[Description of the use of inhaled rescue medication in an asthmatic population treated in the Primary Care clinics. UMI-ASMA Study]. / Descripción del uso de medicación inhalada de rescate en una población asmática atendida en el ámbito de Atención Primaria. Estudio UMI-ASMA.

OBJECTIVE: To describe the quantitative use of inhaled rescue medication in an asthmatic population treated in the Primary Care clinics, and secondly to determine its possible relationship as regards other variables associated with control. MATERIAL AND METHODS: An observational, descriptive study was conducted on a randomised sample of all the asthmatic patients with more than one year of onset, and coming from 17 Primary Care catchment areas. 1 year observation period. The data collected included sociodemographic variables and characteristics of the asthma, such as the use of short-acting beta-agonists (SABA) and level of control as regards its frequency of use, the use of inhaled control medication (ICM), number of hospital exacerbations, smoking habits, and availability of an action plan. The data were obtained from the clinical history and the computerised prescription modules. RESULTS: A total of 442 asthmatic patients were included (59.5% female), with a mean age of 45.4 years. The total number of SABA containers prescribed in one year per patient was between 0 and 25 containers, with a mean of 4.26 (SD=4.1). Only 46.6% showed a regular use of an ICM. The number of SABA containers prescribed to patients with an intermittent use of an ICM was significantly higher than those patients that used it regularly (P=.001). There was an association between the number of exacerbations and the number of SABA containers prescribed (Spearman correlation coefficient=0.474, P<.001), as such that the higher the number of containers prescribed there was also a higher number of hospitalised asthmatic exacerbations. CONCLUSIONS: A considerable number of asthmatics in the sample had elevated prescriptions for SABA inhalers and within the defined quantitative ranges of at least a partially or poor-controlled asthma. There is a positive relationship between the overuse of SABA and the intermittent use of the ICM, the same as with hospital exacerbations, smoking, and the lack of a written action plan..

[Can we detect mental disorders in primary care? Usefulness and agreement of 2 diagnostic instruments]. / Podemos detectar trastornos mentales en atención primaria? Utilidad y concordancia de dos instrumentos diagnósticos.

OBJECTIVES: The main objective was to evaluate the use of two diagnostic instruments for mental disorders in primary care (PC): the PRIME-MD and the Goldberg anxiety and depression scales. Second, to determine the concordance between the two tests and evaluate the quality of psychiatric diagnosis records in the clinical notes. DESIGN: Crossover observational study. SETTING: Luis Vives Health Centre (EAP 1), Alcalá de Henares (Madrid). PATIENTS: 175 patients who attended for consultation on-demand over three months. MEASUREMENTS AND MAIN RESULTS: Each patient was given the PRIME-MD test for detecting disorders of depression, anxiety, food, alcohol and body form; and the Goldberg scale to evaluate anxiety and depression. The clinical records were then reviewed for previous psychiatric diagnoses. The two scales were compared and the level of concordance obtained. The PRIME-MD found that 78 patients (44.6%) had some mental disorder, the most frequent being depression (32.6% of the total). The Goldberg scale detected 89 patients (50.8%) with some suspected mental disorder: here too, the most common was depression (41.7% of the total). The best indication of concordance between the two tests was the diagnosis of anxiety disorders: kappa = 0.68 (CI 95%, 0.53-0.82). CONCLUSIONS: Both scales seem useful instruments for detecting a pathology which is very common in PC clinics: mental disorders. Moreover, the concordance between the two scales is acceptable. There was poor recording of psychiatric diagnoses in clinical records.