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1. Seguimiento de las guías españolas para el manejo del asma por el médico de atención primaria: un estudio observacional ambispectivo

Author

M. Roman-Rodriguez, J. Molina-Paris, A. Fernandez-Sanchez, Mohsen Abedianzadeh Timar, Jesús Acha Domínguez, Jesus Aguaviva Bascuñana, Ignacio Aguilar Martín, Francisco Ignacio Ales Conejo, Juan Vicente Alfaro González, Patricia Alfonso Landa, Andrés Altés Boronat, Jesús Joaquín Álvarez Arriero, Juan Ángel Álvarez Rojo, Allut Vidal German, Jesús Amaro Cendón, María Teresa Amiano Arregui, Esther Angulo Vallejo, Juan José Anton Álvarez, Javier Anton Ortega, Ana Arconada Perez, Lidia Ardiaca Burgués, Juan Manuel Armario Vázquez, Amador Arroyo Cubeiro, Koldo Aso Mendialdea, Francesca Attardo, José Francisco Ávila de Tomás, M. Jesús Avinent Arnal, Francisco Aznar Aguilar, Pilar Aznar Tejero, Emilio Baena Montilla, José María Baeza López, Juan José Barón Carrillo, Rafael Bartolomé Resano, Francisco Becoña de la Torre, Isabel Benavent Martín, María Teresa Benedí Sánchez, José Berrocal del Brío, Antonio Blanco Delgado, Jesús Bleda Cano, Josep Boladeras Sabater, Zenaida Bolívar Mantilla, Elisenda Brito Brito, M. Rosario Burgos Parra, Isaac Buxadé Martí, Juan Carlos Caballero Garcia, Luis Fernando Cabañas Enríquez, Marcelino Calviño Cerqueiro, Juan Calvo Fernández, Felipe Calle Velles, Beatriz Camaro Zafra, Jaume Campomar Quetlas, Mónica Capitán Jurado, Dolores Cárdenas Joyanes, Gonzalo Carles Bueso, Cristina Carvajal Puente, Cristina Casado Rodriguez, Carlos Casanova García, Santiago Castellà Cahiz, Cristina Castellà Cuesta, Manuel Antonio Castellano Martínez, Rafael Catalán Félez, Miguel Ángel Cavada García, Antonio Cavada Velasco, Jose Luis Cidra Gordillo, Julia Clemente Garcia, José Luis Collada Jiménez, Andrés Cornejo Figueroa, Roberto Cornejo Rodríguez, Julio Cuevas Morales, María Jesús Curado-Moliní Álvarez, Susana Daviña Romero, Leonor de Arriba Muñoz, Manuel de la Flor Benítez, Mariam de la Poza Abad, Gustavo de los Bueis Martinez, María Pía de Miguel Márquez, Jesús de Pablo Martín, Manuel Delgado Mora, Joaquín Díaz Mateo, Almudena Díaz Saborido, María Díez-Caballero Murua, Constantino Doganis Peppas, Gonzalo Domínguez Alonso, Julián Domínguez Ávila, María Nieves Domínguez González, María Isabel Domínguez Hernández, Javier Oscar Dosantos Hernández, Aurelio Dueñas Buey, M. Jesús Eiris Cambre, Yussef Abu El Wafa Vaca, Antonio Alberto Enseñat Sanchez, Eulalia Esquerra Tuñí, José María Esteve Ribelles, José Antonio Estevez Barrondo, M. Dolores Estraviz Vidal, Rosa María Fajardo Salguero, José Francisco Felipe Olivero, María Luisa Fernández Bujía, Patricia Fernández Cano, M. Isabel Fernández Cañaveras, Carmen Fernández Fernández, José Manuel Fernández García, Patricia Fernández Gómez, José María Fernández González, Irene Fernández Gutiérrez Denia, M. Esther Fernández Huelga, Yolanda Fernández Martin, Francisco Fernández Navarro, Araceli Fernández Revuelta, José María Fernández Toro, Luis María Fernández-Pacheco Corchado, Joaquín Ferrándiz Miquel, Carmen Ferrari Piquero, José María Ferrer García-Borrás, Carlos Gago Fernandez, Fernando Gago Gómez, Luz Inmaculada Galera de Ulierte, Ingrid Gallegos Juárez, José Enrique Garceran Azorín-Gómez, Carmen Garcés Romero, Francisco Javier García Alonso, Andres A. García Cabana, Josefa García Cano, Victoria Gema García Ceballos, Sara García de Francisco, Francisco García Fuentes, Yolanda García Vázquez, Sergio García Collado, Luis García-Giralda Ruiz, Beatriz García-Serrano Jiménez, Montse Garrido Pérez, Jon Kepa Garro Mendiolagaray, Jorge Gea Villar, Teresa Genover Llimona, Felipe Gil Moreno, Javier Julián Gil Pastor, Adrià Gispert Servitje, Isidro Domingo Godoy García, Gabriel Gómez Martínez, Francisco Javier Gómez Sanmiguel, Jose Gómez Yelo, Pedro Alejandro Gonzales Flores, Luis González Hernández, Jaime Gonzálvez Rey, Roberto Gorgues Comas, María Victoria Guillen Anton, Miguel Ángel Gutiérrez Almarza, Jose Luis Gutiérrez Esteban, Marta Guzón Centeno, Antonio Hermoso Sabio, Manuel Hernández Castellanos, Ana Hernández Pérez, Alfredo Herranz Alfaro, José Francisco Hinojosa Díaz, José Iglesias Fernández, Iñaki Intxausti Erdoiza, Miriam Izarra Páramo, Ana Isabel Jiménez Marcen, Rosa María Jimeno Bernad, María José Jover Andreu, Francisco Emilio Juan Alcaraz, Esther Labrador Arranz, Salvador Laencina López, Elena Lapuente Troncoso, Montserrat Latorre Cásedas, Mariano Leal Hernández, Lourdes Ledesma Santiago, Francisco Javier Lillo Bravo, Marta Lizarribar Sans, Rocío Lobato Martínez, Emilia Begoña López Alonso, Urbano López Cruz, Silvia López Chamon, Ana Isabel López de Viñaspre Muguerza, Ana Belén López Herranz, Víctor López Marina, Francisco López Ortiz, M.a Carmen López Silva, José María Lucas Boronat, Héctor Leonardo Lugo Ramos, Erika Lutz Garcia, Juan Luis Llosa Ventura, Antonio Macías Corbacho, Juan Magem Niubo, Diego Mancilla las Heras, Alfonso Maneu Juan, José Manzano Jiménez, Pascual Mañes Vicente, María Isabel Maranges Comella, Emilio Marco Segarra, Miguel Ángel María Tablado, Juan Carlos Marlasca Garcia, Juan Carlos Martí Canales, José Martín Clos, Saúl Martín de la Vega, Francisco Martín Ruiz Lavela, M. Desamparada Martinez Aparicio, Rafael Martínez de Carnero Calzada, Agustín Martinez González, Juan Manuel Martínez Jiménez, Daniel Martínez Laguna, María Teresa Martínez Mayora, Pilar Martinez Merodio, Luis Martínez Novoa, Mireia Martínez Ortega, Francisco Martínez Rojas, Antonio Martínez Rossello, María del Carmen Meijome Sánchez, Jesús Méndez-Cabeza Velázquez, Jose María Méndez Maiques, Santiago Misericordia Garcia, José Molina Cabildo, Luis Javier Molina Martínez, José Manuel Monge García, María Ester Montes Belloso, Susana Moreno Molina, Patrocinio Motos Díaz, Marta Mourelo Cereijo, Ana Moyá Amengual, Pedro José Muñoz Ruiz, José María Narváez Martín, Juan Luis Navarro Luna, Fernando Navarro Tarin, Jorge Nicolau Grego, Cristina Niño Azcarate, José Nova Alvarez, Juan Carlos Núñez Cordón, Asunción Olagorta de Prado, Vicente Oros Espinosa, M. Concepción Ortega Pinilla, María Paz Ortega Ruiz, David Osca Pellicer, Ana Otamendi Murillo, Manuel Otero Mata, Myriam Ouzzine Marín, Eduardo Paja Fano, Domingo Palacio Gonzalez, Rosario Palau Oñate, Néstor Pazos Garrido, Virginia Pecharroman Fuente, Jose Manuel Peña Rosa, Francisco Javier Peral Cabot, Iván Yamir Pérez Barreto, Isabel Pérez Caballero, Maria del Carmen Pérez Fernández, Antonio Luis Pérez Fernández, Esteban Pérez Gutiérrez, Manuel Pérez Rios, José Manuel Petit Sánchez, Maria José Piñero Acin, Jerónimo Pozuelos Estrada, Manuel Prieto Cid, Joaquín Prieto Gutiérrez, José Vicente Raga Casasus, Manuel Francisco Ramírez Espinosa, Eduardo Rebollo Hernamperez, Alejandra Rey Rañal, Ricardo Sagunto Ribelles Villalba, José Antonio Rodas Peral, Aurora Rodil Martinez, null Rodríguez, José Manuel, Enrique Emperador Rodríguez Calcaño, Concepción Rodríguez Fernandez, José Miguel Rodríguez Galipienzo, Miguel Ángel Rodriguez Lois, José Antonio Rodríguez Partida, Jaime Roel Conde, Miguel Roman Rodriguez, Gregorio Romero Caballero, Pedro Romero Hernández, Luis Miguel Rosales García, Manuel Royo del Río, María Ruiz Gomes, Francisco Javier Ruiz Moruno, Jaime Ruiz Perez, José Ramón Salinero Acevedo, Manuel Sánchez Apresa, María Antonia Sanchez Calavera, Fernando Sánchez Garcia, Miguel Ángel Sánchez Gutiérrez, Antonio Sánchez Ibáñez, Eugenio Sánchez López, Manuel Sánchez Loureiro, Ana Sanchez Lozano, Gregorio Sánchez Romero, Fernando Sánchez Ruano, Gabriela Sánchez Ruiz, Froilán Sánchez Sanchez, Asier Santiago Ayarza, Juan Antonio Santos Bermejo, Elena Sanz de Miguel, Marta Sanz Sanz, Carmelina Sanz Velasco, Inmaculada Sauco Colón, José Ignacio Sedano García, Luis Segovia Castro, María Rosa Senan Sanz, Pere Serra Cabot, Marta Serra Gallego, Daniel Serrano Tomás, Francisco Tomás Sesma Aisa, Jordi Seuba Garcés, Vicente Soler David, Jose Antonio Soria Mesa, César Sosa Álvarez, María Suárez Pérez, Antonio Tafalla Martín, Thaimi Tamayo Ferriol, José Luis Tamayo Marín, Juan Aitor Thalamas Atienza, Ana María Toledo Muñoz, Lluis Miquel Tomás-Rodo Massaneda, Milko Torres de Castro, Francisco Javier Torres Martínez, Enrique Tovar Álvarez, Ainhoa Ugarte Goñi, Irene Valle González, Sonia Vasco Mahillo, Vázquez Seijas Enrique José, Antonio Vericat Roure, Arelis Villalba Parrado, Jose María Villanueva Rebollo, Ricardo Villar Valgañon, Vicente Villena Masegosa, Montserrat Viñals Gigena, Lydia Viñas Cabrera, and David Zarco Pinteño

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030212 general & internal medicine, General Medicine, business, Humanities
Abstract

Objetivo Evaluar el grado de seguimiento de las recomendaciones de las versiones de la Guía española para el manejo del asma (GEMA 2009 y 2015) y su repercusión en el control de la enfermedad. Material y métodos Estudio observacional y ambispectivo realizado entre septiembre del 2015 y abril del 2016, en el que participaron 314 médicos de atención primaria y 2.864 pacientes. Resultados Utilizando datos retrospectivos, 81 de los 314 médicos (25, 8% [IC del 95%, 21, 3 a 30, 9]) comunicaron seguir las recomendaciones de la GEMA 2009. Al inicio del estudio, 88 de los 314 médicos (28, 0% [IC del 95%, 23, 4 a 33, 2]) seguían las recomendaciones de la GEMA 2015. El tener un asma mal controlada (OR 0, 19, IC del 95%, 0, 13 a 0, 28) y presentar un asma persistente grave al inicio del estudio (OR 0, 20, IC del 95%, 0, 12 a 0, 34) se asociaron negativamente con tener un asma bien controlada al final del seguimiento. Por el contrario, el seguimiento de las recomendaciones de la GEMA 2015 se asoció de manera positiva con una mayor posibilidad de que el paciente tuviera un asma bien controlada al final del periodo de seguimiento (OR 1, 70, IC del 95%, 1, 40 a 2, 06). Conclusiones El escaso seguimiento de las guías clínicas para el manejo del asma constituye un problema común entre los médicos de atención primaria. Un seguimiento de estas guías se asocia con un control mejor del asma. Existe la necesidad de actuaciones que puedan mejorar el seguimiento por parte de los médicos de atención primaria de las guías para el manejo del asma. Objective: To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guía Española para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods: We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results: Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions: Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines.

Published
2020

2. ¿Diagnosticamos correctamente la osteoporosis postmenopáusica en atención primaria?

Author

María del Pilar Carmona García, Anna Cruz Esteban, Emilio Marco Segarra, Mireia Pellicera Mesquida, and Eva Vilaplana Morillo

Abstract

espanolObjetivo. Estudiar la prevalencia de osteopenia y osteoporosis en mujeres postmenopausicas en el Area Basica de Salud (ABS) de Sarria de Ter desde mayo de 2014 a mayo de 2015. Material y metodos. Estudio descriptivo, transversal, de prevalencia. Se incluyo a 73 mujeres postmenopausicas entre 49 y 85 anos del total de la poblacion, con el diagnostico N95 de la clasificacion CIM-10 en su historia clinica. Se excluyo a las pacientes sin datos clinicos en los ultimos dos anos, con menopausia iatrogenica, neoplasias activas, exitus o trasladadas de ABS en el periodo de estudio. Se analizo la edad, el peso, la talla, el indice de masa muscular (IMC) y el consumo de tabaco, diureticos, corticoides y anos de amenorrea. Tambien se tuvo en cuenta si tenian diagnostico de osteopenia u osteoporosis. Resultados. La prevalencia de la osteoporosis fue de 18 % y la de la osteopenia de 8 %. La media de edad en las mujeres postmenopausicas con osteoporosis era de 66,3 anos; el 53,85 % era menor de 65 anos. El 15,4 % de las mujeres habian sido diagnosticadas tras presentar una fractura patologica. El 14,9 % de las pacientes con IMC menor de 25 tenia osteoporosis. Conclusiones. La prevalencia en la alteracion de la densidad de mineral osea (DMO) en nuestras pacientes fue parecida a la del resto de estudios (26 %); un 53,85 % eran menores de 65 anos. Por ello insistimos en la necesidad de realizar un correcto diagnostico/tratamiento asi como identificar los factores que contribuyen a mantener la DMO en mujeres postmenopausicas. EnglishIntroduction. To study the prevalence of osteopenia and osteoporosis in post-menopausal women in Sarria de Ter (Health Area) from May 2014 to May 2015. Material and Methods. Descriptive, cross-sectional prevalence study. 73 post-menopausal women aged 49 to 85 years old, who have a diagnosis of CIM-10 N95 in their medical history, were included from the total population. We excluded patients without clinical data from the last two years, iatrogenic menopause, active malignancies, deaths, or who have moved from the Health Area. We analyzed age, weight, height, BMI, smoking, diuretics, corticosteroids and those suffering from amenorrhea. It also took into account whether they had been diagnosed with osteopenia or osteoporosis. Results. The prevalence of osteoporosis was 18 % and osteopenia 8 %. The average age in post-menopausal women with osteoporosis was 66.3 years, 53.85 % were Conclusions. The prevalence in altering the bone mineral density (BMD) in our patients was similar to other studies (26 %), and 53.85 % under 65 years, so we stress the importance of the correct identification, diagnosis and treatment of the factors that contribute to preserve BMD in post-menopausal women.

Published
2017

3. STOP-BANG: a method to detect obstructive sleep apnea and discriminate for severity in primary care

Author

Maria Buxó Pujolras, Susana Mota Casals, Anton Obrador Legares, Mercè Salvans Sagué, Rafel Ramos Blanes, Immaculada Castellà i Dagà, Emilio Marco Segarra, Anna Torrente Nieto, Xavier Espuña Capote, Daniela Soledad Torres Scianca, Eric Rojas Calvera, Marta Plana Pes, and Ramon Orriols Martinez

Subjects
medicine.medical_specialty, medicine.diagnostic_test, business.industry, Primary care, Polysomnography, medicine.disease, Likelihood ratios in diagnostic testing, Respiratory polygraphy, Obstructive sleep apnea, 03 medical and health sciences, 0302 clinical medicine, 030228 respiratory system, Internal medicine, Medicine, Stop bang, 030212 general & internal medicine, business
Abstract

Introduction: A STOP-BANG questionnaire (SBQ) score of ≥3 may detect obstructive sleep apnea (OSA) but is not well studied in primary care (PC) Aims and Objectives: Assess the ability of SBQ to predict OSA severity in PC Methods: 30 to 70 year-olds attending any of 4 PC centres in a 22-month period were randomly selected. PC physician did the SBQ. A home respiratory polygraphy (HRP) was done when scores of ≥3 were found and an attended polysomnography (PSG) when apnea-hypopnea index (AHI) was Results: Of included patients (565), 38.2% had SBQ≥3. Of these, 93.1% were diagnosed with OSA (Figure 1). All cases with SBQ≥6 had an AHI≥5/h. SBQ discriminated patients with severe OSA (AHI≥30/h)(n=70, AUC=0.697, 95% CI:0.621-0.773): moderate in women (n=23, AUC=0.733, 95% CI:0.605-0.860) and lower in men (n=47, AUC=0.679, 95% CI:0.583-0.766). In these cases, SBQ≥5 in women had a sensitivity (Sn) of 52.2%, specificity (Sp) of 85.7%, positive likelihood ratio (LR+) of 3.65 and negative likelihood ratio (LR-) of 0.56; and SBQ≥6 in men gave Sn of 44.7%, Sp of 86.7%, LH+ of 3.35 and LH- of 0.64 Conclusions: SB≥3 may adequately screen for OSA in PC. Scores of SB≥5 in women and ≥6 in men could be good opportunistic predictors of severe OSA in PC.

Published
2019

4. Compliance with the clinical guidelines for managing asthma by primary care physicians: An ambispective observational study

Author

M. Roman-Rodriguez, J. Molina-Paris, A. Fernandez Sanchez, Mohsen Abedianzadeh Timar, Jesús Acha Domínguez, Jesus Aguaviva Bascuñana, Ignacio Aguilar Martín, Francisco Ignacio Ales Conejo, Juan Vicente Alfaro González, Patricia Alfonso Landa, Andrés Altés Boronat, Jesús Joaquín Álvarez Arriero, Juan Ángel Álvarez Rojo, Allut Vidal German, Jesús Amaro Cendón, María Teresa Amiano Arregui, Esther Angulo Vallejo, Juan José Anton Álvarez, Javier Anton Ortega, Ana Arconada Perez, Lidia Ardiaca Burgués, Juan Manuel Armario Vázquez, Amador Arroyo Cubeiro, Koldo Aso Mendialdea, Francesca Attardo, José Francisco Ávila de Tomás, M. Jesús Avinent Arnal, Francisco Aznar Aguilar, Pilar Aznar Tejero, Emilio Baena Montilla, José María Baeza López, Juan José Barón Carrillo, Rafael Bartolomé Resano, Francisco Becoña de la Torre, Isabel Benavent Martín, María Teresa Benedí Sánchez, José Berrocal del Brío, Antonio Blanco Delgado, Jesús Bleda Cano, Josep Boladeras Sabater, Zenaida Bolívar Mantilla, Elisenda Brito Brito, M. Rosario Burgos Parra, Isaac Buxadé Martí, Juan Carlos Caballero Garcia, Luis Fernando Cabañas Enríquez, Marcelino Calviño Cerqueiro, Juan Calvo Fernández, Felipe Calle Velles, Beatriz Camaro Zafra, Jaume Campomar Quetlas, Mónica Capitán Jurado, Dolores Cárdenas Joyanes, Gonzalo Carles Bueso, Cristina Carvajal Puente, Cristina Casado Rodriguez, Carlos Casanova García, Santiago Castellà Cahiz, Cristina Castellà Cuesta, Manuel Antonio Castellano Martínez, Rafael Catalán Félez, Miguel Ángel Cavada García, Antonio Cavada Velasco, Jose Luis Cidra Gordillo, Julia Clemente Garcia, José Luis Collada Jiménez, Andrés Cornejo Figueroa, Roberto Cornejo Rodríguez, Julio Cuevas Morales, María Jesús Curado-Moliní Álvarez, Susana Daviña Romero, Leonor de Arriba Muñoz, Manuel de la Flor Benítez, Mariam de la Poza Abad, Gustavo de los Bueis Martinez, María Pía de Miguel Márquez, Jesús de Pablo Martín, Manuel Delgado Mora, Joaquín Díaz Mateo, Almudena Díaz Saborido, María Díez-Caballero Murua, Constantino Doganis Peppas, Gonzalo Domínguez Alonso, Julián Domínguez Ávila, María Nieves Domínguez González, María Isabel Domínguez Hernández, Javier Oscar Dosantos Hernández, Aurelio Dueñas Buey, M. Jesús Eiris Cambre, Yussef Abu El Wafa Vaca, Antonio Alberto Enseñat Sanchez, Eulalia Esquerra Tuñí, José María Esteve Ribelles, José Antonio Estevez Barrondo, M. Dolores Estraviz Vidal, Rosa María Fajardo Salguero, José Francisco Felipe Olivero, María Luisa Fernández Bujía, Patricia Fernández Cano, M. Isabel Fernández Cañaveras, Carmen Fernández Fernández, José Manuel Fernández García, Patricia Fernández Gómez, José María Fernández González, Irene Fernández Gutiérrez Denia, M. Esther Fernández Huelga, Yolanda Fernández Martin, Francisco Fernández Navarro, Araceli Fernández Revuelta, José María Fernández Toro, Luis María Fernández-Pacheco Corchado, Joaquín Ferrándiz Miquel, Carmen Ferrari Piquero, José María Ferrer García-Borrás, Carlos Gago Fernandez, Fernando Gago Gómez, Luz Inmaculada Galera de Ulierte, Ingrid Gallegos Juárez, José Enrique Garceran Azorín-Gómez, Carmen Garcés Romero, Francisco Javier García Alonso, Andres A. García Cabana, Josefa García Cano, Victoria Gema García Ceballos, Sara García de Francisco, Francisco García Fuentes, Yolanda García Vázquez, Sergio García Collado, Luis García-Giralda Ruiz, Beatriz García-Serrano Jiménez, Montse Garrido Pérez, Jon Kepa Garro Mendiolagaray, Jorge Gea Villar, Teresa Genover Llimona, Felipe Gil Moreno, Javier Julián Gil Pastor, Adrià Gispert Servitje, Isidro Domingo Godoy García, Gabriel Gómez Martínez, Francisco Javier Gómez Sanmiguel, Jose Gómez Yelo, Pedro Alejandro Gonzales Flores, Luis González Hernández, Jaime Gonzálvez Rey, Roberto Gorgues Comas, María Victoria Guillen Anton, Miguel Ángel Gutiérrez Almarza, Jose Luis Gutiérrez Esteban, Marta Guzón Centeno, Antonio Hermoso Sabio, Manuel Hernández Castellanos, Ana Hernández Pérez, Alfredo Herranz Alfaro, José Francisco Hinojosa Díaz, José Iglesias Fernández, Iñaki Intxausti Erdoiza, Miriam Izarra Páramo, Ana Isabel Jiménez Marcen, Rosa María Jimeno Bernad, María José Jover Andreu, Francisco Emilio Juan Alcaraz, Esther Labrador Arranz, Salvador Laencina López, Elena Lapuente Troncoso, Montserrat Latorre Cásedas, Mariano Leal Hernández, Lourdes Ledesma Santiago, Francisco Javier Lillo Bravo, Marta Lizarribar Sans, Rocío Lobato Martínez, Emilia Begoña López Alonso, Urbano López Cruz, Silvia López Chamon, Ana Isabel López de Viñaspre Muguerza, Ana Belén López Herranz, Víctor López Marina, Francisco López Ortiz, Mª Carmen López Silva, José María Lucas Boronat, Héctor Leonardo Lugo Ramos, Erika Lutz Garcia, Juan Luis Llosa Ventura, Antonio Macías Corbacho, Juan Magem Niubo, Diego Mancilla las Heras, Alfonso Maneu Juan, José Manzano Jiménez, Pascual Mañes Vicente, María Isabel Maranges Comella, Emilio Marco Segarra, Miguel Ángel María Tablado, Juan Carlos Marlasca Garcia, Juan Carlos Martí Canales, José Martín Clos, Saúl Martín de la Vega, Francisco Martín Ruiz Lavela, M. Desamparada Martinez Aparicio, Rafael Martínez de Carnero Calzada, Agustín Martinez González, Juan Manuel Martínez Jiménez, Daniel Martínez Laguna, María Teresa Martínez Mayora, Pilar Martinez Merodio, Luis Martínez Novoa, Mireia Martínez Ortega, Francisco Martínez Rojas, Antonio Martínez Rossello, María del Carmen Meijome Sánchez, Jesús Méndez-Cabeza Velázquez, Jose María Méndez Maiques, Santiago Misericordia Garcia, José Molina Cabildo, Luis Javier Molina Martínez, José Manuel Monge García, María Ester Montes Belloso, Susana Moreno Molina, Patrocinio Motos Díaz, Marta Mourelo Cereijo, Ana Moyá Amengual, Pedro José Muñoz Ruiz, José María Narváez Martín, Juan Luis Navarro Luna, Fernando Navarro Tarin, Jorge Nicolau Grego, Cristina Niño Azcarate, José Nova Alvarez, Juan Carlos Núñez Cordón, Asunción Olagorta de Prado, Vicente Oros Espinosa, M. Concepción Ortega Pinilla, María Paz Ortega Ruiz, David Osca Pellicer, Ana Otamendi Murillo, Manuel Otero Mata, Myriam Ouzzine Marín, Eduardo Paja Fano, Domingo Palacio Gonzalez, Rosario Palau Oñate, Néstor Pazos Garrido, Virginia Pecharroman Fuente, Jose Manuel Peña Rosa, Francisco Javier Peral Cabot, Iván Yamir Pérez Barreto, Isabel Pérez Caballero, Maria del Carmen Pérez Fernández, Antonio Luis Pérez Fernández, Esteban Pérez Gutiérrez, Manuel Pérez Rios, José Manuel Petit Sánchez, Maria José Piñero Acin, Jerónimo Pozuelos Estrada, Manuel Prieto Cid, Joaquín Prieto Gutiérrez, José Vicente Raga Casasus, Manuel Francisco Ramírez Espinosa, Eduardo Rebollo Hernamperez, Alejandra Rey Rañal, Ricardo Sagunto Ribelles Villalba, José Antonio Rodas Peral, Aurora Rodil Martinez, null Rodríguez, José Manuel, Enrique Emperador Rodríguez Calcaño, Concepción Rodríguez Fernandez, José Miguel Rodríguez Galipienzo, Miguel Ángel Rodriguez Lois, José Antonio Rodríguez Partida, Jaime Roel Conde, Miguel Roman Rodriguez, Gregorio Romero Caballero, Pedro Romero Hernández, Luis Miguel Rosales García, Manuel Royo del Río, María Ruiz Gomes, Francisco Javier Ruiz Moruno, Jaime Ruiz Perez, José Ramón Salinero Acevedo, Manuel Sánchez Apresa, María Antonia Sanchez Calavera, Fernando Sánchez Garcia, Miguel Ángel Sánchez Gutiérrez, Antonio Sánchez Ibáñez, Eugenio Sánchez López, Manuel Sánchez Loureiro, Ana Sanchez Lozano, Gregorio Sánchez Romero, Fernando Sánchez Ruano, Gabriela Sánchez Ruiz, Froilán Sánchez Sanchez, Asier Santiago Ayarza, Juan Antonio Santos Bermejo, Elena Sanz de Miguel, Marta Sanz Sanz, Carmelina Sanz Velasco, Inmaculada Sauco Colón, José Ignacio Sedano García, Luis Segovia Castro, María Rosa Senan Sanz, Pere Serra Cabot, Marta Serra Gallego, Daniel Serrano Tomás, Francisco Tomás Sesma Aisa, Jordi Seuba Garcés, Vicente Soler David, Jose Antonio Soria Mesa, César Sosa Álvarez, María Suárez Pérez, Antonio Tafalla Martín, Thaimi Tamayo Ferriol, José Luis Tamayo Marín, Juan Aitor Thalamas Atienza, Ana María Toledo Muñoz, Lluis Miquel Tomás-Rodo Massaneda, Milko Torres de Castro, Francisco Javier Torres Martínez, Enrique Tovar Álvarez, Ainhoa Ugarte Goñi, Irene Valle González, Sonia Vasco Mahillo, Vázquez Seijas Enrique José, Antonio Vericat Roure, Arelis Villalba Parrado, Jose María Villanueva Rebollo, Ricardo Villar Valgañon, Vicente Villena Masegosa, Montserrat Viñals Gigena, Lydia Viñas Cabrera, and David Zarco Pinteño

Subjects
medicine.medical_specialty, business.industry, Health Personnel, Primary care physician, General Medicine, Primary care, Disease, medicine.disease, Asthma, Physicians, Primary Care, Compliance (psychology), Retrospective data, 03 medical and health sciences, 0302 clinical medicine, Asthma control, Emergency medicine, medicine, Humans, Patient Compliance, Observational study, 030212 general & internal medicine, business, Retrospective Studies
Abstract

Objective To assess the degree of compliance with the recommendations of the 2009 and 2015 versions of the Spanish guidelines for managing asthma (Guia Espanola para el Manejo del Asma [GEMA]) and the effect of this compliance on controlling the disease. Material and methods We conducted an observational ambispective study between September 2015 and April 2016 in which 314 primary care physicians and 2864 patients participated. Results Using retrospective data, we found that 81 of the 314 physicians (25.8%; 95% CI 21.3–30.9) stated that they complied with the GEMA2009 recommendations. At the start of the study, 88 of the 314 physicians (28.0%; 95% CI 23.4–33.2) complied with the GEMA2015 recommendations. Poorly controlled asthma (OR, 0.19; 95% CI 0.13–0.28) and persistent severe asthma at the start of the study (OR, 0.20; 95% CI 0.12–0.34) were negatively associated with having well-controlled asthma by the end of the follow-up. In contrast, compliance with the GEMA2015 recommendations was positively associated with a greater likelihood that the patient would have well-controlled asthma by the end of the follow-up (OR, 1.70; 95% CI 1.40–2.06). Conclusions Low compliance with the clinical guidelines for managing asthma is a common problem among primary care physicians. Compliance with these guidelines is associated with a better asthma control. Actions need to be taken to improve primary care physician compliance with the asthma management guidelines.

Published
2019

5. Primary care diagnosis of sleep apnoea syndrome in the Girona Healthcare area

Author

Daniela Soledad Torres Scianca, Eric Rojas Calvera, Immaculada Castellà i Dagà, Anton Obrador Legares, Emilio Marco Segarra, Rafel Ramos Blanes, Mercè Salvans Sagué, Maria Buxó Pujolras, Susana Mota Casals, Ramon Orriols Martinez, and Xavier Espuña Capote

Subjects
High probability, Pediatrics, medicine.medical_specialty, Sleep apnoea syndrome, business.industry, Concordance, Health care, medicine, In patient, Mean age, Primary care, business, Respiratory polygraphy
Abstract

Introduction: Diagnosing sleep apnoea syndrome (SAS) in hospital settings limits detection and is costly. We compare SAS diagnosis in primary care (PC) by respiratory polygraphy with automatic analysis (RPa) with currently validated methodology and hospital techniques. Material and methods: Random, cross-sectional, single-blind, multicentre study at four primary care centres and their reference hospital over 6 months. Patients between 30 and 70 years with high probability of SAS (STOP-BANG ≥3) who were visited at their primary care centre were included. Apnealink Air respiratory polygraphy was performed at home and read by the primary care doctor. Recorded data were sent online to the reference hospital and analysed manually by a sleep specialist. In patients with non-severe SAS (Apnoea-Hypopnoea Index Results: 76.2% (48/63) of patients completed the protocol; mean age 57.5±8.5; male sex 62.5%; BMI 30.5±5.8. 85.4% were diagnosed with RPa. Concordance between PC and hospital diagnosis was k=0.22 (Table 1). For severity, patients with SAS had a concordance of k=0.54 with a sensitivity of 45.4%; 95% CI (11.5-79.4), specificity of 100.0%; 95% CI (98.3-100.0), PPV 100.0% and NPV 83.3% (Table 2). Conclusion: RPa could be useful in diagnosing SAS in PC. Hospital diagnosis would not be needed in cases of severe SAS.

Published
2017

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