M. Leal Hernández

Paciente polimedicado: ¿conoce la posología de la medicación?, ¿afirma tomarla correctamente?

Objetivos Averiguar si los pacientes polimedicados que acuden a nuestras consultas conocen la posologia de la medicacion prescrita. Verificar si estos pacientes afirman tomarse la medicacion prescrita correctamente Diseno Estudio descriptivo mediante una encuesta realizada al paciente, o al cuidador responsable de la medicacion Emplazamiento Centro de salud de la periferia de nuestra ciudad Participantes Un total de 212 pacientes (104 varones y 108 mujeres) menores de 65 anos y 228 (118 varones y 110 mujeres) mayores de dicha edad, en tratamiento farmacologico por via oral, rectal o transdermica Mediciones principales Encuesta donde se formulaban oralmente dos preguntas al paciente o cuidador sobre cada uno de los farmacos que tenia indicado (entre 1 y 9): a) ?como le ha dicho su medico que debe tomar el farmaco?, y b) ?como toma usted realmente el farmaco? Las respuestas eran anotadas por el entrevistador y posteriormente eran evaluadas al verificar los datos en la historia clinica Resultados En los menores de 65 anos, solo el 20% de los que toman 8 o 9 farmacos recuerda de manera correcta la posologia de todos. El 10% de los que toman 9 farmacos afirma tomarlos correctamente. En los mayores de 65 anos, el 30% de los que toman 8 farmacos conoce la posologia de cada uno de ellos. El 10% de los que toman 9 farmacos y el 20% de los que toman 8 afirma tomarlos todos correctamente Conclusiones En pacientes polimedicados, el medico debe intentar establecer esquemas posologicos sencillos (1 o 2 veces al dia) del medicamento eficaz mas eficiente

Los nuevos factores de riesgo cardiovascular

En esta revision se definen las caracteristicas y criterios epidemiologicos de los factores de riesgo cardiovascular (FRCV), su clasificacion segun su importancia y la posibilidad de intervencion, su tendencia a asociarse entre si y la multiplicacion del riesgo que ello entrana. De entre los llamados “nuevos FRCV”, se analizan la reactividad cardiovascular, el fibrinogeno, la microalbuminuria, la homocisteina y la lipoproteina (a). En el estudio de la reactividad cardiovascular se definen los tipos de estresores y la respuesta hemodinamica al estres. Se detalla la relacion de la reactividad cardiovascular como factor desencadenante de hipertension arterial (HTA). Respecto del fibrinogeno, se analizan las evidencias cientificas y epidemiologicas que lo avalan como FRCV y se detallan los factores que modifican su tasa. Sobre la microalbuminuria se definen y pormenorizan los metodos de su determinacion, asi como su importante relacion con la diabetes y la HTA. Se expone la fisiopatologia de la hiperhomocisteinemia, asi comos sus causas y correlacion con la enfermedad cardiovascular, su deteccion y posible tratamiento y control. Referido a la lipoproteina (a), se analiza su metabolismo y los factores que influyen sobre su concentracion. Se repasan sus funciones fisiologicas y su relacion con la cardiopatia coronaria.

Hipertensión en el anciano

En la primera parte de la revision se establecen los criterios y definiciones de hipertension ajustada a la edad. Asimismo se revisa la fisiopatologia del envejecimiento vascular y organico. Se establecen una serie de normas para un correcto registro de la presion arterial del anciano y evitar los errores desencadenados por el “pozo auscultatorio” y la pseudohipertension. En el apartado terapeutico se recomiendan las cifras de presion sistolica y diastolica a conseguir segun las cifras iniciales. Se analizan los grandes ensayos terapeuticos de intervencion (SYST-EUR, MRC, STOP, EWPHE, SNEP, MONICA, THOMS, HOT, HYET) que demuestran una clara disminucion de la morbimortalidad cardiovascular. En los individuos de alto riesgo cardiovascular lo mas adecuado sera el tratamiento farmacologico. Los diureticos a dosis bajas serian los farmacos de eleccion. Los antagonistas del calcio tipo dihidropiridinas de accion prolongada pueden resultar utiles en muchos pacientes. Cabe mencionar, por ultimo, que se iran acumulando mas evidencias acerca de la bondad de los inhibidores de la enzima de conversion de la angiotensina y antagonistas de los receptores de angiotensina (ARAS) en la poblacion anciana. Este planteamiento nos lleva una vez mas a aceptar la individualizacion terapeutica para cada caso en particular.

Papel del médico de familia en la cumplimentación y registro del documento de instrucciones previas

The attitude of professionals about living wills (advance directives) is not homogenous and varies depending on the specialty, experience and beliefs. Many doctors are still afraid of inconveniencing patients. The situation confronting the professional in an acute care hospital with a relatively unknown patient in a palliative care unit is not the same as consulting a family doctor who is caring for the patient holistically. Primary care has a unique position to approach the life and values of our patients and their families and not just the disease, which makes it the right place to guide and advise the patient on the preparation and registration of living wills.

Calidad del registro en OMI-AP de los pacientes con ictus seguidos en atención primaria

OBJECTIVES 1) To determine the level of registration and control of cardiovascular risk factors in stroke patients treated in primary care in Murcia through electronic medical records. 2) To describe the registered drug treatment in patients with stroke. MATERIAL AND METHODS Observational descriptive, retrospective, evaluated through the records in OMI (electronic medical records) in all areas of Murcia Health Service. A sample of 407 patients with stroke was analyzed. The analyzed variables were type of stroke, time of evolution, registered cardiovascular risk factors, registered cardiovascular disease, medication and degree of control of modifiable risk factors. RESULTS Cardiovascular risk factors recorded were hypertension (81.1%), dyslipemia (72.5%), diabetes (41.3%), abdominal obesity (22.9%) and tobacco (8.8%). Registered cardiovascular diseases were ischemic heart disease (22.1%), atrial fibrillation (13.8%), nephropathy (11.8%), myocardial infarction (5.7%) and left ventricular hypertrophy (3.4%). 2.5% (10) of patients met all criteria for good control. The LDL cholesterol was controlled (<100mg/dl) and recorded in 24.8% of patients and blood pressure in 41.3%. 78.1% of patients were being treated with antihypertensive drugs, 47.4% with lipid-lowering drugs, and 79.1% with antiplatelet or anticoagulant. CONCLUSIONS According to data recorded at OMI-AP the patients who have suffered a stroke have poor control of cardiovascular risk factors.

Información escrita sobre el uso de aerosoles en pacientes con enfermedad pulmonar obstructiva crónica. ¿Mejoramos su calidad de utilización?

Objectives. To determine whether the use of written information alone improved inhalation technique with pressurized canister inhalers in patients with chronic obstructive pulmonary disease (COPD). To compare the effectiveness of written information versus verbal explanation provided by nursing personnel on the use of inhalers. Design. Interventional study. Setting. Urban health center located outside the city center. Participants. 120 patients with COPD treated with pressurized canister inhalers. Interventions. The participants were divided randomly into three groups of 40 patients each. In one group no intervention was used, in the second group verbal explanations were provided, and in the third group written information was provided. Main measures. We recorded percentage compliance with 5 criteria for the correct use of inhalers at the start of the study and 3 months after the intervention in all groups. Results. Initially, performance of the inhalation technique by patients with COPD was poor (mean compliance 40%). Performance improved significantly in both intervention groups, with no significant difference between them. Final mean compliance was 74% in the written information group and 82% in the verbal information group. Conclusions. The use of written information about the use of inhalers for patients with COPD significantly improved utilization to a degree similar to that obtained with verbal explanations.

Tratamiento farmacológico en la deshabituación tabáquica. Ventajas e inconvenientes de los tratamientos actuales

There are currently three families of drugs that are commonly used in the clinic to help smokers to stop; nicotine replacement therapy, bupropion and varenicline. Summary knowledge of the specific efficacy and contraindications of each of them can be useful before prescribing them to our patients.

¿Qué opinan los pacientes de nuestros centros de salud? ¿Realizarían cambios? Situación a las puertas de siglo XXI

364 masificación existente. También resaltan la necesidad de una alta cualificación de los profesionales que les atendemos y sobre todo quitarían a los que ellos consideran incompetentes. También existe la percepción de que existe una excesiva burocratización de los centros de salud, demasiados papeles y mostradores. Todo esto nos debe hacer reflexionar a la hora de diseñar las estrategias para gestionar adecuadamente los equipos de atención primaria, teniendo siempre en cuenta las necesidades de los usuarios1 y de los profesionales que trabajamos en ellos2,3.

[LB.02.20]PERIPHERAL ARTERIAL DISEASE, PRIMARY CARE MANAGEMENT IN A SPANISH HEALTH CENTRE

Objective: 1) To assess the current situation in primary care consultations by means of the analysis of all patients diagnosed with peripheral artery disease (PAD) and / or intermittent claudication (IC) in a health area of a southeastern Spanish city. 2) To analyze the relationship between this pathology and other cardiovascular risk factors, cerebrovascular and coronary artery disease; as well as the relation with sociodemographic factors such as age and sex. Design and method: Descriptive and cross-sectional study. All patients with PAD and/or IC were selected usin g a health management software (OMIap®) used in primary care attention. We examined the existence or non-existence of cardiovascular risk factors including hypertension, diabetes or smoking and other cardiovascular diseases as coronary artery disease and previous stroke. Statin, antiplatelet treatment and anticoagulant treatment are also analyzed in the selected patients. Together with the treatment study, we analyzed the proportion of patients who underwent the ankle-brachial index test. Finally, we determined the proportion of patients who were referred to a specialized care centre. Results: We recruit a total of 100 patients with diagnosis of PAD/IC, 61 men and 39 women aged 42 to 94 years, with a mean of 70.0 ± 12.9 years. Among all patients, 37% were diabetics, 63% were hypertense, 21% had a previous diagnosis of coronary artery disease and 7% of stroke. The percentage of smokers was 36%. Regarding treatment, 51% were treated with a single antiplatelet drug and 6% with two. They were under anticoagulant treatment in 18% and 59% on statins. Ankle-brachial index test was performed just in 41% of all patients and 47% were referred to specialized care centre. Conclusions: 1) The prevalence of PAD is greater than that perceived by health professionals, being therefore an underestimated and underdiagnosed disease. 2) There is a low prescription of statins and antiplatelet drugs in patients with peripheral arteriopathy. 3) Less than half of the patients studied with diagnosis/episode of PAD have performed the ankle-brachial index test.

Valoración del control de los factores de riesgo cardiovascular en mujeres menopáusicas obesas tras el seguimiento de un programa estructurado de educación dietética y ejercicio físico. (Programa SÍSIFO)

OBJECTIVE Evaluate the influence of a specific program of physical exercise on cardiovascular risk, quality of life and eating habits of menopausal women. METHOD Prospective, intervention study previous-after without control group for three months. 66 menopausal women were included. The intervention consisted of a structured diet and exercise program. Biochemical, anthropometric, dietary and life quality parameters were determined before and three months after surgery. RESULTS After the intervention a decrease in weight (4.4±2,3kg) and BMI (1.83±0.84kg/m(2)) (p<.05) occurs. A decrease in SBP (p<.05) was also observed. The fasting glucose went down 13.75±11.11mg/dl and HbA1c fell by 0.19±0,12%, both with p<.05. The lipid profile follows a similar behavior, highlighting a decline of 8± 6.2mg/dl in LDL cholesterol values (p<.05). The score on the measured cardiovascular risk by the Framingham tables decreases by 3% postoperatively (p<.05). Regarding the quality of life, it is significantly improved in all analyzed areas. CONCLUSIONS The application of a structured exercise and diet program improves close monitoring parameters associated with cardiovascular risk of the women studied. It also improves the quality of life and dietary habits.