[¿Disminuye la vacunación antigripal el riesgo de COVID-19? Estudio de casos y controles en un centro de Atención Primaria durante el año 2020.] / Does influenza vaccination reduce the risk of COVID-19? Case-control study in a Primary Care center during the year 2020.

OBJECTIVE: There are controversies regarding the effect of the influenza vaccine on the risk of suffering from COVID-19. The aim of this paper was to compare the risk of suffering from COVID-19 between vaccinated and unvaccinated patients against influenza. METHODS: A retrospective case-control study of patients assigned to an urban CAP (coverage: 44,564 inhabitants) was carried out during 2020. Patients with diagnostic confirmation of COVID-19 (ART, PCR or serology) were defined as cases, and those who have not had said infection, selected by simple random sampling, were defined as controls. The case/control ratio was 1:1. The data sources used were the Khalix health data registry databases and the computerized medical record (E-cap). Data were analyzed with a multivariable logistic regression model. RESULTS: A total of 4,320 patients were included in the study: 2,160 cases (50%) and 2,160 controls. 18% of the cases and 14.3% of the controls were vaccinated against influenza [OR=1.3 (95% CI: 1.2-1.5; p=0.001)]. Multivariate analysis showed that in patients under eighty years of age, there were no differences between vaccinated and unvaccinated patients [OR=1.02 (95% CI: 0.8-1.3; p=0.8)]; while in those over eighty years of age, there was a lower risk of presenting COVID-19 in vaccinated patients [OR=0.4 (95% CI: 0.3-0.7; p<0.001)]. CONCLUSIONS: The adjusted model shows that at ages above than 80 years, flu-vaccinated patients have decreased risk of COVID-19 with statistical significance.

OBJETIVO: Existen controversias en relación al efecto de la vacuna antigripal (VAG) sobre el riesgo de padecer COVID-19. El objetivo de este artículo fue comparar el riesgo de padecer COVID-19 entre pacientes vacunados y no vacunados contra la gripe. METODOS: Se realizó un estudio de casos y controles retrospectivo de pacientes asignados a un Centro de Atención Primaria urbano (cobertura: 44.564 habitantes) durante 2020. Se definieron como casos los pacientes con confirmación diagnóstica de COVID-19 (TAR, PCR o serología) y como controles los que no habían presentado dicha infección, seleccionados por muestreo aleatorio simple. La relación de casos/controles fue 1:1. Se utilizaron las bases de datos de registro de datos sanitarios Khalix y la historia clínica informatizada (E-cap). Se analizaron los datos con un modelo de regresión logística multivariable. RESULTADOS: Se incluyeron en el estudio un total de 4.320 pacientes: 2.160 casos (50%) y 2.160 controles. Estaban vacunados de la gripe el 18% de los casos y el 14,3% de los controles [OR=1,3 (IC95%:1,2-1,5; p=0,001)]. El análisis multivariable mostró que en los pacientes menores de ochenta años no existían diferencias entre los pacientes vacunados y los no vacunados, [OR=1,02 (IC95%:0,8-1,3; p=0,8)]; mientras que en los mayores de 80 años, existía un menor riesgo de presentar COVID-19 en los pacientes vacunados [OR=0,4 (IC95%:0,3-0,7; p<0,001)]. CONCLUSIONES: El modelo ajustado mostró que, en la población estudiada, en edades superiores a ochenta años, los pacientes vacunados de la gripe presentan un menor riesgo de sufrir COVID-19.

Perceptions and attitudes regarding delayed antibiotic prescription for respiratory tract infections: a qualitative study.

BACKGROUND: Antibiotics are overprescribed for respiratory tract infections (RTIs). However, the decision to prescribe is often complex. Delayed antibiotic prescription (DAP), a strategy designed to promote more rational antibiotic use, is still not widely used. The aim of this study was to explore perceptions and attitudes in primary care professionals, regarding antibiotic use and different DAP strategies for uncomplicated RTIs. METHODS: We conducted a qualitative study, using an inductive thematic approach to generate themes, based on focus group discussions and semi-structured interviews with professionals, recruited from 6 primary care centres (Barcelona metropolitan area, Spain). RESULTS: 26 professionals (25 family physicians and one nurse) were included in four focus group discussions and three semi-structured interviews. Participants commented that RTIs were a main reason for consultation, motivated often by patient anxiety and fear of possible complications, and this was associated with the patients' poor health-related education. Acknowledging inappropriate antibiotic use in the health system, participants attributed this, mainly to defensive medicine strategies. DAP was used when in doubt about the aetiology, and considering factors related to patient-physician interactions. The main perceived advantage of DAP was that it could reduce the need for additional visits, while the main disadvantage was uncertainty regarding proper use by the patient. CONCLUSIONS: DAP was used by participants in cases of doubt, in specific situations, and for specific patient profiles. Weak points were detected in our primary care system and its users that affect the proper use of both antibiotics and DAP, namely, time pressure on professionals, poor patient health-related education, and the lack of a patient-physician relationship in some scenarios.

Opportunistic detection of atrial fibrillation in subjects aged 65 years or older in primare care: a randomised clinical trial of efficacy. DOFA-AP study protocol.

BACKGROUND: Clinical Practice Guidelines recommend using peripheral blood pulse measuring as a screening test for Atrial Fibrillation. However, there is no adequate evidence supporting the efficacy of such procedure in primary care clinical practice. This paper describes a study protocol designed to verify whether early opportunistic screening for Atrial Fibrillation by measuring blood pulse is more effective than regular practice in subjects aged 65 years attending primary care centers. METHODS/DESIGN: An cluster-randomized controlled trial conducted in Primary Care Centers of the Spanish National Health Service. A total of 269 physicians and nurses will be allocated to one of the two arms of the trial by stratified randomization with a 3:2 ratio (three practitioners will be assigned to the Control Group for every two practitioners assigned to the Experimental Group). As many as 12 870 patients aged 65 years or older and meeting eligibility criteria will be recruited (8 580 will be allocated to the Experimental Group and 4 290 to the Control Group). Randomization and allocation to trial groups will be carried out by a central computer system. The Experimental Group practitioners will conduct an opportunistic case finding for patients with Atrial Fibrillation, while the Control Group practitioners will follow the regular guidelines. The first step will be finding new Atrial Fibrillation cases. A descriptive inferential analysis will be performed (bivariate and multivariate by multilevel logistic regression analysis). DISCUSSION: If our hypothesis is confirmed, we expect Primary Care professionals to take a more proactive approach and adopt a new protocol when a patient meeting the established screening criteria is identified. Finally, we expect this measure to be incorporated into Clinical Practice Guidelines. TRIAL REGISTRATION: The study is registered as NCT01291953 (ClinicalTrials.gob).

Estudio de cohorte prospectiva de un programa de seguimiento farmacoterapéutico a pacientes anticoagulados ingresados en residencias geriátricas / Prospective cohort study of a pharmacological follow-up program of anticoagulated patients admitted to nursing homes

Introducción: El tratamiento anticoagulante, pese a conseguir un claro beneficio para prevenir y tratar la patología tromboembólica, presenta dificultades para su manejo en la práctica habitual. Ello debido a la variabilidad individual de dosificación, estrecho margen terapéutico, interacciones farmacológicas y efectos secundarios graves. Los pacientes ingresados en residencias geriátricas presentan cada vez más indicaciones para seguir un tratamiento anticoagulante oral, producto de trombosis venosa profunda y, muy especialmente, fibrilación auricular. Se trata de pacientes con un perfil que dificulta la prescripción del tratamiento anticoagulante: edad avanzada, polimedicación y pluripatologías. Objetivos: nos planteamos la hipótesis de que la implantación desde atención primaria de un programa de seguimiento farmacoterapéutico del tratamiento anticoagulante oral en pacientes ingresados en residencias geriátricas, que coordine a distintos profesionales de diferentes estamentos y niveles asistenciales, ha de mejorar su beneficio y disminuir los efectos secundarios. Métodos: se realiza un estudio descriptivo tipo cohorte prospectiva, de un año de evolución, de 27 pacientes ingresados en residencia geriátrica que realizan tratamiento anticoagulante controlado por el equipo de atención primaria. Se analizan distintas variables obtenidas a partir de la historia clínica informatizada, a partir de las cuales se establecen indicadores sobre el procedimiento del programa (indicadores de cobertura y registro) y otros sobre el resultado (indicadores definidos por el Comité Británico de Estándares en Hematología). Resultados: los resultados muestran que el perfil del paciente ingresado en una residencia geriátrica tratado con anticoagulantes es de edad avanzada (84 años), con predominio de mujeres (70 por ciento), con fibrilación auricular como indicación más frecuente (70,4 por ciento)...

Introduction. Anticoagulant treatment, despite providing a clear benefit to prevent and treat thrombo-embolic disease, is difficult to manage in routine practice. This is due to individual variability of dosing, narrow therapeutic margin, drug interactions, and side effects. An increasing number of patients admitted to nursing homes are under oral anticoagulant therapy because of deep venous thrombosis and, especially, atrial fibrillation. These are patients with a profile that makes prescription of anticoagulant treatment more difficult - elderly, taking multiple concomitant medications and with multiple ailments. Objetive. We hypothesized that the implementation of a primary care pharmacological follow-up program of oral anticoagulant therapy in patients admitted to nursing homes, with the purpose of coordinating the different professionals and care levels, would lead to greater benefit and reduction of side effects. Methods. A one-year descriptive prospective cohort study was conducted of 27 patients admitted to nursing homes who are under anticoagulation therapy followed by the primary care team. We analyzed different variables obtained from computerized medical records, from which indicators on the program were established (coverage and registration) as well as outcome indicators (as defined by the British Committee for Standards in Haematology). Results. The profile of patients under anticoagulation and admitted to nursing homes is elderly (84 years), with a predominance of women (70 percent), atrial fibrillation as most frequent indication (70.4 percent), hypertension as major cardiovascular risk factor (92 percent) and most of them on multiple drugs (92 percent). The analysis of the program results showed excellent coverage and registration indicators (100 percent)...