[How to increase the involvement of casualty patients in their treatments: efficacy of some informative posters]. / Cómo aumentar la implicación del paciente de urgencias en su tratamiento? Eficacia de unos pósters informativos.

OBJECTIVE: To determine whether posters/leaflets increase doctors' information on the allergies and on the medication their patients are taking and patients' understanding of their treatment. DESIGN: First stage: multi-centre transversal descriptive study. Second stage: intervention with control and without randomisation. SETTING: Primary care medical emergency services (MES). PARTICIPANTS: MES patients under prescribed drug treatment. INTERVENTIONS: Use of posters/leaflets. MAIN MEASUREMENTS: 1) Proportion of patients for whom the doctor was ignorant of allergies to drugs or of accompanying medication. 2) Proportion of prescriptions in which patients understood the dosage of the medication prescribed. SOURCE: ad hoc questionnaire to patients. ANALYSIS: chi2 test (category variables). In some cases, the Breslow-Day and Tarone tests were conducted. RESULTS: Total patients included, 1233; 1766 prescriptions analysed; 53.4% women. Mean age: 29+/-18 years old. 1) Doctor's understanding of accompanying medication: at the second stage, drop of 25.5% (95% CI, 33.5-17.5) for intervention group versus drop of 12.5% (95% CI, 19.8-5.2) for control group, in the number of patients for whom the doctor did not know the medication (P=.024). 2) Patient's understanding of dosage: at the second stage, increase of 16.8% (95% CI, 9.8-23.8) for intervention group, versus a decrease of 1% in control group, in the medicines whose dosage the patient was aware of (P<.001). CONCLUSIONS: The dissemination of posters/leaflets was effective in increasing patients' knowledge of their medication's dosage and doctors' understanding of questions affecting prescription.

¿Cómo aumentar la implicación del paciente de urgencias en su tratamiento?: eficacia de unos pósters informativos / How to increase the involvement of casualty patients in their treatments: efficacy of some informative posters

Objetivo. Determinar si unos pósters/folletos aumentan la información del médico sobre las alergias a la medicación que están tomando los pacientes y la comprensión del tratamiento por parte de éstos. Diseño. Primera fase: descriptivo, transversal, multicéntrico. Segunda fase: de intervención, controlado, sin aleatorización. Emplazamiento. Servicios de urgencias médicas no hospitalarios (SUM). Participantes. Pacientes del SUM con tratamiento farmacológico prescrito. Intervenciones. Difusión de los pósters/folletos. Mediciones principales. La proporción de pacientes de los que el médico no conocía la alergias a medicamentos o la medicación concomitante, y la proporción de prescripciones en las que el paciente conocía la posología del fármaco recetado. Fuente: cuestionario ad hoc realizado a los pacientes. Análisis: test de la *2 (variables categóricas). En algunos casos se efectuó la prueba de Breslow-Day y Tarone. Resultados. Se incluyó a un total de 1.233 pacientes; se analizaron 1.766 prescripciones; el 53,4% eran mujeres y la edad media era de 29 ± 18 años. 1. Desconocimiento de la medicación concomitante por parte del médico: en la segunda fase, disminución del 25,5% (intervalo de confianza [IC] del 95%, 33,5-17,5) en el grupo de intervención frente al 12,5% (IC del 95%, 19,8-5,2) en el grupo control del número de pacientes en que el médico desconocía esta medicación (p = 0,024) 2. Conocimiento de la posología por parte del paciente: en la segunda fase, incremento del 16,8% (IC del 95%, 9,8-23,8) en el grupo de intervención frente a un decremento del 1% en el grupo control del número de prescripciones en que el paciente conocía la posología (p < 0,001). Conclusiones. La difusión de pósters/folletos dirigidos a los pacientes fue eficaz para incrementar el conocimiento sobre la posología de su medicación y para que el médico conociera más la medicación concomitante a su prescripción

Objective. To determine whether posters/leaflets increase doctors' information on the allergies and on the medication their patients are taking and patients' understanding of their treatment. Design. First stage: multi-centre transversal descriptive study. Second stage: intervention with control and without randomisation. Setting. Primary care medical emergency services (MES). Participants. MES patients under prescribed drug treatment. Interventions. Use of posters/leaflets. Main measurements. 1) Proportion of patients for whom the doctor was ignorant of allergies to drugs or of accompanying medication. 2) Proportion of prescriptions in which patients understood the dosage of the medication prescribed. Source: ad hoc questionnaire to patients. Analysis: *2 test (category variables). In some cases, the Breslow-Day and Tarone tests were conducted. Results. Total patients included, 1233; 1766 prescriptions analysed; 53.4% women. Mean age: 29±18 years old. 1) Doctor's understanding of accompanying medication: at the second stage, drop of 25.5% (95% CI, 33.5-17.5) for intervention group versus drop of 12.5% (95% CI, 19.8-5.2) for control group, in the number of patients for whom the doctor did not know the medication (P=.024). 2) Patient's understanding of dosage: at the second stage, increase of 16.8% (95% CI, 9.8-23.8) for intervention group, versus a decrease of 1% in control group, in the medicines whose dosage the patient was aware of (P<.001). Conclusions. The dissemination of posters/leaflets was effective in increasing patients' knowledge of their medication's dosage and doctors' understanding of questions affecting prescription

[Efficiency of methotrexate in the treatment of cortico-dependent asthmatic patients]. / Eficacia del metotrexato en el tratamiento de pacientes asmáticos corticodependientes.

OBJECTIVE: To evaluate the efficiency of low doses of methotrexate as corticosteroid sparing agent in asthmatic patients requiring long term corticosteroid therapy. METHODS: A prospective study was conducted with seven adult patients and one female pediatric patient suffering from corticosteroid-dependent bronchial asthma. The minimal stabilization time for each patient before initiating treatment with MTX was 3 months. The administered dose of methotrexate was 10 mg/week p.o. for adult patients and 15 mg/week for the pediatric patient. Dose tapering of methyl-prednisolone both during the stabilization and therapy periods was a 2 mg decrease every two weeks provided that no worsening in FEV1 higher than 5% occurred. RESULTS: For the group of adult patients, the stabilization time was 5.6 +/- 2.7 months. Methyl-prednisolone dose during the stabilization period could be decreased from 15.0 mg down to 25.4 +/- 12.0 mg (p = 0.013). The period of treatment of methotrexate was 7.3 +/- 3.4 months and the dose of methyl-prednisolone could be decreased from 25.4 +/- 12.0 mg down to 12.0 +/- 11.9 mg (p < 0.001). In the pediatric patient, the deflazacor dose was decreased from 60 down to 30 mg/day during treatment with methotrexate. In all patients a significant decrease could be obtained in the MP dose during treatment with methotrexate with no decrease in FEV1. No secondary effects were observed with the exception of a labial herpes in the pediatric patient. CONCLUSIONS: The administration of one single weekly dose of methotrexate 10 mg in adults and 15 in one pediatric patient allowed for a decrease of approximately 50% in the glucocorticosteroid dosage in this group of patients with corticosteroid-dependent bronchial asthma with no relevant adverse reactions during therapy.