9 research outputs found

    Adherence to european clinical practice guidelines for secondary prevention of cardiovascular disease : A cohort study

    Get PDF
    Funding: This study was supported by a grant from the Primary Health Care University Research Institute (IDIAP) Jordi Gol located in Barcelona, Spain (Grant ref: IDIAP 7Z12/006).To provide a better understanding of the actions taken within health systems and their results, this study aims to assess clinicians' adherence to clinical practice guidelines regarding recommended treatments in patients with cardiovascular disease in primary care settings, and to determine the associated factors. We conducted an ambispective cohort study in 21 primary care centres in 8 Spanish regions. Patients diagnosed with coronary heart disease, stroke and/or peripheral arterial disease were included. Patients who received the treatment recommended in the European guidelines on cardiovascular disease prevention (CPG's adherent group) were compared with patients who did not (CPG's non-adherent group). The outcome variables were cardiovascular hospital admissions, all-cause and cardiovascular mortality during follow-up. Of the 438 participants, 38.6% (n = 169) received the drug therapies recommended in the guidelines. The factors that increased the likelihood of good adherence to CPG's were being diagnosed with hypertension (p = 0.001), dyslipidaemia (p < 0.001) or diabetes (p = 0.001), and not having a psychiatric disorder (p = 0.005). We found no statistically significant association between good adherence to CPG's and lower incidence of events (p = 0.853). Clinician adherence to guidelines for secondary prevention of cardiovascular disease was low in the primary care setting

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

    Get PDF
    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

    Get PDF
    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Impacto de una intervención múltiple sobre la calidad y el gasto de la prescripción de medicamentos en atención primaria y sobre el uso de fármacos para la osteoporosis en mujeres postmenopáusicas

    Get PDF
    La prescripción de medicamentos es una de las tareas esenciales de los médicos que trabajan en atención primaria y constituye un complejo ejercicio de responsabilidad profesional y ética. Realizar una prescripción adecuada a las necesidades de cada paciente es una preocupación constante de los médicos de familia. Desde hace años, organismos internacionales como la Organización Mundial de la Salud ha promovido una prescripción razonada de medicamentos y, por otro lado, los sistemas nacionales de salud se han dotado de herramientas para implementar sus políticas de medicamentos y de indicadores para evaluar los resultados. En este estudio se analiza el efecto de una intervención sobre la calidad de la prescripción de los médicos de atención primaria y sobre el gasto de medicamentos. Objetivo: analizar el efecto de una intervención múltiple, que combina acciones de información y formación continuada con la monitorización y retroalimentación de los resultados, sobre el porcentaje de médicos que mejoran los indicadores de la calidad de su prescripción de medicamentos en el ámbito de atención primaria de Terres del Ebre (TE) del Institut Català de la Salut (ICS), entre los años 2006 y 2012. Para diseñar, coordinar y poner en marcha esta intervención se constituyó un Comité Farmacoterapéutico (CFT) de Atención Primaria formado principalmente por médicos especialistas en medicina familiar y comunitaria y que cuenta con el apoyo técnico de la Fundació Institut Català de Farmacologia. Emplazamiento: ámbito de atención primaria de la Gerencia de TE que atiende una población de 189.091 habitantes. Participantes: 150 médicos de atención primaria que trabajan en 11 áreas básicas de salud. Mediciones principales: la variable principal utilizada fue el porcentaje de médicos que consiguen más del 75% de puntuación de los objetivos de farmacia. Se comparan los cambios producidos en esta variable entre los años 2006 y 2008 y su evolución hasta el 2012. Como grupo control se utiliza el resto de médicos del ICS. Resultados: el porcentaje de médicos de TE que consiguen más del 75% de puntuación de los objetivos del estándar de la calidad de la prescripción se iguala al ICS en el año 2008, a pesar de que partía de un porcentaje menor que el ICS en 2006. Este porcentaje se mantiene estable hasta el 2012 en que se reduce en TE, mientras que continua aumentando en el resto del ICS. La evolución del gasto en TE ha sido similar al resto del ICS. Sin embargo, TE es el tercer ámbito territorial que experimenta un mayor descenso del gasto entre los años 2006 y 2012. Conclusiones: la intervención realizada ha tenido un efecto moderado en la mejoría de la calidad de la prescripción y en la reducción del gasto. El CFT, liderado por clínicos, es un instrumento útil para diseñar y coordinar actividades dirigidas a mejorar la calidad de la prescripción de los médicos.Drug prescription is an essential task of physicians working in primary health care. It is a complex professional exercise and an ethical responsibility. To adapt drug prescribing to each patient's needs is a common concern among primary care physicians. International organizations like World Health Organization have promoted rational prescribing of drugs for years. National health systems as well have developed tools to implement their drug policies and indicators to evaluate results. The effect of an intervention on the quality of prescribing primary care physicians and on the drug spending is analyzed in this study. Objective: to analyze whether a multifaceted intervention has an effect on the percentage of primary care physicians who improve their prescribing quality indicators between 2006 i 2008 in Terres del Ebre in the Institut Català de la Salut (ICS). This intervention combines actions of information and continuing education with monitoring and feedback of results. In order to design, coordinate and implement this intervention, a pharmacotherapeutic Committee (CFT) of primary care was set up. This CFT includes mainly specialists in family and community medicine and has the technical support of the Catalan Institute of Pharmacology Foundation. Location: a population of 189.091 residents is served by the primary health care system in TE. Participants: 150 primary health care physicians who are working in 11 primary health care centers. Primary endpoint: the primary outcome used was the percentage of physicians who get more than 75% score goals in their prescribing quality indicator. Changes in this variable between 2006 and 2008 and its evolution until 2012 are compared. The rest of ICS primary health care physicians are used as a control group. Results: The percentage of physicians of TE getting more than 75% score goals in their prescribing quality indicator is similar to that in the rest of the ICS physicians in 2008, although TE started from a lower percentage than the ICS in 2006. This percentage has remained stable until 2012 when TE is reduced while it continues to rise in the rest of the ICS. The evolution of drug expenditure in TE was similar to that in the rest of ICS. However, TE is the third territory experiencing a greater decline in spending between 2006 and 2012. Conclusions: the intervention has had a moderate effect on improving the prescribing quality indicator and on reducing spending. The CFT, led by clinicians, is a useful tool to design and coordinate activities to improve quality of physicians prescribing

    Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

    Get PDF
    BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas

    Elective Cancer Surgery in COVID-19–Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study

    No full text

    Delaying surgery for patients with a previous SARS-CoV-2 infection

    Get PDF
    Not availabl
    corecore