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Comparative Study
. 2000 Sep 30;26(5):287-92.
doi: 10.1016/s0212-6567(00)78666-5.

[Effectiveness of the protocols on cardiovascular risks in the Basque Country]

[Article in Spanish]
A Casi Casanellas  1 , F Aizpuru Barandiarán, F Ibáñez Pérez, J Múgica Campos, S Torrabadella Luna
Affiliations
Comparative Study

[Effectiveness of the protocols on cardiovascular risks in the Basque Country]

[Article in Spanish]
A Casi Casanellas et al. Aten Primaria. .

Abstract
in English, Spanish

Objectives: To find the effectiveness of clinical protocols in detecting and monitoring the most important cardiovascular risk factors: tobacco dependency, high blood pressure, hyperlipaemia and diabetes mellitus.

Design: Cross-sectional descriptive study.

Setting: Primary care centres in the Basque Country.

Participants: 1485 clinical histories of users aged between 40 and 75 who had attended for consultation over the previous two years, registered with general practitioners in the Basque Country who normally use clinical histories.

Measurements and main results: A questionnaire was sent to the people in charge of the 103 hierarchically organised centres requesting information on the use of protocols to detect and monitor the problems studied, and copies of protocols were requested. 77 centres (76%) replied and 66 sent 170 protocols. 990 clinical histories of doctors who used the four protocols and 495 of doctors who used none were analysed. These clinical histories belonged to lists of 45 doctors from 22 centres, chosen at random and stratified by whether their centre is registered with the PAPPS (preventive programme) or is a family and community medicine teaching centre. The centres using protocols were better at detecting tobacco dependency (24.6% vs 11.9%--p < 0.0005), hyperlipaemia (61.8% vs 53.1%--p < 0.001) and diabetes mellitus (75% vs 66.1%--p < 0.0005). The difference was less in the case of high blood pressure: 56.8% vs 52.1% (p = 0.097). No differences in quality in the monitoring of these problems were found.

Conclusions: The use of cardiovascular risk protocols by primary care centres is related to an improvement in the quality of cardiovascular risk detection, although not of its control.

Objetivos: Conocer la efectividad de los protocolos clínicos para la detección y control de los riesgos cardiovasculares más importantes: tabaquismo, hipertensión arterial, hiperlipemia y diabetes mellitus.

Diseño: Estudio descriptivo. transversal.

Emplazamiento: Centros de atención primaria del País Vasco.

Participantes: Un total de 1.485 historias clínicas de usuarios de 40-75 años que han acudido a consulta en los 2 últimos años, adscritos a médicos de atención primaria del País Vasco, que utilizan habitualmente la historia clínica.

Mediciones y resultados: Se envió encuesta a responsables de los 103 centros jerarquizados, solicitando información sobre uso de protocolos para la detección y control de los problemas estudiados y se pidieron copias. Contestaron 77 centros (76%) y 66 remitieron 170 protocolos. Se analizaron 990 historias clínicas de médicos que utilizan los 4 protocolos y 495 de médicos que no usan ninguno, pertenecientes a 45 médicos de 22 centros distintos, seleccionadas de forma aleatoria y estratificada según su centro esté adscrito al PAPPS o sea docente para MFyC. Los centros que usan protocolos presentan una mayor calidad en detección del tabaquismo, 24,6 frente a 11,9% (p < 0,0005); hiperlipemia, 61,8 frente a 53,1% (p < 0,001), y diabetes mellitus, 75,0 frente a 66,1% (p < 0,0005). La diferencia es menor para hipertensión arterial, 56,8 frente 52,1% (p = 0,097). No se encuentran diferencias de calidad en el control de estos problemas.

Conclusiones: La utilización de protocolos de riesgos cardiovasculares por los centros de atención primaria se relaciona con una mejora en la calidad de su detección, aunque no con la de su control.

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