Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

the SPREDIA-2 Group To cite: Salinero-Fort Miguel Á, de Burgos-Lunar C,

Validating prediction scales of type

Adecuación del uso de las benzodiacepinas zolpidem y zopiclona en problemas atendidos en atención primaria

ObjetivoEstimar la proporción de prescripciones de las benzodiacepina zolpidem y zopiclona que cumplen criterios normativos de adecuada prescripción.Identificar las variables asociadas con una adecuada prescripción.DiseñoObservacional, transversal.ÁmbitoCentro de Salud de Monóvar del Área IV de Madrid.SujetosMuestra aleatoria de 270 prescripciones activas de benzodiacepinas en adultos del registro de prescripciones del sistema informático OMI-AP versión 5.0.MedicionesDimensiones: a) correcta indicación diagnóstica; b) ausencia de benzodiacepinas de vida media larga en ancianos; c) existencia de visitas de apoyo o seguimiento, y d) adecuación global o coexistencia de indicaciones correctas y visitas de seguimiento. Variables independientes recogidas en relación con el paciente, el prescriptor y la prescripción.ResultadosCorrecta indicación diagnóstica en el 75,6%, ausencia de benzodiacepinas de vida media larga en ancianos del 79,8%, existencia de visitas de apoyo en el 63,3% y adecuación global en el 53%. Principales diagnósticos: ansiedad pura en el 29%, ansiedad relacionada con otros procesos en el 18,6%, insomnio en el 14,8%, enfermedades circulatorias en el 14,8%, abuso de alcohol y drogas en el 4,5%, enfermedad osteomuscular en el 4,4% y esquizofrenia en el 4,4%. Sustancias más prescritas: lorazepam en el 27,8% y bromazepam en el 23,7%. Duración media de las prescripciones: 18,58 meses. Origen: el 68,5% en el centro de salud, el 10% en el cantro de salud mental y el 10% en el hospital. La variable que más se asocia con la adecuación global tras ajustar por las restantes variables es la prescripción originada en salud mental (odds ratio [OR]=6,67; intervalo de confianza [IC] del 95%, 1,92-23,18).ConclusionesLa duración media de las prescripciones contraviene todos los estándares. La adecuación global o coexistencia de indicación diagnóstica correcta con presencia de visitas de seguimiento se asocia con la prescripción en el ámbito de la salud mental.ObjetivesTo estimate the proportion of benzodiazepine prescriptions that comply with the guidelines for appropriate prescription.To identify the variables associated with appropriate prescription.DesignObservational, cross-sectional study.SettingMonóvar Health Centre in Area IV, Madrid, Spain.SubjetsRandom sample of 270 active benzodiazepine prescriptions in adult patients from the prescriptions record of the OMI-AP V. 5.0 computer system.MeasurementsThe chosen dimensions for appropriate prescription were: a) correct diagnostic indication; b) absence of benzodiazepines with long half-life in the elderly; c) existence of support or monitoring visits; d) oerall appropriateness or coexistence of correct diagnostic indications and monitoring visits. Independent variables were recorded in relation to patient, person prescribing and prescription.ResultsDiagnostic indication, 75.6%; absence of benzodiazepines with long half-life in the elderly, 79.8%; existence of support visits, 63.3%; overall appropriateness, 53%. Main diagnoses: pure anxiety, 29%; anxiety related to other illness, 18.6%; insomnia, 14.8%; cardiovascular illness, 14.8%; alcohol and drug abuse, 4.5%; osteo-muscular illness, 4.4%; schizophrenia, 4.4%. Most prescribed substances: lorazepam, 27.8%; bromazepam, 23.7%. Average life of prescriptions: 18.58 months. Origins: health centre, 68.5%; outpatient psychiatry, 10%; hospital, 10%. The variable that is most closely associated with overall appropriateness, fitted with the rest of the variables, is out-patient psychiatry prescription (OR, 6.67; 95% CI, 1.92-23.18).ConclusionsThe mean duration of the prescriptions infringes all standards. The overall appropriateness or correct coexistence of adequate diagnostic indication with followup visits is associated with out-patient Psychiatry prescription

Association between a mediterranean lifestyle and Type 2 diabetes incidence: a prospective UK biobank study

Abstract Background There is mounting evidence that the Mediterranean diet prevents type 2 diabetes, but little is known about the role of Mediterranean lifestyles other than diet and among non-Mediterranean populations. This work aimed to examine the association between a comprehensive Mediterranean-type lifestyle and type 2 diabetes incidence in a British adult population. Methods We used data from 112,493 individuals free of cardiovascular disease and type 2 diabetes mellitus, aged 40–69 years, from the UK Biobank cohort, who were followed from 2009 to 2010 to 2021. The Mediterranean lifestyle was assessed through the 25-item MEDLIFE index, which comprises three blocks: (a) “Mediterranean food consumption”, (b) “Mediterranean dietary habits”, (c) “Physical activity, rest, social habits, and conviviality”. Diabetes incidence was obtained from clinical records. Cox proportional-hazards regression models were used to analyze associations and adjusted for the main potential confounders. Results After a median follow-up of 9.4 years, 2,724 cases of type 2 diabetes were ascertained. Compared to the first quartile of MEDLIFE adherence, the hazard ratios (95% confidence interval) for increasing quartiles of adherence were 0.90 (0.82–0.99), 0.80 (0.72–0.89) and 0.70 (0.62–0.79) (p-trend < 0.001). All three blocks of MEDLIFE were independently associated with lower risk of diabetes. Conclusions Higher adherence to the MEDLIFE index was associated with lower risk of type 2 diabetes in the UK Biobank. A Mediterranean-type lifestyle, culturally adapted to non-Mediterranean populations, could help prevent diabetes

Health-Related Quality of Life of Latin-American Immigrants and Spanish-Born Attended in Spanish Primary Health Care: Socio-Demographic and Psychosocial Factors

<div><p>Background</p><p>This study compares the health-related quality of life of Spanish-born and Latin American-born individuals settled in Spain. Socio-demographic and psychosocial factors associated with health-related quality of life are analyzed.</p><p>Methods</p><p>A cross-sectional Primary Health Care multi center-based study of Latin American-born (n = 691) and Spanish-born (n = 903) outpatients from 15 Primary Health Care Centers (Madrid, Spain). The Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) was used to assess health-related quality of life. Socio-demographic, psychosocial, and specific migration data were also collected.</p><p>Results</p><p>Compared to Spanish-born participants, Latin American-born participants reported higher health-related quality of life in the physical functioning and vitality dimensions. Across the entire sample, Latin American-born participants, younger participants, men and those with high social support reported significantly higher levels of physical health. Men with higher social support and a higher income reported significantly higher mental health. When stratified by gender, data show that for men physical health was only positively associated with younger age. For women, in addition to age, social support and marital status were significantly related. Both men and women with higher social support and income had significantly better mental health. Finally, for immigrants, the physical and mental health components of health-related quality of life were not found to be significantly associated with any of the pre-migration factors or conditions of migration. Only the variable “exposure to political violence” was significantly associated with the mental health component (p = 0.014).</p><p>Conclusions</p><p>The key factors to understanding HRQoL among Latin American-born immigrants settled in Spain are age, sex and social support. Therefore, strategies to maintain optimal health outcomes in these immigrant communities should include public policies on social inclusion in the host society and focus on improving social support networks in order to foster and maintain the health and HRQoL of this group.</p></div

Physical (A) and mental (B) components of Health Related Quality of Life and pre-migration factors for Latin American-born immigrants.

<p>Physical (A) and mental (B) components of Health Related Quality of Life and pre-migration factors for Latin American-born immigrants.</p

Distribution of socio-demographic variables and social support in the study population, stratified by country of origin and gender.

<p>a: Differences between Spanish-born and Latin American-born p-value < 0.05.</p><p>b: Differences between Latin American-born men and women p-value < 0.05.</p><p>c: Differences between Spanish-born men and women p-value < 0.05.</p><p>d: Differences between Latin American-born and Spanish-born women p-value < 0.05.</p><p>e: Differences between Latin American-born and Spanish-born men p-value < 0.05.</p><p>f: Differences between women and men.</p><p>Bold type indicates total data.</p><p>Distribution of socio-demographic variables and social support in the study population, stratified by country of origin and gender.</p