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1. Development and Validation of a Clinical Score to Estimate Progression to Severe or Crítical State in COVID-19 Pneumonia Hospitalized Patients

Author

Jorge Ricoy Gabaldón, María Jesús Domínguez-Santalla, Ana T. Marques-Afonso, Carmen Martínez-Rey, Nuria Rodríguez-Núñez, Julián Álvarez Escudero, Luis Valdés, Antonio Pose, Óscar Lado-Baleato, María Pazo-Núñez, Cristobal Galban, Carlos Rábade Castedo, Martín Vidal-Vázquez, Cristina Pou Álvarez, María Luisa Pérez del Molino Bernal, Adriana Lama Lopez, Plácido Mayán Conesa, Felipe Calle Velles, Pablo Manuel Varela-García, Ana Casal Mouriño, Romina Abelleira, Vanessa Blanco, Néstor Agra-Vázquez, Sonia Molinos-Castro, María E. Toubes, Juan Suárez-Antelo, Manuel Taboada Muñiz, Arturo Gonzalez-Quintela, Francisco Gude, Tamara Lourido Cebreiro, Carmen Beceiro-Abad, Hadrián Pernas-Pardavila, Emilio Páez-Guillán, and Lucía Ferreiro

Subjects
medicine.medical_specialty, Framingham Risk Score, Receiver operating characteristic, business.industry, Retrospective cohort study, Institutional review board, Logistic regression, medicine.disease, Pneumonia, Informed consent, Internal medicine, Good clinical practice, medicine, business
Abstract

Background: The prognosis of a patient with Covid-19 pneumonia is uncertain. Our objective was to establish a predictive model of disease progression to facilitate early decision-making. Methods: A retrospective study was performed of patients admitted with Covid-19 pneumonia, classified as severe (admission to the intensive care unit, mechanic invasive ventilation, or death) or non-severe. A predictive model based on clinical, analytical, and radiological parameters was built. The probability of progression to severe disease was estimated by logistic regression analysis. Calibration and discrimination (receiver operating characteristics curves and AUC) were assessed to determine model performance. Findings: During the study period 1,152 patients presented with Covid-19 infection, of whom 229 (19.9%) were admitted for pneumonia. During hospitalization, 51 (22.3%) progressed to severe disease, of whom 26 required ICU care (11.4); 17 (7.4%) underwent invasive mechanical ventilation, and 32 (14%) died of any cause. Five predictors determined within 24 hours of admission were identified: Diabetes, Age, Lymphocyte count, SaO2, and pH (DALSH score). The prediction model showed a good clinical performance, including discrimination (AUC 0.87 CI 0.81, 0.92) and calibration (Brier score = 0.11). In total, 0%, 12%, and 50% of patients with severity risk scores ≤5%, 6-25%, and >25% exhibited disease progression, respectively. Interpretation: A simple risk score based on five factors predicts disease progression and facilitates early decision-making according to prognosis. Funding Statement: This project was funded by the Carlos III Health Institute, Spain, Grant/Award Number: COV20/00404; Ministry of Economy and Competitiveness (SPAIN) and the European Regional Development Fund (FEDER). Declaration of Interests: The authors declare no conflicts of interest associated with this publication. Ethics Approval Statement: The study was conducted in accordance with the guidelines of the Declaration of Helsinki and the principles of good clinical practice and was approved by the Institutional Review Board (IRB) of the Galician Health Service on April 3, 2020 (#2020/194). Informed consent forms were waived by the IRB.

Published
2020
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2. Development and validation of a clinical score to estimate progression to severe or critical state in Covid-19 pneumonia hospitalized patients

Author

Manuel Taboada-Muñiz, María Jesús Domínguez-Santalla, Luis Valdés, Francisco Gude, Felipe Calle-Velles, María Luisa Pérez del Molino, Cristóbal Galbán-Rodríguez, Romina Abelleira-Paris, Carmen Beceiro-Abad, Lucía Ferreiro, Cristina Pou, Antonio Pose, Óscar Lado-Baleato, José Ramón González-Juanatey, Hadrián Pernas-Pardavila, Pablo Manuel Varela-García, María Pazo-Núñez, Juan Suárez-Antelo, Arturo Gonzalez-Quintela, Adriana Lama, Ana Iglesias Casal, Sonia Molinos-Castro, María E. Toubes, Plácido Mayán-Conesa, Vanessa Riveiro, Néstor Agra-Vázquez, Martín Vidal-Vázquez, Emilio Páez-Guillán, Tamara Lourido, Nuria Rodríguez-Núñez, Julián Álvarez-Escudero, Carlos Rábade, Ana T. Marques-Afonso, Jorge Ricoy, and Carmen Martínez-Rey

Subjects
Male, 2019-20 coronavirus outbreak, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Hospitalized patients, Critical Illness, European Regional Development Fund, lcsh:Medicine, severity, Diseases, Comorbidity, 030204 cardiovascular system & hematology, Severe Acute Respiratory Syndrome, Severity of Illness Index, Article, predictive model, 03 medical and health sciences, 0302 clinical medicine, Medical research, Modelo Predictivo, Gravedad, Severity of illness, Medicine, Humans, pneumonia, 030212 general & internal medicine, lcsh:Science, Aged, Inpatients, Multidisciplinary, business.industry, lcsh:R, COVID-19, neumonía, síndrome respiratorio agudo grave, Middle Aged, medicine.disease, Respiration, Artificial, Coronavirus, Pneumonia, Emergency medicine, Disease Progression, Christian ministry, Female, lcsh:Q, business, Gravidade
Abstract

The prognosis of a patient with Covid-19 pneumonia is uncertain. Our objective was to establish a predictive model of disease progression to facilitate early decision-making. A retrospective study was performed of patients admitted with Covid-19 pneumonia, classified as severe (admission to the intensive care unit, mechanic invasive ventilation, or death) or non-severe. A predictive model based on clinical, analytical, and radiological parameters was built. The probability of progression to severe disease was estimated by logistic regression analysis. Calibration and discrimination (receiver operating characteristics curves and AUC) were assessed to determine model performance. During the study period 1,152 patients presented with Covid-19 infection, of whom 229 (19.9%) were admitted for pneumonia. During hospitalization, 51 (22.3%) progressed to severe disease, of whom 26 required ICU care (11.4); 17 (7.4%) underwent invasive mechanical ventilation, and 32 (14%) died of any cause. Five predictors determined within 24 hours of admission were identified: Diabetes, Age, Lymphocyte count, SaO2, and pH (DALSH score). The prediction model showed a good clinical performance, including discrimination (AUC 0.87 CI 0.81, 0.92) and calibration (Brier score = 0.11). In total, 0%, 12%, and 50% of patients with severity risk scores ≤5%, 6-25%, and >25% exhibited disease progression, respectively. A simple risk score based on five factors predicts disease progression and facilitates early decision-making according to prognosis. Carlos III Health Institute, Spain, Ministry of Economy and Competitiveness (SPAIN) and the European Regional Development Fund (FEDER) Instituto de Salud Carlos III

Published
2020

3. 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

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

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