RESUMO
This study aims at evaluating the effectiveness of a computerized-based Clinical Record in monitoring hypertension in a Primary Care Setting. Blood pressure (BP) recording increased by 62% to 70% in the years 2004 to 2006. No improvement, however, was noticeable in the achievement of gold-standard targets in BP control (62% in all period). At the end of 2006 BP was recorded in 65% of patients. Among them, 2/3 of the non diabetics reached < 140/90 mmHg standard, while only 23% of diabetics reached < 130/80 mmHg standard. In conclusion, using a computerized clinical record appears not to be sufficient to obtain good clinical performances, yet it is a necessary first step to clinical audit.
Assuntos
Monitorização Ambulatorial da Pressão Arterial , Hipertensão/diagnóstico , Hipertensão/terapia , Sistemas Computadorizados de Registros Médicos , Atenção Primária à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Auditoria Clínica , Complicações do Diabetes , Feminino , Humanos , Hipertensão/prevenção & controle , Itália , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
We evaluated the effectiveness of diabetes mellitus disease management, implemented in Modena province since ten years, on the prevention of complications and early diagnoses at a population level. Time trends show that diabetic patients had significantly decreasing values over time of age, diabetes duration, and glycated haemoglobin; and increasing percentage over time of new-onset diabetes and optimal glycaemic control. That indicates an improved ability of early diagnosis and care of diabetes mellitus. It indicates at a population level that the Local Health Unit, as health system, promoted diabetes prevention and its complications.
Assuntos
Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/complicações , Diagnóstico Precoce , Feminino , Hemoglobinas Glicadas/metabolismo , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Summer 2003 witnessed an excess in heat-related mortality in the elderly population. The Argento Project was planned to define risk factors for heat-related death in Modena, Italy, during the hottest month of 2003 (August). METHODS: We performed a retrospective, case-control study of a cohort of 394 older persons living in Modena, 197 dead (cases) and 197 survivors (controls). A questionnaire to collect information about demographic, social, environmental, and clinical characteristics and about causes of death was completed. RESULTS: Cases were more likely to be living in a nursing home and needing assistance (p =.024, and p <.001, respectively). Survivors were living on higher level floors (p =.046). Spending the summer in Modena was significantly related to poor outcomes (p <.01). A higher number of cases were using public health services (p <.001). Individuals who died had a greater degree of comorbidity and dependence (p <.001); they were cognitively impaired (p <.001), took a larger number of drugs (p <.001), and had a greater number of hospital admissions (p <.001). Multivariate analysis showed that patients who spent the summer in Modena had a higher mortality. Other predictors of death were the use of home public-integrated assistance, a higher comorbidity and a higher degree of disability; the loss of at least 1 Activity of Daily Living (ADL) represents the strongest risk factor of heat-related death. CONCLUSIONS: Our study identifies the major risk factors of heat-related death in the elderly population. With the creation of an up-to-date database, when a new heat wave will come, it will be possible to identify frail persons for preventive targeted strategies.
Assuntos
Transtornos de Estresse por Calor/mortalidade , Tempo (Meteorologia) , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Doença Crônica , Transtornos Cognitivos/epidemiologia , Estudos de Coortes , Pessoas com Deficiência/estatística & dados numéricos , Feminino , Idoso Fragilizado/estatística & dados numéricos , Serviços de Saúde para Idosos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Casas de Saúde , Admissão do Paciente/estatística & dados numéricos , Polimedicação , Estudos Retrospectivos , Fatores de Risco , Estações do Ano , SobreviventesRESUMO
We implemented simple tools for Clinical Practice in Primary Care, i.e. reports of Diabetes Project's Registry addressed to Primary Care Groups in Modena in order to promote the clinical practice through a detailed peer-review of program indicators. The efforts of health organisations to involve the general practitioners in clinical practice should be improved by implementing audit-and-feedback tools of simple interpretation for clinical practice.
Assuntos
Diabetes Mellitus , Padrões de Prática Médica/organização & administração , Atenção Primária à Saúde/organização & administração , Assistência Ambulatorial/organização & administração , Diabetes Mellitus/sangue , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Hemoglobinas Glicadas/metabolismo , Humanos , Itália , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Sistema de RegistrosRESUMO
OBJECTIVES: To describe the characteristics of a diabetic population in a primary care setting, and to evaluate changes in glycaemic control at varying body weight categories. METHODS: We collected 4,610 valid baseline and three years follow-up paired data sheets sent from 77% of the general practitioners adhering to our shared-care program (257 GPs out of 521) for people with type 2 diabetes. Three conventional body weight categories were defined: "normal" (BMI, < or = 25 kg/m2), "overweight" (BMI 25.0-29.9), "obesity" (BMI > or = 30). According to weight status we calculated descriptive statistics and follow-up paired changes. RESULTS: A fifth of the diabetic patients had a "normal" BMI, about 45% was "overweight" and 34% was "obese". At follow-up, the glycaemic control significantly improved both in "normal" and "overweight" people, while it significantly worsened in "obese" ones. CONCLUSIONS: Our data confirm the crucial role played by body weight and its changes in diabetic patients.