[Design of a set of indicators for 'Do Not Do' recommendations]. / Diseño de un conjunto de indicadores sobre recomendaciones de «No Hacer¼.

BACKGROUND: There is a growing interest in the optimisation of health care that has fostered and developed initiatives advocating more efficient and safe health care. OBJECTIVE: To determine indicators set for assessing the 'Do Not Do' Recommendations (DNDR) in a Spanish health area, in order to set interventions in motion for improving the quality of care and the patient safety. METHOD: The DNDR published by the health care organisation in 2016 were identified, and those that could be analysed were designed and tested using two assessment methods (if possible, directly from the whole data or, if not, by applying the lot quality assurance sampling - LQAS) and 2016 data from a Spanish health area. Both validity and reliability of these indicators were checked. RESULTS: Of the 271 DNDR identified, 25 (9.3%) were prioritised and their corresponding quality indicator designed. From them, 80% were obtained directly, whereas the rest required LQAS. The interobserver agreement was very high. Efficiency was the quality dimension most frequently involved. CONCLUSIONS: In order to improve the quality of care in terms of adequacy, safety, and sustainability, to assess the DNDR is possible, compulsory, and urgent. Thus, a set of valid, reliable and useful indicators has been designed. This set is focused on identifying improve opportunities and making it possible to approach them.

[Prevention of thromboembolic disease in elderly patients admitted to medical wards]. / Adecuación de la profilaxis tromboembólica en pacientes de edad avanzada hospitalizados en servicios médicos de un hospital de tercer nivel.

OBJECTIVES: To determine the suitability of the prevention of thromboembolic disease in elderly patients admitted to medical departments, as well as some associated factors, such as the measures required in order to improve quality and safety. PATIENTS AND METHODS: A retrospective study in a tertiary level hospital that included elderly patients that were admitted to medical departments. A simple, non-proportional, randomised sample was used, stratified by department. The risk was measured using the Padua prediction model and the risk assessment model of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) adjusting depending on the number of discharges. A Lot Quality Assurance Sampling (LQAS) plan was used with three levels, good, (standard 95%, threshold 70%), acceptable (standard 95%, threshold 50%), and not acceptable. RESULTS: A total of 72 cases from 8 departments were evaluated. Just over half (51.4%) of patients had a high risk of thromboembolic disease (Padua≥4), and 23.6% of bleeding (IMPROVE≥7). Besides the advanced age, the adjusted scores were particularly due to cancer (22%) and reduced mobility (19%) for Padua, and male gender (13%) and renal failure (12%) for IMPROVE. The adjusted overall suitability was 57.5% (95%CI: ±19.0%). The OR for suitable conduct on not starting medication, 1.56 (95%CI: 1.07-2.26). The suitability by department was not uniform: all the lots were acceptable, in 3 with level "good" and in 5 with "acceptable". CONCLUSIONS: The suitability of thromboembolic prophylaxis in the study hospital maintains acceptable levels, although not homogeneous. There is an opportunity for improvement that must be taken. The data obtained may help in deciding interventions, with LQAS being useful to optimise the evaluation effort.

Cumplimiento farmacoterapéutico de antiagregantes orales en pacientes que acuden a farmacias rurales de Girona y Almería / Pharmacotherapy compliance of oral antiplatelets in patients who go to the rural drugstores in Girona and Almeria

La falta de cumplimiento terapéutico puede producir un fracaso del tratamiento. En el caso de los antiagregantes, podría aumentar el riesgo de episodios cerebrovasculares y cardiovasculares, por lo que sería importante cuantificar y mejorar su cumplimiento. Objetivos: Comprobar el grado de cumplimiento farmacoterapéutico de los antiagregantes en los pacientes que acuden a farmacias rurales de Girona y Almería. Método: Estudio observacional, descriptivo y transversal, realizado entre febrero y marzo de 2008. Los datos se procesaron con el programa SPSS en su versión 15.0, con un intervalo de confi anza del 95%, y se utilizaron las pruebas de la t de Student y de la chi cuadrado. Resultados: La población incluida fue de 121 pacientes. Viven más personas solas en Girona, la población tiene una edad más avanzada y el nivel cultural es inferior. En Girona existen unos hábitos más saludables, y el 63% de la población realiza prevención primaria, mientras que en Almería el 87% hace prevención secundaria. El test de Morisky indica que en ambas poblaciones se incumple el tratamiento en un 43% de los casos. Cumplen más los pacientes a quienes les recogen la medicación, los que tienen estudios universitarios y los que están en prevención primaria. Incumplen más los varones y los pacientes que viven solos. Conclusión: Los pacientes que utilizan antiagregantes incumplen en un 43%, independientemente de las diferencias de perfil, y la principal causa es el olvido de la toma. Durante el primer año de tratamiento sólo incumple una cuarta parte de ellos, y aumenta hasta el 50% a partir del segundo año. En este estudio comprobamos que el test de Batalla identifica mejor el conocimiento y el test de Morisky el incumplimiento, por lo que es importante elegir el método que mejor se adapte a la población estudiada(AU)

Non-adherence to the drug therapy may cause therapeutic failure. In patients treated with antiplatelet drugs, non-adherence increases the risk of cardiovascular diseases. It would be important to quantify and to improve their compliance. Objectives: Check the pharmacotherapy compliance of the antiplatelet therapy of patients that go to rural drugstores in Girona and Almeria. Method: Observational cross-sectional descriptive study, from February to March 2008. The data were processed with SPSS V.15 CI: 95%, using the t-Student and Chi-square. Results: 121 patients were included in the study. There are more patients living alone in Girona, they are older and their cultural level is lower. In Girona there are some healthier habits, and 63% of the population is in primary prevention while in Almeria 87% of patients are in secondary prevention. The Morisky test in both populations indicates that there is non-adherence to the treatment in a 43%. The patients who comply the most are those whose medicine is picked up for them, who has studies in the university and who is in primary prevention. Men and patients living alone present a lower compliance. Conclusion: Patients using antiplatelet agents are non-compliant in 43%, with no relation to the profi le of the population, being the main reason for not taking the medication to forget to take it. During the fi rst year of treatment there is one quarter of non-compliant patients, increasing to 50% from the second year. In this study we found that the Batalla test is better for identifying the knowledge and the Morisky test for the compliance, so it is important when choosing the method to consider the population studied(AU)

Estudio del uso de omeprazol en una farmacia comunitaria de la costa de Girona / Study of the Use of Omeprazole in a Community Pharmacy on the Coast of Girona

Antecedentes: En España se vendieron, durante el año 2007,50 millones de fármacos del grupo de los inhibidores de la bomba de protones (IBP), un 26% más que en el año 2006 según los datos de la empresa IMS Health España. Los IBP son fármacos de consumo elevado y en crecimiento progresivo en el Sistema Nacional de Salud. La elevada prevalencia de la dispepsia, su cronicidad y la potencia farmacológica del omeprazol justificarían, en principio, tan elevado consumo. Sin embargo, su utilización en la prevención gastrointestinal es muchas veces inadecuada, tanto por exceso cuando no están indicados, como por defecto en pacientes que deberían tomarlos. Método: Estudio observacional, descriptivo y transversal, realizado durante un periodo de 52 días (de mayo a junio de 2008). Se incluyó a los pacientes mayores de 18 años, que acudieron a la oficina de farmacia solicitando omeprazol, con o sin receta, y que aceptaron participar en el estudio. Los datos se procesaron mediante el programa SPSS V.15. Se estableció la significación estadística a partir de un valor de p <0,05, mediante las pruebas de la t de Student y la chi al cuadrado de Pearson. Resultados: Se incluyó un total de 82 pacientes, situándose la media de edad (± desviación estándar) en 60,8 ± 14,1 años (rango: 25-87), con diferencias significativas por sexos (p=0,048; intervalo de confianza [IC] del 95%: -12,24 a -0,04). El nivel cultural fue alto. La patología más prevalerte resultó ser la dispepsia funcional en un 36% de las solicitudes, la hernia de hiato en el 20,7% y la úlcera gastroduodenal en el 4,9% de la muestra. La demanda de omeprazol por tratamiento representó el 8% de las solicitudes, por prevención el 26% y por mantenimiento el 57%. Un 28% de la muestra no cumplía con los criterios de uso del omeprazol y un 8,5% se automedicaba. El 70,7% de los usuarios de omeprazol lo utilizaba de forma continua, y la duración media del tratamiento era de 4,65 ± 4,4 años (rango: 1-15). En el momento de la adquisición, el 86,6% de los pacientes no presentaba ningún síntoma, y el 91,5% de la muestra creía que el medicamento controlaba su problema de salud (AU)

Background: throughout the year 2007 in Spain, 50 million medicines of the group of proton pump inhibitors were sold, which according to data from the IMS1 is 26% more than in the year 2006. The consumption of these proton pump inhibitors (PPIs)in the Spanish National Health System is high, and is growing steadily. In principle, the high prevalence of dyspepsia, its chronic nature and the pharmacological potency of Omeprazole justify the above mentioned high consumption. However, in many cases its use for gastrointestinal prevention is inappropriate, due both toan excess in cases in which they are not recommended, as well as a lack in patients who should be taking them. Method: cross-sectional, descriptive, observational study, conducted over a period of 52 days (May-June 2008). The study included patients over the age of 18 years who went to the community pharmacy and requested Omeprazole with or without a prescription, and who agreed to participate in the study. The data was processed using SPSS V.15, establishing statistical significance at p<0.05, using Student's t and Pearson's chi-squaretests. Results: a total of 82 patients were included, with an average age of 60.8 years (SD: 14-1) (range of 25 to 87 years), with significant differences by gender (p= 0.048; CI: -12.24 to -0.04). The cultural level was high. The most prevalent pathology turned out to be Functional Dyspepsia, accounting for 36% of the requests; hiatal hernias accounted for 20.7% and gastroduodenal ulcers for 4.9% of the sample. The requests for Omeprazole as a treatment accounted for 8% of the requests, as preventionfor 26% and as maintenance for 57%. Of the total sample, 28% did not meet the criteria for use of Omeprazole3 and 8.5% was self-medicating. Of the Omeprazole users, 70.7% used it in a continuous manner, with an average treatment duration of 4.65 years (SD: 4.4) (range of 1 to 15 years). In 86.6% of the cases the patients did not show any symptoms at the time of acquisition, and 91.5% of the sample believed that the drug controlled their health problem (AU)