Medicina de Familia-SEMERGEN最新文献

The WHO defines Primary Health Care as essential health care, based on practical, scientifically founded and socially acceptable methods and technologies, made available to all individuals and families in the community, through their full participation, and at a cost that the community and the country can bear, at each and every stage of their development, in a spirit of self-responsibility and self-determination.

With the intention of fulfilling the basic objective of caring for and promoting health in all the groups that make up our current society, the need arises to focus on certain groups in which the actions of Primary Care are currently consensual or poorly protocolised, as is the case with the health care of transgender people.

Objective

To quantify the incremental impact that population dispersion has on the number of health personnel in Primary Care in Alto Aragón, using a reproducible method.

Method

Descriptive observational study that compares health the number of health personnel (family medicine, pediatrics and nursing) in EAP and PA emergencies in 2019 in an unpopulated and dispersed territory such as Huesca, with the number that would correspond to it by applying population ratios per professional of hypothetical constructs with different population densities.

Results

Huesca, with respect to the national average, has 39% more PA health personnel. There are 239 additional professionals (112 in family medicine, 2 in pediatrics and 115 in nursing), 130 in emergencies and 109 in EAP.

With the average of the five most densely populated provinces, it would reduce this staff by 49%, and with the average of the five least densely populated provinces, it would increase it by 12%.

Conclusions

There is a relationship between low population density and a greater number of family medicine and PC nurses, but not with pediatrics.

The powerful incremental effect that dispersion has on health care spending gives it a relevant role in the regional financing system.

Comparing PC health personnel in scenarios with different population density is a useful method for quantifying the impact of dispersion.

Objective

To determine the prevalence, impact and management of hypertension-mediated organ damage (HMOD) according to the presence of type 2 diabetes (T2DM).

Methods

IBERICAN is an ongoing multicenter, observational and prospective study, including outpatients aged 18–85 years who attended the Primary Care setting in Spain. In this study, the prevalence, impact and management of HMOD according to the presence of T2DM at baseline were analyzed.

Results

At baseline, 8066 patients (20.2% T2DM, 28.6% HMOD) were analyzed. Among patients with T2DM, 31.7% had hypertension, 29.8% dyslipidemia and 29.4% obesity and 49.3% had ≥1 HMOD, mainly high pulse pressure (29.6%), albuminuria (16.2%) and moderate renal impairment (13.6%). The presence of T2DM significantly increased the risk of having CV risk factors and HMOD. Among T2DM population, patients with HMOD had more dyslipidemia (78.2% vs 70.5%; P = 0.001), hypertension (75.4% vs 66.4%; P = 0.001), any CV disease (39.6% vs 16.1%; P = 0.001) and received more drugs. Despite the majority of types of glucose-lowering agents were more frequently taken by those patients with HMOD, compared to the total T2DM population, the use of SGLT2 inhibitors and GLP-1 receptor agonists was marginal.

Conclusions

In patients daily attended in primary care setting in Spain, one in five patients had T2DM and nearly half of these patients had HMOD. In patients with T2DM, the presence of HMOD was associated with a higher risk of CV risk factors and CV disease. Despite the very high CV risk, the use of glucose-lowering agents with proven CV benefit was markedly low.

Introduction

There are few data about the optimal use of natriuretic peptides (NP) in the Primary Care (PC) setting. The aim to assess how, through a common coordinated PC-hospital care pathway, the use of NPs in patients with suspected heart failure (HF) is improved.

Material and methods

Analytical, experimental, prospective, non-randomized study. An intervention group composed of 22 PC physicians from 2 health centers is provided with face-to-face training and a consensual protocol is attached with a cut-off point of NT-proBNP > 300 pg/mL as pathological. The control group is made up of the rest of PC physicians in the healthcare area. The aim is to compare the use and results of PN in both groups. Propensity analysis is performed so thar the patient populations with requested PN are comparable.

Results

From June 2021 to March 2022, NP was requested in 103 and 105 patients in the intervention/control groups. Both populations were similar, with equal HF risk. Symptomatology was present in 100% of intervention vs 41% of asymptomatic patients in the control group (p < 0.001). ECG was performed in 100% vs 33.3%, p < 0.001. Optimal NP indication in 76.7% vs 29.5%, p < 0.001. In the intervention group more patients with NT-proBNP > 300 pg/mL are referred to cardiology consultations (76.6% vs 27.2%, p 0.001).

Conclusion

The optimal indication for NP and its interpretation as a diagnostic tool for HF, in the PC setting seems not to be appropriate, but improvable with a coordinated and multidisciplinary intervention approach.