RESUMO
BACKGROUND: In subjects with hypercholesterolaemia, cholesterol values remain above guideline levels. One of the limiting factors to the achievement of goals in such patients is therapeutic non-adherence. The aim of this study is to assess the effectiveness of an intervention designed to improve control of hypercholesterolaemic patients, consisting of a combined strategy that would include the delivery of printed information, treatment-compliance check cards and the dispatch of text messages as complementary measures in support of the intervention at the general practitioner's practice. METHODS/DESIGN: A randomised, parallel-group clinical trial will be conducted at the family medicine outpatient facilities of eight health centres in three of Spain's Autonomous Regions (Comunidades Autónomas), covering a total of 358 subjects aged 18 years or over with diagnosis of hypercholesterolaemia. Patients in the intervention group will be supplied with printed material with information on the disease and its management, mobile-telephone text messages with guideline summaries, reminders of forthcoming appointments and/or arrangements for making new appointments in the event of non-attendance, and self-report cards to check compliance with recommendations. Both groups -intervention and control- will receive routine recommendations from their physicians in accordance with current European clinical practice guidelines for hypercholesterolaemia and cardiovascular risk management. As regards the measurements to be made, the main variable is the proportion of subjects who attain the low density lipoprotein cholesterol levels set as a target across a follow-up period of 24 months. The secondary variables are as follows: adherence to recommendations on lifestyle and adherence to drug treatment; variation in lipid profiles and cardiovascular risk levels; appearance of cardiovascular events; physical activity; food consumption; smoking habit; anthropometric measures; blood pressure; health problems; use of hypolipidaemic agents; socio-demographic data; beliefs and expectations about preventive recommendations; and degree of satisfaction with the combined strategy. DISCUSSION: Should this intervention prove effective, a recommendation could be issued on the application of this combined strategy to subjects with hypercholesterolaemia. It is a simple, relatively inexpensive intervention. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02314663.
Assuntos
Hipercolesterolemia/terapia , Cooperação do Paciente , Atenção Primária à Saúde/métodos , Sistemas de Alerta , Doenças Cardiovasculares/prevenção & controle , Comportamentos Relacionados com a Saúde , Humanos , Hipercolesterolemia/complicações , Hipercolesterolemia/tratamento farmacológico , Estilo de Vida , Educação de Pacientes como Assunto , Fatores de Risco , Envio de Mensagens de TextoRESUMO
INTRODUCTION AND OBJECTIVES: Several interventions can improve low-density lipoprotein cholesterol (LDL-C) control. Our main objective was to evaluate the efficacy of a combined intervention to improve LDL-C control in patients with hypercholesterolemia. The study also assessed the efficacy of the intervention in improving adherence (pharmacological, diet, and exercise). METHODS: A multicenter, parallel group, randomized clinical trial (primary care) was conducted in 358 adults diagnosed with hypercholesterolemia, whether receiving prior drug therapy or not. We compared 178 participants who received the combined intervention (written material, self-completed registration cards, and messages to mobile telephones) with 178 controls. The main outcome variable was the proportion of participants with adequate LDL-C control (target levels of the European guidelines on dyslipidemia and cardiovascular risk) at 24 months. RESULTS: At 24 months, the mean reduction in LDL-C was significantly higher in the intervention group (23.8mg/dL [95%CI, 17.5-30.1]) than in the control group (14.6mg/dL [95%CI, 8.9-20.4]; P=.034). The mean LDL-C decrease was 13.1%±28.6%. At 1 year, the proportion of participants with adequate control was significantly higher in the intervention group than in the control group (43.7% vs 30.1%; P=.011; RR, 1.46). Adherence was significantly higher in the intervention group, both to drug therapy (77.2% vs 64.1%; P=.029) and exercise (64.9% vs 35.8; P<.001), but not to diet. CONCLUSIONS: The combined intervention significantly reduced LDL-C (by more than 13% at 2 years) and improved the degree of LDL-C control in patients with hypercholesterolemia at 1 year.
Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hipercolesterolemia/tratamento farmacológico , Guias de Prática Clínica como Assunto , LDL-Colesterol/sangue , LDL-Colesterol/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Seguimentos , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Resultado do TratamentoRESUMO
INTRODUCTION: To estimate the prevalence of self-reported anxiety/hypnotics use in adults 65 years and older and identify potential factors that determine the use of these drugs. MATERIAL AND METHODS: Cross-sectional study conducted on a study population of 1,161 non-institutionalised adults 65 years old and older with enough ability to conduct a personal interview. Participants were randomly selected from health care registers. The main outcomes of interest included consumption of anxiolytics, hypnotics and other drugs (filed by ATC classification system), mood (based on the Yesavage geriatric depression scale), cognitive status (Pfeiffer questionnaire), physical-functional assessment of basic activities of daily living (Katz index), health problems (ICPC-2 classification WONCA), and sociodemographic variables. RESULTS: The prevalence of self-reported anxiety/hypnotics consumption was 16.6% (95% CI: 14.5 - 18.7), of which 90.5% were benzodiazepines (BZD), mainly lorazepam (39.4% of BZD). Long half-life BZD accounted for 24.7% of BZD. Hypnotics accounted for 27.5% of anxiolytics/hypnotics. The use of sedatives/hypnotics was independently associated with other drugs (non-psychotropics) consumption (OR 6.8, 95% CI: 2.1-22.0), presence of established depression (OR: 2.5; 95% CI: 1.0 -5.9), presence of 4 or more comorbidities (OR: 2.0; 95% CI: 1.4-2.9), being female (OR 2.1, 95% CI: 1.5-3.1) and being dependent for basic activities of daily living (OR: 1.8, 95% CI: 1.1-2.9). CONCLUSIONS: The prevalence of sedatives/hypnotics use in the elderly from Albacete is high. Several factors were identified as potential determinants of sedatives/hypnotics use in our study population. It will be important to evaluate the misuse of these drugs in order to develop effective, efficient and safe prescription strategies.
Assuntos
Ansiolíticos/uso terapêutico , Hipnóticos e Sedativos/uso terapêutico , Idoso , Estudos Transversais , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , AutorrelatoRESUMO
OBJETIVO: Conocer el uso de las consultas telefónicas no urgentes en medicina de familia, perfil de usuario y factores asociados a su utilización. Comprobar motivos, idoneidad de las llamadas y capacidad de resolución. DISEÑO: Estudio descriptivo transversal. EMPLAZAMIENTO: Zona Básica de Salud urbana. PARTICIPANTES: Todas las llamadas realizadas por ≥ 14 años incluidas en la agenda de consulta telefónica no urgente de tres cupos médicos, durante los meses de septiembre, octubre y noviembre de 2017. MEDICIONES PRINCIPALES: Proporción de consultas telefónicas no urgentes respecto al total, cuantificación de los sujetos, idoneidad de las llamadas y capacidad de resolución. Variables independientes: perfil del usuario (sociodemográficas, Índice de Charlson, polimedicación y uso de servicios sanitarios) y motivos. Análisis multivariante para determinar posibles factores asociados al uso de las llamadas. RESULTADOS: De 6050 citas atendidas, 259 fueron telefónicas (4,28 %; IC95 %: 3,80-4,82) de 184 sujetos. Edad media de 64,6 años (DE: 20,1). El 69,6 % mujeres. Presentaban Índice de Charlson severo el 10,3 %, consumían ≥ 5 fármacos el 59,2 %. Hubo 294 motivos: renovación de recetas (45,9 %) y consultas clínicas (20,9 %, sobre todo osteomusculares). Se resolvieron el 80,5 % de los motivos. Consultas idóneas fueron 211 (81,5 %). Mediante análisis multivariante realizar ≥ 2 llamadas se asoció de modo independiente con: menor número de pacientes visitados/día de la llamada (OR:1,1; p=0,044), mayor número de fármacos usados (OR=1,25; p=0,006) y mayor número de ingresos hospitalarios/último año (OR=2,93; p=0,021). CONCLUSIONES: En nuestro entorno las consultas telefónicas no urgentes representan una proporción baja de la actividad del médico de familia. Sin embargo, parecen tener elevada idoneidad y capacidad de resolución. Sería necesario cuantificar su impacto en la demanda presencial
OBJECTIVE: To assess the use of non-urgent telephone consultations in family medicine, the user profile, and the factors associated with its use. To check reasons, suitability of phone calls and resolution capacity. DESIGN: Descriptive, cross-sectional study. LOCATION: Urban Primary Healthcare Area. PARTICIPANTS: All phone calls made by persons ≥ 14 years old included in the non-urgent telephone consultation schedule of three doctor's rosters, during September, October and November 2017. MAIN MEASURES: Proportion of non-urgent phone consultations to total calls, quantification of persons, suitability of phone calls, and resolution capacity. Independent variables: user profile (socio-demographic characteristics, Charlson Index, polypharmacy, and use of healthcare services) and reasons for the call. Multivariate analysis to determine possible factors associated with the use of telephone calls. RESULTS: 259 out of 6,050 consultations were telephone calls (4.28%; 95% CI: 3.80-4.82) from 184 persons. The average age was 64.6 (SD: 20.1), 69.6% women. 10.3% presented severe Charlson Index, 59.2% used ≥ 5 drugs. There were 294 reasons: prescription renewal (45.9%) and clinical consultations (20.9%, especially musculoskeletal). 80.5% of reasons were resolved. 211 were suitable consultations (81.5%). Through multivariate analysis, making ≥ 2 calls was independently associated with: lower number of patients seen/day of the call (OR: 1.1; p=0.044), higher number of drugs used (OR: 1.25; p=0.006), and higher number of hospital admissions/last year (OR: 2.93; p=0.021). CONCLUSIONS: In our environment, non-urgent telephone consultations represent a low propor-tion of the family doctor's activity. However, they seem to have high suitability and resolution capacity. It would be necessary to quantify their impact on face-to-face consultations
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Consulta Remota/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Telemonitoramento , Capacidade de Resposta ante Emergências/estatística & dados numéricos , Uso Excessivo dos Serviços de Saúde/estatística & dados numéricos , Polimedicação , Telefone/estatística & dados numéricos , Estudos TransversaisRESUMO
Introducción y objetivos: Intervenciones diferentes pueden mejorar el control del colesterol unido a lipoproteínas de baja densidad (cLDL). El objetivo principal era evaluar la eficacia de una intervención combinada para mejorar el control del cLDL de pacientes con hipercolesterolemia. También se evaluó su eficacia para mejorar el cumplimiento (farmacológico, dieta y ejercicio). Métodos: Ensayo clínico aleatorizado, de grupos paralelos y multicéntrico (atención primaria) que incluyó a 358 adultos diagnosticados de hipercolesterolemia con tratamiento previo farmacológico o no. Se comparó a 178 sujetos que recibieron intervención combinada (material escrito, tarjetas autocumplimentadas y mensajes al móvil) frente a 178 controles. La variable principal de resultado fue la proporción de sujetos con adecuado control del cLDL (valores recomendados en las guías europeas de dislipemias y riesgo cardiovascular) a los 24 meses. Resultados: El grupo de intervención mostró una reducción media del cLDL significativamente superior a los 24 meses respecto al control, 23,8 mg/dl (IC95%, 17,5-30,1) y 14,6 mg/dl (IC95%, 8,9-20,4), respectivamente (p = 0,034). El promedio de la reducción del cLDL fue del 13,1 ± 28,6%. La proporción de sujetos con adecuado control al año fue significativamente superior en el grupo de intervención (43,7 frente a 30,1%; p = 0,011; RR = 1,46). En el grupo de intervención, el cumplimiento farmacológico fue significativamente superior (77,2 frente a 64,1%; p = 0,029) y de la práctica de ejercicio (64,9 frente a 35,8%; p < 0,001), aunque no de la dieta. Conclusiones: La intervención combinada consigue una reducción significativa de las cifras de cLDL (superior al 13% al cabo de 2 años) y mejora el grado de control de pacientes con hipercolesterolemia al año (AU)
Introduction and objectives: Several interventions can improve low-density lipoprotein cholesterol (LDL-C) control. Our main objective was to evaluate the efficacy of a combined intervention to improve LDL-C control in patients with hypercholesterolemia. The study also assessed the efficacy of the intervention in improving adherence (pharmacological, diet, and exercise). Methods: A multicenter, parallel group, randomized clinical trial (primary care) was conducted in 358 adults diagnosed with hypercholesterolemia, whether receiving prior drug therapy or not. We compared 178 participants who received the combined intervention (written material, self-completed registration cards, and messages to mobile telephones) with 178 controls. The main outcome variable was the proportion of participants with adequate LDL-C control (target levels of the European guidelines on dyslipidemia and cardiovascular risk) at 24 months. Results: At 24 months, the mean reduction in LDL-C was significantly higher in the intervention group (23.8 mg/dL [95%CI, 17.5-30.1]) than in the control group (14.6 mg/dL [95%CI, 8.9-20.4]; P = .034). The mean LDL-C decrease was 13.1% ± 28.6%. At 1 year, the proportion of participants with adequate control was significantly higher in the intervention group than in the control group (43.7% vs 30.1%; P = .011; RR, 1.46). Adherence was significantly higher in the intervention group, both to drug therapy (77.2% vs 64.1%; P = .029) and exercise (64.9% vs 35.8; P < .001), but not to diet. Conclusions: The combined intervention significantly reduced LDL-C (by more than 13% at 2 years) and improved the degree of LDL-C control in patients with hypercholesterolemia at 1 year (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Hipercolesterolemia/tratamento farmacológico , Hipercolesterolemia/prevenção & controle , Colesterol/uso terapêutico , Anticolesterolemiantes/uso terapêutico , Lipoproteínas LDL/uso terapêutico , Atenção Primária à Saúde , Resultado do Tratamento , Adesão à Medicação , Modelos Lineares , Inquéritos e Questionários , Modelos LogísticosRESUMO
Introducción. Estimar la prevalencia del consumo de ansiolíticos e hipnóticos referido por los mayores de 65 años e identificar posibles factores condicionantes del citado uso. Material y métodos. Estudio transversal. La población de estudio fue de 1.161 sujetos de ≥65 años no institucionalizados con suficiente capacidad para llevar a cabo una entrevista personal. Selección mediante muestreo aleatorizado simple del listado de tarjeta sanitaria. Las principales variables evaluadas incluyeron: consumo referido de ansiolíticos/hipnóticos y otros fármacos (según el sistema de clasificación ATC), estado anímico (GDS-VE), estado cognitivo (cuestionario Pfeiffer), valoración física-funcional sobre actividades básicas de la vida diaria (índice de Katz), problemas de salud (clasificación CIAP-2 de la WONCA) y variables sociodemográficas. Resultados. La prevalencia de uso referido de ansiolíticos/hipnóticos fue del 16,6% (IC 95%: 14,5-18,7). El 90,5% fueron benzodiacepinas (BZD), fundamentalmente lorazepam (39,4% de las BZD). Las BZD de vida media prolongada supusieron el 24,7% de todas. Los hipnóticos representaron el 27,5% de los ansiolíticos/hipnóticos. El uso de ansiolíticos/hipnóticos se asoció independientemente con consumir otros fármacos no psicotrópicos (OR: 6,8; IC 95%: 2,1-22,0), presentar depresión establecida (OR: 2,5; IC 95%: 1,0-5,9), presentar 4 o más problemas de salud (OR: 2,0; IC 95%: 1,4-2,9), ser mujer (OR: 2,1; IC 95%: 1,5-3,1) y ser dependiente para las actividades básicas de la vida diaria (OR: 1,8; IC 95%: 1,1-2,9). Conclusiones. La prevalencia de uso de ansiolíticos/hipnóticos es elevada en mayores de Albacete. Diversos factores han sido identificados como potenciales condicionantes de su utilización. Sería importante mejorar el conocimiento sobre el mal uso de estos fármacos con el fin de desarrollar estrategias de prescripción efectivas y seguras (AU)
Introduction. To estimate the prevalence of self-reported anxiety/hypnotics use in adults 65 years and older and identify potential factors that determine the use of these drugs. Material and Methods. Cross-sectional study conducted on a study population of 1,161 non-institutionalised adults 65 years old and older with enough ability to conduct a personal interview. Participants were randomly selected from health care registers. The main outcomes of interest included consumption of anxiolytics, hypnotics and other drugs (filed by ATC classification system), mood (based on the Yesavage geriatric depression scale), cognitive status (Pfeiffer questionnaire), physical-functional assessment of basic activities of daily living (Katz index), health problems (ICPC-2 classification WONCA), and sociodemographic variables. Results. The prevalence of self-reported anxiety/hypnotics consumption was 16.6% (95% CI: 14.5 - 18.7), of which 90.5% were benzodiazepines (BZD), mainly lorazepam (39.4% of BZD). Long half-life BZD accounted for 24.7% of BZD. Hypnotics accounted for 27.5% of anxiolytics/hypnotics. The use of sedatives/hypnotics was independently associated with other drugs (non-psychotropics) consumption (OR 6.8, 95% CI: 2.1-22.0), presence of established depression (OR: 2.5; 95% CI: 1.0 -5.9), presence of 4 or more comorbidities (OR: 2.0; 95% CI: 1.4-2.9), being female (OR 2.1, 95% CI: 1.5-3.1) and being dependent for basic activities of daily living (OR: 1.8, 95% CI: 1.1-2.9). Conclusions. The prevalence of sedatives/hypnotics use in the elderly from Albacete is high. Several factors were identified as potential determinants of sedatives/hypnotics use in our study population. It will be important to evaluate the misuse of these drugs in order to develop effective, efficient and safe prescription strategies (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Ansiolíticos/administração & dosagem , Ansiolíticos/uso terapêutico , Entrevistas como Assunto , Amostragem Aleatória Simples , Transtornos Cognitivos/complicações , Transtornos Cognitivos/epidemiologia , Benzodiazepinas/uso terapêutico , Lorazepam/uso terapêutico , Estudos Transversais/métodos , Estudos Transversais , Envelhecimento Cognitivo/psicologia , Escalas de Graduação Psiquiátrica/estatística & dados numéricosRESUMO
Objetivo: Evaluar la calidad de la prescripción de los nuevos anticoagulantes orales. Identificar posibles factores asociados a su utilización inadecuada. Diseño: Estudio descriptivo transversal. Emplazamiento: Zona Básica de Salud urbana. Participantes: Todos los pacientes que consumieron nuevos anticoagulantes orales (NACO) durante 2015 (153 sujetos). Mediciones Principales: Adecuación de la prescripción a las recomendaciones de la Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Otras variables: NACO prescrito (clasificación ATC), indicación y duración del tratamiento, prescriptor, Índice de Charlson, polimedicación (5 o más fármacos), uso de servicios sanitarios y variables sociodemográficas. Análisis multivariante para determinar posibles factores asociados al uso inadecuado. Resultados: 145 sujetos incluidos (23,8 % del total de usuarios de anticoagulantes orales). Edad media 76 años (DE:11,4), un 50,3 % mujeres. Rivaroxaban el más prescrito (41,4 %). Indicación y prescriptor principal: fibrilación auricular no valvular -FANV- (93,1 % de casos) y cardiólogos (71,7 %). Mediana de uso de 20 meses (rango intercuartil: 8 a 32). Utilizaban acenocumarol el 46,9 % de pacientes y el motivo habitual de cambio: mal control del INR. En el 74,1 % (100 casos) (IC 95 %: 65,8 - 81,2) el uso global de NACO (pacientes con FANV) fue inadecuado. Variables asociadas al uso inadecuado: no prescribir de inicio el NACO (OR: 7,0; IC 95 %: 1,8 - 27,1) y la mayor duración del tratamiento anticoagulante (OR: 2,4; IC 95 %: 1,3 - 4,5). Conclusiones: En nuestro entorno una de cada cuatro prescripciones de los nuevos anticoagulantes, en pacientes con FANV, sigue las recomendaciones de la AEMPS. Debemos estar alerta ante posibles riesgos de este elevado uso inadecuado (AU)
Objective: To assess the quality of prescription of the new oral anticoagulants. To identify possible factors associated with its inappropriate use. Design: Descriptive cross-sectional study. Location: Urban primary healthcare district. Participants: All patients who used new oral anticoagulants (NOAC) during 2015 (153 subjects). Main measurements: Prescription compliance to the recommendations of the Spanish Agency of Medicines and Medical Devices (AEMPS). Other variables: NOAC prescribed (ATC classification), indication and duration of treatment, prescriber, Charlson index, polypharmacy (5 or more drugs), use of healthcare services, and socio-demographic variables. Multivariate analysis to determine possible factors associated with inappropriate use. Results: 145 subjects were included (23.8 % of the total users of oral anticoagulants). Average age 76 years (SD:11.4), 50.3 % were women. Rivaroxaban the most prescribed (41.4 %). Indication and usual prescriber: non-valvular atrial fibrillation - NVAF - (93.1 % of cases) and cardiologists (71.7 %). The median of use was 20 months (interquartile range: 8 to 32). 46.9 % of patients used acenocoumarol, and the usual reason for the change was poor INR control. In 74.1 %(100 cases) (CI 95 %: 65.8 - 81.2) the global use of NOAC, in patients with NVAF, was inappropriate. Variables associated with inappropriate use: not to prescribe NOAC from the beginning (OR: 7.0; CI 95 %: 1.8 - 27.1) and longer duration of anticoagulant therapy (OR: 2.4; CI 95 %: 1.3 - 4.5).Conclusion: . In our environment, one of every four prescriptions of new anticoagulants, in patients with NVAF, follows the recommendations of the AEMPS. We must be vigilant against possible risks of this high inappropriate use (AU)
Assuntos
Humanos , Masculino , Feminino , Idoso , Medicamentos sob Prescrição/uso terapêutico , Anticoagulantes/uso terapêutico , Atenção Primária à Saúde/métodos , Qualidade da Assistência à Saúde/normas , Estudos Transversais/métodos , População Urbana/estatística & dados numéricos , Prescrição Inadequada/efeitos adversos , Prescrição Inadequada/prevenção & controle , Inquéritos e QuestionáriosRESUMO
Objetivo. Determinar factores asociados a la prescripción de tratamiento antibiótico en faringoamigdalitisaguda en niños de 2 a 8 años.Diseño. Estudio observacional analítico de casos y controles.Emplazamiento. Atención primaria.Participantes. Selección de 194 niños (97 casos con tratamiento antibiótico y 97 controles sin tratamientoantibiótico) que consultaron por faringoamigdalitis aguda.Mediciones principales. Mediante entrevista semiestructurada, realizada a los acompañantes de losniños, y a partir de la historia clínica, se determinó: variable exposición (consulta urgente/no urgente),variable resultado (prescripción o no de antibióticos), signos de infección faríngea, síntomas y otrosdatos clínicos o sociodemográficos.Resultados. Las manifestaciones clínicas más comunes en los pacientes con faringoamigdalitis quetomaron algún antimicrobiano fueron fi ebre (92,9%) y exudado faringoamigdalar (80,6%). El antibióticomás prescrito fue amoxicilina (68,4%). La proporción de niños que recibieron tratamiento antibióticofue signifi cativamente superior ante la presencia de fi ebre (62,3% vs. 14%; p<0,001) o amígdalaspultáceas (56,8% vs. 33,3%, p<0,01), así como en los atendidos de forma urgente (64,2% vs. 36,6%;p<0,001). También mediante regresión logística, las variables asociadas de forma independiente conla prescripción de antibióticos fueron: atención urgente (OR= 1,96), amigdalitis pultácea (OR= 2,16)y fi ebre (OR= 7,36).Conclusiones: la atención urgente es un factor predictor independiente para una mayor prescripciónde tratamiento antibiótico en niños con faringoamigdalitis aguda. Frente a los síntomas referidos por los niños o sus padres, los signos clínicos de sospecha de faringoamigdalitis producida por el estreptococo del grupo A objetivados por el médico, como fi ebre y exudado purulento, constituyen variablesasociadas estadísticamente con una mayor prescripción de tratamiento antibiótico
Objective. To determinate factors involved with the prescription of antibiotics in cases of acute pharyngotonsillitis in children from 2 to 8 years oldDesign. Cases and controls analytical and observational research.Setting. Primary care health servicesSubjects. Selection of 194 children (97 cases with antibiotic treatment and 97 controls without antibiotictreatment), who were consulted with acute pharyngotonsillitis.Principal measurement. By semi-structured interview of adults with child and from clinical history,It has been determined: exposition variables (consultation urgent or non urgent), result variables(prescription or not of antibiotics), signs of faringeal infection, symptoms and other clinical or socialdemographic data .Results. The clinical manifestations encountered most frequently in those patients with pharyngotonsillitiswho took antibiotic treatment were fever (92.9%) and puss (80.6%). The most prescribed antibioticwas amoxiciline (68.4%). The percentage of children who have been treated by antibiotics, wassignifi cantly higher where fever existed (62.3% vs 14%; p<0.001) or adenoidal puss (56.8 % vs 33.3%, p<0.01), also those who have been attended to in emergencies (64.2% vs 36.6%; p<0.001). Also,by logistical regression, the independent variables statistically involved with prescription of antibioticswere: urgent attention (OR=1.96), adenoidal puss (OR= 2.16) and fever (OR= 7.36).Conclusions. The urgent attention is a predictor independent factor, involved with higher prescriptionof antibiotics in children with acute pharyngotonsillitis. Despite symptoms told by children to the parents, clinical signs of suspected streptococcal A pharyngotonsillitis produced and detected by doctors, for example fever and puss, are variables statistically related with a higher prescription of antibiotic treatment
Assuntos
Humanos , Masculino , Feminino , Criança , Faringite/epidemiologia , Tonsilite/epidemiologia , Antibacterianos/uso terapêutico , Serviço Hospitalar de Emergência/estatística & dados numéricos , Faringite/tratamento farmacológico , Tonsilite/tratamento farmacológico , Prescrições de Medicamentos/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos de Casos e ControlesRESUMO
La atención global de los pacientes con EPOC se basa en la utilización de forma gradual de lasdiferentes medidas terapéuticas en función de la severidad de la enfermedad. La principal actuaciónpara frenar la progresión de la enfermedad en cualquier fase de la misma es la supresión del tabaco. Los broncodilatadores son la medicación central para el manejo de los pacientes con EPOC. El papel de los corticoides en la progresión de esta patología es controvertido. Revisamos las recomendaciones de guías de práctica clínica basada en la evidencia para hacer las indicaciones oportunas sobre la utilización de estos fármacos.En la EPOC estable se recomienda el uso regular de corticoides inhalados junto con el tratamientobroncodilatador en pacientes con deterioro funcional por FEV1 <50% y con exacerbaciones frecuentes (A). El tratamiento combinado de corticoides inhalados con agonistas beta-2 de larga duración ha demostrado ser más efectivo que el tratamiento con cada uno de estos fármacos por separado (A). Se debe evitar el tratamiento a largo plazo con corticoides sistémicos en pacientescon EPOC estable debido a que la relación riesgo-beneficio es desfavorable (A). Los glucocorticoides sistémicos son útiles en el tratamiento de la exacerbación de la EPOC, pues acortan el tiempo de recuperación y ayudan a restaurar la función pulmonar más rápidamente
Global care of COPD has its base on the progressive use of different therapeutic tools dependingon illness severity. First steep in order to halt illnes progression in every phase consist of tobaccoabstinence. Broncodilators are the fundamental drugs in the treatment of COPD patients. The role of steroids in the progression of this pathology is controversial. We have reviewed recommendations in based on evidence clinical practice guidelines in order to ensure the correctuse of this drugs.In stable COPD it is recommended the regular use of inhaled steroids together with broncodilatorstreatment in patients with functional deterioration of FEV1 < 50 % and with frequent relapses (A).The convined treatment of inhaled steroids and long action _2 adrenergics have demonstrated tobe most effective over this drugs take separately (A). It is necessary to avoid long term treatmentwith systemic steroids in patients with stable COPD because of the risk-benefit ralationship isunafortable (A). The systemic steroids are usefull in the treatment of COPD relapses because they shorten the recuperation time and help to restore the pulmonary function more rapidly
Assuntos
Humanos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Corticosteroides/uso terapêutico , Padrões de Prática Médica , Medicina Baseada em EvidênciasRESUMO
Las demencias causan un gran impacto en la vida de los afectados y de sus familias y provocan efectos sociosanitarios y económicos destacados.Los síntomas conductuales y psicológicos asociados a la demencia (SCPD) son motivo frecuente de consulta y provocan un importante deterioro en la calidad de vida de los pacientes y sus cuidadores. Los médicos de familia asumimos la responsabilidad de su atencióny contamos con guías basadas en pruebas que pueden ayudarnos a mejorar nuestra capacidad de respuesta a estos problemas. Las medidas no farmacológicas de atención al enfermo y a sus cuidadores son la primera elección en el abordaje de los SCPD, aunque losdatos que respaldan su uso son limitados en muchos casos. Los síntomas que mejor parecen responder a este tipo de intervenciones son el humor depresivo leve, la apatía, el vagabundeo, el caminar insistente y las preguntas y gestos repetidos.El uso de fármacos esta claramente indicado para los SCPD moderados a graves que interfieren en la calidad de vida del paciente o el cuidador. Los fármacos que han demostrado más efectividad son los neurolépticos, antidepresivos y benzodiacepinas, Sin embargo,su uso debe ser muy cauteloso, considerando la mayor susceptibilidad de estos pacientes a sus efectos adversos. Revisamos las recomendaciones de uso en cada uno de los SCPD y su nivel de evidencia.La formación, el adiestramiento y la actuación integral y continua de los equipos de atenciónprimaria, con la participación fundamental de los cuidadores, constituyen instrumentos de primer orden en el manejo de este tipo de pacientes
Dementia causes a big shock in patients and family lifes and provokes important economic and health-social effects. Behavioral and psichological symptoms associated with dementia are frequently the origin of consultancy and are involved with an important worsening of quality life in patients and careers. Family doctors have the responsability of health service and management based on tryals guides that help us in order to improve our answer capability. Firts step in the BPSD assistance observe not pharmaceutic actions, however evidence that supports its use are limited. The symptoms that offer a best answer to not pharmaceutical actions are slight depressive humour, apathy, aimlessness, continuouswalking and repetitive questions and gestures.Use of drugs has its target on middle and serious BPSD that modify life quality of patients or carers. Drugs that have demonstrated moore efectivity are neuroleptics, antidepressives and benzodiazepines. However, it use has to be with care, considering higher sensibility of these patients to its adverse effects. We have to check use recommendations in everyBPSD and its evidence level.Training and full and continuous actuation on first health level teams and the active work of carers have a particular importance in the management of these patients