COVID persistente: prevalencia, seguimiento y uso de recursos en Atención Primaria / Long COVID: prevalence, monitoring and use of resources in Primary Care

Objetivo: estimar la prevalencia de la COVID persistente, signos y síntomas, y uso de recursos en pacientes en Atención Primaria (AP). Métodos: estudio observacional, descriptivo y retrospectivo de una serie de casos realizado en AP. Se incluyeron pacientes mayores de 18 años positivos para SARS-CoV-2 del 29 de febrero al 15 de abril de 2020. Se registraron variables clínicas y de uso de recursos, desde 4 hasta 39 semanas tras el diagnóstico. Resultados: la edad media de los 267 pacientes fue 57 años (desviación estándar [DE]: 16,0), siendo el 55,8% mujeres. La prevalencia de la COVID persistente fue del 45,7% (intervalo de confianza [IC] 95%: 39,6-51,9), y el 53,3% tuvo síntomas más de 12 semanas. Los síntomas más comunes fueron disnea (45,1%; IC 95%: 36,1-54,3), astenia (42,6%; IC 95%: 33,7-51,9), tos (24,6%; IC 95%: 17,2-33,2) y trastornos neuropsiquiátricos (18%; IC 95%: 11,7-26). El 98,4% de pacientes con COVID persistente precisó seguimiento en AP, con 6,7 (DE: 5,0) citas de media. El 45,1% necesitó pruebas de laboratorio; el 34,4%, radiografías de tórax, y el 41,8%, baja laboral. El 20,5% requirió derivaciones hospitalarias, frente al 3,4% en pacientes sin COVID persistente. Los factores asociados a mayor número de citas con AP incluyeron padecer COVID persistente (razón de riesgo de incidencia [RRI]: 2,9; IC 95%: 2,5-3,4) y precisar baja laboral (RRI: 2,4, IC 95%: 2,1-2,9). Conclusión: casi la mitad de los pacientes seguidos en la primera ola desarrollaron COVID persistente. Los síntomas persistentes más frecuentes fueron disnea, astenia y tos. El uso de recursos fue hasta seis veces mayor en pacientes con COVID persistente, frente a aquellos que no lo desarrollaron. (AU)

Aim: to estimate the prevalence of long COVID, its signs and symptoms and use of resources in adult patients in primary care (PC). Methods: an observational, descriptive, retrospective case series study performed in primary care. Patients older than 18 years positive for SARS-CoV-2 from 29 February until 15 April 2020 were included. Variables related to clinical symptoms and use of resources were recorded from four weeks after diagnosis up to 39 weeks. Results: mean age of the 267 patients was 57 years old (16.0 SD); 55,8% were women. In the acute phase, 61.8% of patients required hospitalization and 43.8% suffered bilateral pneumonia. Long COVID prevalence was 45,7% (95% CI 39.6-51.9), and 53.3% had symptoms lasting longer than 12 weeks. Most common symptoms were dyspnoea (45.1%, 95% CI 36.1-54.3), asthenia (42.6%, 95% CI 33.7-51.9), cough (24.6%, 95% CI 17.2-33.2) and neuropsychiatric disorders (18%, 95% CI 11.7-26.0). A total of 98.4% of long COVID patients contacted primary care during follow-up, with 6.7 (5.0 SD) contacts on average. A total of 45.1%, 34.4% and 41.8% underwent laboratory tests, chest x-rays and required work leave, respectively. Long COVID patients needed more hospital referrals (20.5%) compared to those who did not develop this (3.4%). Factors associated with more primary care appointments included developing long COVID (IRR 2.9, 95% CI 2.5-3.4) and requiring a work leave (IRR 2.4, 95% CI 2.1-2.9). Conclusion: virtually half of patients developed long COVID. Most common chronic symptoms were dyspnoea, asthenia and cough. Use of resources was two to six times greater among long COVID patients, in contrast to those who did not develop long COVID. (AU)

Drug interactions detected by a computer-assisted prescription system in primary care patients in Spain: MULTIPAP study.

BACKGROUND: Drug interactions increase the risk of treatment failure, intoxication, hospital admissions, consultations and mortality. Computer-assisted prescription systems can help to detect interactions. OBJECTIVES: To describe the drug-drug interaction (DDI) and drug-disease interaction (DdI) prevalence identified by a computer-assisted prescription system in patients with multimorbidity and polypharmacy. Factors associated with clinically relevant interactions were analysed. METHODS: Observational, descriptive, cross-sectional study in primary health care centres was undertaken in Spain. The sample included 593 patients aged 65-74 years with multimorbidity and polypharmacy participating in the MULTIPAP Study, recruited from November 2016 to January 2017. Drug interactions were identified by a computer-assisted prescription system. Descriptive, bivariate, and multivariate analyses with logistic regression models and robust estimators were performed. RESULTS: Half (50.1% (95% CI 46.1-54.1)) of the patients had at least one relevant DDI and 23.9% (95% CI 18.9-25.6) presented with a DdI. Non-opioid-central nervous system depressant drug combinations and benzodiazepine-opioid drug combinations were the two most common clinically relevant interactions (10.8% and 5.9%, respectively). Factors associated with DDI were the use of more than 10 drugs (OR 11.86; 95% CI 6.92-20.33) and having anxiety/depressive disorder (OR 1.98; 95% CI 1.31-2.98). Protective factors against DDI were hypertension (OR 0.62; 95% CI 0.41-0.94), diabetes (OR 0.57; 95% CI 0.40-0.82), and ischaemic heart disease (OR 0.43; 95% CI 0.25-0.74). CONCLUSION: Drug interactions are prevalent in patients aged 65-74 years with multimorbidity and polypharmacy. The clinically relevant DDI frequency is low. The number of prescriptions taken is the most relevant factor associated with presenting a clinically relevant DDI.

Characteristics of a COVID-19 confirmed case series in primary care (COVID-19-PC project): a cross-sectional study.

BACKGROUND: To estimate the prevalence of symptoms and signs related to a COVID-19 case series confirmed by polymerase chain reaction (PCR) for SARS-CoV-2. Risk factors and the associated use of health services will also be analysed. METHODS: Observational, descriptive, retrospective case series study. The study was performed at two Primary Care Health Centres located in Madrid, Spain. The subjects studied were all PCR SARS-CoV-2 confirmed cases older than 18 years, diagnosed from the beginning of the community transmission (March 13) until April 15, 2020. We collected sociodemographic, clinical, health service utilization and clinical course variables during the following months. All data was gathered by their own attending physician, and electronic medical records were reviewed individually. STATISTICAL ANALYSIS: A descriptive analysis was carried out and a Poisson regression model was adjusted to study associated factors to Health Services use. RESULTS: Out of the 499 patients studied from two health centres, 55.1% were women and mean age was 58.2 (17.3). 25.1% were healthcare professionals. The most frequent symptoms recorded related to COVID-19 were cough (77.9%; CI 95% 46.5-93.4), fever (77.7%; CI95% 46.5-93.4) and dyspnoea (54.1%, CI95% 46.6-61.4). 60.7% were admitted to hospital. 64.5% first established contact with their primary care provider before going to the hospital, with a mean number of 11.4 Healthcare Providers Encounters with primary care during all the follow-up period. The number of visit-encounters with primary care was associated with being male [IRR 1.072 (1.013, 1.134)], disease severity {from mild respiratory infection [IRR 1.404 (1.095, 1.801)], up to bilateral pneumonia [IRR 1.852 (1.437,2.386)]}, and the need of a work leave [IRR 1.326 (1.244, 1.413]. CONCLUSION: Symptoms and risk factors in our case series are similar to those in other studies. There was a high number of patients with atypical unilateral or bilateral pneumonia. Care for COVID has required a high use of healthcare resources such as clinical encounters and work leaves.

Correction: Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study.

[This corrects the article DOI: 10.2196/14130.].

Potentially inappropriate prescriptions according to explicit and implicit criteria in patients with multimorbidity and polypharmacy. MULTIPAP: A cross-sectional study.

BACKGROUND: Multimorbidity is a global health challenge that is associated with polypharmacy, increasing the risk of potentially inappropriate prescribing (PIP). There are tools to improve prescription, such as implicit and explicit criteria. OBJECTIVE: To estimate the prevalence of PIP in a population aged 65 to 74 years with multimorbidity and polypharmacy, according to American Geriatrics Society Beers Criteria® (2015, 2019), the Screening Tool of Older Person's Prescription -STOPP- criteria (2008, 2014), and the Medication Appropriateness Index -MAI- criteria in primary care. METHODS: This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling elderly aged 65 to 74 years, with multimorbidity and polypharmacy, who participated in the MULTIPAP trial. Socio-demographic, clinical, professional, and pharmacological-treatment variables were recorded. Potentially inappropriate prescribing was detected by computerized prescription assistance system, and family doctors evaluated the MAI. The MAI-associated factors were analysed using a logistic regression model. RESULTS: A total of 4,386 prescriptions were evaluated. The mean number of drugs was 7.4 (2.4 SD). A total of 94.1% of the patients in the study had at least one criterion for drug inappropriateness according to the MAI. Potentially inappropriate prescribing was detected in 57.7%, 43.6%, 68.8% and 71% of 50 patients according to the explicit criteria STOPP 2014, STOPP 2008, Beers 2019 and Beers 2015 respectively. For every new drug taken by a patient, the MAI score increased by 2.41 (95% CI 1.46; 3.35) points. Diabetes, ischaemic heart disease and asthma were independently associated with lower summated MAI scores. CONCLUSIONS: The prevalence of potentially inappropriate prescribing detected in the sample was high and in agreement with previous literature for populations with multimorbidity and polypharmacy. The MAI criteria detected greater inappropriateness than did the explicit criteria, but their application was more complex and difficult to automate.

Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study.

BACKGROUND: Multimorbidity is a global health problem that is usually associated with polypharmacy, which increases the risk of potentially inappropriate prescribing (PIP). PIP entails higher hospitalization rates and mortality and increased usage of services provided by the health system. Tools exist to improve prescription practices and decrease PIP, including screening tools and explicit criteria that can be applied in an automated manner. OBJECTIVE: This study aimed to describe the prevalence of PIP in primary care consultations among patients aged 65-75 years with multimorbidity and polypharmacy, detected by an electronic clinical decision support system (ECDSS) following the 2015 American Geriatrics Society Beers Criteria, the European Screening Tool of Older Person's Prescription (STOPP), and the Screening Tool to Alert doctors to Right Treatment (START). METHODS: This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling adults aged 65-75 years (henceforth called young seniors), with multimorbidity (≥3 diseases) and polypharmacy (≥5 medications), who had visited their primary care doctor at least once over the last year at 1 of the 38 health care centers participating in the Multimorbidity and Polypharmacy in Primary Care (Multi-PAP) trial. Sociodemographic data, clinical and pharmacological treatment variables, and PIP, as detected by 1 ECDSS, were recorded. A multivariate logistic regression model with robust estimators was built to assess the factors affecting PIP according to the STOPP criteria. RESULTS: PIP was detected in 57.0% (338/593; 95% CI 53-61) and 72.8% (432/593; 95% CI 69.3-76.4) of the patients according to the STOPP criteria and the Beers Criteria, respectively, whereas 42.8% (254/593; 95% CI 38.9-46.8) of the patients partially met the START criteria. The most frequently detected PIPs were benzodiazepines (BZD) intake for more than 4 weeks (217/593, 36.6%) using the STOPP version 2 and the prolonged use of proton pump inhibitors (269/593, 45.4%) using the 2015 Beers Criteria. Being a woman (odds ratio [OR] 1.43, 95% CI 1.01-2.01; P=.04), taking a greater number of medicines (OR 1.25, 95% CI 1.14-1.37; P<.04), working in the primary sector (OR 1.91, 95% CI 1.25-2.93; P=.003), and being prescribed drugs for the central nervous system (OR 3.75, 95% CI 2.45-5.76; P<.001) were related to a higher frequency of PIP. CONCLUSIONS: There is a high prevalence of PIP in primary care as detected by an ECDSS in community-dwelling young seniors with comorbidity and polypharmacy. The specific PIP criteria defined by this study are consistent with the current literature. This ECDSS can be useful for supervising prescriptions in primary health care consultations.

Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-sectional Study.

BACKGROUND: Multimorbidity is a global health problem that is usually associated with polypharmacy, which increases the risk of potentially inappropriate prescribing (PIP). PIP entails higher hospitalization rates and mortality and increased usage of services provided by the health system. Tools exist to improve prescription practices and decrease PIP, including screening tools and explicit criteria that can be applied in an automated manner. OBJECTIVE: This study aimed to describe the prevalence of PIP in primary care consultations among patients aged 65-75 years with multimorbidity and polypharmacy, detected by an electronic clinical decision support system (ECDSS) following the 2015 American Geriatrics Society Beers Criteria, the European Screening Tool of Older Person's Prescription (STOPP), and the Screening Tool to Alert doctors to Right Treatment (START). METHODS: This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling adults aged 65-75 years (henceforth called young seniors), with multimorbidity (≥3 diseases) and polypharmacy (≥5 medications), who had visited their primary care doctor at least once over the last year at 1 of the 38 health care centers participating in the Multimorbidity and Polypharmacy in Primary Care (Multi-PAP) trial. Sociodemographic data, clinical and pharmacological treatment variables, and PIP, as detected by 1 ECDSS, were recorded. A multivariate logistic regression model with robust estimators was built to assess the factors affecting PIP according to the STOPP criteria. RESULTS: PIP was detected in 57.0% (338/593; 95% CI 53-61) and 72.8% (432/593; 95% CI 69.3-76.4) of the patients according to the STOPP criteria and the Beers Criteria, respectively, whereas 42.8% (254/593; 95% CI 38.9-46.8) of the patients partially met the START criteria. The most frequently detected PIPs were benzodiazepines (BZD) intake for more than 4 weeks (217/593, 36.6%) using the STOPP version 2 and the prolonged use of proton pump inhibitors (269/593, 45.4%) using the 2015 Beers Criteria. Being a woman (odds ratio [OR] 1.43, 95% CI 1.01-2.01; P=.04), taking a greater number of medicines (OR 1.25, 95% CI 1.14-1.37; P<.001), working in the primary sector (OR 1.91, 95% CI 1.25-2.93; P=.003), and being prescribed drugs for the central nervous system (OR 3.75, 95% CI 2.45-5.76; P<.001) were related to a higher frequency of PIP. CONCLUSIONS: There is a high prevalence of PIP in primary care as detected by an ECDSS in community-dwelling young seniors with comorbidity and polypharmacy. The specific PIP criteria defined by this study are consistent with the current literature. This ECDSS can be useful for supervising prescriptions in primary health care consultations.

Adherencia a la dieta mediterránea: comparación entre pacientes con cáncer de cabeza y cuello y población sana / Adherence to Mediterranean diet: A comparison of patients with head and neck cancer and healthy population

Antecedentes y objetivo: La dieta mediterránea (DM) tradicional se asocia a un menor riesgo de padecer numerosos cánceres. Sin embargo, pocos estudios han analizado la relación de la DM con el riesgo de padecer cáncer de cabeza y cuello (CCyC). Se lleva a cabo un estudio de casos y controles en el que se compara la adherencia a la DM en pacientes diagnosticados de CCyC y población sana. Pacientes y método: Mediante el cuestionario Mediterranean Diet Adherence Screener (MEDAS), de 14 ítems, empleado en el estudio PREDIMED, se evalúa el nivel de adherencia a la DM tanto en casos obtenidos de pacientes diagnosticados de CCyC en el hospital 12de Octubre de Madrid, como en controles obtenidos de población sana de un centro de salud del Área, estratificando dicha adherencia en función de la puntuación: baja (≤7puntos), media (8-9puntos) y alta (≥10puntos). Se calcula el odds ratio (OR) para desarrollar CCyC en base a diferentes factores. Resultados: Se analiza una muestra de 168 individuos: 100 controles y 68 casos. El hábito tabáquico (OR: 2,98 [IC95%: 1,44-6,12]; p=0,003) y el consumo de alcohol (OR: 2,72 [IC95%: 1,39-5,33]; p=0,003) demuestran ser factores de riesgo para desarrollar CCyC. Sin embargo, la adherencia media-alta a la DM se asocia a menor riesgo de CCyC (OR: 0,48 [IC95%: 0,20-1,07]; p=0,052). Conclusiones: La adherencia media-alta a la DM se asocia a menor riesgo para desarrollar CCyC

Background and objective: The traditional Mediterranean diet (MD) is associated to a lower risk of suffering multiple tumors. However, few studies have analyzed the relationship between MD and the risk of developing head and neck cancer (HNC). A case-control study comparing adherence to MD was conducted in patients diagnosed with HNC and healthy population. Patients and methods: The level of adherence to MD was assessed using the 14-item MEDAS (Mediterranean Diet Adherence Screener) questionnaire, used in the PREDIMED study, in patients diagnosed with HNC at 12de Octubre Hospital in Madrid (cases) and in healthy subjects enrolled in a nearby primary health care center (controls). Adherence was stratified based on the score as low (≤7points), medium (8-9points), and high (≥10points). The odds ratio (OR) for developing HNC was estimated based on different factors. Results: A sample of 168 subjects (100 controls and 68 cases) was analyzed. Smoking (OR, 2.98 [95%CI: 1.44-6.12]; P=.003) and alcohol consumption (OR, 2.72 [95%CI: 1.39-5.33], P=.003) were strongly associated to HNC. However, medium-high adherence to MD was associated to a lower risk of developing HNC (OR, 0.48 [95%CI: 0.20-1.07], P=.052). Conclusions: Consistent medium-high adherence to MD contributes to decrease the risk of developing HNC

Adherence to Mediterranean diet: A comparison of patients with head and neck cancer and healthy population. / Adherencia a la dieta mediterránea: comparación entre pacientes con cáncer de cabeza y cuello y población sana.

BACKGROUND AND OBJECTIVE: The traditional Mediterranean diet (MD) is associated to a lower risk of suffering multiple tumors. However, few studies have analyzed the relationship between MD and the risk of developing head and neck cancer (HNC). A case-control study comparing adherence to MD was conducted in patients diagnosed with HNC and healthy population. PATIENTS AND METHODS: The level of adherence to MD was assessed using the 14-item MEDAS (Mediterranean Diet Adherence Screener) questionnaire, used in the PREDIMED study, in patients diagnosed with HNC at 12de Octubre Hospital in Madrid (cases) and in healthy subjects enrolled in a nearby primary health care center (controls). Adherence was stratified based on the score as low (≤7points), medium (8-9points), and high (≥10points). The odds ratio (OR) for developing HNC was estimated based on different factors. RESULTS: A sample of 168 subjects (100 controls and 68 cases) was analyzed. Smoking (OR, 2.98 [95%CI: 1.44-6.12]; P=.003) and alcohol consumption (OR, 2.72 [95%CI: 1.39-5.33], P=.003) were strongly associated to HNC. However, medium-high adherence to MD was associated to a lower risk of developing HNC (OR, 0.48 [95%CI: 0.20-1.07], P=.052). CONCLUSIONS: Consistent medium-high adherence to MD contributes to decrease the risk of developing HNC.