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Objectives: Successful deprescribing depends largely on factors related to the patient. The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was developed with the objective of evaluating the beliefs and attitudes of older adults and caregivers towards deprescribing. The present study was designed to validate a Spanish version of the rPATD questionnaire, both the versions for older adults and for caregivers, through a qualitative validation phase and the analysis of its psychometric properties., Design: Cross-sectional validation study., Setting: Primary care settings in Málaga (Spain)., Participants: A sample of 120 subjects (60 patients with polypharmacy and 60 caregivers of patients with polypharmacy) were enrolled in the study., Main Outcome Measures: In the qualitative validation stage, the rPATD questionnaire was translated/back-translated and subjected to a cross-cultural adaptation to evaluate its face validity and feasibility. Next, its psychometric properties were assessed. Confirmatory factor analysis was used to evaluate construct validity. Internal consistency was determined using Cronbach's alpha test. Criterion validity through pre-established hypotheses from the Beliefs about Medicines Questionnaire (BMQ) Specific-Concerns Scale, and test-retest reliability were analysed., Results: Confirmatory factor analysis verified the four-factor structure of the original rPATD questionnaire, with items loading into four factors: involvement , burden , appropriateness and concerns about stopping . The Cronbach's alpha coefficient of the factors ranged from 0.683 to 0.879. The burden , appropriateness and concerns about stopping factors were significantly correlated with the BMQ Specific-Concerns Score, except for the concerns about stopping factor in the older adults' version. The consistency of the items between administration times (test-retest reliability) showed weighted Cohen's kappa values ranging from moderate (>0.4) to very good (>0.8)., Conclusions: The Spanish version of the rPATD questionnaire is a feasible, valid and reliable instrument to evaluate attitudes towards deprescribing in Spanish-speaking patients and caregivers., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction and Objective: Polypharmacy has become a priority public health problem in developed countries. In response to its approach, deprescription stands out. Its success will depend largely on the attitudes and beliefs of patients towards the number of drugs they are taking and their willingness to initiate a process of deprescription. To explore these factors, researchers have developed the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire, originally in English. The objective of this study is the validation into Spanish of rPATD questionnaire, both older adults and caregivers versions., Material and Methods: A first qualitative validation phase and a second phase of analysis of its psychometric characteristics will be carried out through an observational descriptive study of validation of a measurement instrument. One hundred and twenty subjects (polymedicated older adults and caregivers) from three health centers will be selected by consecutive sampling. The questionnaire will be provided and clinical and sociodemographic data will be collected. Feasibility, reliability (through internal consistency and intraobserver reliability) and validity (apparent, construct and criterion) of the questionnaire will be evaluated., Expected Results: It is expected to obtain a questionnaire that will serve as a tool for the clinician to identify patients with a favorable predisposition to deprescription and that will allow to contribute the patient's perspective to this process., Conclusion: The use of the rPATD questionnaire, alone or integrated into other more complex interventions, may lead to an improvement in the quality of care for the polymedicated patients., (Copyright © 2021 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: There are several methods to promote informed decision making before undergoing a screening program. This research aimed to analyze the contents of official documents about breast cancer screening programs., Methods: A descriptive research was performed. After a literature review an agreed checklist was performed with the information needed to make decisions about participation in mammography screening programs. Informative documents about mammography screening valid in Spain in 2016 were analyzed by two independent researchers. The inter-rater agreement was verified and the discrepancies were solved by consensus. Absolute and relative frequencies of each item were calculated., Results: 8 invitations and 14 citation letters, 12 leaflets, 8 brochures and 14 websites, from 18 screening programs, were reviewed. The information turned out to be very different according to each program. Only a third warned that participation is voluntary. 8 programs (44.4%) offered information on what is breast cancer and 7 (38.9%) on the cumulative risk of developing the disease. 15 (83.3%) explained the objectives of the program and 14 (77.8%) explained what mammography is. 14 programs (77.8%) presented as screening benefits the least invasive treatments, 12 the increase in survival (66.7%) and 10 the decrease in specific mortality (55.6%). Most of the programs did not report the possibility of false positives (27.8%) or false negatives (38.9%). Only 7 (38.9%) mentioned the possibility of overdiagnosis and 6 (33.3%) of overtreatment., Conclusions: The information provided by the different breast cancer screening programs is variable and does not contain sufficient information for informed decision-making., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Deprescribing is the process of reconstructing multiple medication use by review and analysis and which concludes with dose modification, replacement or elimination of some drugs or adding others. Its development is intended to resolve tensions and contradictions between two sets of questions: 1/is life expectancy shorter than the time the drug takes to obtain a benefit?, and 2/are the goals of prescribing-deprescribing consistent with those of care? The validity of the rationale on deprescribing is based on scientific and ethical reasons. The usefulness and safety of many drugs that frail elderly or terminally ill takes is unknown, and other drugs may cause troublesome or severe side effects. Thus, in some cases their removal could be justified, being substantially safe doing so., (Copyright © 2012 SEGG. Published by Elsevier Espana. All rights reserved.)

Objective: To determine what family doctors think about various aspects of patient involvement in clinical decision making in Primary Care., Design: Qualitative study using focus groups., Location: Primary Care., Participants: Family physicians with and without expertise in clinical communication., Methods: Three focus groups were developed, involving 6-8 professionals per group, and took part in two meetings. The conversations were recorded and transcribed verbatim. The discussion was analysed using literature-based categories and other emerging from the text, encoding the information and making an inductive interpretation., Results: Family physicians refer mainly to involving the patient in decisions by proposing a plan tailored to the knowledge of patient problems and then verifying their approval or rejection. However, some professionals ponder whether this could be classified as patient involvement, questioning the real role that both players would take at the time of deciding., Conclusions: The explanation of how family physicians would involve the patient in decisions clashes with the most widespread theories on the subject and, also opposes the view of patients who would like to be involved more actively. Taking into account discordant reflections on the relevance of considering this process as real patient involvement, it is necessary to describe a realistic theoretical model that allows further development of strategies to improve the attitude and training of professionals to patient involvement in clinical decisions., (Copyright © 2011 Elsevier España, S.L. All rights reserved.)

Primary care offers huge potential for research. This setting is an area of knowledge that must expand to improve the quality of its services and patients' health. Population-based clinical studies with a focus on health promotion and primary, secondary and tertiary disease prevention offer unique research opportunities. Developing research in the biopsychosocial model of clinical practice and new models of integrated healthcare and community care is therefore a priority. The framework and activities carried out by the Research Network in Preventive Activities and Health Promotion have been instrumental in the development of research in primary care in Spain. Despite the efforts invested by various institutions, foundations, teaching and research departments in primary care research, the projected outputs in terms of volume, quality and impact have not been achieved. The involvement of primary care professionals in research platforms is insufficient, with scarce contribution toward investment in specific primary care research projects. To change the current status of research in primary care, a number of measures are required, namely, the consolidation of research organisms specific to primary care with adequate allocation of funding and staff, and the allocation of specific time for research to primary care professionals to enable them to produce significant projects and consolidate established research lines in their areas of expertise, with applications mainly in quality improvement and innovation of primary care services., (Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objectives: This work aims to explore to what extent Spanish primary care providers involve patients in decisions and describe the development of a suggested tool for assessing patient involvement in these settings., Design: Cross-sectional, development of a measurement tool., Setting: Primary care clinics., Participants: Family doctors and residents., Interventions: Based on a review of the literature and the opinions of primary care doctors, a selection was made of items from a previous scale used to measure general communication skills (CICAA-Patient Centred) and new specific items were added to this to measure involvement., Main Measurements: The involvement of patients in decision-making was evaluated initially with this tool in 31 different clinical visits and the scale was then reformulated. A pool of 161 interviews was used to complete the process. Some psychometric properties (reliability and internal consistency) were estimated for the different samples and stages of the process., Results: Some degree of patient involvement was found in just 31 visits. Despite this, only in 18 of these (58%) was there some involvement in a discussion about more than one treatment option. The Cohen's kappa values of the CICAA-Decision scale were between 0.48 and 0.94. Cronbach's alpha was 0.60/0.51. The global Intra-class correlation coefficient was 0.96., Conclusions: The levels of patient involvement were lower than expected. A simple question, such as that defined by one item in particular, and the CICAA-D scale, in general, could be useful to assess patient involvement in decision making in primary care., (Copyright 2009 Elsevier España, S.L. All rights reserved.)

Objective: To analyse the psychometric properties by a scale for evaluating patient centered clinical communication., Design: Validation and observational study of a measurement tool., Setting: Health centres and hospital outpatient clinics., Participants: Three researchers independently evaluated video recorded interviews of different sub-samples: health professionals (family medicine medical residents, family doctors, specialist care physicians, and primary care nurses), actual patients who consulted for chronic or acute health problems, and standardised patients., Primary Measurements: Dimensionality (exploratory factor analysis), internal consistency (alpha de Cronbach), intra- and inter-observer agreement (Kappa index, intraclass correlation coefficient [ICC], generalisability), sensitivity to change (Student t test) and convergent validity with the GATHA questionnaire (Pearson correlation coefficient)., Results: Six factors have been identified that explain 66.0% of the variance. The overall internal consistency of the test was alpha=0.94. The overall intra-observer agreement, measured with the ICC, varied between 0.94 and 0.97, whilst the inter-observer was between 0.82-0.90. The number of completed questionnaires required for the evaluator to obtain adequate reproducibility (generalisability) varied between 6 and 12. Statistical significance was not obtained when testing the sensitivity to change. The CICAA scale and the GATHA questionnaire had a correlation of 0.67., Conclusions: The CICAA scale is a generic patient centered clinical communication evaluation tool that may be used in different clinical contexts and situations, since it has shown to be reliable, valid and efficient., (Copyright (c) 2009 Elsevier España, S.L. All rights reserved.)

Aims: To assess patient expectations at general practitioner (GP) visits, and compare them with what GPs think about them., Material and Method: Cross sectional study of patients attending GPs consultations. Physicians sample from Andalusia. Before the consultation patients were asked to select, from a list of 10 expectations, the most important they had for that particular visit. They were then asked to prioritise them into the 3 most and least important. Doctors received the list of 10 expectations and were asked to select which expectations they considered as the most important for a patient when consulting; doctors had also to prioritise the 3 most and least important expectations., Results: The study included 805 patients, 140 physicians. Out of the list of ten expectations, patients marked as important for that particular visit an average of 7.7. 797 (99%) patients claimed the important ones for them were three or more, but 207 (30%) were not able to prioritise more than two. When doctors prioritised the most important expectation, within the first three, they coincided with patients in two of them: the first, (listening) and the third (explaining). Similarly, doctors coincided with patients in the two least important expectations: to be referred and to receive a prescription. Out of the list of ten expectations, doctors over-scored significantly the patients wishes for receiving a diagnosis (43%), advice (40%), to be referred (35%), to receive a prescription (25%), a test (17%) and be examined (15%)., Conclusions: General expectations as regards physician-patient communication are more important for patients than other more specific ones. Generally, physicians agree with patients in this assessment, but they over-estimated patient wishes of receiving prescriptions, tests or to be referred., (Copyright © 2008 Sociedad Española de Calidad Asistencial. Published by Elsevier Espana. All rights reserved.)

Objectives: To ascertain and analyse the drug consumption of the immobile elderly, as well as the number of potentially inappropriate medications (PIM)., Design: Cross-sectional study., Setting: Fourteen rural primary care centres., Participants: Non-institutionalised immobile patients, older than 64 years were selected by systematic sampling., Principal Measurements: Review of patients' medicine cabinets and noting the daily doses and current number of drugs, as well as the origin of the prescription. Identification of PIM (Beers criteria)., Results: One-hundred forty-three homes visits were made. The mean age was 81.3+/-7.9 years, of whom 74.8% were women. The most common drugs were: analgesics (9.2%), antacids (7.1%), nitrites-calcium antagonists (6.5%), non-steroidal anti-inflammatories (5.0%), and angiotensin converting enzyme inhibitors (4.7%). The percentage of patients who took more than 4 drugs was 76.1%. A PIM was taken by 35% of the elderly. The most common were: long-acting tranquilisers (41.5%), hypnotics (13.8%), digoxin (13.8%), indomethacin (7.7%), and antispasmodics (6.1%). In the majority of cases, the prescribing of the PIM was made by the family doctor (77.7%). Women took significantly more inappropriate drugs than men (0.50+/-0.72 vs to 0.25+/-0.50; P=.001) and those on multiple medication more than those not on multiple medication (0.50+/-0.73 vs 0.31+/-0.52; P=.008)., Conclusions: The prevalence of inappropriate therapy in the immobile elderly is high, therefore an effort must be made to reduce it. Procedures directed towards increasing the quality of prescribing could improve the state of health and quality of life of these patients.

Background: It has recently been demonstrated that the lipid profile of smokers improves if they follow a Mediterranean diet., Aim: To establish whether the Sstl polymorphism of the apo C-III gene interacts with smoking and determines the lipid response to diet in healthy subjects., Methods and Results: Fifty-nine volunteers (18 smokers: 8 with the S1S1 genotype, and 10 with the S2 allele; 41 non-smokers: 29 with the S1S1 genotype and 12 with the S1S2 genotype) consecutively followed three different diets: a diet enriched in saturated fatty acids (SFA) (38% fat, 20% SFA) followed by a randomised, cross-over period during which they ate a diet enriched in carbohydrates (NCEP-1) (30% fat, 10% SFA, 55% carbohydrates) and a diet enriched in monounsaturated fatty acids (MUFA) (8% fat, 22% MUFA). Cholesterol, triacylglycerol, LDL-cholesterol (LDL-C) and HDL-cholesterol (HDL-C) levels were measured at the end of each dietary period. The smokers carrying the S1S1 genotype were not influenced by any of the diets, but the atherogenic ratio decreased in the carriers of the S2 allele when they changed from the diet rich in SFA to a diet rich in olive oil or carbohydrates (p < 0.039). No significant difference was observed when the non-smoking carriers of the S2 allele changed from one diet to another, but there was a decrease in the LDL-C/HDL-C ratio when the subjects with the S1S1 genotype changed from the saturated diet to either of the other diets (p < 0.001)., Conclusions: Smoking interacts with the apo CM polymorphism and determines the level of lipid response to dietary changes.