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Background and Objective: This study was aimed at determining the degree of blood pressure (BP) control in hypertensive patients attended in primary care (PC) settings., Patients and Method: Cross-sectional, multicenter study. Hypertensive patients ≥18 years under antihypertensive treatment attended in Spanish PC settings were included. BP control was regarded as optimum when BP values were <140/90mmHg in general population and <130/80mmHg in patients with diabetes, chronic renal disease or cardiovascular disease. BP control was also calculated for all patients when it was <140/90mmHg., Results: A total of 12,961 hypertensive patients (52.0% women) with a mean age of 66.3 (±11.4) years were included. A percentage of 46.3 (95% CI: 45.4-47.1) presented good systolic BP and diastolic BP control; 61.1% (IC 95%: 60.2-61.9) of patients presented good BP control<140/90. A percentage of 63.6% was treated with combination therapy (44.1% with 2 drugs, 19.5% with 3 or more). BP control was significantly higher in evening measurements (50.4%) than in morning measurements (45.1%), and in patients who had taken the treatment before the visit (47.9%) compared with those who had not (30.5%). Factors such as not taking the medication before the visit, heavy alcohol consumption and dyslipemia were the risk factors mostly associated with a poor BP control (P<.001)., Conclusions: Five out of 10 hypertensive patients treated in PC settings have an optimal BP control. The degree of control of arterial hypertension has improved with respect to the PRESCAP 2006 study., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Objective: Osteoporosis predominantly affects menopausal women and has a significant morbidity expressed as fractures. The study aimed to describe the types of bisphosphonates used to treat osteoporosis in post-menopausal women and to establish how treatment non-compliance affects the fracture rate., Design: Retrospective cohort study of women on active treatment with bisphosphonates for the past five years., Location: Utebo Health Centre (Zaragoza) (16,000 inhabitants) with a general medical quota of 1,890 patients)., Participants: A total of 129 women who were on active treatment with bisphosphonates for five years were included., Main Measures: The distribution by drug was analysed, as well as the percentage of women who did not comply with the treatment correctly and any identified fractures., Results: A total of 129 women on treatment were identified (13.0% of all women patients): alendronic acid (45.7%), ibandronic acid (21.7%), risedronic acid (19.4%) and alendronic acid plus cholecalciferol (13,2%). 19.4% of women stopped their treatment after at least 3 months. Thirteen hip fractures were identified., Conclusions: The overall treatment compliance was 80.6%, Depending on the type of bisphosphonate: alendronic acid plus cholecalciferol (88.2%), risedronic acid (88.0%), alendronic acid (78.0%), ibandronic acid (75.0%). The incidence of hip fractures was similar incidence to that observed with respect to non-compliance to treatment. Lack of therapeutic compliance is common in menopausal women, and measures should be promoted to increase effectiveness as well as to make patients aware of the importance of continuing treatment., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)

Aims: To analyse the cardiovascular risk of a broad sample of hypertensive patients and to examine whether there are differences in blood pressure control and associated factors according to the different cardiovascular risk categories., Major Findings: A total of 10,520 patients > or = 18 years old were included (mean age 64.6+/-11.3 years; 53.7% women). In this cohort, 3.3% were average risk, 22.6% low added risk, 22.2% moderate added risk, 33.5% high added risk and 18.4% very high added risk. Blood pressure was controlled in 41.4% (95% CI 40.5-42.4) of the total population, in 91.7% of patients with low added risk, in 19.4% with moderate added risk, in 27.4% with high added risk and in 6.8% with very high added risk. Diabetes was the factor most strongly associated with poor blood pressure control in patients with high to very high added risk (OR=7.2; p<0.0001)., Principal Conclusion: More than half of the hypertensive patients treated in primary health care have a high or very high added cardiovascular risk. In these patients, blood pressure control is inadequate and diabetes is associated with a sevenfold increase in the likelihood of poor blood pressure control.

Background and Objectives: More information is needed on hypertension control and its evolution in clinical practice. This study aimed to determine the degree of blood pressure (BP) control in Spanish hypertensive patients attended in primary care (PC) and to determine the factors associated with poor BP control., Patients and Method: Cross-sectional, multicenter study, carried out in PC settings throughout Spain. Hypertensive patients >or= 18 years, with antihypertensive treatment (>or= 3 months) were consecutively recruited. BP measurement was performed in surgery hours (morning and evening) following standardized methods and averaging 2 consecutive readings. BP control was regarded as optimum when BP values were < 140/90 mmHg in general population and <130/80 mmHg in patients with diabetes, chronic renal disease or cardiovascular disease., Results: 10,520 hypertensive patients were included (53.7% women), mean age (SD) 64.6 (11.3) years. 41.4% (95% confidence interval [CI], 40.5-42.4) presented good systolic BP (SBP) and diastolic BP (DBP) control, 46.5% (95% CI, 45.5-47.4) only SBP control and 67.1% (95% CI, 66.2-68.0) only DBP control. 55.6% of patients were treated with combination therapy (41.2% 2 drugs, 11.7% 3 and 2.8% more than 3). BP control was significantly (p<0.001) higher in the evening measurement (48.9%) than in the morning measurement (40.5%), and if patients had taken the treatment before measurement (42.0%) compared with those who had not taken it (38.8%). Factors such as diabetes, cardiovascular disease, sedentary lifestyle, alcohol consumption and surgery hour were associated with poor BP control (p<0.001)., Conclusions: The results of the PRESCAP 2006 study indicate that 4 out of 10 hypertensive patients treated in PC in Spain have an optimal BP control. The degree of control of arterial hypertension has improved remarkably with respect to the PRESCAP 2002 study.

Background and Objective: Information about the prevalence of chronic kidney disease (CKD) in population treated in primary care (PC) is scarce. The aim of this study was to determine undetected CKD prevalence in dyslipidemic population measuring creatinine clearance according to the Cockcroft-Gault equation corrected for surface area., Patients and Method: Cross-sectional study including patients with diagnosis of dyslipidemia selected by consecutive sampling in PC. CKD was diagnosed when the glomerular filtration rate (GFR) was < 60 ml/min/1.73 m2. We assessed sociodemographic and clinical data, cardiovascular risk factors, coronary disease risk categories, dyslipidemia characteristics, functional CKD stage, and pharmacological treatments., Results: The sample included 5,990 patients (50.2% women). The mean (standard deviation) age was 60.9 (11.1) years. The main reason for iclusion was hypercholesterolemia (65%), followed by mixed hyperlipidemia (26.4%), low high density lipoproteins (HDL)-cholesterol (4.9%) and hypertrigliceridemia (3.7%). According to the Cockcroft-Gault equation, CKD prevalence was 16.2% (95% confidence interval, 15.3-17.1) and it was significantly higher in women (22.7%) than in men (9.8%) (p < 0.0001). Patients with CKD were older compared with patients with normal GFR, and had higher systolic blood pressure, glucose and HDL-cholesterol (p < 0.001), as well as lower levels of total cholesterol, low density lipoproteins-cholesterol, and triglycerides (p < 0.01). The probability of presenting CKD was related to female gender, age, and lower body mass index., Conclusions: The LIPICAP study results indicate that almost 20% of PC dyslipidemic patients in Spain present undetected CKD when the GFR is measured according to the Cockcroft-Gault equation corrected for surface area.

Introduction and Objectives: Little information is available about the control of arterial hypertension in the elderly population. The aim of this study was to investigate hypertension control, factors associated with poor control, and general practitioners' responses to poor control in a large sample of hypertensive patients aged 65 years or older receiving primary care in Spain., Patients and Method: A cross-sectional study of elderly hypertensive patients taking antihypertensives was carried out. Blood pressure was measured in the standard manner. Blood pressure control was regarded as optimum if pressure averaged less than 140/90 mm Hg or, in diabetics, less than 130/85 mm Hg., Results: The study included 5970 patients (mean age, 72.4 years; 62.8% women). Both systolic and diastolic blood pressures were well controlled in 33.5% of patients, systolic blood pressure alone in 35.5%, and diastolic blood pressure alone in 76.2%. Blood pressure control was found to be good more frequently when it was assessed in the evening (39.8%; P<.001), and when patients had taken treatment on the day of assessment (35.1%; P <.001). Some 12.9% of diabetics had pressures less than 130/85 mmHg and 9.7% had pressures less than 130/80 mmHg. General practitioners modified their therapeutic approach with only 17.2% of poorly controlled patients., Conclusions: Arterial blood pressure control was optimum in only three out of 10 Spanish hypertensive patients aged 65 years or older. Blood pressure control assessment was significantly influenced by surgery hours and by the timing of antihypertensive intake. General practitioners' therapeutic responses to poor control were too conservative.

Objective: To quantify and describe the self-care practices for children up to 14 seeking care because of an acute pathology., Design: An observation study carried out by means of a questionnaire administered to the person accompanying the patient., Setting: Primary Care: an urban Health Centre., Patients and Other Participants: The total number of cases of acute pathology treated during April and May 1993 in the Centre's paediatric clinics., Measurements and Main Results: 248 cases were studied (53% boys and 47% girls, with an average age of 5.3 +/- 3.85). Self-care (self-medication, 84.6%; non-pharmacological measures, 11.5%; both of these, 3.9%) was practised in 61.3% of cases (CI 95%: 55.2-67.4). The most common drugs were: antipyretics-analgesics (60%), antitussives (9.6%) and antibiotics (8.1%). Self-care was practised most often on patients presenting respiratory symptoms (69.6%) (p < 0.001), with self-medication predominant (91.2%) (p < 0.001). The number of days occurring between the appearance of symptoms and the medical consultation was greater among those who did not practise self-care (4.5 +/- 5.2 as against 2.1 +/- 1.8) (p < 0.001)., Conclusions: Self-care is a very common practice among people seeking paediatric treatment. Self-medication, especially for respiratory trouble, is the most common form. Patients who practise self-care tend to be earlier in seeking a medical consultation.

Objective: To design a simple method to calculate overall cardiovascular risk (CVR), which could be used in Primary Care (PC)., Design: A descriptive study to correlate and validate our method (called CVR-PC) using the Framingham, the British Regional Heart study and the Spanish Society to fight against Arterial Hypertension methods., Setting: Urban health centre., Patients: 670 patients of both sexes chosen at random in clinics, to apply a programme of preventive measures., Measurements and Main Results: The age, gender, blood pressure, tobacco consumption, Cholesterolaemia and Glycaemia were determined for each patient. A multiplicative memory method was designed to obtain the index of cardiovascular risk without recourse to electronic support. Figures obtained were correlated with those from the equation of the Framingham study. The Pearson r values were: 0.85 for the series total (0.85 for men and 0.83 for women). The cut-off point for high/low-moderate risk was identified. From this 76.3% sensitivity and 95.7% specificity were obtained., Conclusions: The method studied shows adequate correlation as well as high sensitivity and specificity when compared with the Framingham method. It can be useful in Primary Care clinic for identifying individuals at high cardiovascular risk.

Objective: To investigate serious cholesterol levels in the population seeking medical attention, utilising HOTH (How Often That High) graphs, and to look at implications these results have for recording of cholesterol incidence., Design: This was a non-longitudinal, retrospective, observational study., Setting: Carried out at the general practice level, in the Valdefierro Basic Health Area (Zaragoza Province)., Patients: 742 subjects aged between 18 and 65 years with no previous history of dyslipemia., Measurements and Main Results: After obtaining the figures on cholesterolemia, the HOTH graph was drawn from which, for a given cholesterol value, the percentage of the population with a given value can be seen. The mean cholesterol value was 201 mg/dl. A total of 54% of male subjects and 40% of female subjects were situated above the threshold figure of 200 mg/dl. Furthermore, 15% of male subjects and 10% of female subjects were situated above 250 mg/dl., Conclusions: The application of recording procedures for cholesterol, based on a globally discriminatory score, reveals a startling number of patients who need tests and treatment. We suggest a strategy based on the different levels according to age, sex, bloodstream cholesterol level, and the existence or otherwise of other cardiovascular risk factors. Lastly, we would mention the usefulness of the HOTH graphs in improving our knowledge of the cholesterol levels in a population.

Objective: To make an assessment of the effectiveness and safety of a single oral dose compared with the conventional way of treating low-level Urinary Infections presenting no complications., Design: This was an investigative and prospective study, using a control, a simple blind and randomised sample. SITE. Health Centres in Oviedo and Zaragoza., Patients or Others Participants: We looked at 150 patients and included 106 females between the ages of 16 and 75 in the study. Their clinical symptoms were compatible with low-level urinary infections presenting no complications., Interventions: 49 patients were given Trometamol Phosphomicine (TP) in a single oral dose; 36 took Pipemidic Acid (PA) and 21 Norfloxacine (NFX), both of these in a dose of 400 mg twice a day for 5 to 7 days., Main Measurements and Results: Clinical and bacteriological assessments of the results were made 3, 7, and 28 days after treatment. A total of 75 gems were isolated: E. coli was the most common (68%). In all three groups, the main symptoms rapidly disappeared after the start of the treatment., Conclusions: Having considered the bacteriological and clinical findings, as well as tolerance levels, we are able to conclude that a single oral dose of Trometamol Phosphomicine is a good alternative to conventional therapy for the treatment of low-level Urinary Infections Which present no complications.

The results of a quality control of a computer system of repeated prescription (RPS) and its basic features are reported. The selected quality criteria were the following: reduction of the bureaucratic index in the visit, correct fulfillment of the treatment order, health attention circuits of the RPS, and compliance of the patient with the treatment. The record of activities and a random sample of treatment orders (TO) were used as sources of data. Quality indexes near the optimal standard (OS) were achieved: bureaucratic index 12.8% (OS = 15%), fulfillment of the TO 94% (OS = 100%), specified dosages 86% (OS = 100%), prescriptions in out-of-date orders 7% (OS = 0%), use higher than calculated 1% (OS = 0%), and use lower than calculated 36% (OS = 25%). Finally, the corrective measures for the detected quality problems are proposed, and the advantages of the computer RPS are discussed.

It is hereby presented a quality control study of a systematic vaccination program developed in an urban primary care center. Target population were children between 0 and 8 years attended in the center. They were considered as having a correct vaccination coverage those cases in which it was possible to verify documented accomplishment of the local vaccination schedule. Out of the 538 children included in our study, 168 (31%) were founded not to have appropriate vaccination coverage evidenced in their clinical records, and their families were requested for an interview: 126 (75%) attended de appointment. In 93 of them it was founded a recording mistake, and 33 cases were verified as no correctly covered. Vaccination coverage rate was 86%, being inverse relationship between age and coverage rate. They are discussed corrective actions derived from the quality control.

To identify the prevalence of psychological abnormalities in the adult population of the Valdefierro Health Area, we carried out an epidemiological study following the methodology of the cross sectional two-phase study. A random sample of 400 individuals, stratified for age and sex, was selected from the population over 15 years of age. In a first phase, the GHQ positive individuals underwent the semistructured interview Clinical Interview Schedule (CIS). The prevalence of psychological distress detected by the GHQ questionnaire was 13.4%. There was a significant association between psychological distress and female gender, educational level, working status, marital status and use of health care services. 42 of the 51 GHQ positive cases (82%) were considered as psychiatric conditions by the CIS. This represents a 11% prevalence of psychiatric disorders in the evaluated sample.

Following the guidelines for preventive and health promoting activities in Primary Health Care presented by the S.E.M.F.Y.C., we developed a study to evaluate the adequacy of the parallel nurse clinic for their implementation. 209 individuals (94 males and 115 females, mean age 36,4 +/- 13 years) were included in the study. The results showed a remarkably high prevalence of risk factors in the study series and a good acceptance of the program by the users. The opportunistic screening by means of a referral to a nurse clinic was shown to be an adequate strategy for the development of the program, with a multimplicator effect on the whole of nursing activities to be evaluated at the time of planning their implementation rate.