Actividades preventivas en el mayor. Actualización PAPPS 2022 Acosta Benito, Miguel Ángel; García Pliego, Rosa Ana; Baena Díez, José Miguel ...
Atención primaria,
October 2022, 2022-10-00, 20221001, 2022-10-01, Letnik:
54, Številka:
Suppl 1
Journal Article
Recenzirano
Odprti dostop
En este artículo se examina la última evidencia disponible sobre las actividades preventivas en la persona mayor, incluyendo los trastornos de sueño, el ejercicio físico, la deprescripción, los ...trastornos cognitivos y las demencias, la nutrición, el aislamiento social y la fragilidad.
This article examines the latest available evidence on preventive activities in the elderly, including sleep disorders, physical exercise, deprescription, cognitive disorders and dementias, nutrition, social isolation and frailty.
Abstract Influenza vaccination coverage among health-care workers (HCWs) remains the lowest compared with other priority groups for immunization. Little is known about the acceptability and ...compliance with the pandemic (H1N1) 2009 influenza vaccine among HCWs during the current campaign. Between 23 December 2009 and 13 January 2010, once the workplace vaccination program was over, we conducted a cross-sectional, questionnaire-based survey at the University Hospital 12 de Octubre (Madrid, Spain). Five hundred twenty-seven HCWs were asked about their influenza immunization history during the 2009–2010 season, as well as the reasons for accepting or declining either the seasonal or pandemic vaccines. Multiple logistic-regression analysis was preformed to identify variables associated with immunization acceptance. A total of 262 HCWs (49.7%) reported having received the seasonal vaccine, while only 87 (16.5%) affirmed having received the pandemic influenza (H1N1) 2009 vaccine. “Self-protection” and “protection of the patient” were the most frequently adduced reasons for acceptance of the pandemic vaccination, whereas the existence of “doubts about vaccine efficacy” and “fear of adverse reactions” were the main arguments for refusal. Simultaneous receipt of the seasonal vaccine (odds ratio OR: 0.27; 95% confidence interval 95% CI: 0.14–0.52) and being a staff (OR: 0.08; 95% CI: 0.04–0.19) or a resident physician (OR: 0.16; 95% CI: 0.05–0.50) emerged as independent predictors for pandemic vaccine acceptance, whereas self-reported membership of a priority group was associated with refusal (OR: 5.98; 95% CI: 1.35–26.5). The pandemic (H1N1) 2009 influenza vaccination coverage among the HCWs in our institution was very low (16.5%), suggesting the role of specific attitudinal barriers and misconceptions about immunization in a global pandemic scenario.
Actualización PAPPS GdT Mayor 2020 Gorroñogoitia Iturbe, Ana; López-Torres Hidalgo, Jesús; Martin Lesende, Iñaki ...
Atención primaria,
November 2020, 2020-11-00, 20201101, 2020-11-01, Letnik:
52, Številka:
Suppl 2
Journal Article
Recenzirano
Odprti dostop
En la presente actualización se han introducido nuevos temas que creemos que son de vital importancia en el mayor, como son la revisión de las ayudas para caminar, recomendaciones en nutrición y ...aislamiento social.
Se han revisado las recomendaciones sobre deprescripción, fragilidad, deterioro cognitivo leve y demencia ya presentadas en actualizaciones anteriores.
In this update, we have introduced new topics that we believe are of vital importance in the major areas, such as the revision of walking aids, as well as recommendations on nutrition and social isolation.
Recommendations on deprescribing, fragility, mild cognitive impairment, and dementia have already been presented in previous updates.
Abstract
Knowing the frequency and characteristics of adverse events (AEs) is key to implementing actions that can prevent their occurrence. However, reporting systems are insufficient for this ...purpose and epidemiological studies are also required. Currently, the reviewing of clinical records is the gold standard method for knowing the frequency and characteristics of AEs. Research on AEs in a primary care setting has been limited and primarily focuses on specific types of events (medication errors, etc.) or patients. Large studies that search for any kind of AE in all patients are scarce. This study aimed to estimate the prevalence of AEs in the primary care setting and their characteristics. Setting: all 262 primary health-care centres in the Madrid region (Spain) during the last quarter of 2018. Design: cross-sectional descriptive study. Eligible population: subjects over 18 years of age who attended medical consultation over the last year (N = 2 743 719); a randomized sample stratified by age. Main outcomes: age, sex, occurrence of an AE, number of consultations in the study period, avoidability, severity, place of occurrence, type of event, and contributory factors. The clinical records were reviewed by three teams, each composed of one doctor and one nurse trained and with expertise in patient safety. The SPSS software package (version 26) was used for the statistical analyses. The evaluators reviewed 1797 clinical records. The prevalence of AEs over the study period was 5.0% 95% confidence interval (CI): 4.0%‒6.0%, with higher values in women (5.7%; 95% CI: 4.6%‒6.8%;P = 0.10) and patients over 75 years of age (10.3%; 95% CI: 8.9%‒11.7%; P < 0.001). The overall occurrence per hundred consultations was estimated to be 1.58% (95% CI: 1.28%‒1.94%). Of the detected AEs, 71.3% (95% CI: 62.1%‒80.5%) were avoidable. Additionally, 60.6% (95% CI: 50.7%‒70.5%) were categorized as mild, 31.9% (95% CI: 22.4%‒41.4%) as moderate, and 7.4% (95% CI: 2.1%‒12.7%) as severe. Primary care was the occurrence setting in 76.6% (95% CI: 68.0%‒85.2%) of cases. The overall incidence of AEs related to medication was 53.2% (95% CI: 50.9%‒55.5%). The most frequent types of AEs were prescription errors (28.7%; 95% CI: 19.5%‒37.9%), followed by drug administration errors by patients (17.0%; 95% CI: 9.4%‒24.6%), and clinical assessment errors (11.7%; 95% CI: 5.2%‒18.2%). The most common contributory factors were those related to the patient (80.6%; 95% CI: 71.1%‒90.1%) and tasks (59.7%; 95% CI: 48.0%‒71.4%). A high prevalence of AEs (1 in 66 consultations) was observed, which was slightly higher than that reported in similar studies. About 3 out of 4 such events were considered to be avoidable and 1 out of 13 was severe. Prescription errors, drug administration errors by patients, and clinical assessment errors were the most frequent types of AEs.
Graphical Abstract
PAPPS GdT Major 2020 Update Gorroñogoitia Iturbe, Ana; López-Torres Hidalgo, Jesús; Martin Lesende, Iñaki ...
Atención primaria,
11/2020, Letnik:
52 Suppl 2
Journal Article
Recenzirano
Odprti dostop
In this update, we have introduced new topics that we believe are of vital importance in the major areas, such as the revision of walking aids, as well as recommendations on nutrition and social ...isolation. Recommendations on deprescribing, fragility, mild cognitive impairment, and dementia have already been presented in previous updates.
Resumen Objetivo Comprobar si el proceso asistencial en Atención Primaria de Salud (APS), definido por 7 criterios de correcta atención, influye en el riesgo de hospitalizaciones evitables por ...Ambulatory Care Sensitive Conditions (ACSH) por insuficiencia cardíaca (IC). Diseño Estudio de casos y controles que analizó el riesgo de hospitalización por IC. Factor de exposición: proceso asistencial de APS. Emplazamiento Área sanitaria de la Comunidad de Madrid (n = 466.901). Participantes Pacientes mayores de 14 años con el registro del diagnóstico de IC en la historia clínica electrónica de APS (n = 3.277) antes del 1 de enero de 2007. Los casos fueron pacientes que ingresaron en el hospital de referencia por IC durante 2007. Los controles no requirieron ingreso. Mediciones principales Riesgo de ACSH por IC relacionado con el proceso asistencial considerado tanto de forma conjunta como por cada uno de los criterios. Diferencias en complejidad clínica mediante Adjusted Clinical Group (ACG). Resultados Doscientos veintisiete ingresos por IC frente a un grupo control de 3.050 pacientes. El peso medio de ACG fue mayor en los casos. Los controles tuvieron mayor cumplimentación de criterios, pero ninguno cumplió los 7. Solo en 2 de los criterios se observó menor riesgo de ACSH. A medida que no se cumplimentaba progresivamente cada criterio, el riesgo de ingresar aumentó (OR = 1,33; IC 95%: 1,19-1,49). Conclusión La calidad del proceso asistencial en APS influyó en el riesgo de ingreso por IC.
The aim of the study was to construct and validate a reduced set of high-performance triggers for identifying adverse events (AEs) via electronic medical records (EMRs) review in primary care (PC).
...This was a cross-sectional descriptive study for validating a diagnostic test. The study included all 262 PC centers of Madrid region (Spain). Patients were older than 18 years who attended their PC center over the last quarter of 2018. The randomized sample was n = 1797. Main measurements were as follows: ( a ) presence of each of 19 specific computer-identified triggers in the EMR and ( b ) occurrence of an AE. To collect data, EMR review was conducted by 3 doctor-nurse teams. Triggers with statistically significant odds ratios for identifying AEs were selected for the final set after adjusting for age and sex using logistic regression.
The sensitivity (SS) and specificity (SP) for the selected triggers were: ≥3 appointments in a week at the PC center (SS = 32.3% 95% confidence interval {CI}, 22.8%-41.8%; SP = 92.8% 95% CI, 91.6%-94.0%); hospital admission (SS = 19.4% 95% CI, 11.4%-27.4%; SP = 97.2% 95% CI, 96.4%-98.0%); hospital emergency department visit (SS = 31.2% 95% CI, 21.8%-40.6%; SP = 90.8% 95% CI, 89.4%-92.2%); major opioids prescription (SS = 2.2% 95% CI, 0.0%-5.2%; SP = 99.8% 95% CI, 99.6%-100%); and chronic benzodiazepine treatment in patients 75 years or older (SS = 14.0% 95% CI, 6.9%-21.1%; SP = 95.5% 95% CI, 94.5%-96.5%).The following values were obtained in the validation of this trigger set (the occurrence of at least one of these triggers in the EMR): SS = 60.2% (95% CI, 50.2%-70.1%), SP = 80.8% (95% CI, 78.8%-82.6%), positive predictive value = 14.6% (95% CI, 11.0%-18.1%), negative predictive value = 97.4% (95% CI, 96.5%-98.2%), positive likelihood ratio = 3.13 (95% CI, 2.3-4.2), and negative likelihood ratio = 0.49 (95% CI, 0.3-0.7).
The set containing the 5 selected triggers almost triples the efficiency of EMR review in detecting AEs. This suggests that this set is easily implementable and of great utility in risk-management practice.
PAPPS update on older people 2022 Acosta Benito, Miguel Ángel; García Pliego, Rosa Ana; Baena Díez, José Miguel ...
Atención primaria,
10/2022, Letnik:
54 Suppl 1
Journal Article
Recenzirano
Odprti dostop
This article examines the latest available evidence on preventive activities in the elderly, including sleep disorders, physical exercise, deprescription, cognitive disorders and dementias, ...nutrition, social isolation and frailty.
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