[Diagnostic accuracy of blood pressure determination in clinics in control of hypertension: Proposal of new cut-off values]. / Precisión diagnóstica de la determinación de la presión arterial en consulta en el control del hipertenso: Propuesta de nuevos valores de corte.

AIM: This study seeks to determine the optimal cut-off values for the determination of the blood pressure in the clinic as a follow-up test in Primary Care practice. DESIGN: A total of 153 hypertensive patients under 80years of age who met inclusion and exclusion criteria for the study, were subjected to ambulatory monitoring of their blood pressure for 24hours (ABPM). After which two clinic-based measurements were obtained. With the results obtained from the clinic, and taking the ABMP as a reference, the ROC curve was calculated choose the optimal cut-off point. The agreement between both measurements was determined by the intraclass correlation coefficient and the Bland-Altman equation. A validation study was then carried out with the objective of diagnosing whether or not the hypertensive patient was in control. RESULTS: The optimal cut-off values were 137mmHg for systolic BP (sensitivity: 89.3%; specificity: 72.2%) and 84mmHg for diastolic blood pressure (sensitivity: 79.4%; specificity: 72.3%). The agreement in the diagnosis of control between clinic-based measurement and ABPM was 58.9% (Kappa: 0.418). CONCLUSION: The optimal cut-off value of the diastolic BP for follow-up is lower than the values currently established.

[Sociodemographic characteristics and geographic variability associated with patient satisfaction in Primary Care]. / Características sociodemográficas y variabilidad geográfica relacionada con la satisfacción del paciente en Atención Primaria.

BACKGROUND: Patient satisfaction with health services plays an important role in programs to improve the quality of care from the point of view of users. The objectives of this study were: To identify sociodemographic characteristics associated with patient satisfaction in the care provided by family doctors in Primary Health Care (PHC) centres, and describe the geographical variability of this phenomenon in the Spanish National Health Service. MATERIAL AND METHODS: The data come from the European Health Survey (2009). Prevalence ratios (crude and adjusted) of the characteristics associated with both excellent satisfaction and dissatisfaction using Poisson regression, and their geographical variability are discussed. RESULTS: About one in every 3 users of the PHC believes that the care provided was excellent, while 6.7% were dissatisfied. There is a wide variability in the perception of satisfaction among the various regional health services, with prevalence ranging between 10.9% and 55.2%. Moreover, this assessment is closely related to age, level of self-perceived health, mental health, previous hospitalisation, chronic disease status, and limitations in daily activities. CONCLUSIONS: Satisfaction with the care provided by the PHC physician is relatively high. However, the distribution between regions and socio-demographic characteristics and health status of the user is heterogeneous.

Identification of potential clinically significant drug interactions in HIV-infected patients: a comprehensive therapeutic approach.

OBJECTIVES: The aim of the study was to determine the prevalence of potential clinically significant drug interactions (CSDIs) in HIV-positive individuals and to identify associated risk factors. METHODS: A cross-sectional study was conducted including all HIV-infected out-patients attending the Pharmacy Service of a regional reference hospital in Murcia, south-eastern Spain. The complete treatment was screened for possible CSDIs using the Spanish College of Pharmacists' online software resource, bot. Additionally, the severity level of the CSDIs involving antiretroviral (ARV) drugs was compared with that established in the specific antiretroviral database InteraccionesHIV.com. Multivariate logistic regression was used to identify associated risk factors. RESULTS: Two hundred and sixty-eight patients were included in the study. A total of 292 potential drug interactions were identified, of which 102 (34.9%) were CSDIs, of which 52.9% involved ARV drugs. Seven therapeutic drug classes were involved in 75% of CSDIs (protease inhibitors, benzodiazepines, nonsteroidal anti-inflammatory drugs, nonnucleoside reverse transcriptase inhibitors, corticosteroids, antithrombotics and proton pump inhibitors). Factors independently associated with CSDIs were treatment with more than five drugs [odds ratio (OR) 15.1; 95% confidence interval (CI) 6.3-36.2], and treatment with a protease inhibitor (OR 5.3; 95% CI 2.4-11.74). CONCLUSIONS: The findings of this study suggest that the prevalence of clinically relevant drug-drug interactions is high in HIV-infected patients, and could represent a major health problem. Awareness, recognition and management of drug interactions are important in optimizing the pharmaceutical care of HIV-infected patients and helping to prevent adverse events and/or loss of efficacy of the drugs administered.

[Spanish adaptation of Beers criteria]. / Adaptación española de los criterios Beers.

BACKGROUND: The Beers criteria, which were drawn up in the USA and updated in 2012, were developed to detect potentially inappropriate prescriptions in older adults. Since there are significant differences between the Spanish and North American drug catalogues, our aim was to produce a Spanish adaptation of the criteria. PATIENTS AND METHODS: A comparison of the drugs mentioned in the Beers list with the 2012 Spanish Drugs Catalogue identified those active substances that were on the list in the USA but not commercially available in Spain. We also searched for Spanish drugs that were similar to those listed in the criteria. If these drugs were available in the USA, it was assumed that they had been evaluated by the Beers authors. On the other hand, if similar active substances were not available in the USA, they were evaluated by reference to three information sources: articles reviewed by the American Geriatrics Society in support of the Beers criteria, the product characteristics and information leaflets, and the European STOPP/START, NORGEP and PRISCUS criteria. RESULTS: Of the 199 active substances listed in the Beers criteria, 54 (27.0%) were not commercially available in Spain, but 50 new active substances could be included. These figures differed when "Direct Criteria" were considered: 47 (34.3%) active substances were not commercially available in Spain and 40 new ones could be included in the Beers list. As regards "Disease Dependent Criteria" the figures were 33 (21.3%) and 48, respectively. CONCLUSIONS: A great number of drugs on the Beers list were not commercially available in Spain, and we added many active substances not included in the original version. This study is thus an adaptation of the Beers Criteria to the Spanish health care scenario.

[Risk prescription associated to treatment at home of the elderly patient when admitted to the hospital]. / Prescripciones de riesgo asociadas al tratamiento domiciliario del paciente anciano al ingreso hospitalario.

OBJECTIVE: To determine the prevalence, the incidence of error, and the potential harm associated to particular prescriptions identified as a risk for medication error in the home treatment of elderly patients admitted to the hospital, as well as factors associated to their occurrence. MATERIAL AND METHODS: Cross-sectional, descriptive study. Patients aged 65 years and older, being admitted to the hospital from the emergency department in the last quarter of 2009. The SPSS software version 15.0 was used for the statistical analysis. RESULTS: 324 patients were included in the study. 1,176 (47%) prescriptions were identified as risk prescriptions in 91% of the patients. The most relevant risk prescription was prescription of high-risk medications (51.5% patients) that accounted for an error incidence of 88/100 patients with high-risk medications, being severe in 68 patients. Factors associated to the occurrence of moderate/high risk error due to risk prescriptions were suffering from a chronic respiratory illness, diabetes or polymedication. CONCLUSIONS: Actions aimed at decreasing the errors due to high risk medications should be prioritized.

Objetivo: Determinar la prevalencia, la incidencia de error y el daño potencial asociado a determinadas prescripciones señaladas como de riesgo de error de medicación en el tratamiento domiciliario de pacientes ancianos que ingresan en el hospital, así como los factores asociados a su aparición. Material y métodos: Estudio transversal descriptivo. Se incluyeron los pacientes de edad igual o mayor a 65 años que ingresaron en el hospital desde el servicio de urgencias durante el último trimestre de 2009.Para el análisis estadístico se utilizó el programa SPSSv15.0. Resultados: Se incluyeron en el estudio 324 pacientes. Se identificaron 1176 (47%) prescripciones de riesgo en el 91% de los pacientes. La prescripción de riesgo más relevante fue la prescripción de medicamentos de alto riesgo (51.5% pacientes) que presentó una incidencia de error de 88/100 pacientes con medicamentos de alto riesgo, de los cuales en 68 pacientes fue grave. Los factores asociados a la presencia de error grave/moderado ocasionado por prescripciones de riesgo fueron tener enfermedad respiratoria crónica o diabetes y la polimedicación. Conclusiones: Se deben priorizar actuaciones dirigidas a disminuir errores por medicamentos de alto riesgo.

[Back pain and restricted daily physical activity in the Spanish adult population]. / Dolor de espalda y limitación de la actividad física cotidiana en la población adulta española.

BACKGROUND: Low back pain is a widespread health problem that affects a great part of the Spanish adult population; it also places a constraint on developing activities of daily living. The aim of this paper is to estimate the association between daily physical activity and chronic back pain in Spain. MATERIAL AND METHODS: This paper analyses data from the European Health Survey in Spain 2009; it presents a cross sectional epidemiological study designed to assess the health of the Spanish population, in which 22,188 people participated (10,876 men and 11,312 women over 16 years ), representative of the total Spanish population. The variables studied are: back pain indicators obtained from the European Health Status Module and the European Health Care Module included in this survey, and the daily physical activity pattern obtained from the European Module of Health Determinants. RESULTS: The total volume of daily physical activity is similar in healthy people and those who have back pain, but a pattern of low or moderate intensity in people with chronic back pain in the last twelve months (p <0.01) was observed with greater frequency. CONCLUSIONS: People with chronic back pain do not show a lower volume of physical activity, but their physical activity pattern is often low or moderate. Developing a vigorous pattern of physical activity should be considered not only as a strategy to prevent this disease, but also as a therapeutic target in these patients.

Evaluación de la anamnesis farmacoterapéutica realizada en el servicio de urgencias al ingreso hospitalario / Medication history taking on admission to a hospital emergency department

Objetivo: Determinar la calidad y la precisión de la historia farmacoterapéutica realizada al ingreso en el servicio de urgencias y los factores asociados a la presencia de discrepancias. Método: Estudio transversal descriptivo. Se incluyeron los pacientes mayores de 64 años que ingresaron en el hospital desde el servicio de urgencias durante el último trimestre de 2009. Para determinar la presencia de discrepancias se cotejó la historia farmacoterapéutica realizada por un farmacéutico clínico con la obtenida por el urgenciólogo al ingreso hospitalario. Los factores asociados a de discrepancias se identificaron mediante un análisis de regresión logística univariante con el paquete estadístico SPSS versión 15.0. Resultados: Se incluyeron en el estudio 324 pacientes (53,4% mujeres) con una edad media de 78,3 años. Se identificaron 2.928 discrepancias que afectaron al 95,1%(IC95%: 92,7-97,4%) de los pacientes. Los grupos terapéuticos con mayor número de las discrepancias detectadas fueron los antiulcerosos (10,8%), los antitrombóticos (9,5%) y psicolépticos (7,2%). Se detectaron 257 discrepancias (8,8%) en medicamentos de alto riesgo en el 33,3% (IC95%: 28,2-38,5%) de los pacientes. La polimedicación fue la única variable independiente asociada a una mayor prevalencia de discrepancias [OR: 8,02 (IC95%: 2,79-23,02)].Conclusiones: Nuestros resultados muestran que existe un amplio margen de mejora,en la historia farmacoterapéutica realizada en urgencias, y debe extremarse la precaución en la población anciana y polimedicada (AU)

Objectives: To determine the quality and accuracy of medication histories taken during admission to the emergency department (ED) and to analyze the factors that may be related to the presence of discrepancies. Methods: Descriptive cross-sectional study. Patients over the age of 64 years were enrolled on admission to the hospital from the during the last quarter of 2009. To detect the presence of discrepancies we compared the medication histories taken by a clinical pharmacist to the ones taken by an emergency physician on admission. Regression analysis was used to identify factors associated with the presence of discrepancies. Results: A total of 324 patients (53.4% women) with a mean age of 78.3 years were enrolled. We detected 2928 discrepancies affecting 95.1% (95% confidence interval [CI], 92.7%-97.4%) of the patients. The medication groups with the largest numbers of discrepancies were antiulcer drugs (10.8%), antithrombotic drugs (9.5%), and psycholeptics(7.2%). We detected discrepancies in the recording of 257 high-risk drugs (8.8%) in 33.3% (95% CI, 28.2%-38.5%) of the patients. The only independent variable associated with a higher prevalence of discrepancies was the use of multiple medications (odds ratio, 8.02 (95% CI, 2.79-23.02).Conclusion: Our findings demonstrate that there is ample room for improvement, on medication history taken at ED, and increased cuation should be taken for patients of advanced age and those taking multiple medications (AU)

Análisis de las interacciones medicamentosas asociadas a la farmacoterapia domiciliaria en pacientes ancianos hospitalizados / Analysis of the drug interactions associated to domiciliary drug therapy in elderly hospitalized patients

Objetivo. Determinar la prevalencia de interacciones medicamentosas clínicamente relevantes asociadas al tratamiento crónico de pacientes mayores de 64 años que ingresan en el hospital, así como los factores asociados a una mayor presencia de éstas. Sujetos y método. Estudio observacional y transversal realizado en un hospital de referencia de área. Se incluyeron todos los pacientes mayores de 64 años que ingresaron en el hospital durante el último trimestre de 2009. Se identificaron las interacciones y su nivel potencial de relevancia clínica mediante la base de datos de interacciones BOT del Consejo General del Colegio de Farmacéuticos. Para identificar las variables asociadas a una mayor prevalencia de interacciones medicamentosas se realizaron análisis de correlaciones y de regresión lineal univariable y análisis de regresión logística uni y multivariable mediante el paquete estadístico SPSS, versión 15.0. Resultados. Se incluyeron 382 pacientes, con una edad media de 77,7 años. El 45,3% de los pacientes fueron pluripatológicos y el 78,8% tomaban 5 o más medicamentos. Las combinaciones por pares supusieron 272 interacciones clínicamente relevantes que corresponden a 159 (41,6%) pacientes. Siete grupos farmacológicos fueron responsables del 80,6% de las interacciones medicamentosas. Las variables con asociación estadísticamente significativa a la presencia de interacciones fueron: polimedicación, presencia de insuficiencia respiratoria, estar en tratamiento con inhibidores de la bomba de protones (IBPs), antagonistas de la vitamina K, diuréticos o antiagregantes. Conclusiones. Existe una elevada prevalencia de interacciones medicamentosas relevantes en pacientes ingresados de edad avanzada. Dado que éstas son una causa reconocible y por tanto prevenible de eventos adversos, pueden establecerse estrategias para su detección y actuaciones consecuentes, especialmente en pacientes de alto riesgo(AU)

Objective. To determine the prevalence of potentially relevant drug-drug interactions associated with chronic treatment of elderly patients over 64-years of age on hospital admission and the factors associated with an increased presence of these. Subjects and methods. Cross-sectional observational study in a hospital referral area. All patients aged 65 or over admitted to the hospital in the last three months in 2009 were included. Based on the drug database of the General Council of Colleges of Pharmacy (BOT), drug-drug interactions and their potential clinical relevance were identified. To identify the variables associated with a higher prevalence of drug-drug interactions, analyses of correlation and of univariable linear regression and uni-and multivariable logistic regression analyses were performed using the SPSS, version 15.0. Results. We analyzed the drug prescription data of 382 patients, whose mean age was 7.7 years. A total of 45.3% of patients had comorbidities and 78.8% had taken 5 or more drugs. We identified 272 clinically relevant drug-drug interactions that involved 159 patients (41.6%). Seven pharmacological groups accounted for 80.6% of the drug-drug interactions. The variables that had a statistically significant association to a higher prevalence of relevant interactions were polypharmacy, respiratory insufficiency, and treatment with proton-pump inhibitors, vitamin K antagonists, diuretics or anti-platelet drugs. Conclusions. A high prevalence of relevant drug-drug interactions was found in elderly hospitalized patients. Our findings suggest that prevention strategies should be implemented to avoid their associated adverse events, especially in high risk populations(AU)

[Analysis of the drug interactions associated to domiciliary drug therapy in elderly hospitalized patients]. / Análisis de las interacciones medicamentosas asociadas a la farmacoterapia domiciliaria en pacientes ancianos hospitalizados.

OBJECTIVE: To determine the prevalence of potentially relevant drug-drug interactions associated with chronic treatment of elderly patients over 64-years of age on hospital admission and the factors associated with an increased presence of these. SUBJECTS AND METHODS: Cross-sectional observational study in a hospital referral area. All patients aged 65 or over admitted to the hospital in the last three months in 2009 were included. Based on the drug database of the General Council of Colleges of Pharmacy (BOT), drug-drug interactions and their potential clinical relevance were identified. To identify the variables associated with a higher prevalence of drug-drug interactions, analyses of correlation and of univariable linear regression and uni-and multivariable logistic regression analyses were performed using the SPSS, version 15.0. RESULTS: We analyzed the drug prescription data of 382 patients, whose mean age was 7.7 years. A total of 45.3% of patients had comorbidities and 78.8% had taken 5 or more drugs. We identified 272 clinically relevant drug-drug interactions that involved 159 patients (41.6%). Seven pharmacological groups accounted for 80.6% of the drug-drug interactions. The variables that had a statistically significant association to a higher prevalence of relevant interactions were polypharmacy, respiratory insufficiency, and treatment with proton-pump inhibitors, vitamin K antagonists, diuretics or anti-platelet drugs. CONCLUSIONS: A high prevalence of relevant drug-drug interactions was found in elderly hospitalized patients. Our findings suggest that prevention strategies should be implemented to avoid their associated adverse events, especially in high risk populations.

[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)

[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.