Impact of the implementation of electronic guidelines for cardiovascular prevention in primary care: study protocol

Background The electronic medical records software of the Catalan Institute of Health has recently incorporated an electronic version of clinical practice guidelines (e-CPGs). This study aims to assess the impact of the implementation of e-CPGs on the diagnosis, treatment, control and management of hypercholesterolaemia, diabetes mellitus type 2 and hypertension.Methods Eligible study participants are those aged 35–74 years assigned to family practitioners (FPs) of the Catalan Institute of Health. Routinely collected data from electronic primary care registries covering 80% of the Catalan population will be analysed using two approaches: (1) a cross-sectional study to describe the characteristics of the sample before e-CPG implementation; (2) a controlled before-and-after study with 1-year follow-up to ascertain the effect of e-CPG implementation. Patients of FPs who regularly use the e-CPGs will constitute the intervention group; the control group will comprise patients assigned to FPs not regularly using the e-CPG. The outcomes are: (1) suspected and confirmed diagnoses, (2) control of clinical variables, (3) requests for tests and (4) proportions of patients with adequate drug prescriptions.Results This protocol should represent a reproducible process to assess the impact of the implementation of e-CPGs. We anticipate reporting results in late 2013.Conclusion This project will assess the effectiveness of e-CPGs to improve clinical decisions and healthcare procedures in the three disorders analysed. The results will shed light on the use of evidence-based medicine to improve clinical practice of FPs

Programa pilot de farmàcies sentinella: seguiment de la dispensació de l’anticoncepció d’urgència a Catalunya durant l’any 2016

Anticoncepció d’urgència; Farmàcies sentinella; Acetat d’ulipristalAnticoncepción de urgencia; Farmacias centinela; Acetato de ulipristalEmergency contraception; Sentinel drugstores; Ulipristal acetateIntroducció. Registre de la dispensació de l’anticoncepciód’urgència a les oficines de farmàcia sentinella de la província de Barcelona, amb l’objectiu d’obtenir informació sobre el perfil de les usuàries de la píndola postcoital i altres condicionants que permetin millorar les estratègies dels programes d’anticoncepció actuals. Mètodes. S’ha dissenyat un formulari electrònic amb 18 ítems. S’han recollit les dades de l’oficina de farmàcia, dels usuaris, del medicament, del tipus de dispensació, de la sospita de reaccions adverses i del tipus d’actuació farmacèutica. Resultats. Durant els deu mesos d’estudi, s’han rebut 205 notificacions de dispensació de la píndola postcoital. Pel que fa a l’adquisició de la píndola a les oficines de farmàcia segons edat i sexe, la mitjana d’edat de les dones és de 28,2 anys ± 7,8 anys i la dels homes, de 24 anys ± 6,3 anys. El 56,6% de les usuàries manifesten haver-se pres la medicació en altres ocasions, la majoria fa més d’un any. El principal mètode anticonceptiu que utilitzen és el preservatiu. En la majoria de les dispensacions, el farmacèutic ha realitzat actuacions addicionals i ha proporcionat informació personalitzada a l’usuari. Conclusions. La informació registrada permet identificar el perfil de les usuàries i el seu patró de conducta i, en conseqüència, es confirma la necessitat de continuar fent un seguiment de la dispensació de la píndola per tal de poder planificar estratègies educatives i de salut pública de l’ús dels diferents mètodes anticonceptius existents.Introducción. Registro de la dispensación de la anticoncepción de emergencia en las oficinas de farmacia centinela de la provincia de Barcelona, con el objetivo de obtener información sobre el perfil de las usuarias de la píldora postcoital y otros condicionantes que permitan mejorar las estrategias de los programas de anticoncepción actuales. Métodos. Se ha diseñado un formulario electrónico con 18 ítems. Se han recogido los datos de la oficina de farmacia, de los usuarios, del medicamento, del tipo de dispensación, de la sospecha de reacciones adversas y del tipo de actuación farmacéutica. Resultados. Durante los diez meses de estudio, se han recibido 205 notificaciones de dispensación de la píldora postcoital. En cuanto a la adquisición de la píldora en las oficinas de farmacia según edad y sexo, la media de edad de las mujeres ha sido de 28,2 ± 7,8 años y la de los hombres, de 24 ± 6,3 años. El 56,6% de las usuarias manifiestan haberse tomado la medicación en otras ocasiones, la mayoría hace más de un año. El principal método anticonceptivo que usan es el preservativo. En la mayoría de las dispensaciones, el farmacéutico ha realizado actuaciones adicionales proporcionando información personalizada al usuario. Conclusiones. La información registrada permite identificar el perfil de las usuarias y su patrón de conducta y, en consecuencia, se confirma la necesidad de continuar haciendo un seguimiento de la dispensación de la píldora con el fin de poder planificar estrategias educacionales y de salud pública sobre el uso de los diferentes métodos anticonceptivos existentes.Introduction. Emergency contraception dispensation register in sentinel pharmacy offices of Barcelona province, with the objective of obtaining information on users profile and other conditions that allow to improve current contraception programmes’s strategies. Methods. An 18-item electronic form was designed. Data on the pharmacy office, patient, drug, type of dispensing, suspected adverse reactions and type of pharmaceutical action were collected. Results. During the 10-month study, 205 postcoital contraceptive dispensing reports were received. As regards postcoital contraceptive purchased by age and sex, the mean age of women was 28.2 ± 7.8 years and men’s 24 ± 6.3 years. 56.6% of women users report having taken medication on previous occasions, most of them more than a year ago. The main contraceptive method used is condom. In most dispensations, pharmacists performed additional actions by providing individually-tailored information to patients. Conclusions. Registered information allows to identify users profile and their behaviour pattern, confirming the need to continue monitoring in order to be able to plan educational and public health strategies on the use of different contraceptive methods

Programa de vigilància de les infeccions nosocomials als hospitals de Catalunya (Programa VINCat)

Infeccions nosocomials; Hospitals; Vigilància epidemiològicaNosocomial infections; Hospitals; Epidemiological surveillanceInfecciones nosocomiales; Hospitales; Vigilancia epidemiológicaVINCat és un programa del Servei Català de la Salut que estableix un sistema de vigilància unificat de les infeccions nosocomials als hospitals de Catalunya. La seva missió és contribuir a reduir les taxes d’aquestes infeccions mitjançant la vigilància epidemiològica activa i continuada. El programa es fonamenta en la tasca que porten a terme els professionals dels equips multidisciplinaris de control d’infecció dels hospitals catalans.VINCat is a program of the Catalan Health Service that establishes a unified surveillance system for nosocomial infections in hospitals in Catalonia. Its mission is to help reduce the rates of these infections through active and ongoing epidemiological surveillance. The program is based on the work carried out by the multidisciplinary teams of infection control of Catalan hospitals.VINCat es un programa del Servicio Catalán de la Salud que establece un sistema de vigilancia unificado de las infecciones nosocomiales en los hospitales de Cataluña. Su misión es contribuir a reducir las tasas de estas infecciones mediante la vigilancia epidemiológica activa y continuada. El programa se fundamenta en la tarea que llevan a cabo los profesionales de los equipos multidisciplinares de control de infección de los hospitales catalanes

Quality indicators for patient safety in primary care. A review and Delphi-survey by the LINNEAUS collaboration on patient safety in primary care

Contains fulltext : 153776.pdf (publisher's version ) (Open Access)BACKGROUND: Quality indicators are measured aspects of healthcare, reflecting the performance of a healthcare provider or healthcare system. They have a crucial role in programmes to assess and improve healthcare. Many performance measures for primary care have been developed. Only the Catalan model for patient safety in primary care identifies key domains of patient safety in primary care. OBJECTIVE: To present an international framework for patient safety indicators in primary care. METHODS: Literature review and online Delphi-survey, starting from the Catalan model. Results : A set of 30 topics is presented, identified by an international panel and organized according to the Catalan model for patient safety in primary care. Most topic areas referred to specific clinical processes; additional topics were leadership, people management, partnership and resources. CONCLUSION: The framework can be used to organize indicator development and guide further work in the field

Leiomyosarcoma of the Infrarenal Inferior Vena Cava: Management in Three Cases and a Review of the Literature

Leiomyosarcoma (LMS) of the inferior vena cava (IVC) represents 90% of inferior vena cava tumours. It has a poor prognosis. We present three LMS of infrarenal IVC. Survival was long in two patients in spite of a non-radical resection. Chemotherapy and repeat surgery was performed for recurrence. The third patient was in complete remission at last follow-up at 29 months. Mainstay treatment for this tumour is surgical resection. Rescue surgery for local and metastastic recurrences together with systemic chemotherapy and radiotherapy may improve survival

Survival in Mediterranean Ambulatory Patients With Chronic Heart Failure. A Population-based Study

Contains fulltext : 127330.pdf (publisher's version ) (Closed access)INTRODUCTION AND OBJECTIVES: Scarce research has been performed in ambulatory patients with chronic heart failure in the Mediterranean area. Our aim was to describe survival trends in our target population and the impact of prognostic factors. METHODS: We carried out a population-based retrospective cohort study in Catalonia (north-east Spain) of 5659 ambulatory patients (60% women; mean age 77 [10] years) with incident chronic heart failure. Eligible patients were selected from the electronic patient records of primary care practices from 2005 and were followed-up until 2007. RESULTS: During the follow-up period deaths occurred in 950 patients (16.8%). Survival after the onset of chronic heart failure at 1, 2, and 3 years was 90%, 80%, 69%, respectively. No significant differences in survival were found between men and women (P=.13). Cox proportional hazard modelling confirmed an increased risk of death with older age (hazard ratio=1.06; 95% confidence interval, 1.06-1.07), diabetes mellitus (hazard ratio=1.53; 95% confidence interval, 1.33-1.76), chronic kidney disease (hazard ratio=1.73; 95% confidence interval, 1.45-2.05), and ischemic heart disease (hazard ratio=1.18; 95% confidence interval, 1.02-1.36). Hypertension (hazard ratio=0,73; 95% confidence interval, 0,64-0,84) had a protective effect. CONCLUSIONS: Service planning and prevention programs should take into consideration the relatively high survival rates found in our area and the effect of prognostic factors that can help to identify high risk patients. Full English text available from:www.revespcardiol.org/en