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1. Quality assurance in specialized headache units in Spain: an observational prospective study

Author

Patricia Pozo-Rosich, Julio Pascual, Alba Martínez-García, Almudena Layos-Romero, Jesús Porta-Etessam, Emilio Ignacio, Germán Latorre-González, Guerrero-Peral Ál, José Joaquín Mira, José Balseiro-Gómez, and César Lucas

Subjects
Male, media_common.quotation_subject, lcsh:Medicine, 03 medical and health sciences, Patient safety, 0302 clinical medicine, Patient satisfaction, medicine, Humans, Indicators, Quality (business), 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Referral and Consultation, media_common, Aged, business.industry, lcsh:R, Headache, General Medicine, medicine.disease, Quality assurance, Anesthesiology and Pain Medicine, Neurology, Patient Satisfaction, Spain, Observational study, Female, Neurology (clinical), Medical emergency, business, 030217 neurology & neurosurgery, Research Article
Abstract

Objective To assess the quality of the therapeutic approach in Specialized Headache Units in Spain. Methods An observational (prospective) study was conducted. Anonymized data of 313 consecutive patients during a defined period of time were analyzed and a comparison of performance in 13 consensual quality indicators between Specialized Headache Units and neurology consultations was calculated. Specialized Units and neurology consultations represented the type of provision that Spaniards receive in hospitals. Results The consensus benchmark standard was reached for 8/13 (61%) indicators. Specialized Headache Units performed better in the indicators, specifically in relation to accessibility, equity, safety, and patient satisfaction. Patients attended in Specialized Headache Units had more complex conditions. Conclusion Although there is variability among Specialized Headache Units, the overall quality was generally better than in traditional neurology consultations in Spain.

Published
2019
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2. Factors associated with poor anticoagulation control with vitamin K antagonists among outpatients attended in Internal Medicine and Neurology. The ALADIN study

Author

Cristina Barbagelata, Francisco Cabrera, María Herrera, Pedro Cardona, Radka Ivanova Georgieva, José Miguel Pons, Maite Martínez, Jesús Saiz, Tomás Pérez, José Ángel Satué, Cristina Tejera Pérez, Joan Rosal, Javier Fernández, M. José Gómez, Jordi Sanahuja, Patricia Ibáñez, Ana Rodríguez, José M. Errea, Alejandro Martínez-Domeño, Antonio Manquillo, Ana Latorre, Luis Beltrán, Juli Font, Cecile van Eedenburg, Xavier Ustrell, Elena Bello, Raquel González, M. Carmen Gil, José Antonio Díaz, Francisco Purroy, Elena Calzado, José Carlos Gómez, Susana Arias, Clara Sainz, Óscar Fabre, Francisco Javier Barrero, José Ferreiro, José M. Ramírez-Moreno, Mariano Aguayo, Lamberto Landete, Manuel Rodríguez, Ramón Villaverde, Eduardo Agüera-Morales, C. Suárez Fernández, José Ramírez, Gemma Reig, Covadonga Fernández, Carmen Jiménez, Ana M Roa, Alejandro Ponz, Joaquín Carnedo, Rafael Fernández de la Puerta, Jerzy Kuprinski, Raquel Chamarro, Enrique Cabrerizo, Rafael López, M. Ángeles Revilla, Xavier Nogués, Marta Serrano, Roberto Muñoz, José M. Trejo, Jaume Roquer, Beatriz Zandio, María Pérez de la Blanca, Santiago Montull, Helena Quesada, Juan Carlos Anglada, Ana de Arce, Ana Pampliega, Juan Carlos Belinchón, Jaime Gállego, Francisco Moniche, Inmaculada Villegas, Nuria Aymerich, Juan José Mengual, Ana Calleja, Antonio Gil-Núñez, Antonio Medina, Fernando Salgado, Antonio Pose, Blanca Batalla, Sandra Boned-Riera, Juan José Cara, José M. Terrero, Juan Luengo, Román Cerro, José Tembl, Laia Seró, Christian Homedes, Manuel Payan, Imma Cañas, Blanca Fuentes, Fernando Díaz, Laura Ballester, Francisco Lozano, Ignacio Casado, M. Pilar Moreno, Luis López, Antonio Arjona, Miguel Yebra, Jorge Romero, Marco Antonio Budiño, Francesc Puchades, Jacinto Hernández, Javier García, María Concepción Prados Sánchez, Joan Martí-Fàbregas, José Castro, M. Ángeles Fidalgo, Javier Marta, Alicia de Felipe, David Esteva, María Bestué, Vicente Oliver, Marta Guillan, David Vinuesa García, Esther Aragón, Natividad Raña, José Maciñeiras, José Luis Vázquez, Juan Carlos Martínez-Acitores, Dolores Fernández, Félix González, Demetrio Sánchez, Rafael Bustamante, María Ángeles Ortega, Nuria Navarrete, Jesús M. Juega, Emilio Barroso, Pedro Luis Muñoz, Leticia Álvarez, Mónica Arias, Carlos Sánchez, Juan Antonio Arroyo, Juan José Timiraos, Ana Jurado, José Carlos Pontes, Sonia M. García, Iluminada García Polo, Daniel Irigoyen, Arturo Artero, Maria Àngels Font, Miguel Ángel Rico, Laura Imaz, Salvadora Martínez, José Carlos Fernández, Ikram Benabdelhak, Ana María González, Patricia Martínez, Sonia Huertas, Francisco Javier Martínez, Yolanda Bravo, Alfonso Aguirre, Luis Mérida, Carlos Tejero, Jordi Espinosa, Montserrat González, Consuelo Matute, José M. de Lis, Marian Muchada, José Bernardo Escribano, M. Dolores Moragues, Miguel Ángel Corrales, Mar Freijo, Juan F. Arenillas, J. Manuel Cerqueiro, Aida Lago, Manuel Montero, Enrique Mostacero, Javier de la Torre, Jesús Foronda, David Gorriz, Óscar Fernández, Elisa Rodríguez, Alex Culla, José M. Rivera, Juan Carlos Portilla, Roberto Pérez, Marta Pena, Bárbara Vives, Julián Fernández, Jose Antonio Egido, Ana Castellano, Mónica Zamora, Agustín Pijierro, Eva Calvo, Elisa Cortijo, Fernando Aguilar, David Cánovas, José Vivancos, Pablo Irimia, Enrique Calderón, Carlos Molina, Pedro Jesús Serrano, Esther Fernández, J. Tejada, Carmen Morata, María Paz Martínez, Gerardo Ruiz, César Lucas, Purificación Durán, Ángel Ois, Noemí Díez, José Antonio Tamayo, Jordi Casanova, Igor Molina, Jaime Díaz, Carmen Caro, Susana Mederer, Fernando Jaén, Jordi Estela, Dionisio Carrillo, Irene Navalpotro, José Luis Beato Pérez, Alain Luna, Jorge Artal, Jesús Cantero, Enrique Palacio, Elisa Cuadrado, Javier Reyes, Pilar Meler, Miguel Alberto de Zarraga, Gema Sanz, M. Ángeles López, Ricardo Gómez, Joaquín Sánchez, Miguel Ángel García, Raúl Quirós, Rosario Gil, Héctor Guerrero, Jorge Marrero, Eduardo Carmona, José Carlos Morán, José Antonio Trujillo, Alan Flores, Juan Manuel García, Manuel Gómez-Choco, Amparo Romero, Carlos Vilar, Santiago Freire, M. del Mar Castellanos, Silvia Tur, Cristina Borrachero, Jesús Vega, Sonia Gonzalo, Alberto Morán, Laura Ramos, Antonio Cayon, Manuel Seijo, Raquel Delgado-Mederos, M. José Fonseca, Juan Girón, Aida Rodríguez, Yesica Miranda, Jaime Masjuan, Álvaro González, Iván Moreno, Fernando Sierra, Jordi Jiménez, M. del Carmen Riveira, Davinia Larrosa, Rosa Díaz, Daniel Peña, M.M. Contreras Muruaga, Joaquín Antón, Irene Escudero, Borja Enrique Sanz, and Antoni German

Subjects
medicine.medical_specialty, Acenocoumarol, Neurology, business.industry, Warfarin, Atrial fibrillation, General Medicine, 030204 cardiovascular system & hematology, Vitamin k, medicine.disease, Thromboembolic risk, 03 medical and health sciences, 0302 clinical medicine, Multicenter study, Diabetes mellitus, Internal medicine, medicine, 030212 general & internal medicine, business, medicine.drug
Abstract

Objective To identify factors associated with poor anticoagulation control with vitamin K antagonists (VKA) among outpatients with nonvalvular atrial fibrillation (NVAF) attended in Neurology and Internal Medicine in Spain. Methods Cross-sectional and multicenter study, from the ALADIN database, of outpatients with NVAF treated with VKA and attended in Internal Medicine and Neurology in Spain. Rates of anticoagulation control were determined with the direct and Rosendaal methods, considering data from the 6 months before the inclusion. Results Out of 1337 patients included in the ALADIN study, 750 were taking VKA, and complete information about INR values in the last 6 months was available in 383 patients. Mean scores of Charlson Index, CHADS2, CHA2DS2-VASc and HAS-BLED were 1.94 ± 1.54; 3.10 ± 1.26; 4.63 ± 1.54, and 2.20 ± 0.90, respectively. 46.2% and 47.0% of patients had an adequate anticoagulation control according to the direct and Rosendaal methods, respectively. Inadequate anticoagulation control according to the direct method was associated with diabetes (OR: 2.511; 95% CI: 1.144–5.659), prior labile INR (OR: 35.371; 95% CI: 15.058–83.083) and the determination of >6 INR controls in the last 6 months (OR: 4.747; 95% CI: 2.094–10.759), and according to the Rosendaal method, with prior labile INR (p Conclusions Despite the high thromboembolic risk, only a little more than a half of patients were well controlled. Factors associated with poor anticoagulation control were diabetes, labile INR, >6 INR controls and HAS-BLED.

Published
2018
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3. Factores asociados al mal control de la anticoagulación con antivitamina K en pacientes con fibrilación auricular no valvular atendidos en consultas de Medicina Interna y Neurología. Estudio ALADIN

Author

M.M. Contreras Muruaga, G. Reig, J. Vivancos, A. González, P. Cardona, J.M. Ramírez-Moreno, J. Martí-Fábregas, C. Suárez Fernández, Antonio Pose, José Antonio Díaz, Manuel Rodríguez, Marta Pena, Susana Arias, Davinia Larrosa, Álvaro González, Elisa Rodríguez, Montserrat González, Dolores Fernández, Cristina Barbagelata, Natividad Raña, Santiago Freire, J. Manuel Cerqueiro, Héctor Guerrero, Laura Ramos, Leticia Álvarez, José M. de Lis, Carmen Caro, Manuel Seijo, Susana Mederer, Miguel Alberto de Zarraga, José Ferreiro, José M. Terrero, Mónica Arias, Roberto Pérez, Joaquín Sánchez, José Maciñeiras, Julián Fernández, Fernando Jaén, David Esteva, Mónica Zamora, Nuria Navarrete, Javier García, Luis Mérida, Miguel Ángel Corrales, Raúl Quirós, Jesús Cantero, Francisco Javier Barrero, Inmaculada Villegas, José Castro, Jesús Foronda, Dionisio Carrillo, Jesús Vega, José Antonio Trujillo, Manuel Montero, Ana Jurado, Carlos Sánchez, Eduardo Agüera-Morales, María Sánchez, Purificación Durán, Rafael Fernández de la Puerta, María Pérez de la Blanca, María Paz Martínez, Óscar Fernández, José Antonio Tamayo, Rafael Bustamante, Pedro Jesús Serrano, Antonio Arjona, Javier Fernández, Manuel Payan, Ricardo Gómez, Daniel Peña, Enrique Cabrerizo, Fernando Salgado, Radka Ivanova Georgieva, Antonio Gil-Núñez, Elena Bello, Fernando Díaz, Antonio Medina, Ana Castellano, Yesica Miranda, Óscar Fabre, Iluminada García Polo, Patricia Ibáñez, Clara Sainz, Fernando Sierra, Esther Aragón, Jaime Díaz, Fernando Aguilar, María Ángeles Ortega, José Antonio Egido, José Carlos Pontes, Miguel Ángel García, Francisco Cabrera, Blanca Batalla, Alex Culla, Carlos Molina, Alan Flores, Laia Seró, Marian Muchada, Pilar Meler, Sandra Boned-Riera, David Cánovas, Jordi Estela, Juli Font, Francisco Purroy, Ikram Benabdelhak, Jordi Sanahuja, Jaume Roquer, Ana Rodríguez, Ángel Ois, Elisa Cuadrado, Jordi Jiménez, Xavier Nogués, Jerzy Kuprinski, Antoni German, Daniel Irigoyen, Juan José Cara, Maria Àngels Font, Sonia Huertas, Alejandro Martínez-Domeño, Juan Antonio Arroyo, Raquel Delgado-Mederos, Manuel Jesús Gómez-Choco, Juan José Mengual, Sonia M. García, M. del Mar Castellanos, Cecile van Eedenburg, Imma Cañas, Jordi Espinosa, Santiago Montull, Helena Quesada, Xavier Ustrell, Christian Homedes, Irene Navalpotro, Jordi Casanova, Aida Pilar Lago, Carmen Morata, David Gorriz, Iván Moreno, José Tembl, Alejandro Ponz, M. José Fonseca, Raquel Chamarro, Rosario Gil, Vicente Oliver, Ana Pampliega, Arturo Artero, Francesc Puchades, Lamberto Landete, Carlos Vilar, Carmen Jiménez, Bárbara Vives, M. Dolores Moragues, Rosa Díaz, Silvia Tur, José Bernardo Escribano, César Lucas, Francisco Martínez, José Miguel Pons, Amparo Romero, David García, José Pérez, Ramón Villaverde, Salvadora Martínez, Aida Rodríguez, Carlos Tejero, Cristina Pérez, Enrique Mostacero, Covadonga Fernández, Alain Luna, Tomás Pérez, Félix González, Ana de Arce, Maite Martínez, Noemí Díez, Jaime Gállego, Beatriz Zandio, María Herrera, Nuria Aymerich, Roberto Muñoz, Javier Marta, Jorge Artal, José M. Errea, Juan José Timiraos, M. Pilar Moreno, Mar Freijo, Juan Manuel García, M. Carmen Gil, M. Ángeles Revilla, Enrique Palacio, José Luis Vázquez, María Bestué, Ana Latorre, Eva Calvo, Laura Ballester, Marta Serrano, Jesús M. Juega, M. Ángeles López, Pablo Irimia, Laura Imaz, Blanca Fuentes, Borja Enrique Sanz, Luis Beltrán, Gerardo Ruiz, Patricia Martínez, Demetrio Sánchez, Emilio Barroso, Igor Molina, Marco Antonio Budiño, Jaime Masjuan, Alicia de Felipe, Consuelo Matute, Javier Tejada, Alberto Morán, Esther Fernández, M. del Carmen Riveira, Joaquín Carnedo, Antonio Manquillo, Raquel González, José Carlos Fernández, Marta Guillan, Miguel Yebra, José M. Trejo, Jesús Saiz, Juan Carlos Martínez-Acitores, Yolanda Bravo, Juan Francisco Arenillas, Ana Calleja, Elisa Cortijo, Javier Reyes, Luis López, Pedro Luis Muñoz, M. Ángeles Fidalgo, Jacinto Hernández, José Carlos Gómez, José Carlos Morán, Sonia Gonzalo, Jorge Marrero, José Ángel Satué, Juan Carlos Belinchón, Francisco Moniche, Enrique Calderón, Irene Escudero, Javier de la Torre, Ignacio Casado, Joaquín Antón, Juan Carlos Portilla, Juan Luengo, Joan Rosal, Elena Calzado, Juan Carlos Anglada, Juan Girón, José M. Ramírez, Agustín Pijierro, Ana Roa, Jorge Romero, Mariano Aguayo, Cristina Borrachero, Gema Sanz, M. José Gómez, Miguel Ángel Rico, Antonio Cayon, Eduardo Carmona, Román Cerro, Rafael López, Alfonso Aguirre, Francisco Lozano, and José M. Rivera.

Subjects
03 medical and health sciences, 0302 clinical medicine, business.industry, Medicine, 030212 general & internal medicine, General Medicine, 030204 cardiovascular system & hematology, business, Humanities
Abstract

Resumen Objetivo Identificar los factores asociados con el mal control de la anticoagulacion con antagonistas de la vitamina K (AVK) en pacientes con fibrilacion auricular no valvular (FANV) atendidos en consultas de Neurologia y Medicina Interna de Espana. Metodos Estudio transversal, multicentrico, anidado en el estudio ALADIN, de sujetos con FANV, tratados con AVK, atendidos en consultas de Medicina Interna o Neurologia de Espana. El grado de control de la anticoagulacion se estudio mediante el metodo directo y el de Rosendaal, considerando los 6 meses previos a la inclusion. Resultados De los 1.337 pacientes incluidos en ALADIN, 750 estaban tratados con AVK, con informacion completa sobre el INR de los ultimos 6 meses en 383 pacientes. Las puntuaciones medias del indice de Charlson, CHADS2, CHA2DS2-VASc y HAS-BLED fueron 1,94 ± 1,54; 3,10 ± 1,26; 4,63 ± 1,54 y 2,20 ± 0,90, respectivamente. El 46,2% y el 47,0% de los pacientes presentaban un control adecuado de la anticoagulacion por los metodos directo y Rosendaal, respectivamente. El control inadecuado de la anticoagulacion se asocio por el metodo directo con diabetes (OR: 2,511; IC 95%: 1,144-5,659), antecedentes de INR inestable (OR: 35,371; IC 95%: 15,058-83,083) y la realizacion de > 6 controles en los ultimos 6 meses (OR: 4,747; IC 95%: 2,094-10,759), y por el metodo de Rosendaal, con los antecedentes de INR inestable (p Conclusiones Pese al alto riesgo tromboembolico, solo estaban bien controlados algo mas de la mitad. Los factores asociados al mal control de la anticoagulacion fueron la diabetes, INR inestable, > 6 controles de INR y el HAS-BLED.

Published
2018
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