Experiencia de 20 años en el control de la hipertensión arterial en un centro de salud en España: control estricto versus no estricto / Twenty-year experience in strict versus non-strict control of arterial hypertension in a health center in Spain

Introducción y objetivos En los ensayos clínicos la reducción eficaz de la presión arterial (PA) produce una disminución de la incidencia de la morbimortalidad cardiovascular (CV). Nuestro objetivo principal es conocer si en las condiciones reales de la práctica clínica el control de la PA reduce a largo plazo los eventos CV. Pacientes y métodos El estudio se realizó en 164 pacientes con hipertensión arterial (HTA) elegidos entre los pacientes que acudían a las consultas de medicina de familia por HTA. Se hizo un análisis entre los pacientes que presentaban una PA clínica inferior a 140/90mmHg y los que la tenían más elevada. Los pacientes se seguían hasta que se producía un evento CV o hasta un máximo de 20 años, en que se finalizaba el seguimiento. Resultados Del total de los 164 pacientes alcanzaron un buen control clínico de la HTA 93 (56,7%) pacientes y no lo alcanzaron 71 (42,2%). En el análisis multivariante quedó únicamente como variable predictora de eventos CV la falta de control estricto de la HTA (HR: 2,93; IC 95%: 1,45-5,89; p=0,003), y el sexo femenino fue protector para eventos CV (HR: 0,37; IC 95%: 0,18-0,74; p=0,005) Conclusiones La variable predictora fundamental de morbimortalidad CV en pacientes con HTA es la falta de control estricto de la HTA; las mujeres también tuvieron menos complicaciones CV (AU)

Introduction and aims During clinical trials effective reduction of blood pressure (BP) leads to a reduction in the incidence of cardiovascular (CV) morbimortality. Our main aim is to ascertain whether, under actual conditions of clinical practice, BP monitoring leads to a long-term reduction in CV events. Patients and methods The study was performed on 164 patients with hypertension (HT) selected among patients who came to family medicine consultations because of HT. An analysis was performed between patients who presented clinical BP lower than 140/90mmHg and those that had higher levels. When patients entered the study, they were followed up until a CV event occurred or up to a maximum of 20 years, at which time follow up ended. Results Of the total of 164 patients, good control of BP was attained by 93 (56.7%), and 71 did not attain good control (42.2%). In the multivariate analysis, the only predictive variable for CV events was the lack of strict control of BP (HR: 2.93; 95% CI: 1.45-5.89; p=0.003), and the female sex was protective for CV events (HR: 0.37; 95% CI: 0.18-0.74; p=0.005). Conclusions The fundamental predictor variable of CV morbimortality in patients with HT is the lack of HT strict control; the women also had fewer CV complications (AU)

[Twenty-year experience in strict versus non-strict control of arterial hypertension in a health center in Spain]. / Experiencia de 20 años en el control de la hipertensión arterial en un centro de salud en España: control estricto versus no estricto.

INTRODUCTION AND AIMS: During clinical trials effective reduction of blood pressure (BP) leads to a reduction in the incidence of cardiovascular (CV) morbimortality. Our main aim is to ascertain whether, under actual conditions of clinical practice, BP monitoring leads to a long-term reduction in CV events. PATIENTS AND METHODS: The study was performed on 164 patients with hypertension (HT) selected among patients who came to family medicine consultations because of HT. An analysis was performed between patients who presented clinical BP lower than 140/90mmHg and those that had higher levels. When patients entered the study, they were followed up until a CV event occurred or up to a maximum of 20 years, at which time follow up ended. RESULTS: Of the total of 164 patients, good control of BP was attained by 93 (56.7%), and 71 did not attain good control (42.2%). In the multivariate analysis, the only predictive variable for CV events was the lack of strict control of BP (HR: 2.93; 95% CI: 1.45-5.89; p=0.003), and the female sex was protective for CV events (HR: 0.37; 95% CI: 0.18-0.74; p=0.005). CONCLUSIONS: The fundamental predictor variable of CV morbimortality in patients with HT is the lack of HT strict control; the women also had fewer CV complications.

Effect of an educational intervention in primary care physicians on the compliance of indicators of good clinical practice in the treatment of type 2 diabetes mellitus [OBTEDIGA project].

AIM: To evaluate the effect of an educational intervention among primary care physicians on several indicators of good clinical practice in diabetes care. METHODS: Two groups of physicians were randomly assigned to the intervention or control group (IG and CG). Every physician randomly selected two samples of patients from all type 2 diabetic patients aged 40 years and above and diagnosed more than a year ago. Baseline and final information were collected cross-sectionally 12 months apart, in two independent samples of 30 patients per physician. The educational intervention comprised: distribution of educational materials and physicians' specific bench-marking information, an on-line course and three on-site educational workshops on diabetes. External observers collected information directly from the physicians and from the medical records of the patients on personal and family history of disease and on the evolution and treatment of their disease. Baseline information was collected retrospectively in the control group. RESULTS: Intervention group comprised 53 physicians who included a total of 3018 patients in the baseline and final evaluations. CG comprised 50 physicians who included 2868 patients in the same evaluations. Measurement of micro-albuminuria in the last 12 months (OR = 1.6, 95% CI: 1.1-2.4) and foot examination in the last year (OR = 2.0, 95% CI: 1.1-3.6) were the indicators for which greater improvement was found in the IG. No other indicator considered showed statistically significant improvement between groups. CONCLUSIONS: The identification of indicators with very low level of compliance and the implementation of a simple intervention in physicians to correct them is effective in improving the quality of care of diabetic patients.

Quality of care of patients with type-2 diabetes in Galicia (NW Spain) [OBTEDIGA project].

AIMS: The aim of this study was to describe the degree of compliance of agreed practices with reference to primary care patients with Type 2 diabetes of 40 years old and older in Galicia (NW Spain). METHODS: A total of 108 primary care physicians were selected at random from the totality of doctors. Each physician selected 30 patients at random from their patients suffering from diabetes of 40 years old or older. External observers gathered information from each patient's medical record regarding their characteristics, condition and degree of compliance of selected indicators of good practice. RESULTS: Group of physicians participated in this study had a mean age of 50 years (standard deviation = 3.9); 48% of them were females; and 17.5% involved in medical residents training. A total of 3078 diabetic patients were included in the study: mean age = 69 years (SD = 10.9), 47.6% women, presence of high blood pressure (72%), hypercholesterolaemia (56%), and regular smokers (10.3%). Compliance with selected indicators such as foot examination (14%), ophthalmological examination (30.6%), abdominal circumference measurement (6.1%), measurement of total or LDL-cholesterol (78.1), blood pressure measurement (84.8), glycosylated haemoglobin measurement < 7% (54.3%) was observed. Adequate monitoring in cases of high blood pressure and hypercholesterolaemia were 34.2% and 27.4%, respectively. Variability between physicians differs according to the different indicators, with interquartile range for compliance of between 16.4 and 66%. CONCLUSIONS: There is a wide margin for improvement in the adaptation of clinical practice to recommendations for diabetic patients. The large variation existing in certain indicators would suggest that certain control objectives are less demanding than advisable in those that comply least, while low compliance and low variability in other indicators point to structural problems or unsatisfactory training of doctors.

[HIV/AIDS in primary care: the opinions and needs of Galician health professionals]. / VIH/SIDA en atención primaria: opiniones y necesidades de los profesionales sanitarios gallegos.

OBJECTIVE: To find the views and identify the needs of Galician primary health care (PHC) professionals concerning HIV/AIDS. DESIGN: An observational cross-sectional study. SETTING: Autonomous Community of Galicia. PARTICIPANTS: Primary care professionals from medicine (N = 1,523, n = 510), nursing (N = n = 220) and paediatrics (N = n = 249). METHODS: A postal questionnaire was used to gather data. Four mailings were sent. RESULTS: The percentage of replies was 64.6%. Less than 30% of the professionals were involved in specific activities with at-risk groups. Less than half were involved in recruitment and early diagnosis of persons with at-risk practices and their contacts. About 50% thought that the initiative was currently being left up to each individual professional, which only a third believed was desirable. CONCLUSION: Galician PHC professionals are in favour of a greater involvement of their health care level in questions of HIV/AIDS. They call explicitly for greater efforts from the health authorities to provide training, means and coordination.