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Giner-Soriano M, Díaz Baena D, Ouchi D, Gomez-Lumbreras A, Morros R. [Pharmacological treatment of the heart failure according to the ventricular ejection fraction in primary care]. Aten Primaria 2022; 54:102362. [PMID: 35777241 PMCID: PMC9251560 DOI: 10.1016/j.aprim.2022.102362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/07/2022] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
Objetivo Aunque se dispone de mejores diagnósticos y tratamientos, la insuficiencia cardíaca (IC) es una causa importante de muerte en España. El objetivo de este estudio es describir el tratamiento y las características de la población con IC crónica, clasificada según la fracción de eyección del ventrículo izquierdo (FEVI). Diseño Estudio observacional de cohortes de base poblacional en atención primaria (AP). Emplazamiento Cataluña, 2014-2018. Participantes Se incluyeron pacientes adultos con diagnóstico incidente de IC clasificada según la FEVI. Intervención Análisis de los datos de salud registrados en la base de datos Sistema de Información para el Desarrollo de la Investigación en AP (SIDIAP). Variables principales Demográficas, FEVI, comorbilidades y uso de fármacos para la IC. Resultados Se incluyeron 10.130 pacientes; el 18,9% con FEVI < 40 (ICFEr), el 15,9% con FEVI 40-49 (ICFEi) y el 65,2% con FEVI ≥ 50 (ICFEp), este último grupo con mayor proporción de mujeres (57,5%) y una mayor edad media (80,2 años). La población con ICFEi era similar a la de ICFEr en edad, género, comorbilidades o tratamiento. Las comorbilidades más frecuentes eran la hipertensión (78.3%), la dislipemia (54%) y la fibrilación auricular (41,5%). Los tratamientos más frecuentes fueron los β-bloqueantes, con diferencias según la FEVI (FEVIr 1.515 [79,2%], FEVIi 1.142 [70,8%] y FEVIp 3.371 [51,0%]), seguido de los diuréticos de asa (65,7%). Conclusiones El tratamiento farmacológico de la IC varía en función de la FEVI. El tratamiento y las características poblacionales de los pacientes con ICFEi son similares a aquellos con ICFEr.
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Affiliation(s)
- Maria Giner-Soriano
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España
| | - Dioselina Díaz Baena
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; UCEVA Unidad Central del Valle del Cauca, Tuluá, Valle del Cauca, Colombia
| | - Dan Ouchi
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España
| | - Ainhoa Gomez-Lumbreras
- College of Pharmacy, Department of Pharmacotherapy, University of Utah, Salt Lake City, Utah, EE. UU..
| | - Rosa Morros
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, España; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, España; Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, España
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Sotorra-Figuerola G, Ouchi D, García-Sangenís A, Giner-Soriano M, Morros R. Pharmacological treatment after acute coronary syndrome: Baseline clinical characteristics and gender differences in a population-based cohort study. Aten Primaria 2022; 54:102157. [PMID: 34717156 PMCID: PMC8566964 DOI: 10.1016/j.aprim.2021.102157] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe baseline socio-demographic and clinical characteristics and drugs prescribed for secondary prevention after a first episode of ACS and to assess differences between men and women. SETTING PHC in Catalonia. DATA SOURCE SIDIAP (Information System for Research in Primary Care). PARTICIPANTS Patients who suffered an ACS during 2009-2016 and followed-up in PHC centres of the Catalan Health Institute in Catalonia. INTERVENTIONS Not applicable. MAIN MEASURES Socio-demographic and clinical characteristics at baseline: sex, age, socioeconomic index, toxic habits, comorbidities, study drugs (prescribed for cardiovascular secondary prevention: antiplatelets, betablockers, statins, drugs acting on the renin-angiotensin system) and comedications. RESULTS 8071 patients included, 71.3% of them were men and 80.2% had an acute myocardial infarction. Their mean age was 65.3 and women were older than men. The most frequent comorbidities were hypertension, dyslipidaemia and diabetes and they were more common in women. Antiplatelets (91.3%) and statins (85.7%) were the study drugs most prescribed. The uses of all comedications were significantly higher in women, except for nitrates. The combination of four study groups was initially prescribed in 47.7% of patients and combination of beta-blockers, statins and antiplatelets was prescribed in 18.4%. More men than women received all recommended pharmacological groups. CONCLUSION Women were older, had more comorbidities and received more comedications. Most patients were treated with a combination of four or three study drugs for secondary prevention. Men initiated more drug treatments for secondary prevention and dual antiplatelet therapy than women. EUPAS REGISTER EUPAS19017.
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Affiliation(s)
- Gerard Sotorra-Figuerola
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Dan Ouchi
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Ana García-Sangenís
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Maria Giner-Soriano
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
| | - Rosa Morros
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Institut Català de la Salut, Barcelona, Spain; Universitat Autònoma de Barcelona, Departament de Farmacologia, Terapèutica i Toxicologia, Bellaterra (Cerdanyola del Vallès), Spain; Plataforma SCReN, UICEC IDIAP Jordi Gol, Barcelona, Spain
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Giner-Soriano M, Cortes J, Gomez-Lumbreras A, Prat-Vallverdú O, Quijada-Manuitt MA, Morros R. The use and adherence of oral anticoagulants in Primary Health Care in Catalunya, Spain: A real-world data cohort study. Aten Primaria 2020; 52:529-538. [PMID: 32788057 PMCID: PMC7505898 DOI: 10.1016/j.aprim.2020.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/05/2020] [Accepted: 05/21/2020] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE We aimed to describe sociodemographic, comorbidities, co-medication and risk of thromboembolic events and bleeding in patients with NVAF initiating oral anticoagulants (OAC) for stroke prevention, and to estimate adherence and persistence to OAC. SETTING Primary Health Care (PHC) in the Catalan Health Institute (ICS), Catalunya, Spain. PARTICIPANTS All NVAF adult patients initiating OAC for stroke prevention in August 2013-December 2015. METHODS Population-based cohort study. Persistence was measured in patients initiating OAC in August 2013-December 2014. DATA SOURCE SIDIAP, which captures electronic health records from PHC in the (ICS), covering approximately 5.8 million people. RESULTS 51,690 NVAF patients initiated OAC; 47,197 (91.3%) were naive to OAC and 32,404 (62.7%) initiated acenocoumarol. Mean age was 72.8 years (SD 12.3) and 49.4% were women. Platelet-aggregation inhibitors were taken by 9105 (17.6%) of the patients. Persistence and adherence were estimated up to the end of follow-up. For 22,075 patients, persistence was higher among the non-naive patients [n=258 (61.7%)] than among the naive [n=11,502 (53.1%)]. Adherence was estimated for patients initiating DOAC and it was similar in naive and non-naive patients. Among the naive to DOAC treatment, those starting rivaroxaban showed a highest proportion [(n=360 (80.1%)] of good adherence at implementation (MPR>80%) while patients starting dabigatran were less adherent [n=203 (47.8%)]. CONCLUSIONS Acenocoumarol was the most frequently prescribed OAC as first therapy in NVAF patients. Non-naive to DOAC showed better persistence than naive. Rivaroxaban showed higher proportion of adherent patients during the implementation phase than apixaban and dabigatran the lowest.
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Affiliation(s)
- Maria Giner-Soriano
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Jordi Cortes
- Department d'Estadística i Investigació Operativa, Universitat Politècnica de Catalunya, Spain
| | - Ainhoa Gomez-Lumbreras
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Departament de Ciències Mèdiques, Facultat de Medicina, Universitat de Girona, Girona, Spain.
| | - Oriol Prat-Vallverdú
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Mª Angeles Quijada-Manuitt
- Department of Clinical Pharmacology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Department of Pathology and Experimental Therapeutics, Unitat Docent Campus de Bellvitge, Universitat de Barcelona, L'Hospitalet (Barcelona), Spain
| | - Rosa Morros
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain; UICEC IDIAP Jordi Gol, Plataforma SCReN, Barcelona, Spain
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Azorín-Samper MC, Aguilar-Jiménez J, Flores-Pastor B, Aguayo-Albasini JL. A quality improvement cycle of the care process in a general surgery hospitalization ward. CIR CIR 2020; 88:175-184. [PMID: 32116319 DOI: 10.24875/ciru.19001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background There could be important failures in clinical data and plan records that potentially influence the surgical care process. Objective To complete a quality of care improvement cycle on the surgical care process in the General Surgery ward rounds. Structured quality criteria were measured, in order to identify major deficiencies, to implement improvement measures and to reassess the quality of surgical care process. Furthermore, we'll value the viability the implementation of a structured registration system and nutritional assessment method. Method Comparative quality study (n = 60) before-after the setting of several improvement measures derived from the analysis of the surgical care process. Evaluated criteria were the information received by the patient, adequate recording of the clinical course and plan of care established by the surgeon in the Electronic Health Record, recording of patient's weight and size and nutritional assessment. Informative sessions, subjective, objective, assessment, plan notes on the electronic clinical record and a nutritional assessment test were implemented. Results There was a significant improvement in all measured criteria (information, data records and nutritional assessment). Conclusion Simple organizational measures allow a significant improvement in the information process, clinical records and malnutrition risk detection in a surgical ward.
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Affiliation(s)
| | - José Aguilar-Jiménez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Morales Meseguer, Murcia, España
| | - Benito Flores-Pastor
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Morales Meseguer, Murcia, España
| | - José L Aguayo-Albasini
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Morales Meseguer, Murcia, España
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Guadarrama-Ortega D, Delgado-Sánchez P, Martínez-Piedrola M, López-Poves EM, Acevedo-García M, Noguera-Quijada C, Camacho-Pastor JL. [Integration of the nursing process in the electronic health record in an university hospital]. ACTA ACUST UNITED AC 2017; 32:127-134. [PMID: 28389163 DOI: 10.1016/j.cali.2017.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/28/2016] [Accepted: 02/15/2017] [Indexed: 10/19/2022]
Abstract
AIM To describe the process of implementation of Individualized Care Plan in the Electronic Health Record and its impact on the University Hospital Alcorcón Foundation. METHODOLOGY Working groups of staff nurses who analyzed activities usually performed to create a catalog of diagnoses, outcomes and interventions. A group of referents that refined the catalog to make it manageable was created. A training plan, nursing assessment forms and the Nursing Discharge Report were designed. RESULTS In February 2016 the new methodology was implemented in inpatient units of adults. Between 74.86 and 88.18% of the patients underwent a care plan with the new methodology. Between 69.41 and 76.25% of patients are discharged with a Nursing Discharge Report accordance with regulations. An increase of 24.1% of patients with Nursing Discharge Report after implantation is observed (P=.000; RR: 1.46; 95% CI 1.36-1.56). A total of 116 nurses has been trained. CONCLUSIONS In the study conditions, the use of nursing taxonomies has generated thinking skills and allowed nurses to issue judgments, ensure quality of care, and implementing interventions with a planned results. The nursing taxonomy and care plan in the Electronic Health Record have increased interprofessional communication to improve continuity of care through improved Nursing Discharge Report.
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Affiliation(s)
| | | | | | - E M López-Poves
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
| | - M Acevedo-García
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Garrastazu R, García-Rivero JL, Ruiz-Nuñez M, Helguera JM, Arenal S, Bonnardeux C, León C, Miravitlles M, Santibañez M. [Reliability of a chronic obstructive pulmonary disease diagnosis register in Primary Care]. Semergen 2016; 43:364-374. [PMID: 27692678 DOI: 10.1016/j.semerg.2016.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/24/2016] [Accepted: 06/02/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION/OBJECTIVE One of main limitations in studies of COPD in health databases could be the low quality of the information. Our first aim was evaluate reliability of the registry of COPD diagnosis register in Primary Care. A description and comparison is also presented of the characteristics of the patients according to the diagnostic confirmation. MATERIAL AND METHODS A cross-sectional study using healthcare databases of Cantabria. A pre-selected sample of 1,457 patients was obtained in which COPD diagnosis was specifically registered. COPD confirmation was classified into confirmed COPD, not confirmed-not rejected COPD, and diagnostic error (over-diagnosis). Descriptive and clinical characteristics, comorbidities, and treatments were collected in each group. RESULTS COPD was confirmed in 766 patients: 52.6% (95%CI: 49.9-55.2). Prevalence of over-diagnosis was 7.2% (95%CI: 5.9-8.6). There were statistically significant gender differences. In the COPD confirmed group age, tobacco consumption and severity according to FEV1 was higher. An average of 1.95 bronchial exacerbations during the last 4years was observed among diagnostic errors. Inhaled corticosteroids were prescribed in 74.9% of COPD confirmed patients, and in 41.9% of over-diagnosed patients. CONCLUSIONS The reliability of the COPD register was deficient, with only 52.6% with a confirmed diagnosis. Stable treatment for COPD was prescribed in all groups, highlighting the use of inhaled corticosteroids.
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Affiliation(s)
- R Garrastazu
- Centro de Salud de Gama, Servicio Cántabro de Salud, Bárcena de Cicero, España.
| | | | - M Ruiz-Nuñez
- Centro de Salud de Liérganes, Servicio Cántabro de Salud, Miera, España
| | - J M Helguera
- Centro de Salud Bajo Asón, Servicio Cántabro de Salud, Ampuero, España
| | - S Arenal
- Centro de Salud de Suances, Servicio Cántabro de Salud, Suances, España
| | - C Bonnardeux
- Centro de Salud Campoo-Los Valles, Servicio Cántabro de Salud, Mataporquera, España
| | - C León
- Centro de Salud de Suances, Servicio Cántabro de Salud, Suances, España
| | - M Miravitlles
- Servicio de Neumología, Hospital Universitari Vall d'Hebron, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, España
| | - M Santibañez
- Área de Medicina Preventiva y Salud Pública, Universidad de Cantabria-IDIVAL, Santander, España
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