation to renew prescriptions for medications or supplies for long-term treatment. Measures. Total number of administrative visits per patient for patients who came to the center to renew prescriptions for long-term treatment, as recorded by the Diraya system (Historia Clínica Digital del Ciudadano, or Citizen's Digital Medical Record) during the period from February to July 2004. Total number of the same type of administrative visits recorded by the previous system (TASS) during the period from February to July 2003. Main results. The mean number of administrative visits per month during the period from February to July 2003 was 160, compared to a mean number of 64 visits during the period from February to July 2004. The reduction in the number of visits for prescription renewal was 60%. Conclusions. Introducing a system for computer-aided prescribing significantly reduced the number of administrative visits for prescription renewal for long-term treatment. This could help reduce the administrative burden considerably in primary care if the system were used in all centers