Good practice regarding smoking cessation management in Spain: Challenges and opportunities for primary care physicians and nurses

INTRODUCTION We analyze the activities carried out by primary care (PC) physicians and nurses with respect to smoking cessation and evaluate their self-reported training, knowledge, and behavior. METHODS A cross-sectional study was conducted including 1514 PC physicians and nurses from June 2016 to March 2017, in Spain. The main variable was Good Practice (GP) in attention to smokers. To identify associated factors, a multilevel logistic regression model was used adjusted for sex, age, type of center, contract, years of employment, tobacco consumption, and self-reported training/knowledge. RESULTS Of the 792 physicians and 722 nurses, 48.6% referred to GP in smoking cessation management. The finding related to: being a non-smoker (OR=1.8; 95% CI: 1.2-2.5) or ex-smoker (OR= 1.4; 95% CI: 1.02-2.1), having a good level of knowledge (OR=1.8; 95% CI: 1.3-2.4) and training (OR=2.4; 95% CI: 1.8-3.2), and, to a lesser extent, being female (OR=1.3; 95% CI: 1.03-1.7), and work experience >10 years (OR=1.4; 95% CI: 1.03-1.9). The main GP barriers were: lack of time (45.5%), organizational problems (48.4%), and 35.4% lack of training. CONCLUSIONS The GP of PC physicians and nurses regarding smoking cessation management is related to being non-smokers or ex-smokers, and having sufficient training and knowledge. Lack of time and organizational problems were considered to be the main barriers. The promotion of training activities in the Spanish National Health Service with the support of scientific societies is required

Seguimiento de la adherencia al tratamiento antidepresivo en pacientes que inician su consumo

Objetivo: Conocer la adherencia al tratamiento en pacientes que inician fármacos antidepresivos y analizar los factores asociados al incumplimiento, tanto clínicos como sociodemográficos. Diseño: Estudio observacional longitudinal prospectivo. Emplazamiento: Consultas de atención primaria y de salud mental de tres áreas sanitarias de Castilla-La Mancha. Participantes: Un total de 185 pacientes mayores de 18 años que iniciaron tratamiento antidepresivo. Mediciones principales: Cumplimiento terapéutico (test Haynes-Sackett, Morisky-Green, recuento de comprimidos y MEMS), efectos adversos, intensidad de los síntomas depresivos, características sociodemográficas y otras características relacionadas con los antidepresivos o con los participantes. Resultados: Tras 6 meses del inicio del tratamiento antidepresivo, el 46,9% (IC 95%: 36,5-57,3) mostró un cumplimiento inadecuado mediante el método de recuento de comprimidos, y el 28,6% (IC 95%: 19,1-38,0) con el cuestionario de Morisky-Green. A los 15 días la falta de adherencia fue del 48,5% (IC 95%: 40,6-56,4) y del 33,5% (IC 95%: 26,1-41,0), respectivamente. El 38,4% (IC 95%: 31,1-45,7) manifestó algún efecto secundario durante el seguimiento. Mediante un modelo de riesgos proporcionales de Cox las variables relacionadas con incumplimiento fueron menor edad, nivel de instrucción inferior a enseñanza secundaria, prestación farmacéutica como pensionista, no recibir tratamiento psicoterápico, consumir menor número de fármacos no antidepresivos y frecuentación ≤ 3 visitas al médico de familia los 3 meses previos al inicio del estudio. Conclusiones: El incumplimiento del tratamiento antidepresivo es elevado en atención primaria desde las primeras semanas tras iniciarlo. Constituyen factores condicionantes del mismo los relacionados con características sociodemográficas y con otras características de los pacientes como tipo de financiación de prestación farmacéutica y frecuentación a las consultas

Satisfacción con el tratamiento antidepresivo: validación del cuestionario "ESTA"

Background: We have no questionnaires to assess satisfaction with antidepressant treatment, which affects the health related quality of life. The objective was to develop and validate a specific instrument to assess satisfaction with antidepressant treatment, determining convergent validity regarding clinical effectiveness, fulfillment of expectations, adherence and tolerability. Methods: Longitudinal observational study where 168 patients started antidepressant treatment and were followed for one year. The variables included adverse effects, compliance and intensity of depressive symptoms. The questionnaire for the Evaluation of Antidepressant Treatment Satisfaction (ESTA) consists of 11 items answered using Likert scale. We evaluated its reliability, construct validity and concurrent validity with conceptually related measures with the construct assessed. Results: The Cronbach's alpha statistic ranged between 0.936 and 0.951. In the factor analysis one factor accounted for 64.11% of the variance. The average score of the questionnaire ranged from 40.0 to 44.7 points, showing a negative correlation regarding the Hamilton scale (-0.321 / -0.601) and Montgomery-Asberg scale (-0.491 / -0.307). After a month, the antidepressant treatment satisfaction was 39.5 points in noncompliant patients and 44.3 in compliers. In those who had adverse effects was 39.2 versus 43.3 for those who had not. At the first visit (15 days) the score was 40.0, in a month 42.6, in 3 months 44.4 and in 6 months 44.5. These differences were statistically significant (p <0.05). In test-retest analysis, intraclass correlation coefficient was 0.908. Conclusions: The questionnaire, designed to assess satisfaction with antidepressant treatment, is valid and reliable, and provides a patient-centered instrument which is complementary to the clinical assessment of the effectiveness of antidepressant treatment.Fundamento: No existen cuestionarios para evaluar la satisfacción con el tratamiento antidepresivo, el cual repercute en la calidad de vida relacionada con la salud. El objetivo fue desarrollar y validar un instrumento específico para valorar la satisfacción con el tratamiento antidepresivo, determinando su validez convergente respecto a su efectividad clínica, cumplimiento de expectativas, adherencia terapéutica y tolerabilidad. Métodos: Estudio observacional longitudinal donde 168 pacientes iniciaron tratamiento antidepresivo y fueron evaluados durante un año. Las variables incluyeron efectos adversos, cumplimiento e intensidad de síntomas depresivos. En el cuestionario para la Evaluación de la Satisfacción con el Tratamiento Antidepresivo (ESTA), de 11 ítems respondidos mediante escala Likert, se evaluó su fiabilidad, validez de construcción y concurrente con mediciones relacionadas conceptualmente con dicho constructo. Resultados: El α de Cronbach osciló entre 0,936 y 0,951. En el análisis factorial un solo factor explicó el 63,76% de la varianza. La puntuación media del cuestionario ESTA osciló entre 40,0 y 44,7 puntos, observándose una correlación negativa respecto a las escalas de Hamilton (-0,321/-0,601) y Montgomery-Asberg (-0,491/-0,307). La satisfacción con el tratamiento antidepresivo al cabo de un mes fue 39,5 en incumplidores y 44,3 en cumplidores. En quienes presentaron efectos adversos fue 39,2 frente a 43,3 de quienes no los presentaron. En la primera visita (15 días) la puntuación fue 40,0; al mes 42,6; a los 3 meses 44,4 y a los 6 meses 44,5. Estas diferencias fueron estadísticamente significativas para p<0,05. En el análisis de fiabilidad test-retest el coeficiente de correlación intraclase fue 0,908. Conclusiones: El cuestionario ESTA, diseñado para evaluar la satisfacción con el tratamiento antidepresivo, es válido y fiable, constituyendo un instrumento de medición centrado en el paciente complementario a la valoración clínica de la efectividad del tratamiento antidepresivo

Comorbilidad y riesgo cardiovascular en sujetos con primer diagnóstico de hipercolesterolemia

Background: For a proper approach to the subjects, in which the presence of hypercholesterolemia is identified for the first time, is important to consider simultaneously both cardiovascular risk factors and the presence of other diseases. The purpose of our study was to describe the lipid profile of patients in which the presence of hypercholesterolemia is detected for the frist time and to determine their cardiovascular risk and comorbidity. Methods: Observational cross-sectional study in a Primary Care setting. In 274 subjects with a plasma cholesterol level higher or equal to 200 mg / dL ("limit" hypercholesterolemia), selected by consecutive sampling, we assessed: lipid profile, cardiovascular risk factors and cardiovascular risk (SCORE and Castelli's atherogenic index), comorbidity (Charlson's Index) and sociodemographic characteristics. Results: The mean cholesterol level was 232.9 mg/dl. Hypercholesterolaemia was reported "definite" (>= 250 mg / dl) in 21.1% (95% CI: 16.2 to 26.1). A 9.5% showed a cardiovascular risk >= 5%. Lipoprotein ratio of total cholesterol/HDL cholesterol was higher in men than in women (4.4 vs. 3.8, p = 1 (4.1 vs. 3.9, p = 0.04), in smokers (4.3 vs. 3.9, p = 0.04) and in hypertensive subjects (4.2 vs. 3.9, p = 0.03), obese (4.2 vs 3 , 7, p 200 mg/dl (hipercolesterolemia "límite"), seleccionados mediante muestreo consecutivo. Se evaluó perfil lipídico, factores de riesgo cardiovascular y riesgo cardiovascular (SCORE e índice aterógénico de Castelli), comorbilidad (Índice de Charlson) y características sociodemográficas. Resultados: El nivel medio de colesterol fue de 232,9 mg/dl. Se observó hipercolesterolemia "definida" (>250 mg/dl) en el 21,1% (IC95%: 16,2-26,1). El 9,5% mostró un riesgo cardiovascular >5%. El cociente lipoprotéico colesterol total/colesterol HDL fue superior en hombres que en mujeres (4,4 vs 3,8 (p1 (4,1 vs 3,9 p=0,04), en fumadores (4,3 vs 3,9 (p=0,04) y en sujetos hipertensos (4,2 vs 3,9,(p=0,03), obesos (4,2 vs 3,7 (p<0,05) o con síndrome metabólico (4,4 vs 3,9 (p=0,02). Se observó mayor proporción de sujetos con riesgo cardiovascular moderado/alto o enfermedad cardiovascular entre los que presentaban comorbilidad (87,3% vs 42,3% (p<0,01). Conclusiones: Más de la tercera parte de los sujetos en los que se identifica por primera vez hipercolesterolemia "límite" presenta comorbilidad, tratándose de hipercolesterolemia "definida" en el 21,1%. Considerando la función Score, uno de cada 10 pacientes presenta riesgo elevado de mortalidad cardiovascular después de 10 años. Tanto el cociente lipoprotéico como el cardiovascular son claramente superiores en sujetos que presentan comorbilidad

Attitudes towards anti-smoking legislation and prevalence of tobacco consumption in Spanish primary healthcare personnel

Introduction Our aim was to ascertain how the anti-smoking legislation of 2005/2010 has affected the behavior of primary healthcare center (PHC) personnel (medical and nonmedical) with respect to their attitudes towards tobacco, its consumption and the legislative changes. Methods The sample consisted of 2040 PHC employees (1578 women, 77.4%). Never smokers, ex-smokers, and smokers represented 46.7%, 37.8%, and 15.5% of the sample, respectively. Tobacco prevalence amongst physicians and nurses was 12.3%. Following the introduction of the antismoking legislation, a decrease in consumption was observed. Most of the participants considered that tobacco consumption affected health, was an addictive illness, and passive smoking had an impact on the health of non-smokers. Whilst 91.6% agreed with the current legislation, only 25% felt that it encouraged cessation. Results The sample was made up of 2040 PHC employees (1578 women; 77.4%). Never smokers, ex-smokers, and smokers represented 46.7%, 37.8%, and 15.5%, respectively. Tobacco prevalence amongst physicians and nurses was 12.3%. Following the introduction of the anti-smoking legislation a decrease in consumption was observed. Most of the participants considered that tobacco affected health, was an addictive illness, and passive smoking had an impact on the health of non-smokers. Whilst 91.6% agreed with the current legislation, only 25% felt that it encouraged cessation. Conclusions Spanish primary healthcare professionals have a relatively low prevalence of smoking compared to the general population. It is necessary to implement more legislative measures to improve and maintain this outcome