Control de calidad del seguimiento del embarazo normal en atención primaria

ObjetivosGeneral: aumentar la calidad de la atención maternoinfantil en nuestra población.Específicomejorar al menos un 10% el registro de las actividades con peor cumplimiento en la primera evaluación del ciclo de calidad.DiseñoCiclo de calidad del programa de seguimiento de embarazo normal en atención primaria (AP).Dimensión de calidad estudiadacientífico-técnica. Evaluación retrospectiva, cruzada, por iniciativa interna y sobre las historias clínicas de las gestantes. Marco temporal: primera evaluación sobre gestaciones de 1994-1995; aplicación de medidas correctoras durante 1996; segunda evaluación sobre gestaciones de 1997-1998.ÁmbitoAtención primaria.SujetosTodas las gestaciones seguidas en nuestro equipo de AP durante los períodos descritos.Mediciones y resultados principalesCriterios evaluados: actividades asistenciales del programa de seguimiento del embarazo normal del Área 10.Primera evaluación (n = 54)incumplimiento global del 11,5%; los criterios con cumplimiento inferior al 80% fueron suplemento con ácido fólico, consejos a la gestante, detección de diabetes gestacional y visita al mes posparto Segunda evaluación (n = 69) incumplimiento global del 6,3%; todas las actividades superaron el 80% excepto la exploración obstétrica en la primera visita, la visita a la semana posparto y la visita al mes posparto.ConclusionesTras la introducción de unas medidas correctoras sencillas, logramos una mejoría global superior al 40% y un aumento en el cumplimiento de la mayor parte de las actividades, excepto en las visitas posparto y la exploración obstétrica en la primera visita. Creemos que es necesario mantener un ciclo continuo de mejora de calidad para conseguir una adecuada asistencia maternoinfantil.ObjectivesGeneral: to increase the quality of mother-baby care in our population. Specific: to improve by at least 10% the record of activities with poorest compliance at the first evaluation on the quality cycle.DesignQuality cycle of the normal pregnancy monitoring programme in primary care (PC). The scientific-technical dimension of quality was the one studied. There was a retrospective, crossed evaluation, on internal initiative, about the clinical records of the pregnant women. Sequence: first evaluation of pregnancies in 1994-95; application of corrective measures in 1996; second evaluation of pregnancies in 1997-98.SettingPrimary care.PatientsAll the pregnancies monitored by our PC team during the periods described.Measurements and main resultsCriteria evaluated: care activities of the programme for monitoring normal pregnancies in Area 10. First evaluation (n = 54): 11.5% overall non-compliance. The criteria with under 80% compliance were: folic acid supplement, counselling, diagnosis of pregnancy diabetes and attendance in the month after delivery. Second evaluation (n = 69): 6.3% overall non-compliance. All activities surpassed 80% compliance except obstetric examination on the first visit, attendance a week after delivery and attendance a month after delivery.ConclusionsAfter introducing certain simple corrective measures, we achieved overall improvement of over 40% and increased compliance in most activities, except for attendance after delivery and obstetric examination on the first visit. We think a continuous cycle of quality improvement needs to be maintained in order to achieve adequate mother-baby care

Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

<p>Abstract</p> <p>Background</p> <p>Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial.</p> <p>Methods/Design</p> <p>This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid.</p> <p>The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference.</p> <p>Discussion</p> <p>Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.</p