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2.
PLoS One ; 15(8): e0237186, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785232

RESUMO

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.


Assuntos
Prescrição Inadequada/prevenção & controle , Multimorbidade , Polimedicação , Lista de Medicamentos Potencialmente Inapropriados , Idoso , Estudos Transversais , Feminino , Geriatria/métodos , Humanos , Vida Independente , Masculino , Prevalência , Atenção Primária à Saúde , Risco , Espanha
3.
PLoS One ; 15(6): e0235148, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32579616

RESUMO

OBJECTIVE: To estimate the prevalence of nonadherence to treatment and its relationship with social support and social context in patients with multimorbidity and polypharmacy followed-up in primary care. METHODS: This was an observational, descriptive, cross-sectional, multicenter study with an analytical approach. A total of 593 patients between 65-74 years of age with multimorbidity (≥3 diseases) and polypharmacy (≥5 drugs) during the last three months and agreed to participate in the MULTIPAP Study. The main variable was adherence (Morisky-Green). The predictors were social support (structural support and functional support (DUFSS)); sociodemographic variables; indicators of urban objective vulnerability; health-related quality of life (EQ-5D-5L-VAS & QALY); and clinical variables. Descriptive, bivariate and multivariate analyses with logistic regression models and robust estimators were performed. RESULTS: Four out of ten patients were nonadherent, 47% had not completed primary education, 28.7% had an income ≤1050 €/month, 35% reported four or more IUVs, and the average perceived health-related quality of life (HRQOL) EQ-5D-5L-VAS was 65.5. The items that measure functional support, with significantly different means between nonadherent and adherent patients were receiving love and affection (-0.23; 95%CI: -0.40;-0.06), help when ill (-0.25; 95%CI: -0.42;-0.08), useful advice (-0.20; 95%CI: -0.37;-0.02), social invitations (-0.22; 95%CI:-0.44;-0.01), and recognition (-0.29; 95%CI:-0.50;-0.08). Factors associated with nonadherence were belonging to the medium vs. low tertile of functional support (0.62; 95%CI: 0.42;0.94), reporting less than four IUVs (0.69; 95%CI: 0.46;1.02) and higher HRQOL perception (0.98; 95%CI: 0.98;0.99). CONCLUSIONS: Among patients 65-74 years of age with multimorbidity and polypharmacy, lower functional support was related to nonadherence to treatment. The nonadherence decreased in those patients with higher functional support, lower urban vulnerability and higher perceived health status according to the visual analog scale of health-related quality of life.


Assuntos
Adesão à Medicação/estatística & dados numéricos , Multimorbidade , Polimedicação , Atenção Primária à Saúde/estatística & dados numéricos , Meio Social , Apoio Social , Idoso , Estudos Transversais , Feminino , Seguimentos , Humanos , Masculino , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Prevalência , Atenção Primária à Saúde/métodos , Fatores Socioeconômicos , Espanha/epidemiologia
4.
Br J Gen Pract ; 70(suppl 1)2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32554653

RESUMO

BACKGROUND: The steady rise in multimorbidity entails serious consequences for our populations, challenges healthcare systems, and calls for specific clinical approaches of proven effectiveness. The MULTIPAP Study comprises three sequential projects (MULTIPAP and MULTIPAP Plus RCTs, and the MULTIPAP Cohort). Results of MULTIPAP RCT are presented. AIM: To evaluate the effectiveness of a complex, patient-centred intervention in young-old patients with multimorbidity and polypharmacy. METHOD: Pragmatic cluster-randomised clinical trial in a primary healthcare setting. GPs were randomly allocated to either conventional care or the MULTIPAP intervention based on the Ariadne Principles with two components: GPs e-training (that is, eMULTIPAP addresses specific, key concepts on multimorbidity, polypharmacy and shared decision-making) and GP-patient-centred interview. Young-old patients aged 65-74 years with multimorbidity and polypharmacy were included. MAIN OUTCOME: difference in the Medication Appropriateness Index (MAI) after 6-month follow-up between groups. SECONDARY OUTCOMES: MAI, quality of life, patient perception, health services use, treatment adherence and cost-effectiveness after 12-month follow-up. RESULTS: 117 GPs from 38 Spanish primary health care recruited 593 patients randomly assigned to the intervention/control groups. Difference in MAI scores between groups in the intention-to-treat analysis after 6 months' follow-up: -2.42 (-4.27 to -0.59), P = 0.009 (adjusted difference in mean MAI score -1.81(-3.35 to -0.27), P = 0.021). SECONDARY OUTCOMES: not significant, including quality of life (adjusted difference in mean EQ-5D-5L (VAS) 2.94 (-1.39 to 7.28), P = 0.183, EQ-5D-5L (index) -0.006(-0.034 to 0.022), P = 0.689). CONCLUSION: The intervention significantly improved medication appropriateness. The observed quality of life improvement was not significant. GPs e-training in multimorbidity has shown to be feasible and well accepted by the professionals. Future studies may test whether this format facilitates implementation.

5.
JMIR Med Inform ; 8(3): e14130, 2020 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-32149715

RESUMO

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.

6.
JMIR Med Inform ; 8(2): e14130, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32126005

RESUMO

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.

9.
Aten. prim. (Barc., Ed. impr.) ; 51(4): 200-207, abr. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-180860

RESUMO

Objetivo: El objetivo es estimar la prevalencia de consumos de riesgo de drogas y patrones de consumo en atención primaria. Diseño: Estudio multicéntrico descriptivo transversal. Emplazamiento: Cinco centros de salud del área Sur de Madrid. Participantes: Población consultante en atención primaria entre 16-100 años. Mediciones: Se utilizó el test ASSIST validado al castellano de la Organización Mundial de la Salud para el cribado de consumo de drogas. Se calculó la puntuación total para cada droga. Resultados: Se realizaron un total de 441 cribados. La edad media fue de 51,3 años y un 56,1% presentó algún consumo de riesgo moderado o grave para alguna de las 9 sustancias cribadas. Las drogas con cribado de riesgo más consumidas fueron el tabaco (41,7%), el alcohol (15,4%), los sedantes o los hipnóticos (13,7%) y el cannabis (5,7%), encontrándose algunas diferencias: los hombres consumían más alcohol y cannabis; las mujeres tenían mayor consumo de sedantes/hipnóticos que los hombres. Se observó policonsumo en un 16% de los sujetos. Conclusiones: Existen riesgos derivados del consumo tabaco, alcohol, sedantes y cannabis en atención primaria. Existe una mayor prevalencia de sedantes e hipnóticos


Objective: The aim of this study is to estimate risky-drug use patterns of consumption of primary care patients. Design: Multicentric descriptive cross-sectional study. Setting: five primary health care centers of the South of Madrid. Participants: all patients between 16-100 year-old consulting with their family physician. Measurements: Spanish-validated World Health Organization ASSIST test was use to screen risky drug use in primary care. Total points scored at the test were obtained. Results: A sum of 441 screening test were collected. Mean age was 51,3 years and 51.6% of patients presented a moderate-severe risky drug use out of the nine drugs tested. The more frequent drug use screened were tobacco (41.7%) followed by alcohol (15.4%), hypnotics (13.7%) and cannabis (5.7%). Differences were found between genders in the patterns: men had higher risky drug uses compared to women regarding alcohol and cannabis. Women had higher sedatives/hypnotics consumption prevalence. A 16% of patients presented with polyconsumption drug use patterns. Conclusions: There is risk derived from drug misuse in primary care for tobacco, alcohol, hypnotics and cannabis as detected by the ASSIST test. There is a higher rate of hypnotics than expected


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Idoso , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Detecção do Abuso de Substâncias/instrumentação , Programas de Triagem Diagnóstica/organização & administração , Acidentes de Trânsito/prevenção & controle , Atenção Primária à Saúde , Prevenção de Acidentes/métodos , Consumo de Bebidas Alcoólicas/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Estudos Transversais
10.
Aten Primaria ; 51(4): 200-207, 2019 04.
Artigo em Espanhol | MEDLINE | ID: mdl-29551260

RESUMO

OBJECTIVE: The aim of this study is to estimate risky-drug use patterns of consumption of primary care patients. DESIGN: Multicentric descriptive cross-sectional study. SETTING: five primary health care centers of the South of Madrid. PARTICIPANTS: all patients between 16-100 year-old consulting with their family physician. MEASUREMENTS: Spanish-validated World Health Organization ASSIST test was use to screen risky drug use in primary care. Total points scored at the test were obtained. RESULTS: A sum of 441 screening test were collected. Mean age was 51,3 years and 51.6% of patients presented a moderate-severe risky drug use out of the nine drugs tested. The more frequent drug use screened were tobacco (41.7%) followed by alcohol (15.4%), hypnotics (13.7%) and cannabis (5.7%). Differences were found between genders in the patterns: men had higher risky drug uses compared to women regarding alcohol and cannabis. Women had higher sedatives/hypnotics consumption prevalence. A 16% of patients presented with polyconsumption drug use patterns. CONCLUSIONS: There is risk derived from drug misuse in primary care for tobacco, alcohol, hypnotics and cannabis as detected by the ASSIST test. There is a higher rate of hypnotics than expected.


Assuntos
Atenção Primária à Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alcoolismo/diagnóstico , Alcoolismo/epidemiologia , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Hipnóticos e Sedativos , Masculino , Abuso de Maconha/diagnóstico , Abuso de Maconha/epidemiologia , Pessoa de Meia-Idade , Prevalência , Risco , Medição de Risco , Fatores Sexuais , Fatores Socioeconômicos , Espanha/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Tabagismo/diagnóstico , Tabagismo/epidemiologia , Adulto Jovem
12.
Aten. prim. (Barc., Ed. impr.) ; 50(supl.2): 65-69, nov. 2018. ilus
Artigo em Espanhol | IBECS | ID: ibc-179659

RESUMO

Objetivo: El objetivo de esta revisión es actualizar el estado del arte de las diferentes formas de sobreutilización, sobrediagnóstico y sobretratamiento dentro de la salud mental. Método: Se realizó una revisión narrativa utilizando las fuentes de datos de Medline hasta 2018 y se seleccionaron estudios en humanos donde el sobrediagnóstico era objeto de tratamiento en el desarrollo del artículo porque se centrase en su discusión o se abordase como tema principal, no aquellos en los que se mencionase de forma somera. Resultados: Se obtuvieron más de 200 referencias relacionadas con sobrediagnóstico y sobretratamiento en Salud Mental, de las cuales 40 fueron revisiones narrativas. Las principales se relacionaron con el estudio de criterios diagnósticos más que con la estimación de la sobreutilización médica en Salud Mental. Trastornos de ansiedad y depresión, trastorno bipolar y trastorno por déficit de atención e hiperactividad agrupan el mayor número de referencias en este ámbito. Conclusiones: La variedad en la terminología y la dificultad de la objetivación en Salud Mental hacen de este campo un nicho para el sobrediagnóstico


No disponible


Assuntos
Humanos , Sobremedicalização , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Atenção Primária à Saúde
15.
Recurso na Internet em Espanhol | LIS - Localizador de Informação em Saúde, LIS-ES-CIUD | ID: lis-46100

RESUMO

Herramienta de cribado e intervención breve guiada online, para la detección precoz y el tratamiento inicial de algunos problemas relacionados con el consumo de sustancias. Se basa en el test ASSIST (Alcohol, Smoking and Substance Involvement Screenning Test) desarrollado por la Organización Mundial de la Salud (OMS) para la detección precoz de problemas con sustancias adictivas. Al realizar el test, el usuario obtendrá unas puntuaciones que determinan el riesgo, que su patrón actual de consumo, puede tener sobre su salud. Aquellos usuarios que tengan riegos leves o moderados relacionados con la sustancia que estén consumiendo tienen la posibilidad de disminuir o suprimir su consumo, de forma guiada, a lo largo de tres sesiones, en la misma web.


Assuntos
Transtornos Relacionados ao Uso de Substâncias , Inquéritos e Questionários
16.
J Med Internet Res ; 20(2): e57, 2018 02 16.
Artigo em Inglês | MEDLINE | ID: mdl-29453188

RESUMO

BACKGROUND: Information technology in health sciences could be a screening tool of great potential and has been shown to be effective in identifying single-drug users at risk. Although there are many published tests for single-drug screening, there is a gap for concomitant drug use screening in general population. The ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) website was launched on February 2015 in Madrid, Spain, as a tool to identify those at risk. OBJECTIVE: The aim of this study was to describe the use of a tool and to analyze profiles of drug users, their consumption patterns, and associated factors. METHODS: Government- and press-released launching of a Spanish-validated ASSIST test from the World Health Organization (WHO) was used for voluntary Web-based screening of people with drug-related problems. The tests completed in the first 6 months were analyzed . RESULTS: A total of 1657 visitors of the 15,867 visits (1657/15,867, 10.44%) completed the whole Web-based screening over a 6-month period. The users had an average age of 37.4 years, and 78.87% (1307/1657) screened positive for at least one of the 9 drugs tested. The drugs with higher prevalence were tobacco (840/1657, 50.69%), alcohol (437/1657, 26.37%), cannabis (361/1657, 21.79%), and sedatives or hypnotics (192/1657, 11.59%). Polyconsumption or concomitant drug use was stated by 31.80% (527/1657) of the users. Male respondents had a higher risk of having alcohol problems (odds ratio, OR 1.55, 95% CI 1.18-2.04; P=.002) and double the risk for cannabis problems (OR 2.07, 95% CI 1.46-2.92; P<.001). Growing age increased by 3 times the risk of developing alcohol problems for people aged between 45 and 65 years (OR 3.01, 95% CI 1.89-4.79; P<.001). CONCLUSIONS: A Web-based screening test could be useful to detect people at risk. The drug-related problem rates detected by the study are consistent with the current literature. This tool could be useful for users, who use information technology on a daily basis, not seeking medical attention.


Assuntos
Programas de Rastreamento/métodos , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Fumar Tabaco/tendências , Adulto , Estudos Transversais , Feminino , Humanos , Internet , Masculino , Espanha
17.
Implement Sci ; 12(1): 54, 2017 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-28449721

RESUMO

BACKGROUND: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12 months, as compared with usual care. METHODS/DESIGN: Design: pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. SCOPE: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). POPULATION: patients aged 65-74 years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3 months). SAMPLE SIZE: n = 400 (200 per study arm). INTERVENTION: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. OUTCOMES: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. STATISTICAL ANALYSIS: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. DISCUSSION: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. TRIAL REGISTRATION: Clinicaltrials.gov, NCT02866799.


Assuntos
Doença Crônica/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Prescrições de Medicamentos/normas , Assistência Centrada no Paciente/estatística & dados numéricos , Assistência Centrada no Paciente/normas , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/normas , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Multimorbidade , Avaliação de Resultados em Cuidados de Saúde , Polimedicação , Espanha
18.
Implement Sci ; 11: 71, 2016 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-27189180

RESUMO

BACKGROUND: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6 months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. METHODS/DESIGN: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6 months post-intervention, using 95 % confidence intervals. A linear multilevel regression will be used to adjust the model. DISCUSSION: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02210442 .


Assuntos
Tomada de Decisão Clínica/métodos , Medicina Comunitária/educação , Medicina de Família e Comunidade/educação , Jogos Experimentais , Implementação de Plano de Saúde/métodos , Internato e Residência/métodos , Seguimentos , Humanos , Guias de Prática Clínica como Assunto , Avaliação de Programas e Projetos de Saúde , Espanha , Inquéritos e Questionários
19.
Adicciones ; 27(2): 90-8, 2015 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-26132298

RESUMO

UNLABELLED: Brief Counseling Intervention (BCI) and Medical advice (MA) are psychotherapeutic approaches used for the treatment of binge drinkers in Primary Care. Although binge drinking is a common pattern of alcohol misuse in Europe and in the US, no studies have evaluated those subjects who do not respond to Brief Counseling Interventions or Medical Advice. OBJECTIVE: To determine the clinical and demographic characteristics of binge drinkers in whom BCI or MA are not effective in reducing harmful alcohol use. METHODS: This is a secondary analysis of data from a randomized alcohol brief intervention trial with a 12-month follow-up period. A total of 674 subjects (89%) participated right through to the end of the study. The primary outcome measure was change in harmful alcohol use from baseline to 12 months. RESULTS: The strongest baseline predictors of harmful alcohol use during follow-up were educational status, young adults, and high number of cigarettes smoked, present family history of alcoholism, treatment condition and number of drinks per episode of binge drinking. CONCLUSIONS: Binge drinkers are a heterogeneous group that responds to brief intervention or MA but in a subgroup of them these interventions fail to prevent harmful alcohol use. Other interventions should be implemented for these subjects.


Assuntos
Bebedeira/terapia , Aconselhamento Diretivo , Psicoterapia , Adulto , Bebedeira/diagnóstico , Bebedeira/epidemiologia , Feminino , Humanos , Masculino , Fatores Socioeconômicos , Falha de Tratamento
20.
Aten. prim. (Barc., Ed. impr.) ; 47(3): 167-174, mar. 2015. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-134260

RESUMO

OBJETIVO: Estimar la proporción de resultados positivos en el cribado del trastorno bipolar (TB) entre los pacientes de atención primaria que consultan por problemas de naturaleza psicológica, y analizar sus características. DISEÑO: Estudio descriptivo transversal multicéntrico. Emplazamiento: Diecinueve consultas de atención primaria en diferentes comunidades autónomas. PACIENTES: La muestra estuvo formada por 360 pacientes consecutivos de atención primaria con edades entre 18 y 70 años visitados por síntomas psicológicos. Mediciones: El cribado para TB se realizó mediante el Mood Disorders Questionnaire. Se obtuvieron datos sobre calidad de vida (EuroQol-5D), impacto funcional (Sheehan Disability Inventory) y, mediante revisión de historias clínicas, datos sobre comorbilidad psiquiátrica y consumo de psicofármacos. RESULTADOS: Se obtuvo una proporción de cribados positivos del 11,9% (IC 95%: 8,8-15,7%). Solo en 2 de estos pacientes estaba registrado el diagnóstico de TB, y aunque más de la mitad recibían tratamiento con antidepresivos, solo 2 recibían tratamiento con estabilizadores del estado de ánimo. El cribado positivo se asocia a peor calidad de vida, a disfunción laboral, social y familiar, y a mayor estrés percibido. CONCLUSIONES: El cribado del TB en pacientes de atención primaria con otros problemas psicológicos da lugar a una notable proporción de resultados positivos, lo que indica que puede haber una prevalencia relevante de pacientes con TB, la mayor parte de ellos no diagnosticados y no tratados adecuadamente. Es necesario profundizar en la investigación para determinar el eventual papel que puede o debe asumir la atención primaria en la detección, el diagnóstico o el manejo de este trastorno


OBJECTIVE: To estimate the proportion of positive results in the screening of bipolar disorder (BD) among primary care patients presenting with psychological symptoms, and to analyze their characteristics. DESIGN: Multicenter cross-sectional study. Settings: Nineteen Primary Care clinics in different Spanish regions. PATIENTS: A total of 360 consecutive primary care patients aged 18 to 70, presenting with psychological symptoms. Measurements: Screening for BP was performed by means of the Mood Disorders Questionnaire. Data on quality of life (EuroQol-5D) and functional impairment (Sheehan Disability Inventory) were obtained. Data on psychiatric comorbidity and data on the use of psychotropic medication were acquired by review of medical records. RESULTS: Of the patients screened, 11.9% were positive (95% CI: 8.8%-15.7%). Only two patients had a diagnosis of BP in their clinical records and, although more than half received treatment with antidepressants, only two received treatment with mood stabilizers. Positive screening is associated with work, social and family dysfunction, greater perceived stress and poor quality of life. CONCLUSIONS: BD screening in primary care patients with psychological problems leads to a striking proportion of positive results, indicating that there may be a significant prevalence of BP patients, most of them undiagnosed and untreated. Further research is needed to determine the role that Primary Care can or should assume in the screening, diagnosis and management of this disorder


Assuntos
Humanos , Masculino , Feminino , Programas de Rastreamento/análise , Tratamento Preliminar/ética , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/psicologia , Atenção Primária à Saúde/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Estudos Transversais/métodos , Estudos Multicêntricos como Assunto/métodos , Programas de Rastreamento , Tratamento Preliminar/métodos , Transtorno Bipolar/complicações , Transtorno Bipolar/prevenção & controle , Atenção Primária à Saúde/organização & administração , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Estudos Transversais , Estudos Multicêntricos como Assunto
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