Sistemas de gestión para la renovación de recetas médicas: estrategia para optimizar su utilización

ResumenObjetivoMejorar el cumplimiento de los pacientes con el sistema de medicación repetida. Evaluar los motivos de impuntualidad en la recogida de las recetas y su relación con el incumplimiento terapéutico declarado por el mismo paciente.DiseñoEstudio de intervención cuasiexperimental antes-después con grupo control.EmplazamientoCentro de atención primaria que atiende a una población de 62.981 habitantes.ParticipantesPacientes con enfermedades crónicas incluidos en el sistema de gestión de medicación repetida (100 en el grupo control y 100 en el grupo intervención) que son impuntuales al recoger las recetas.IntervencionesSesión informativa-educativa consistente en una breve entrevista con la farmacéutica del centro de atención primaria, en la que se educaba al usuario en el cumplimiento del sistema de medicación repetida y del tratamiento, se identificaban los motivos de impuntualidad y se realizaba el test de Morisky-Green.Mediciones principalesPuntualidad de los pacientes en las recogidas de recetas posteriores a la intervención. Motivo de impuntualidad en la recogida de reclutamiento. Cumplimiento terapéutico según el test de Morisky-Green.ResultadosGlobalmente se obtuvo una mejora absoluta de la puntualidad del 17% en el grupo intervención (el 60% de los pacientes del grupo intervención y el 43% del grupo control fueron puntuales tanto en la primera como en la segunda recogida de seguimiento). Las mujeres del grupo intervención fueron más puntuales. No se observaron diferencias por edad, número de medicamentos o motivo de impuntualidad.ConclusionesEs posible mejorar el cumplimiento de los pacientes con el sistema de medicación repetida mediante una sencilla intervención informativa-educativa.AbstractObjectiveTo improve patient compliance with a repeat prescription system. To evaluate the reasons for not being punctual in collecting prescriptions and the non-compliance declared by the patients themselves.DesignQuasi-experimental study before and after intervention including a control group.SettingPrimary health care centre which serves a population of 62,981 inhabitants.ParticipantsPatients with chronic diseases included in the repeat prescription management system (100 in the control group and 100 in the intervention group) who were unpunctual in collecting their prescriptions.InterventionsAn informative-educational session consisting of a short interview with the pharmacist from Primary Health Care Centre, in which the patient was educated on compliance of the repeat prescription system and treatment. The reasons for the unpunctuality were identified and the Moriskey-Green test was performed.Main measurementsPunctuality of the patients in collecting their prescriptions after the intervention. Reasons for unpunctuality recorded at recruitment. Therapeutic compliance according to the Moriskey-Green test.ResultsThere was an overall absolute improvement of 17% in punctuality in the intervention group (60% of the patients in the intervention group and 43% in the control group were punctual in the first as well as in the second follow up. Women were more punctual in the intervention group. There were no differences seen due to age, number of medications or reason for unpunctuality.ConclusionsIt is possible to improve patient compliance with the prescription renewal system using a simple informative-educational intervention

Relación entre calidad y coste de la prescripción farmacológica en atención primaria

ObjetivoAnalizar la prescripcion farmaceutica de los medicos generales (MG) segun un sistema de indicadores cualitativos y evaluar la relacion de estos con el gasto global de prescripcion farmaceutica por habitante.DisenoEstudio descriptivo, retrospectivo.EmplazamientoAtencion primaria.Mediciones y resultados principalesSe evalua la prescripcion farmaceutica de 285 MG de 32 equipos de atencion primaria, siendo la prescripcion individual de cada medico la unidad de analisis. La prescripcion se clasifico en 3 categorias segun su valor intrinseco (%VIF): bajo (. 75%), medio (76–79%) y alto (. 80%). Como trazadores de hiperprescripcion fueron seleccionados: DHD antibioticos (AB), DHD antiinflamatorios no esteroides (AINE) y DHD antiulcerosos (ULC), y como trazadores de seleccion: %DHD cefalosporinas tercera generacion/DHD cefalosporinas totales (CEF3.aG), %DHD quinolonas amplio espectro/DHD quinolonas totales (QAP), %DHD AINE/DHD (AINE + analgesicos) (ANAL). Los indicadores cuantitativos estudiados fueron: gasto total/poblacion asignada (GPA), coste/receta farmacos de eficacia dudosa y coste/DDD de AB, AINE y ULC. Se aplico el analisis de variancia, incluyendo la prueba de Scheffe para comparaciones multiples y la correlacion lineal de Pearson. Un 26% de las prescripciones tenia un %VIF < 75%, mientras que el 34% lo tenia > 80%. Las medias de DHD AB entre las categorias de VIF eran diferentes (p < 0,0001), al igual que las de DHD de AINE (p < 0,0001) y ULC (p = 0,007), observandose un menor consumo de AB, AINE y ULC en las prescripciones con VIF mas alto. Las CEF3aG, asi como ANAL presentan diferencias significativas con las 3 categorias de VIF (p < 0,0001 y p = 0,041) a diferencia del QAP (p = 0,18). El GPA es menor entre los MG cuyas prescripciones tenian el %VIF mas alto; en cambio, el coste/receta y el coste DDD no presentaron diferencias significativas segun categorias de %VIF.ConclusionesLos medicos con mejor perfil cualitativo segun estos indicadores presentan un menor gasto por habitante. En cambio, no se observan diferencias en el coste por receta ni en el coste/tratamiento entre los distintos medicos. Por tanto, las intervenciones deben priorizar la mejora de la calidad de la prescripcion farmaceutica antes que promover unicamente el cambio al farmaco de menor coste.ObjectivesWith a system of qualitative indicators, to analyse the pharmaceutical prescription of general practitioners (GPs), and to evaluate the relationship of these indicators to the overall pharmaceutical prescription expenditure per inhabitant.DesignRetrospective descriptive study.SettingPrimary care.Measurements and main resultsThe drugs prescription of 285 GPs from 32 primary care teams was evaluated, with the individual prescription of each doctor as the unit of analysis. The prescription was classified in 3 categories according to its intrinsic value (IV): low (. 75%), medium (76–79%) and high (. 80%). Selected as tracers of over-prescription were: daily dose per inhabitant (DDI) of antibiotics (AB), DDI of non-steroid anti-inflammatory drugs (NSAID), and DDI of ulcer drugs (ULC). Selected as tracers of selection were: % DDI third-generation cephalosporins/DDI total cephalosporins; % DDI broad-spectre quinolones/DDI total quinolones; and % DDI NSAID/DDI NSAID plus analgesics. Quantitative indicators studied were: total expenditure per allocated population, cost per drugs prescription of doubtful efficacy, and cost per daily dose of AB, NSAID and ULC. Variance analysis, including the Scheffe test for multiple comparisons and Pearson's linear correlation, was applied. 26% of the prescriptions had an IV below 75%, and 34% had an IV above 80%. The means of DDI of AB among the categories of IV were different (p < 0.0001), as were those of DDI of NSAID (p < 0.0001) and of ULC (p = 0.007). Lower consumption of AB, NSAID and ULC was found in prescriptions with the highest IV %. The third-generation cephalosporins and the NSAID + analgesics showed significant differences in the three IV categories (p < 0.0001 and p = 0.041), unlike broad-spectrum quinolones (p = 0.18). The total expenditure per allocated population was less for GPs whose prescriptions had the highest IV %; whereas the cost per prescription and cost per daily dose showed no significant differences for IV categories.ConclusionsThe doctors with the best qualitative profile on these indicators had less expenditure per inhabitant. However, no differences were found in the cost per prescription or cost per treatment between doctors. Therefore, interventions must prioritise improving drug prescription quality rather than just promoting changes to lower-cost drugs

Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People

Background: SARS-CoV-2 has caused a high mortality in institutionalised individuals. There are very few studies on the involvement and the real impact of COVID-19 in nursing homes. This study analysed factors related to morbidity and mortality of COVID-19 in institutionalised elderly people. Methods: This cohort study included 842 individuals from 12 nursing homes in Sant Cugat del Vallès (Spain) from 15 March to 15 May 2020. We evaluated individual factors (demographic, dependence, clinical, and therapeutic) and those related to the nursing homes (size and staff) associated with infection and mortality by SARS-CoV-2. Infection was diagnosed by molecular biology test. Results: Of the 842 residents included in the analysis, 784 underwent a Polymerase Chain Reaction (PCR) test; 74.2% were women, the mean age was 87.1 years, and 11.1% died. The PCR test was positive in 44%. A total of 33.4% of the residents presented symptoms compatible with COVID-19 and of these, 80.9% were PCR-positive for SARS-CoV-2. Infection by SARS-CoV-2 among residents was associated with the rate of staff infected in the homes. Mortality by SARS-CoV-2 was related to male sex and a greater grade of dependence measured with the Barthel index. Conclusions: SARS-Cov-2 infection in institutionalised people is associated with the infection rate in nursing home workers and mortality by SARS-Cov-2 with sex and greater dependency according to the Barthel index. Adequate management of nursing home staff and special attention to measures of infection control, especially of individuals with greater dependence, are keys for successful management of future pandemic situations. Keywords: COVID-19; comorbidity; frail elderly; frailty; long-term care; nursing homes

Impact of pharmaceutical promotion on prescribing decisions of general practitioners in Eastern Turkey

<p>Abstract</p> <p>Background</p> <p>Commercial sources of information are known to have greater influence than scientific sources on general practitioners' (GPs) prescribing behavior in under developed and developing countries. The study aimed to determine the self-reported impact of pharmaceutical promotion on the decision-making process of prescription of GPs in Eastern Turkey.</p> <p>Methods</p> <p>A cross-sectional, exploratory survey was performed among 152 GPs working in the primary health centers and hospitals in Erzurum province of Eastern Turkey in 2006. A self-administered structured questionnaire was used. The questionnaire included questions regarding sociodemographics, number of patients per day, time per patient, frequency of sales representative visits to GPs, participation of GPs in training courses on prescribing (in-service training, drug companies), factors affecting prescribing decision, reference sources concerning prescribing and self-reported and self-rated effect of the activities of sales representatives on GPs prescribing decisions.</p> <p>Results</p> <p>Of 152 subjects, 53.3% were male and 65.8% were working at primary health care centers, respectively. Mean patient per day was 58.3 ± 28.8 patients per GP. For majority of the GPs (73.7%), the most frequent resource used in case of any problems in prescribing process was drug guides of pharmaceutical companies. According to self-report of the GPs, their prescribing decisions were affected by participation in any training activity of drug companies, frequent visits by sales representatives, high number of patient examinations per day and low year of practice (p < 0.05 for all).</p> <p>Conclusion</p> <p>The results of this study suggest that for the majority of the GPs, primary reference sources concerning prescribing was commercial information provided by sales representatives of pharmaceutical companies, which were reported to be highly influential on their decision-making process of prescribing by GPs. Since this study was based on self-report, the influence reported by the GPs may have been underestimated.</p

The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with &gt;80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

Lola Cabello : una malagueña que triunfó en Barcelona (1920-1936)

Barcelona ha sido un polo de atracción constante durante el siglo XIX y XX para todo tipo de artistas, en especial, los flamencos. Las fuentes hemerográficas no dejan lugar a dudas de este particular El Dorado flamenco, con centenares de locales, espectáculos, público y artistas que dejaron huella en la ciudad condal. Lola Cabello fue una cantaora malagueña de origen y barcelonesa de adopción que se convirtió en una estrella del firmamento flamenco en los años 30 del siglo XX. Descubriremos sus inicios en Radio Barcelona con el guitarrista Rejón y sus incesantes actuaciones con Pepe Hurtado, gran guitarrista flamenco de concierto en multitud de teatros y cines de Barcelona. Desgraciadamente, murió joven, en el apogeo de su carrera artística, y ha sido olvidada por los aficionados. Este artículo es un pequeño homenaje a su memoria

Carmen Amaya, star de Hollywood

El presente artículo ofrece un recorrido cronológico por las apariciones cinematográficas de Carmen Amaya y su compañía en Estados Unidos, desde su llegada a Nueva York en diciembre de 1940 hasta 1945. El primer cortometraje en el que actuó fue Original Gypsy Dances promovido por Sol Hurok en 1941. Participó en el rodaje de Panama Hattie en 1942 aunque, finalmente, sus escenas fueron eliminadas de la versión en las salas comerciales. Sigue inédito un documental sobre su vida titulado The Life of Carmen Amaya que iba a ser rodado en 1943. Actuó en Knickerbocker Holiday y Follow the Boys, ambas estrenadas en 1944 y, por último, fue contratada en la comedia See My Lawyer, de 1945. Estas importantes apariciones en películas de Hollywood confirman su acreditada fama como bailarina gitana y sus dotes para la interpretación.Abstract: This article offers a chronological view over Carmen Amaya and her company's movie appearances in the United States, from her arrival to New York on December 1940 till 1945. In 1941, Sol Hurok commissioned Original Gypsy Dances to promote them. In 1942, she had a contract to act in the film Panama Hattie, but finally she didn’t appear in the finished version. She also performed in Knickerbocker Holiday and Follow the Boys during 1944 and, finally, in See My Lawyer in 1945. This relevant appearances in Hollywood films confirms that Carmen Amaya was a famous gypsy dancer at that time and that she was a talented actress

El flamenco en Barcelona : intentos de adaptación a la II República

Los artistas flamencos que actuaron en Barcelona se amoldaron a los cambios políticos que se iban sucediendo durante la II República. Aunque parte de la bibliografía coloca al flamenco en el espacio propio de la derecha, las actividades flamencas durante los años treinta, con todos sus vaivenes políticos y sociales, estuvieron a menudo comprometidas con la ideología republicana. El ejemplo más claro de esta adaptación fue la creación de los fandangos republicanos, fandangos naturales con letras alusivas a la República, la mayoría de los cuales fueron grabados en compañías discográficas con sede en Barcelona y con artistas asíduos a la cartelera barcelonesa como Guerrita, Miguel Borrull, Manolo Bulerías, Pepe Hurtado, el Chato de las Ventas o el Gran Fanegas. De todos modos, el flamenco, como arte, no debe ser encajado en una determinada corriente política o ideológicaThe Flamenco artists who performed in Barcelona ad apted to political changes that took place during the Second Republic. Though most of the bibliography positions flamenco to the right, flamenco activities during t he politically and socially unstable thirties were often committed to republican ideolog y. The clearest example of this adaptation was the creation of the republican fanda ngos, natural fandangos (without measure) with lyrics allusive to the Republic. The majority of these were recorded in the studios of Barcelona based record companies, and fe atured artists who regularly performed in the city, such as Guerrita, Miguel Bor rull, Manolo Bulerías, Pepe Hurtado, Chato de las Ventas or Gran Fanegas. In any case, flamenco, as an art form should not b e labelled with any specific political ideology