Effect of mobile phone text messaging for improving the uptake of influenza vaccination in patients with rare diseases.

OBJECTIVES: Influenza vaccine is recommended in some chronic medical conditions, including several rare diseases. The objectives of the study were to assess the effect of text message reminders on influenza vaccination uptake of patients with selected rare diseases and delayed vaccination, and to describe their characteristics. METHODS: Quasi-experimental pre-post intervention study performed along the 2016 influenza vaccination campaign in the Autonomous Community of Madrid. Unvaccinated patients diagnosed with a selected rare disease were targeted for intervention. SMS were sent to them at least one month after the beginning of the campaign, in four consecutive weeks. Those with no mobile phones available or no certainty of message reception, were assigned as controls. The association between the reception of the SMS and vaccination uptake was assessed using multiple poisson regression models. RESULTS: Of 69.040 patients with delayed vaccination, 87.2% received an SMS reminder in the asigned contact mobile telephone. Global influenza vaccine coverage reached 41.3%. The uptake of influenza vaccine was significantly higher among those receiving the reminder (9.3% vs. 7.1% in the control group, p < 0.001). Those who received a SMS reminder were 30% more likely to uptake seasonal influenza vaccine. By sex and age, the reception of the reminder was associated with a significantly higher probability of vaccination in men ≥65 years with at least a concurrent chronic condition (IRR: 1.58, CI95%: 1.25-2.00). Among women, this higher probability was detected in those between 14 and 64 years of age (IRR: 1.41, CI95%: 1.22-1.63), and ≥65 years without concurrent chronic conditions (IRR: 1.40, CI95%: 1.05-1.89). CONCLUSION: Although the intervention was modestly effective, it proved beneficial in some cases. It can be an additional strategy to improve vaccine uptake, since it is simple, feasible, affordable and easily scalable, particularly when immunization and target population data are available in population registries.

Clostridium difficile-related hospitalizations and risk factors for in-hospital mortality in Spain between 2001 and 2015.

AIMS: To examine trends in the incidence, characteristics and in-hospital outcomes of Clostridium difficile infection (CDI) hospitalizations from 2001 to 2015, to compare clinical variables among patients according to the diagnosis position (primary or secondary) of CDI, and to identify factors associated with in-hospital mortality (IHM). METHODS: A retrospective study was performed using the Spanish National Hospital Discharge Database, 2001-2015. The study population included patients who had CDI as the primary or secondary diagnosis in their discharge report. Annual hospitalization rates were calculated and trends were assessed using Poisson regression models and Jointpoint analysis. Multi-variate logistic regression models were performed to identify variables associated with IHM. FINDINGS: In total, 49,347 hospital discharges were identified (52.31% females, 33.69% with CDI as the primary diagnosis). The rate of hospitalization increased from 3.9 cases per 100,000 inhabitants in 2001-2003 to 12.97 cases per 100,000 inhabitants in 2013-2015. Severity of CDI and mean cost per patient increased from 6.36% and 3750.11€ to 11.19% and 4340.91€, respectively, while IHM decreased from 12.66% to 10.66%. Age, Charlson Comorbidity Index, severity, length of hospital stay and mean cost were significantly higher in patients with a primary diagnosis of CDI. Irrespective of the CDI diagnosis position, IHM was associated with male sex, older age, comorbidities, readmission and severity of CDI. Primary diagnosis of CDI was associated with lower IHM (odds ratio 0.60; 95% confidence interval 0.56-0.65). CONCLUSION: CDI-related hospitalization rates are increasing, leading to a high cost burden, although IHM has decreased in recent years. Factors associated with IHM should be considered in strategies for the prevention and management of CDI.

Age and gender differences in Clostridium difficile-related hospitalization trends in Madrid (Spain) over a 12-year period.

This study aimed to analyze temporal trends by gender and age in Clostridium difficile infection (CDI)-related hospitalization rates in the Autonomous Community of Madrid (Spain) over a 12-year period. A population-based cross-sectional study of all hospital admissions with a CDI diagnosis from 2003 to 2014 was carried out. Annual age-specific hospitalization rates were calculated by gender. All the analyses were performed separately for total hospitalizations and hospitalizations with CDI as the primary diagnosis. Joinpoint regression models were used to analyze time trends. A total of 13,526 hospital discharges were identified (26.8 % with CDI as the primary diagnosis). In both sexes, a gradient in age-specific rates was observed, ranging in 2014 from 5.92 hospitalizations per 100,000 person-years in patients <15 years of age to 378.96 in patients ≥85 years of age. Since 2009, in the age group of 15-44 years, both men and women presented an increasing trend of around 18 %. A significantly increasing trend was detected in women of age 45-84 years, with an estimated annual percentage of change of 7.6 % in the age group of 45-64 years, and rounding with 4.5 % in the age group of 65-84 years. In men of age 45-64 years, the average annual percentage of increase was 4.7 %, and it was 21.1 % between 2010 and 2014 in the age group of 65-74 years. No trends were identified in the 85 years and over age group. Surveillance methods to assess trends by age group should be implemented. Preventive and therapeutic initiatives should remain a priority.

Incidence of type 2 diabetes and associated factors in the adult population of the Community of Madrid. PREDIMERC cohort.

OBJECTIVES: Determine the incidence and risk factors of type2 diabetes in the adult population of Madrid (Spain) and compare the predictive models of type2 diabetes based on the prediabetes criteria of the American Diabetes Association (ADA) and the World Health Organisation (WHO). MATERIAL AND METHODS: A prospective study was conducted on a population cohort composed of 2048 individuals between 30 and 74years of age with no diabetes. At the start of the study, an epidemiological survey was performed, and baseline glycaemia, HbA1c, body mass index and waist circumference were measured. A follow-up of 6.4years was conducted. New cases of type2 diabetes were identified using the electronic primary care medical history. RESULTS: The incidence of type2 diabetes was 3.5 cases/1000 person-years. In the multivariate analysis, the variables that were associated with the onset of type2 diabetes were age, family history of diabetes, baseline glycaemia (100-125mg/dL), HbA1c (5.7-6.4%) and waist circumference (≥94cm for men and ≥80cm for women). Of these, the most significantly associated variables were baseline glycaemia and HbA1c. The ADA and WHO criteria for defining prediabetes had the same predictive capacity. CONCLUSION: The incidence of type2 diabetes measured in Madrid was lower than that found in other population studies, with the glucometabolic state the main factor associated with progression to type2 diabetes. There were no differences between the prediabetes defined by the ADA and the WHO for predicting the onset of the disease.

Factors Associated to a Reactive Result of Rapid-HIV Test in Socio-culturally Adapted Services in Primary Care in Spain.

The Services of Prevention and Early diagnosis of HIV in Madrid (Spain) are set in selected primary care centers. Cultural mediators targeted to vulnerable groups (economic immigrants, MSM, sex workers…) perform risk assessment and counselling. Between 2010 and 2014 they performed 6 039 rapid-HIV test, 27.8 % in MSM, 41.2 % in men who have sex exclusively with women (MSW) and 31.0 % in women; 35.7 % in immigrants, mainly from Latin America. A reactive result was more common among MSM (6.0 %) compared to women (0.6 %) and MSW (0.5 %). In MSM it was associated to being immigrant and to antecedents of sexually transmitted infections (STI). Among MSW the factors associated to a reactive result were: seropositivity of sexual partner and heroine consumption, and in women: infrequent use of condoms, seropositivity of sexual partner and antecedents of STI. Preventive interventions to reduce risk of HIV transmission and for early detection should be adapted and targeted to high risk population.

Coverage of and factors associated with pneumococcal vaccination in chronic obstructive pulmonary disease.

SETTING: Patients aged ⩾ 40 years with a diagnosis of chronic obstructive pulmonary disease (COPD; codes R95, R79 and R91 in the International Classification for Primary Care) registered in primary care clinical records in the Autonomous Community of Madrid, Spain. OBJECTIVE: To assess pneumococcal vaccination coverage in patients with COPD and to analyse factors associated with vaccination uptake. DESIGN: Population-based cross-sectional study in which data were collected in September 2010. RESULTS: We found that 93,797 patients (72.0% men and 28.0% women) had COPD. Overall coverage was 65.5% (67.5% men vs. 60.4% women, P < 0.001). In patients aged 40-59 years, coverage was 19.5%, reaching 75.8% in those aged ⩾ 60 years. In patients aged <60 years, uptake was associated with a higher number of comorbidities and appropriate adherence to seasonal influenza and pandemic vaccination schedules. In patients aged ⩾ 60 years, factors associated with uptake in both sexes were older age and appropriate adherence to seasonal influenza vaccination schedules. Factors associated with uptake in men were concomitant comorbidities and pandemic vaccination. CONCLUSION: Vaccination coverage in individuals aged <60 years with COPD is less than acceptable in Madrid. Coverage was higher in men and in patients with another chronic condition.

Temporal trends in incidence rates of herpes zoster among patients treated in primary care centers in Madrid (Spain), 2005-2012.

OBJECTIVES: This study aimed to estimate total and age-specific incidence rates of HZ with data from electronic clinical records in primary care (ECRPC) and to analyze trends by sex and age. METHODS: Descriptive cross-sectional study covering the incident HZ episodes registered in the ECRPC of the Madrid Regional Public Health System in 2005-2012. Annual crude and age-adjusted incidence rates were calculated. Differences by sex and age were assessed by poisson regression. The annual percentage of change (APC) of incidence rates and 'breakthrough points' of the time trends were determined with the Joinpoint Regression Program. RESULTS: 211,650 episodes of HZ were identified (60.6% women, 52.2% > 55 years). The incidence rate increased from 363.21 to 481.92 per 100,000 person-year in 2005-2012. Rates were higher among women and increased with age. The APC for the period was 3.59% in men and 3.67% in women (p < 0.05). Age-specific rates increased in patients over 14 years. The APC in the 25-44 age group was 7.4% since 2007. The incidence rate ratio (women/men) was highest in this group. CONCLUSIONS: The incidence of HZ presents an upward trend in 2005-2012 in adults and the elderly. Monitoring the incidence and age-specific rates, will help to detect changes in trends.

Trends in hospitalizations of patients with sepsis and factors associated with inpatient mortality in the Region of Madrid, 2003­2011.

The objectives of this investigation were to study the temporal trends in hospitalizations of patients with sepsis in the Region of Madrid (Spain) from 2003 to 2011 and analyze the factors associated with inpatient mortality. All sepsis hospitalizations from the minimum basic data set (MBDS) during 2003 to 2011 in the Region of Madrid were analyzed. Genderspecific crude and age-adjusted rates were calculated each year. Factors associated with death in these patients were studied with bivariate and multivariate analyses. Simultaneously, sepsis inpatients also underwent descriptive analysis. The study included 98,898 sepsis episodes. The incidence of sepsis hospitalizations per 100,000 habitants increased in males from 114.4 in 2003 to 262.2 in 2011, and in females from 91.2 to 209.1 between 2003 and 2011. The observed inpatient mortality was 23.2 %. There were 45,936 (46.4 %) episodes of severe sepsis (≥1 organ failure), revealing a clear upward trend, especially in multi-organ failure. Severe sepsis mortality showed a decreasing trend in both males (40.0 to 31.8 % from 2003 through 2011) and females (41.6 to 35.2 % from 2003 through 2011). Death was most frequent among the elderly and in patients with more organ failures and comorbidities. In a populous region of Southern Europe, an upward trend in sepsis incidence was observed between 2003 and 2011, as well as a decreasing trend in mortality for sepsis inpatients. Mortality increased with age, comorbidities, and organ failures.

[Clinical pathways for the care of multiple sclerosis patients]. / Diseño de una vía clínica para la atención a los pacientes con esclerosis múltiple.

INTRODUCTION: clinical pathways are standard health care methods to coordinate clinical work, reduce inter-clinician variability, improve patient care and increase staff and patient satisfaction. The aim of this study is to develop a clinical pathway capable of organising and developing standard procedures for diagnosis, treatment and care in patients with multiple sclerosis and to coordinate all medical specialists involved in this disease. METHODS: a multidisciplinary unit for the care of MS patients was developed. All of them and quality specialists analysed some international evidence-based studies, clinical guides, international guidelines and other clinical neurological pathways in several meetings and designed several documents for the clinical pathways. RESULTS: a clinical pathway was created consisting of a scientific-technical framework, which arranges the care in relation to the diagnosis and reatment. The framework is accompanied by various patient-information documents on the disease, an information sheet on diagnostic procedures and a map of the process. Quality standards were established to achieve continuous improvement in patient care. CONCLUSIONS: a clinical pathway for the care of MS patients in a multidisciplinary unit homogenises and organises the care which the MSpatient should receive from the initial symptoms to the progressive stages. This clinical pathway improves the quality of patient care, reduces the variability in work protocols and rationalises the use of the available health care resources.

Diseño de una vía clínica para la atención a los pacientes con esclerosis múltiple / Clinical pathways for the care of multiple sclerosis patients

Introducción: Las vías clínicas (VC) son herramientas para coordinar el trabajo asistencial, reducir la variabilidad entre el personal sanitario y mejorar la atención y el cuidado del paciente. La esclerosis múltiple (EM) es una enfermedad neurológica crónica que afecta a pacientes jóvenes y es incapacitante. El objetivo es desarrollar una vía clínica para mejorar el diagnóstico, el tratamiento y la atención de los pacientes con EM y, asimismo, facilitar la coordinación de todos los especialistas implicados en este proceso. Método: Siguiendo el modelo FOCUS-PDCA se organiza un equipo de trabajo integrado por diferentes profesionales implicados en la atención del paciente con EM. Se realiza una revisión bibliográfica exhaustiva y se llega a consenso; así, se diseñan los documentos de la VC con base en la evidencia científica. Resultados: Se crea una vía clínica compuesta por los siguientes elementos: una matriz temporal con una serie de anexos para ordenar el proceso diagnóstico y el tratamiento, un impreso de información a los pacientes sobre las pruebas diagnósticas, una hoja de información sobre la enfermedad y un mapa de procesos, una encuesta de evaluación de la calidad percibida y un documento con indicadores de calidad para evaluar la VC. Conclusiones: El desarrollo de una VC de EM facilita la atención multidisciplinaria y mejora la calidad asistencial. Esta propuesta es novedosa al enfocar la atención integral de la EM desde su inicio, tanto en aspectos diagnósticos como terapéuticos, incluyendo el ámbito ambulatorio (AU)

Introduction: Clinical pathways are standard health care methods to coordinate clinical work, reduce inter-clinician variability, improve patient care and increase staff and patient satisfaction. The aim of this study is to develop a clinical pathway capable of organising and developing standard procedures for diagnosis, treatment and care in patients with multiple sclerosis and to coordinate all medical specialists involved in this disease. Methods: A multidisciplinary unit for the care of MS patients was developed. All of them and quality specialists analysed some international evidence-based studies, clinical guides, international guidelines and other clinical neurological pathways in several meetings and designed several documents for the clinical pathways. Results: A clinical pathway was created consisting of a scientific-technical framework, which arranges the care in relation to the diagnosis and reatment. The framework is accompanied by various patient-information documents on the disease, an information sheet on diagnostic procedures and a map of the process. Quality standards were established to achieve continuous improvement in patient care. Conclusions: A clinical pathway for the care of MS patients in a multidisciplinary unit homogenises and organises the care which the MSpatient should receive from the initial symptoms to the progressive stages. This clinical pathway improves the quality of patient care, reduces the variability in work protocols and rationalises the use of the available health care resources (AU)

Epidemiological usefulness of population-based electronic clinical records in primary care: estimation of the prevalence of chronic diseases.

BACKGROUND: Chronic health problems are the main cause of disease, disability and death in developed countries, and their prevalence is increasing. OBJECTIVE: To estimate the prevalence of selected chronic illnesses based on electronic clinical records in primary care (ECRPC) and to assess its usefulness for epidemiological research, by comparing ECRPC data against those reported by a contemporary health survey. DESIGN: Descriptive cross-sectional study. SETTING: All primary care medical consultations in the Madrid Regional Public Health System (PHS). SUBJECTS: A total of 23 535 182 ECRPC-registered episodes of illness, generated by PHS patients over 15 years of age seeking medical care during 2005-06. MAIN OUTCOME MEASURES: Prevalences of chronic diseases estimated on the basis of medically examined cases registered in ECRPC and morbidity as reported by a contemporary health survey covering the same geographic area. RESULTS: A total of 52.5% of the adult population had some chronic health problem. The highest overall prevalences were hypertension (14.8%), mental disorders (12.0%) and allergy (11.6%). Prevalences were generally highest among women, elderly and the native population. Depending on the specific disease, ECRPC-based prevalences were similar to (e.g. diabetes), higher (e.g. chronic skin problems) or lower (e.g. asthma and dyslipidaemia) than those reported by surveys, with certain age- and sex-related variations. CONCLUSIONS: Prevalences estimated from ECRPC and survey data present variations depending on the disease, age and sex. Both data sources provide complementary information about chronic disease prevalence. ECRPC have the advantage of generating an ongoing standardized register and entailing no additional effort for health professionals.