Abstract
Objetivo
Conocer la efectividad de un programa de actividades preventivas en el adulto (hipertensión arterial [HTA], tabaco y alcohol) medida por el número de casos detectados, evaluación de las intervenciones iniciales y el grado de control de los factores detectados.
Diseño
Retrospectivo; revisión de historias clínicas.
Emplazamiento
Atención primaria. Estudio multicéntrico: centros de salud de toda España.
Población
Un total de 7.562 historias clínicas de pacientes de edad mayor de 20 años, extraídos mediante muestreo sistemático de 378 unidades asistenciales (médico + enfermera) de 85 centros de salud adscritos al Programa de Actividades Preventivas y de Promoción de la Salud (PAPPS) de la Sociedad Española de Medicina de Familia y Comunitaria (semFYC) que participaron voluntariamente. El período de estudio fue entre el 1 de mayo de 1995 y el 30 de abril de 1997.
Mediciones y resultados principales
Mediante cuestionario, se obtuvo: edad, sexo y datos sobre hábito tabáquico, consumo de alcohol y toma de presión arterial (consta la actividad, fecha del diagnóstico, valoración inicial y control posterior). La proporción de individuos con tabaquismo fue del 28,3%, de consumo excesivo de alcohol 6,9% y de HTA 22,2%. Alrededor de un 20% de casos de cada factor de riesgo fue detectado en el período de estudio. Estaba registrado el abandono del hábito en un 7,6% de fumadores y en el 19,7% de los bebedores excesivos. Un 78,6% de los hipertensos tenía un grado de control aceptable-óptimo.
Conclusiones
El número de casos detectados indica un aceptable rendimiento del programa PAPPS. En cuanto al resultado de la intervención, los abandonos del hábito tabáquico y consumo de alcohol, así como el grado de control de la HTA son cercanos a los ensayos publicados. El PAPPS es un programa efectivo para el control de factores de riesgo en atención primaria.
Palabras clave: Atención primaria salud, Evaluación programas, Examen periódico salud
Abstract
Objective
To find the effectiveness of a programme of preventive activities for adults (hypertension, tobacco and alcohol) measured by the number of cases identified, the evaluation of the initial interventions and the degree of control over the identified factors.
Design
Retrospective study: review of clinical records.
Setting
Primary care. Multi-centre study: health centres from the whole of Spain.
Patients
7562 clinical records of patients over 20, who participated voluntarily and were extracted by systematic sampling from 378 care units (doctor and nurse) at 85 health centres committed to the Programme of Preventive Activities and Health Promotion (PAPPS) of the Spanish Society of Family and Community Medicine (semFYC). The study period was from May 1 1995 to April 30 1997.
Measurements and main results
Age, sex, data on tobacco habit, alcohol consumption and blood pressure were obtained through a questionnaire (recording the actions taken, date of diagnosis, initial assessment and subsequent monitoring). 28.3% were tobacco-dependent, 6.9% consumed too much alcohol, and 22.2% had hypertension. About 20% cases of each risk factor were detected during the study period. Giving up tobacco was recorded in 7.6% of smokers, and giving up alcohol in 19.7% of excess drinkers. 78.6% of hypertense patients had acceptable-optimum control.
Conclusions
The number of cases detected shows that the PAPPS programme performs acceptably. The tobacco and drink given up and the hypertension control attained due to the intervention are similar to the published trials. The PAPPS is an effective programme for controlling risk factors in primary care.
Footnotes
Estudio subvencionado por el Ministerio de Sanidad y Consumo (expediente número 7/98).
Bibliografía
- 1.Martín Zurro A., Martín-Rabadán Muro M., Brotons Cuixart C. Diez años después (editorial) Aten Primaria. 1997;20(Supl 2):9–10. [Google Scholar]
- 2.Subías Lorén P., Martín-Rabadán Muro M., Maymó Pijoan N. Evaluaciones del programa. Objetivos y estructura del PAPPS. Aten Primaria. 1997;20(Supl 2):16–20. [Google Scholar]
- 3.American Academy of Family Physicians, Commission on Public Health and Scientific Affairs . American Academy of Family Physicians; Kansas City: 1993. Age charts for periodic health examination. [Google Scholar]
- 4.American Academy of Pediatrics Committee on Practice and Ambulatory Care. Recommendations for preventive pediatric health care. AAP News. 1991;7:19. [Google Scholar]
- 5.American Cancer Society . American Cancer Society; Atlanta: 1992. Summary of American Cancer Society Recommendations for early detection of cancer in asymptomatic people. [Google Scholar]
- 6.American College of Obstetricians and Gynecologists . American College of Obstetricians and Gynecologists; Washington, DC: 1993. The obstetrician-gynecologist and primary preventive health care. [Google Scholar]
- 7.American College of Physicians Task Force on Adult Immunization and Infectious Diseases Society of America . American College of Physician; Filadelfia: 1990. Guide for adult immunization. [Google Scholar]
- 8.American Medical Association . American Medical Association; Chicago: 1992. Guidelines for adolescent preventive services. [DOI] [PubMed] [Google Scholar]
- 9.Canadian Task Force on the Periodic Health Examination The periodic health examination. Can Med Assoc J. 1979;121:1194–1254. [PMC free article] [PubMed] [Google Scholar]
- 10.Hayward R.S., Steinberg E.P., Ford D.E., Roizen M.F., Roach K.W. Preventive care guidelines. Ann Intern Med. 1991;114(9):758–783. doi: 10.7326/0003-4819-114-9-758. [DOI] [PubMed] [Google Scholar]
- 11.US Preventive Services Task Force . 2.a. Williams and Wilkins; Baltimore: 1996. Guide to clinical preventive services. [Google Scholar]
- 12.Subías Loren P y Grupo de Evaluación del PAPPS . Evaluación 1997. Sociedad Española de Medicina Familiar y Comunitaria; Barcelona: 1998. Programa de Actividades Preventivas y de Promoción de la Salud. [Google Scholar]
- 13.Roberts JBM. Educational benefits of audit. BMJ. 1991;302:174. doi: 10.1136/bmj.302.6769.174. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Ortega Benito J.M. La auditoría médicoclínica (III). Facetas. Med Clin (Barc) 1995;104:25–28. [PubMed] [Google Scholar]
- 15.Salleras Sanmartí L. La investigación epidemiológica en la evaluación de los programas de salud. Aten Primaria. 1988;5(3):122–134. [Google Scholar]
- 16.Jiménez J., Brotons C., Marquet R. Evaluación de las actividades preventivas. In: Gené Badía J., editor. Monografías clínicas en atención primaria: Actividades preventivas. Doyma; Barcelona: 1989. pp. 77–88. [Google Scholar]
- 17.Woolf S.H., Battista R.N., Anderson G.M., Logan A.G. Wang E and the Canadian Task Force on the Periodic Health Examination. Assessing the clinical effectiveness of preventive maneuvers: analytic principles and systematic methods in reviewing evidence and developing clinical practice recommendations. J Clin Epidemiol. 1990;43:891–905. doi: 10.1016/0895-4356(90)90073-x. [DOI] [PubMed] [Google Scholar]
- 18.James P.A., Cowan T.M., Graham R.P., Majeroni B.A., Fox C.H., Jaen C.R. Using a clinical practice guideline to measure physician practice: translating a guideline for the management of heart failure. J Am Board Fam Pract. 1997;10:206–212. [PubMed] [Google Scholar]
- 19.Russell M.A.H., Wilson C., Taylor C., Baker C.D. Effect of general practitioners advice against smoking. BMJ. 1979;2:231–235. doi: 10.1136/bmj.2.6184.231. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Martín C., JanéC C., Nebot M. Evaluación anual de un programa de ayuda al fumador. Aten Primaria. 1993;12:86–90. [PubMed] [Google Scholar]
- 21.Schwartz J.L. Methods of smoking cessation. Med Clin North Am. 1992;76:451–476. doi: 10.1016/s0025-7125(16)30362-5. [DOI] [PubMed] [Google Scholar]
- 22.Babor T.F., Grant M., editors. Project on identification and management of alcohol-related problems. Report on phase II: a randomized clinical trial of brief interventions in primary health care. OMS; Ginebra: 1992. [Google Scholar]
- 23.Campbell S. New AHCPR guideline targets and cost of smoking cessation programs. Health Care Strateg Manage. 1996;14:16–17. [PubMed] [Google Scholar]
- 24.Wallace P., Cutler S., Haines A. Randomised controlled trial of general practitioner intervention in patients with excessive alcohol consumption. Br Med J. 1988;297:663–668. doi: 10.1136/bmj.297.6649.663. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.RomelsjöA A., Anderson L., Barner H., Borg S., Granstrand C., Hultman O. A randomized study of secondary prevention of early stage problem drinkers in primary health care. Addiction. 1989;84 doi: 10.1111/j.1360-0443.1989.tb00733.x. 1139–1127. [DOI] [PubMed] [Google Scholar]
- 26.Heather N., Campion P.D., Neville R.G., MacCabe D. Evaluation of a controlled drinking minimal intervention for problem drinkers in gereral practice (the DRAMS escheme) J Royal College of General Practitioners. 1987;37:358–363. [PMC free article] [PubMed] [Google Scholar]
- 27.Scott E., Anderson P. Randomized controlled trial of general practitioner intervention in women with excessive alcohol consumption. Drug and Alcohol Review. 1990;10:313–321. doi: 10.1080/09595239100185371. [DOI] [PubMed] [Google Scholar]
- 28.Anderson P., Scott E. The effect of general practitioner’s advice to heavy drinking men. Addiction. 1992;87:891–900. doi: 10.1111/j.1360-0443.1992.tb01984.x. [DOI] [PubMed] [Google Scholar]
- 29.Richmond R., Heather N., Wodak A., Kehoe L., Wobster I. Controlled evaluation of a general practice based brief intervention for excessive drinking. Addiction. 1995;90:119–122. doi: 10.1046/j.1360-0443.1995.90111915.x. [DOI] [PubMed] [Google Scholar]
- 30.Coca A. Control de la hipertensión arterial en España. Resultado del estudio Controlpres 95. Hipertensión. 1995;12:182–188. [Google Scholar]
- 31.Aranda P. Arterial hypertension in Spain: the experience of the Spanish League. J Hum Hypertens. 1996;10(Supl 1):73–75. [PubMed] [Google Scholar]