111 research outputs found
The pharmaceutical industry and specialised medical training: Residents' perceptions in Madrid, Spain.
[ES]
Objetivos
Los objetivos de este estudio son describir la frecuencia de exposición y la actitud de los médicos internos residentes (MIR) de la Comunidad de Madrid (CM) con la industria farmacéutica (IF), y analizar la asociación con la especialidad, el entorno profesional y la formación recibida.
Métodos
Estudio descriptivo mediante encuesta electrónica durante mayo y junio de 2015 a los MIR de la CM. Se recogieron variables sociodemográficas y de relación con la IF en cuatro bloques: frecuencia de interacción, actitudes y percepciones, entorno y marco regulatorio, y habilidades adquiridas; con los dos primeros se elaboró un índice sintético de relación con la IF (ISIF). Análisis bivariado y multivariado de regresión logística.
Resultados
Respondieron 350 residentes (28% de medicina familiar y comunitaria [MFyC]), 57% de especialidades hospitalarias y 15% de otras). El 98% refirió haber tenido relación con la IF. El 20% creía que influye en su prescripción y el 48% en los demás médicos. El 96% no había recibido información de su colegio profesional, el 80% desconocía si había normas en su sociedad científica y el 50% no sabía si las había en su institución. El 65% consideró necesaria más formación. Los residentes de especialidades hospitalarias presentaron más probabilidad de presentar un ISIF igual o superior al percentil 75 que los de MFyC (odds ratio [OR]: 3,96; intervalo de confianza del 95% [IC95%]: 1,88-8,35). Formarse en entornos informales se asoció a un ISIF menor o igual al percentil 25 (OR: 2,83; IC95%: 1,32-6,07).
Conclusiones
Los MIR de la CM tienen un alto nivel de contacto con la IF y creen que su influencia es limitada. Los residentes de especialidades hospitalarias presentan mayor contacto. Las regulaciones son poco conocidas por los residentes, que consideran que es necesaria más formación.
[EN]
To assess the frequency of exposure and attitudes to the pharmaceutical industry (PI) of residents in the Region of Madrid (RM), Spain, and to analyse the association with specialty, professional environment and training.
Cross-sectional electronic survey in May and June 2015 of all medical residents in RM. We collected sociodemographic variables and those of interaction with the PI in four blocks: frequency of interactions, attitudes and perceptions, environment and regulatory framework, and skills; with the first two blocks we created a Synthetic PI Interaction Index (SPIII). Bivariate and multivariate analysis of logistic regression.
350 resident's responses (28% family and community medicine [FCM], 57% hospital, 15% others). Ninety-eight percent reported interacting with the PI. Twenty percent believed their prescribing was influenced by the PI and 48% believed it was influenced by other doctors. Sixty-five precent considered more training necessary. Ninety-six percent had received no information from their college of physicians, 80% did not know the regulations in their medical society and 50% were unaware of those of their institution. Hospital specialty residents showed more likelihood of SPIII ≥ percentile 75 than those of FCM (odds ratio [OR]: 3.96; 95% confidence interval [95%CI]: 1.88-8.35). Training in informal settings was associated with SPIII ≤ percentile 25 (OR: 2.83; 95%CI: 1.32-6.07).
The medical residents in RM had a high level of interaction with the PI and believed its influence low. Hospital specialty residents showed more interaction with the PI. Regulations were not well known by residents and they consideredmore training necessary.S
Effectiveness of the MULTIPAP Plus intervention in youngest-old patients with multimorbidity and polypharmacy aimed at improving prescribing practices in primary care: study protocol of a cluster randomized trial
Background: The progressive ageing of the population is leading to an increase in multimorbidity and
polypharmacy, which in turn may increase the risk of hospitalization and mortality. The enhancement of care with
information and communications technology (ICT) can facilitate the use of prescription evaluation tools and
support system for decision-making (DSS) with the potential of optimizing the healthcare delivery process.
Objective: To assess the effectiveness and cost-effectiveness of the complex intervention MULTIPAP Plus,
compared to usual care, in improving prescriptions for young-old patients (65-74 years old) with multimorbidity and
polypharmacy in primary care.
Methods/design: This is a pragmatic cluster-randomized clinical trial with a follow-up of 18 months in health
centres of the Spanish National Health System. Unit of randomization: family physician. Unit of analysis: patient
Social sciences, art and physical activity in leisure environments. An inter-disciplinary project for teacher training
Factors such as social change and increasing urbanization processes in the early years of the 21st century have caused a reduction in the amount of time that children devote to leisure activities in the open-air, resulting in more sedentary lifestyles than children in previous decades. An education in healthy habits from early ages to increase children’s physical and mental well-being together with their level of cultural knowledge contributes to the acquisition of a Leisure Culture that allows children to perceive the close environment as a scene for learning and enjoyment. It is thus be necessary for schools to foster pedagogical experiences, taking the physical and cultural environment as teaching resources. An innovation project is proposed which will be implemented with 25 university students from the School of Teacher Training and Education at the University of Oviedo (Oviedo, Spain). The project will consist of the proposal of educational itineraries through the city of Oviedo and Mount Naranco. As teachers-to-be, students must combine knowledge of the related areas and generate inter-disciplinary activities throughout the routes that will foster respect for the environment and leisure based on culture and physical activity, attitudes that they will transmit to their own students in the future
Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences
BACKGROUND: This paper examines the Willingness to Pay (WTP) for a quality-adjusted life year (QALY) expressed by people who attended the healthcare system as well as the association of attitude towards risk and other personal characteristics with their response. METHODS: Health-state preferences, measured by EuroQol (EQ-5D-3L), were combined with WTP for recovering a perfect health state. WTP was assessed using close-ended, iterative bidding, contingent valuation method. Data on demographic and socioeconomic characteristics, as well as usage of health services by the subjects were collected. The attitude towards risk was evaluated by collecting risky behaviors data, by the subject’s self-evaluation, and through lottery games. RESULTS: Six hundred and sixty two subjects participated and 449 stated a utility inferior to 1. WTP/QALY ratios varied significantly when payments with personal money (mean €10,119; median €673) or through taxes (mean €28,187; median €915) were suggested. Family income, area income, higher education level, greater use of healthcare services, and the number of co-inhabitants were associated with greater WTP/QALY ratios. Age and female gender were associated with lower WTP/QALY ratios. Risk inclination was independently associated with a greater WTP/QALY when “out of pocket” payments were suggested. Clear discrepancies were demonstrated between linearity and neutrality towards risk assumptions and experimental results. CONCLUSIONS: WTP/QALY ratios vary noticeably based on demographic and socioeconomic characteristics of the subject, but also on their attitude towards risk. Knowing the expression of preferences by patients from this outcome measurement can be of interest for health service planning
Utilidad de una estrategia de cribado de hipertensión ocular y glaucoma en atención primaria
ObjetivosEvaluar la utilidad de una estrategia de cribado de glaucoma e hipertensión ocular (HTO) medida como número de casos detectados. Evaluar la aceptabilidad de la toma de presión intraocular (PIO) y la aparición de efectos secundarios.DiseñoEstudio descriptivo transversal.EmplazamientoCentro de salud urbano y consulta de oftalmología del hospital de referencia.ParticipantesEn total, 2.044 pacientes mayores de 40 años, seleccionados por muestreo consecutivo entre los que consultaron en el centro de salud durante 9 meses. Se excluyeron los sujetos diagnosticados de glaucoma, HTO, conjuntivitis o enfermedad corneal.IntervencionesToma de PIO con Tonopen XL en atención primaria. Se remitió a oftalmología a los sujetos con una PIO≥21 mmHg. En éstos se midió la PIO con la prueba de Goldmann y, en los que se confirmó la HTO, se realizaron una oftalmoscopia y una campimetría.Mediciones principalesPorcentaje de sujetos con glaucoma, sospecha de glaucoma e HTO confirmada en oftalmología. Valor predictivo positivo (VPP) para HTO.ResultadosSe detectaron 100 sujetos con HTO (4,89%; intervalo de confianza [IC] del 95%, 3,93-5,85%), de los que 21 fueron diagnosticados de glaucoma (1,04%; IC del 95%, 0,57-1,49%) y 10 de sospecha de glaucoma (0,49%; IC del 95%, 0,16-0,82). El VPP para HTO fue del 44,27%. La aceptabilidad de la prueba fue del 98,09%. Ningún paciente presentó efectos secundarios tras la toma de la PIO.ConclusionesLa estrategia evaluada es útil en cuanto al porcentaje de sujetos con glaucoma e HTO detectados. La aceptabilidad de la toma de la PIO con Tonopen XL es alta.ObjectivesTo evaluate the usefulness of a glaucoma and intraocular hypertension screening strategy for new cases detected. To evaluate the acceptability of taking intraocular pressure (IOP) and the appearance of side effects.DesignCross-sectional, descriptive study.SettingAn urban health centre and the ophthalmology clinic of its main hospital.ParticipantsA total of 2044 patients aged over 40, 63.5% women and 36.5% men, with a mean age of 61.23 (SD, 11.42). They were selected by consecutive sampling from patients who visited the health centre over a 9-month period. Subjects diagnosed with glaucoma, ocular hypertension (OH), conjunctivitis, or corneal pathology were excluded.InterventionsTaking of IOP with Tonopen XL in primary care. Subjects with IOP ≥21 mm Hg were referred to ophthalmology. In these patients, IOP was measured with Goldmann, and patients with confirmed OH received ophthalmoscopy and campimetry.Main measurementsPercentage of subjects with glaucoma, suspected glaucoma, and OH confirmed in ophthalmology. Positive predictive value (PPV) for OH.ResultsOne hundred subjects with OH were detected (4.89%; 95% CI, 3.93%-5.85%), of whom 21 were diagnosed with glaucoma (1.04%; 95% CI, 0.57-1.49) and 10 with suspected glaucoma (0.49%; 95% CI, 0.16-0.82). The PPV for OH was 44.27%. The acceptability of the test was 98.09%. No patients presented with side-effects following the taking of their IOP.ConclusionsThe strategy evaluated is useful in terms of the number of subjects with glaucoma and OH detected. The acceptability of taking IOP with Tonopen XL was high
Differences between willingness to pay and willingness to accept for visits by a family physician: A contingent valuation study
Incidence of diabetes in patients treated with antipsychotics in primary care
Cartas al directorS
Study CAMBIMED: Effects of changes in medication appearance on safety of antihypertensive and hypolipidemic treatments in chronic patients older than 65 years in primary health care
Subsidized pharmacological treatment for smoking cessation by the Spanish public health system
INTRODUCTION Research has shown that financing drug therapy
increases smoking abstinence rates, although most of these
studies have been carried out in the private healthcare setting.
The aim of this work is to assess the effect of subsidized
pharmacological treatment on smoking cessation rates by the
Spanish public healthcare system.
METHODS A pragmatic, randomized, clinical trial was performed
by clusters. Randomization unit was the primary healthcare
center and the analysis unit was the patient. Smokers
consuming ≥10 cigarettes/day were randomly assigned to an
intervention group that received financed pharmacological
treatment or to a control group that followed usual care. The
main outcome was self-reported or CO-confirmed continuous
abstinence at 12 months. The main outcome, continuous
abstinence rates (%), were compared between groups at 12
months post-intervention. A model was adjusted using mixedeffect
logistic regression.
RESULTS A total of 1154 patients were included from 23
healthcare centers. In the intention-to-treat analysis, selfreported
abstinence after 12 months in the control and
intervention groups, respectively, was 9.6% (37/387) and
15.4% (118/767) (gender-adjusted OR=1.75; 95% CI: 1.1–
2.8); for CO-confirmed abstinence the corresponding values
were 3.1% (12/387) and 6.4% (49/767) (gender-adjusted
OR=1.72; 95% CI: 0.7–4.0). Pharmacological treatment use was
35.1% (136/387) in the control group, and 58.3% (447/767)
in the intervention group (adjusted OR=4.25; 95% CI: 1.8–9.9)
CONCLUSIONS Subsidizing pharmacological treatment for smoking
cessation increases self-reported or CO-confirmed abstinence
rates under realistic conditions in the primary care setting of
the Spanish public health systemThis trial was funded by the Fondo de Investigaciones Sanitarias
(FIS) del Instituto de Salud Carlos III (ISCIII), the European Regional
Development Fund (ERDF) under registration number 07528, as well
as the 2016 and 2017 calls for grants for translations and publishing
by the Fundación para la Investigación e Innovación Biosanitaria en
Atención Primaria (FIIBA
Adjusted morbidity groups: Characteristics and comorbidities in patients with chronic conditions according to their risk level in Primary Care
Objetivos: Describir las características de los pacientes crónicos según el nivel de riesgo asignado
por los grupos de morbilidad ajustados (GMA). Analizar los factores asociados al nivel de
riesgo alto y estudiar el efecto de cada uno de ellos.
Dise˜no: Estudio observacional descriptivo transversal con enfoque analítico.
Emplazamiento: Atención Primaria (AP). Servicio Madrile˜no de Salud.
Participantes: Población de 18.107 pacientes estratificados por los GMA integrados en la historia
clínica electrónica de AP de la Comunidad de Madrid.
Mediciones principales: Variables sociodemográficas, clínico-asistenciales y de uso de servicios.
Se realizó análisis univariado, bivariado y multivariante.
Resultados: De los 18.107 pacientes se identificaron 9.866 (54,4%) pacientes crónicos, 444
(4,5%) estratificados como de alto riesgo, 1.784 (18,1%) como de medio riesgo y 7.638 (77,4%)
como de bajo riesgo. Los de alto riesgo, comparados con medio y bajo riesgo, tenían una edad
media mayor (77,8 [12,9]; 72,1 [12,9]; 50,6 [19,4]), menor porcentaje de mujeres (52,3%, 65%,
61,1%), mayor número de enfermedades crónicas (6,7 [2,4]; 4,3 [1,5]; 1,9 [1,1]), polimedicación
(79,1%, 43,3%, 6,2%) y contactos con AP (33,9 [28]; 21,4 [17,3]; 7,9 [9,9]) (p < 0,01). En el multivariante
el nivel de riesgo alto se relacionó de manera independiente con la edad > 65 (OR = 1,43;
IC 95% = 1,03-1,99), sexo masculino (OR = 3,46; IC 95% = 2,64-4,52), inmovilidad (OR = 6,33; IC
95% = 4,40-9,11), número de enfermedades crónicas (OR = 2,60; IC 95% = 2,41-2,81) (p < 0,01) y
número de contactos con AP > 7 (OR = 1,95; IC 95% = 1,36-2,80).
Conclusiones: Más de la mitad de la población fue clasificada por los GMA como crónica, y se
estratificó en 3 niveles de riesgo que presentaban diferencias en sexo, edad, deterioro funcional,
necesidad de cuidados, morbilidad, complejidad, polifarmacia y contactos con AP. La edad > 65,
el sexo masculino, la inmovilidad, el número de enfermedades crónicas y los contactos con AP > 7 fueron los factores asociados al alto riesgo.Aims: To describe the characteristics of patients with chronic conditions according to their risk
levels assigned by the adjusted morbidity groups (AMG). To analyse the factors associated with
a high risk level and to study their effect.
Design: Observational cross-sectional study with an analytical focus.
Location: Primary care (PC), Madrid Health Service.
Participants: Population of 18,107 patients stratified by their risk levels with the AMG in the
computerised clinical records of Madrid PC.
Main measurements: The variables studied were: socio-demographic, clinical-nursing care and
use of services. Univariate, bivariate, and multivariate analysis were performed.
Results: Of the 18,107 patients, 9,866(54.4%) were identified as chronic patients, with 444
(4.5%) stratified as high risk, 1784 (18,1%) as medium risk, and 7,638 (77.4%) as low risk. The
high risk patients, compared with medium and low risk, had an older mean age [77.8 (SD = 12.9),
72.1 (SD = 12.9), 50.6 (SD = 19.4)], lower percentage of women (52.3%, 65%, 61.1%), a higher
number of chronic diseases [6.7 (SD = 2.4), 4.3 (SD = 1.5), 1.9 (SD = 1.1)], polymedication (79.1%,
43.3%, 6.2%), and contact with PC [33.9 (28), 21.4 (17.3), 7.9 (9.9)] (P <. 01). In the multivariate
analysis, the high risk level was independently related to age > 65 [1.43 (1.03-1.99), male gender
(OR = 3.46, 95% CI = 2.64-4.52), immobility (OR = 6.33, 95% CI = 4.40-9.11), number of chronic
conditions (OR = 2.60, 95% CI = 2.41-2.81), and PC contact > 7 times (OR = 1.95, 95% CI = 1.36-
2.80)] (P < .01).
Conclusions: More than half of the population is classified by the AMG as a chronic, and it is
stratified into 3 risk levels that show differences in gender, age, functional impairment, need for
care, morbidity, complexity, and use of Primary Care services. Age > 65, male gender, immobility,
number of chronic conditions, and contact with PC > 7 times were the factors associated with high risk
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