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Background: Differences in complications and multimorbidity for people with type 2 diabetes mellitus (T2D) have been found according to patient sex and socioeconomic status (SES). We analysed the association between sex and SES with glycaemic and cardiovascular control in diabetic primary care patients from the whole city of Madrid.Methods: This was an observational, descriptive, retrospective, multicenter study with an analytical approach within the Heart Healthy Hood Project (HHH). A total of 68,535 T2D patients between 40-75 years who were living in the municipality of Madrid were included. Age, sex, area-level SES (in quintiles from least to most wealth), tobacco use, comorbidities, complications, and health center characteristics were collected from primary care electronic health records during 2017-2018. The primary outcome was glycaemic control indicated by an HbA1c ≤ 7%. The secondary outcomes were combined control target (HbA1c ≤ 7%, blood pressure (BP), < 140/90 mm Hg, LDL Results: The mean age was 62.7 years old, 43,2% were female. Glycaemic control was achieved by 63% of patients. Women had better glycaemic control than men (64.2% vs 62.4%). Those who were in quintile 1 of SES achieved glycaemic control more often than those in quintile 5 (65.9% vs 59.7%). The optimal combined target (HbA1c, BP, LDL) was reached by 10% of patients (women: 9.3% vs men: 11.2%), especially those in quintile 5. If BMI2 was added, the combined target attainment rate decreased to 6.6%. In the adjusted regression model, we found that sex (AOR:0.97, 95%CI: 0.94-1.01) was not related with suboptimal glycaemic control but being part of quintile 4 (AOR: 1.02, 95% CI: 1.06-1.26) and 5 (AOR: 1.20, 95% CI: 1.10-1.32) of SES was associated with not reaching the glycaemic goal.Conclusions: Suboptimal glycaemic and combined control were associated with being less affluent but not with sex in the whole population of people with diabetes in the city of Madrid. Public policies and doctors should take social determinants into account to reduce social and health inequalities.

Toxic oil syndrome is a multisystemic disease that arose in 1981 due to the ingestion of contaminated rapeseed oil. Previous studies have found a higher prevalence of cardiovascular risk factors in these patients. The aim of this study was to analyze the differences in the prevalence of chronic diseases among a population affected by Toxic oil syndrome compared with a reference population in the Community of Madrid.Cross-sectional observational study of patients with a registry diagnosed with Toxic oil syndrome in the primary care medical record and a reference sample without Toxic oil syndrome matched by age group and sex. Sociodemographic variables, cardiovascular risk factors, cardiovascular and cerebrovascular disease, anxiety, depression, asthma, chronic obstructive pulmonary disease, and low back pain, and multimorbidity (≥2 chronic diseases) were assesed. Descriptive and multivariate analysis was performed to study the association between morbidity and Toxic oil syndrome.3,527 patients (1,394 Toxic oil syndrome) were included with a mean age of 66 (SD14) years, 71% women. Patients with a diagnosis of SAT were more likely to present multimorbidity (OR 1.36; 95%CI: 1.10-1.45), diabetes (OR 1.55; 95%CI: 1.29-1.86), complicated hypertension (OR 1.77; IC95%: 1.31-2.39), heart attack (OR 2.23; 95%CI: 1.47-3.38), depression (OR 1.39; 95%CI: 1.17-1.66) and asthma (OR 1.56; 95%CI: 1.23-1.97). The prevalence of anxiety was lower in TOS (OR 0.35; 95% CI: 0.18-0.69) as well as low back pain (OR 0.77; 95%CI: 0.65-0.91).Patients with toxic oil syndrome have a higher frequency of chronic diseases and mutimorbidity compared to the general population of the same sex and age.El síndrome del aceite tóxico es una enfermedad multisistémica que surgió en 1981 debido a la ingesta de aceite de colza contaminado. Estudios previos han encontrado en estos pacientes una mayor prevalencia de factores de riesgo cardiovascular. El objetivo de este estudio fue analizar las posibles diferencias en prevalencia de morbilidad crónica entre una población afectada por síndrome de aceite tóxico comparada con una población de referencia en la Comunidad de Madrid.Estudio observacional transversal de pacientes diagnosticados de síndrome del aceite tóxico en la historia clínica de atención primaria y una muestra de referencia sin síndrome del aceite tóxico apareados por grupo de edad y sexo. Se recogieron variables sociodemográficas, factores de riesgo cardiovascular, enfermedad cardiovascular y cerebrovascular, ansiedad, depresión, asma, enfermedad pulmonar obstructiva crónica, lumbalgia y multimorbilidad (≥2 enfermedades crónicas). Se realizó análisis descriptivo y multivariante para estudiar la asociación entre morbilidad y síndrome del aceite tóxico.Se incluyeron 3.527 pacientes (1.394 SAT) con una edad media de 66 (14) años, el 71% mujeres. Los pacientes con diagnóstico de síndrome del aceite tóxico tuvieron mayor probabilidad de presentar multimorbilidad (OR 1,36; IC95%: 1,10-1,45), diabetes (OR 1,55; IC95%: 1,29-1,86), hipertensión arterial complicada (OR 1,77; IC95%: 1,31-2,39), infarto (OR 2,23; IC95%: 1,47-3,38), depresión (OR 1,39; IC95%: 1,17-1,66) y asma (OR 1,56; IC95%: 1,23-1,97). La prevalencia de ansiedad fue menor (OR 0,35; IC95%: 0,18-0,69) así como de lumbalgia (OR 0,77; IC95%: 0,65-0,91).Los pacientes con síndrome de aceite tóxico presentan una mayor frecuencia de enfermedades crónicas y mutimorbilidad comparado con población general del mismo sexo y edad.

Inequalities in diabetes prevalence among immigrants from Andean countries remain unknown. Andean populations are one of the largest groups of immigrants in Madrid city. We examined the association between country of birth and type 2 diabetes mellitus (T2DM) prevalence in Andean immigrant population relative to Spanish-natives; and whether this association varied by age, sex and length of residence. We analyzed 1,258,931 electronic medical records from Spanish native and Andean immigrant adults aged 40–75 years of Madrid city. We used logistic regression and test interaction terms to address our aims. Andean immigrants showed 1.13 (95% CI 1.10–1.17) greater adjusted odds for T2DM than Spanish natives. This association was positive in Ecuadorians and Bolivians but protective in Peruvians and Colombians. There was heterogeneity of this association according to age and sex. Relative to Spanish natives, odds of T2DM in Andeans of all ages and women were higher but lower in men. Andean adults showed greater odds of T2DM compared with Spanish native adults in Madrid, with variation observed by age and sex. These findings emphasize the need for studying immigrant populations in a disaggregated manner to implement specific clinical and preventive approaches.

Introducción: Las personas mayores suponen un grupo etario vulnerable dentro de la sociedad. La edad avanzada, el mal estado funcional y residir en una institución sociosanitaria son factores de riesgo descritos que determinan un peor control de los parámetros clínicos en pacientes con procesos crónicos. Un abordaje multidisciplinar, disponer de registros poblacionales fiables, como la historia clínica electrónica de Atención Primaria (AP) de Madrid, y de un cuadro de mando con indicadores de resultados intermedios, permite analizar el control de estos procesos en pacientes institucionalizados y no institucionalizados. Objetivo: evaluar el grado de control de procesos crónicos relevantes en pacientes institucionalizados y no institucionalizados. Método: Estudio transversal en población mayor de 65 años de la Comunidad de Madrid (junio 2018). Se seleccionó todos los sujetos institucionalizados en residencias sociosanitarias y una muestra aleatoria de los no institucionalizados ajustados por edad y sexo (1: 1). La fuente de datos ha sido la historia clínica electrónica de AP y la de los indicadores del cuadro de mando (eSOAP) de AP. Las variables recogidas han sido: presencia de Diabetes Mellitus, EPOC, HTA y el control de las mismas (sí / no), nivel de riesgo poblacional, nivel de intervención asignado por el profesional (medidas de 0 a 3), número de patologías crónicas e institucionalizado o no.Se realizó un análisis descriptivo de las variables y la comparación en los sujetos institucionalizados y en los no institucionalizados con la prueba de la X2, la t de Student y de la U de Mann Whitney, en función de las variables estudiadas. Resultados: Se estudiaron 81646 sujetos. El 5,4% presentó EPOC, el 22,6% Diabetes Mellitus y el 66,0% HTA, existiendo entre las 3 patologías diferencias significativas (p

We studied the association between neighborhood social and economic change and type 2 diabetes incidence in the city of Madrid (Spain). We followed 199,621 individuals living in 393 census tracts for diabetes incidence for 6 years using electronic health records, starting in 2009. We measured neighborhood social and economic change from 2005 to 2009 using a finite mixture model with 16 indicators that resulted in four types of neighborhood change. Adjusted results showed an association between neighborhood change and diabetes incidence: compared to those living in Aging/Stable areas, people living in Declining SES, New Housing and Improving SES areas have an 8% (HR = 0.92, 95% CI 0.87 to 0.99), 9% (HR = 0.91, 95% CI 0.81 to 1.01) and 11% (HR = 0.89, 95% CI 0.81 to 0.98) decrease in diabetes incidence. This evidence can help guide policies for diabetes prevention by focusing efforts on specific urban areas.

OBJECTIVES Influenza vaccine is recommended in some chronic medical conditions, including several rare diseases. The objectives of the study were to assess the effect of text message reminders on influenza vaccination uptake of patients with selected rare diseases and delayed vaccination, and to describe their characteristics. METHODS Quasi-experimental pre-post intervention study performed along the 2016 influenza vaccination campaign in the Autonomous Community of Madrid. Unvaccinated patients diagnosed with a selected rare disease were targeted for intervention. SMS were sent to them at least one month after the beginning of the campaign, in four consecutive weeks. Those with no mobile phones available or no certainty of message reception, were assigned as controls. The association between the reception of the SMS and vaccination uptake was assessed using multiple poisson regression models. RESULTS Of 69.040 patients with delayed vaccination, 87.2% received an SMS reminder in the asigned contact mobile telephone. Global influenza vaccine coverage reached 41.3%. The uptake of influenza vaccine was significantly higher among those receiving the reminder (9.3% vs. 7.1% in the control group, p

Objectives To determine quality control of patients with oral anticoagulant treatment recruited in Primary Care (PC) using the Rosendaal method to estimate time in therapeutic range (TTR) and comparing it with fraction of international normalized ratio (INR) in range and cross-sectional analysis (last INR registred). Material and method A retrospective observational study based on electronic medical record in routine clinical practice. Setting: PC centers (262) in Madrid. We included all patients with acenocumarol treatment, with an INR therapeutic range established between 2 and 3. We excluded patients with valvular pathology and disrupted clinical follow up in PC ( 90 days or ≥3 periods of >60 days between 2 determinations). The final population was 49,312 patients. The variables considered were all INR values and their respective dates. TTR was calculated by the 3 methods above mentioned. We considered “therapeutic range” INR between 2 and 3 and “adjusted range” INR between 1.8 and 3.2. Optimal control for each patient was considered TTR > 60%. Results By using Rosendaal method, TTR was 66.8% (81.7% adjusted), with a percentage of total INR in range was 58.8% (66.5% adjusted), and, with the cross-sectional analysis, it was 70.5% (76.8% adjusted). Mean TTR was 65% (standard deviation 20.3), and the percentage of patients with TTR > 60% was 63.3% (88.1% adjusted). Conclusion The quality control of patients with oral anticoagulants in PC in Madrid is acceptable, similar or higher to other studies and pivotal trials of new anticoagulants. Compared to the Rosendaal method, total fraction of INR underestimates quality control, and cross-sectional analysis slightly overestimates it.

Resumen Objetivos Conocer el grado de control de los pacientes en tratamiento con anticoagulantes orales atendidos en Atencion Primaria (AP) estimando el tiempo en rango terapeutico (TRT) segun el metodo de Rosendaal, y compararlo con el porcentaje de international normalized ratio (INR, «razon normalizada internacional») en rango y el analisis transversal (ultima INR). Material y metodo Estudio observacional retrospectivo con datos de la historia clinica electronica de todos los centros de AP (n = 262) de la Comunidad de Madrid. Se incluyeron todos los pacientes en tratamiento con acenocumarol con rango terapeutico de INR entre 2 y 3. Se excluyeron los pacientes con valvulopatias y aquellos con seguimiento discontinuo ( 90 dias o ≥ 3 periodos de > 60 dias entre 2 determinaciones). La poblacion final fue de 49.312. Las variables consideradas fueron todos los valores de INR y sus fechas respectivas. Se calculo el TRT por los 3 metodos referidos, considerando «rango terapeutico» valores de INR entre 2-3, y rango «ajustado» valores de INR entre 1,8-3,2. Consideramos «control optimo» en cada paciente si el TRT > 60%. Resultados El TRT por el metodo de Rosendaal fue del 66,8% (81,7% ajustado), el porcentaje de INR en rango, del 58,8% (66,5% ajustado), y el analisis transversal, del 70,5% (76,8% ajustado). La media (desviacion estandar) de los TRT por paciente fue del 65% (20,3), y el porcentaje de pacientes con un TRT > 60% fue del 63,3% (88,1% ajustado). Conclusion El grado de control de los pacientes anticoagulados en AP es aceptable, similar o superior respecto a otros estudios y a los ensayos pivotales de nuevos anticoagulantes. Comparados con el metodo de Rosendaal, el porcentaje total de INR infraestima el grado de control, y el analisis transversal lo sobrestima ligeramente.

Background Communities of practice are based on the idea that learning involves a group of people exchanging experiences and knowledge. The e-MPODERA project aims to assess the effectiveness of a virtual community of practice aimed at improving primary healthcare professional attitudes to the empowerment of patients with chronic diseases. Methods This paper describes the protocol for a cluster randomized controlled trial. We will randomly assign 18 primary-care practices per participating region of Spain (Catalonia, Madrid and Canary Islands) to a virtual community of practice or to usual training. The primary-care practice will be the randomization unit and the primary healthcare professional will be the unit of analysis. We will need a sample of 270 primary healthcare professionals (general practitioners and nurses) and 1382 patients. We will perform randomization after professionals and patients are selected. We will ask the intervention group to participate for 12 months in a virtual community of practice based on a web 2.0 platform. We will measure the primary outcome using the Patient-Provider Orientation Scale questionnaire administered at baseline and after 12 months. Secondary outcomes will be the sociodemographic characteristics of health professionals, sociodemographic and clinical characteristics of patients, the Patient Activation Measure questionnaire for patient activation and outcomes regarding use of the virtual community of practice. We will calculate a linear mixed-effects regression to estimate the effect of participating in the virtual community of practice. Discussion This cluster randomized controlled trial will show whether a virtual intervention for primary healthcare professionals improves attitudes to the empowerment of patients with chronic diseases. Trial registration ClicalTrials.gov, NCT02757781. Registered on 25 April 2016. Protocol Version. PI15.01 22 January 2016. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2232-9) contains supplementary material, which is available to authorized users.

Introduction: Integrated care has become the focus of the continuity of care. Professionals need follow-up on their role in integrated clinical management. To this end, a scorecard is being built from Primary Care PC, which also aims to make itself known to hospitals. Description of policy context and objective: This project is part of the strategy of care for patients with chronic diseases in the community of Madrid and is part of a management project aimed at developing specific scorecard aimed at clinical management. Objective: Design a scorecard to help the professional in the integrated clinical management of patients with relevant chronic diseases Targeted population: Is the people with a diagnosis of relevant chronic pathology identified at a population level in the community of Madrid. General Practicioners, Pediatrics and Nursing will have access to consult the indicators of their atended people by separating the information at the patient level. In hospitals, aggregate information will be provided to t directors of Their continual care. Highlights: We have defined work phases to develop in the Comprehensive Scorecard of PA to monitor the impact of implanting the chronic strategy: - Design of indicators oriented to intermediate health results of the attended patients in the last year by relevant chronic pathology. 17 indicators of avoidable hospitalization and re-entry to 30 days have been constructed. 2017. Eg 27.7% of patients with HF and avoidable admission and 9.53% in patients with COPD. - Construction of indicators to monitor the level of intervention assigned by professionals to citizens with relevant chronic pathology. The population-level risk is calculated annually for each person. The intervention level is an individual variable assigned by the professional based on the care need generated. Currently, all chronic patients have a population- level risk identified in the clinical history.14% has an intervention level assigned by the professional and 8% of patients with hight risk has been assigned a hight intervention level by the professional. In the last estratification process made in decembre 2017 the level assigned have increased in the groups with the most level risk. - Restructuration of the Primary Care scorecard so that the Directors of continual care of all the 32 hospitals in Madrid have this aggregate information whithin their population of influence. 2018 - Redesign of the evaluation of the AP standardized service portfolio process measure adapted to the levels of intervention in chronic pathology 2019 - Research other intermediate health results through the constitution of a working group composed of agents involved. 2018 and 2019 Comments on transferability: It is transferable to another community that has the AP's medical history computerized Conclusions including key findings, discussion and lessons learned: To guarantee the implementation of a strategy, it is essential to provide feedback on the progress made. Show results and involve professionals in the information they need, it's key to see improvement and grouth integrated management. The results show that we are in the initial phases of the implementation of the chronic strategy in the follow-up with the indicators.

ObjectiveTo study the association between neighbourhood socioeconomic status and diabetes prevalence, incidence, and control in the entire population of northeastern Madrid, Spain.SettingElectronic health records of the primary-care system in four districts of Madrid (Spain).Participants269 942 people aged 40 or older, followed from 2013 to 2014.ExposureNeighbourhoodsocioeconomic status (NSES), measured using a composite index of seven indicators from four domains of education, wealth, occupation and living conditions.Primary outcome measuresDiagnosis of diabetes based on ICPC-2 codes and glycated haemoglobin (HbA1c %).ResultsIn regression analyses adjusted by age and sex and compared with individuals living in low NSES neighbourhoods, men living in medium and high NSES neighbourhoods had 10% (95% CI: 6% to 15%) and 29% (95% CI: 25% to 32%) lower prevalence of diabetes, while women had 27% (95% CI: 23% to 30%) and 50% (95% CI: 47% to 52%) lower prevalence of diabetes. Moreover, the hazard of diabetes in men living in medium and high NSES neighbourhoods was 13% (95% CI: 1% to 23%) and 20% (95% CI: 9% to 29%) lower, while the hazard of diabetes in women living in medium and high NSES neighbourhoods was 17% (95% CI: 3% to 29%) and 31% (95% CI: 20% to 41%) lower. Individuals living in medium and high SES neighbourhoods had 8% (95% CI: 2% to 15%) and 15% (95% CI: 9% to 21%) lower prevalence of lack of diabetes control, and a decrease in average HbA1c % of 0.05 (95% CI: 0.01 to 0.10) and 0.11 (95% CI: 0.06 to 0.15).ConclusionsDiabetes prevalence, incidence and lack of control increased with decreasing NSES in a southern European city. Future studies should provide mechanistic insights and targets for intervention to address this health inequity.

Resumen Introduccion El proposito de este estudio es describir la implantacion del Programa de Atencion al Mayor Polimedicado, impulsado por la Direccion General de Farmacia de la Comunidad de Madrid, en un area de atencion primaria y el ciclo completo de mejora con sus resultados tras la evaluacion inicial. Metodos El programa, dirigido a mayores de 75 anos que consumen 6 o mas principios activos (9.721 personas en el area al inicio del programa), comienza en septiembre de 2006. Se basa en la coordinacion con las oficinas de farmacia, la revision sistematica del tratamiento, la educacion sanitaria y la entrega de sistemas personales de dosificacion para el correcto uso de la medicacion. Para su implantacion en el area se formo a todos los profesionales y a los farmaceuticos de las oficinas de farmacia conjuntamente, se nombro responsables en los equipos de atencion primaria (EAP) y se repartio material de ayuda. Se realizo una evaluacion inicial mediante sentencias informatizadas del modelo de datos del programa en la historia clinica electronica, que mostraba resultados muy mejorables. Mediante herramientas de calidad se identificaron las causas de la escasa cobertura y los resultados insuficientes en el resto de los indicadores de calidad en la atencion y se procedio a implementar las acciones correctivas para, posteriormente, monitorizar y reevaluar el programa. Resultados Evaluacion de los indicadores incluidos en el programa. Primer analisis de datos (febrero de 2007): cobertura del 3,5% (361 usuarios incluidos); revision del tratamiento (RT), 2,1%; revision del uso de farmacos (RU), 51,2%; valoracion del conocimiento sobre medicacion (CM), 84,8%; test de Morisky (TM), 57,6%; propuesta de sistema personal dosificacion (SPD), 57,1%; valoracion del tratamiento (VT), 50,1%; planes de cuidados (PC), 19,2%; criterios de Beers (CB), 14,9%. En diciembre de 2007, tras la implantacion de las acciones de mejora, se obtienen los siguientes resultados: cobertura, 131,8% (12.650 usuarios); RT, 80,6%; RU, 62,7%; CM, 92,4%; TM, 9,3; SPD, 67,3%; VT, 61,6%; PC, 27,59%; CB, 13,6%. Conclusiones La implantacion de un programa institucional, la implicacion de la Direccion Gerencial del Area 4, la aplicacion de las herramientas de calidad adecuadas, la monitorizacion continua de los indicadores y la devolucion de la informacion a los profesionales han permitido que, 10 meses despues de implantar las medidas correctoras, se superen los objetivos institucionales de cobertura y mejoren significativamente las actividades de buena atencion y su registro, con lo que se obtienen los mejores resultados de captacion y de calidad asistencial del programa de la Comunidad de Madrid.

Resumen Objetivo Describir la mejora de la seguridad del proceso de atencion a pacientes con tratamiento de anticoagulacion oral (TAO), implantado en el Area 4 de Atencion Primaria (AP) de Madrid, y evaluar los resultados sobre el control y el seguimiento de dichos pacientes despues de 1 ano de su implantacion. Material y metodo El trabajo se articula como proyecto de mejora en 3 fases: a) analisis de debilidades, amenazas, fortalezas y oportunidades (DAFO) tras 1 ano de implantacion del proceso; b) aplicacion de la metodologia analisis modal de fallos y efectos (AMFE), y c) evaluacion de la implantacion, el control y el seguimiento de los pacientes con TAO. La obtencion de los datos de los pacientes se realizo a traves de una explotacion especifica de los protocolos de seguimiento TAO de la historia clinica informatizada (HCI) OMI-AP. Se incluyo a todos los pacientes anticoagulados seguidos en AP en el ano 2006, con registro en el protocolo especifico TAO informatizado. Resultados La aplicacion de la metodologia AMFE, bastante novedosa en AP, ha supuesto identificar los fallos criticos priorizados por el indice de priorizacion del riesgo (IPR); la puntuacion del IPR oscilo entre 8 y 343. Igualmente el AMFE nos ha servido para la introduccion de acciones de mejora y la elaboracion de los indicadores que nos sirven para monitorizar todo el proceso. Los resultados de la primera evaluacion indican que el programa esta implantado en el 100% de los equipos. El numero de pacientes incluidos en el servicio en 2006 fue de 3.013, lo que supone una cobertura del 59,8%. En cuanto al sexo, el 54,2% de los pacientes seguidos (1.633) son mujeres, el 43% (1.305) son varones y hay un 2,5% (75) no registrado. La media de edad es de 75 anos. En cuanto a las indicaciones, fibrilacion auricular/arritmias cardiacas es la primera causa con un 61% del total. El valor medio de INR ha sido 2,5. La media de determinaciones por paciente: 12,8. Los valores de INR en rango terapeutico son 20.581 (53%) y en rango ajustado a + 0,2 (posible error del coagulometro) los valores aumentan hasta el 66%. El porcentaje de dias que permanecen los valores en rango ha sido del 68%, y si lo ajustamos al + 0,2%, ascienden al 79% de los dias. Solamente encontramos a 13 pacientes con efectos adversos. Conclusiones La aplicacion del AMFE ha supuesto una mejora importante de todo el proceso, fundamentalmente desde el punto de vista de la seguridad, asi como la elaboracion de unos indicadores de seguimiento. Este estudio aporta resultados sobre el seguimiento de todos los pacientes con TAO, sin necesidad de muestreo, despues de 1 ano de su implantacion, que nos revelan en general su buen control clinico y la aceptacion de los profesionales en la realizacion del nuevo servicio.

Resumen Objetivos 1) Analizar la concordancia entre la clasificación por niveles de riesgo del agrupador grupos de morbilidad ajustados (GMA) y el nivel de intervención asignado por los médicos de familia (MF). 2) Estudiar la utilidad del agrupador como herramienta de ayuda en historia clínica electrónica (HCE) para la toma de decisiones clínicas. Diseño Estudio observacional transversal de concordancia. Emplazamiento Atención Primaria, Servicio Madrileño de Salud. Participantes Veintiocho MF. Se seleccionó una muestra de 840 pacientes adscritos a cupos de los MF participantes por muestreo aleatorizado estratificado no proporcional (kappa 0,65, precisión 0,125, porcentajes positivos 5%, nivel de confianza 95%). Mediciones principales Índice kappa de Cohen ponderado para el grado de concordancia entre el nivel (bajo, medio o alto) de riesgo de ingreso hospitalario/consumo de recursos del paciente propuesto por el agrupador GMA y el nivel (bajo, medio o alto) de intervención (autocuidado, gestión de la enfermedad, gestión del caso) asignado por el MF. A través de un cuestionario autoadministrado elaborado ad hoc los MF valoraron la utilidad del agrupador. Resultados El índice de kappa ponderado obtenido fue de 0,60 (IC 95% 0,55-0,65). En un 3% el grado de desacuerdo fue máximo. El MF consideró en el 76% de los casos que el agrupador había sido útil para la asignación de los niveles de intervención. Conclusión La fuerza de concordancia obtenida fue moderada/buena; la incorporación de un agrupador en la HCE puede servir de ayuda como recordatorio para una toma de decisiones más proactiva/integrada según las necesidades sociosanitarias de las personas con enfermedades crónicas.

Objectives: To describe to the automated procedure and the results of an evaluation of evidence-based healthcare quality criteria in the total number of patients in Primary Care Area 4 in Madrid. Methods: The Healthcare Quality Program of Area 4 gathers five prioritized criteria with a total of 22 indicators: follow-up and control of hypertension, control of glycosylated hemoglobin in diabetics, secondary prevention of coronary heart disease, prevention with antiplatelet therapy in diseases with high cardiovascular risk, and angiotensin-converting-enzyme inhibitors in the treatment of patients with heart failure. To evaluate the criteria, we developed a tool based on structured query language (SQL) that allowed us to obtain results on the entire population of the Area (581,000 persons), without the need for sampling, through the data gathered in the computerized clinical histories. Results: The results correspond to the evaluation performed in December 2005. A total of 89,372 patients were evaluated (69,843 with hypertension, 24,142 with diabetes, 10,086 with a diagnosis of coronary heart disease, 30,440 with diseases with high cardiovascular risk, and 2,517 with heart failure). The complete information was distributed to all the health professionals in an Excel spreadsheet with data on all their patients. Conclusions: The implementation of a healthcare quality program allows interventions with an established impact on the health of the population to be promoted and evaluated. The use of the computerized clinical history allows data on the entire population in the catchment area to be obtained rapidly and simply, with minimal cost, and without the need for sampling.

Using electronic clinical records in primary care (ECRPC) of the entire population living in the Autonomous Community of Madrid, Spain (5,102,568 persons) as a data source, this study aimed to ascertain seasonal anti-influenza vaccination coverage in the chronically ill at-risk children (aged 6 months to 14 years) and adults (15-59 years). Of the total population aged 6 months to 59 years with a medical card in the Autonomous Community of Madrid, 10.3% (n=528,095 patients) had a chronic condition for which anti-influenza vaccination was indicated. In children with chronic conditions, coverage was 27.1% and it was particularly high among diabetics (41.1%) and particularly low in children with "other pulmonary conditions" (15.2%). In adults with chronic conditions, coverage was 22.1% and in patients with diagnosed heart failure coverage reached 39.1%; with the lowest coverage was observed in patients suffering neuromuscular diseases (12.8%). The factors associated with vaccination among children and adults suffering a chronic condition included: having been vaccinated during the previous campaign, national origin (lower among immigrants), and having more than one chronic condition. In conclusion, our study shows that vaccination coverage for 2009 seasonal influenza in children and adults with chronic conditions living in Madrid (Spain) was less than acceptable.

Background Chronic health problems are the main cause of disease, disability and death in developed countries, and their prevalence is increasing. Objective To estimate the prevalence of selected chronic illnesses based on electronic clinical records in primary care (ECRPC) and to assess its usefulness for epidemiological research, by comparing ECRPC data against those reported by a contemporary health survey. Design Descriptive cross-sectional study. Setting All primary care medical consultations in the Madrid Regional Public Health System (PHS). Subjects A total of 23 535 182 ECRPC-registered episodes of illness, generated by PHS patients over 15 years of age seeking medical care during 2005-06. Main outcome measures Prevalences of chronic diseases estimated on the basis of medically examined cases registered in ECRPC and morbidity as reported by a contemporary health survey covering the same geographic area. Results A total of 52.5% of the adult population had some chronic health problem. The highest overall prevalences were hypertension (14.8%), mental disorders (12.0%) and allergy (11.6%). Prevalences were generally highest among women, elderly and the native population. Depending on the specific disease, ECRPC-based prevalences were similar to (e.g. diabetes), higher (e.g. chronic skin problems) or lower (e.g. asthma and dyslipidaemia) than those reported by surveys, with certain age- and sex-related variations. Conclusions Prevalences estimated from ECRPC and survey data present variations depending on the disease, age and sex. Both data sources provide complementary information about chronic disease prevalence. ECRPC have the advantage of generating an ongoing standardized register and entailing no additional effort for health professionals.

To estimate the prevalence rates of chronic disorders in immigrants and to compare them with those in the native population, based on electronic clinical records in primary care (ECRPC).We performed a descriptive cross-sectional study in patients aged 16 and over included in the Madrid Regional Public Health System. Age-adjusted prevalence rates for each sex and region were estimated on the basis of medically examined cases registered in the ECRPC with any new data entry made in 2005 or 2006.After age-adjustment, a total of 36.8% immigrants had some chronic health problem (vs. 55.3% natives). These disorders were more frequent among women and among the population from Africa and Latin America. The highest overall prevalence rates in the foreign population were allergy (10.2% crude rate), low-back pain (9.1%), chronic skin problems (6.8%) and mental disorders (6.4%).The prevalence rate of chronic disease is lower in the foreign population and differs according to sex and country of origin.

The purpose is to describe the introduction of a Care Program for the Elderly on Multiple Medication in a Primary Care area and the complete improvement cycle after evaluating the initial results The Program was instigated by the Community of Madrid Pharmacy Directorate.The Program was aimed at patients over 75 years who took 6 or more active ingredients (9721 patients in the area at the start of the program) and began in September 2006. It is based on coordinating with pharmacists, systematic review of treatment, health education, and the providing of personal dose dispensing systems for the correct use of the medication. Before its introduction, all the health professionals and pharmacists were jointly trained, a person was assigned as being responsible for the primary care teams (EAP) and support material was handed out. An initial evaluation was performed using computerised sentences from the Program data model in the electronic clinical notes, which showed much improvable results. Using quality tools, the causes of low coverage and insufficient results in the rest of the quality indicators were identified and corrective actions were introduced to subsequently monitor and re-assess the program.Evaluation of the indicators included in the program. Initial data analysis (February 2007): cover, 3.5% (361 users included); treatment review (RT), 2.1%; review of medication use (RU), 51.2%; assessment of knowledge of the medication (CM), 84.8%; Morisky test (TM), 57.6%; offer of personal dispensing system (SPD), 57.1%; treatment evaluation (VT), 50.1%; care plans (PC), 19.2%; beers criteria (CB), 14.9%. After introducing the improvement actions, the following results were obtained in December 2007: cover, 131.8% (12,650 users); RT, 80.6%; RU, 62.7%; CM, 92.4%; TM, 9.3; SPD, 67.3%; VT, 61.6%; PC, 27.59%, and CB, 13.6%.The introduction of an institutional program, the involvement of the management of Area 4, the application of appropriate quality tools, the continuous monitoring of quality indicators and giving this information back to the professionals has enabled, ten months after the corrective measures were introduced, the institutional objectives of coverage to be achieved. It has also significantly improved quality care activities and their recording, achieving the best results for coverage and quality health care in the Community of Madrid program.

ResumenObjetivoEstimar la prevalencia de problemas de salud crónicos en inmigrantes y compararla con la de la población autóctona, utilizando la historia clínica electrónica (HCE) de atención primaria (AP).MétodosEstudio descriptivo transversal con pacientes de 16 y más años incluidos en el sistema sanitario público de la Comunidad de Madrid. Se estimaron prevalencias ajustadas por edad para cada sexo y nacionalidad (agrupada en regiones) a partir de los episodios de atención registrados en la HCE de AP con alguna anotación en 2005 o 2006.ResultadosEl 36,8% de la población inmigrante presentaba alguna enfermedad crónica (55,3% de autóctonos) tras ajustar por edad, con más frecuencia en mujeres y en población de origen africano y latinoamericano. Las enfermedades más prevalentes en los extranjeros fueron las alergias (tasa cruda: 10,2%), las lumbalgias (9,1%), problemas crónicos de piel (6,8%) y trastornos mentales (6,4%).ConclusionesLa prevalencia de enfermedades crónicas es menor en la población extranjera y varía según el sexo y la procedencia.AbstractObjectiveTo estimate the prevalence rates of chronic disorders in immigrants and to compare them with those in the native population, based on electronic clinical records in primary care (ECRPC).MethodsWe performed a descriptive cross-sectional study in patients aged 16 and over included in the Madrid Regional Public Health System. Age-adjusted prevalence rates for each sex and region were estimated on the basis of medically examined cases registered in the ECRPC with any new data entry made in 2005 or 2006.ResultsAfter age-adjustment, a total of 36.8% immigrants had some chronic health problem (vs. 55.3% natives). These disorders were more frequent among women and among the population from Africa and Latin America. The highest overall prevalence rates in the foreign population were allergy (10.2% crude rate), low-back pain (9.1%), chronic skin problems (6.8%) and mental disorders (6.4%).ConclusionsThe prevalence rate of chronic disease is lower in the foreign population and differs according to sex and country of origin.