ABSTRACT: There is little information available on Therapeutic Inertia in Primary Care (PC). This study aimed to know the therapeutic behavior of the physician for uncontrolled hypertensive patients.
Cross-sectional, multicenter study that included hypertensive patients of both genders, under pharmacological treatment who were recruited consecutively in the PC out-patient clinic in all of Spain. Social-demographic, clinical and treatment data were recorded, as well as the motives for eventual therapeutic modification. Adequate BP control was considered when BP values were below 140/90 mmHg in general, and below 130/80 mmHg in diabetes, renal insufficiency or cardiovascular disease.
A total of 10,520 patients (53.7% women) were included with average age of 64.6 (11.3 years). Of these, 44.4% the patients were receiving monotherapy and 55.6% were treated with combined therapy (two drugs 41.2%, three drugs 11.7%, and more than three 2.8%). Uncontrolled hypertension was found in 58.6% (95% CI. 57.6-59.5) of the patients. Treatment was modified by physicians in 30.4% (95% CI. 29.2-31.6) of the uncontrolled patients, combination with another drug being the most frequent behavior (46.3%), followed by dose increase (26.1%), and antihypertensive drug switch (22.8%). The perception of the physician of good BP control was the factor most associated with not modifying the treatment in uncontrolled patients.
Study results showed that the PC physician modified antihypertensive treatment in only 3 out of 10 uncontrolled patients. When treatment modification was made, association of drugs was the most frequent behavior.
Revista Clínica Española 10/2008; 208(8):393-9. · 2.01 Impact Factor
ABSTRACT: The HICAP study assessed the cardiovascular (CV) global risk and the CV risk factors control in hypertensive patients managed in Primary Care (PC) in Spain.
Cross-sectional and multilocated study in which each investigator included data from 5 consecutives hypertensive patients. A routine laboratory test and a ECG from the previous 6 months had to be available for each patients CV global risk evaluation, blood pressure (BP) and diabetes control was based on ESH-ESC 2003; lipid profile evaluation was based on NCEP 2001 (ATP III) RESULTS: 1288 PC physicians included 6719 hypertensive patients, and data from 6375 patients were analyzed.64.5% (CI95%: 63.3-65.7) of the hypertensive patients managed in Primary Care showed a high or very high CV global risk.BP was controlled in 39.3% (CI95%: 38.1-40.5) of patients, 10.5% (CI95%: 9.1-11.9)among diabetics. 37.3% (CI95%: 35-38.7) of diabetics showed HbA1c < 6.5% and 18.8% (CI95%: 17.6-20) of dyslipidemic subjects had their LDL-c controlled. The control was lower among the patients at higher CV global risk.
These results demostrate the high proportion of hypertensive patients that present a high CV global risk. The cardiovascular risk factors control, specially among patients at higher CV global risk, is insufficient.
Anales de medicina interna (Madrid, Spain: 1984) 07/2007; 24(7):312-6.
ABSTRACT: To know different blood pressure (BP) measurement devices used in primary care (PC).
Cross-sectional study, multilocated, with a non probabilistic sample of consecutive cases selection, all over the country.
Primary care practices from all the country.
PC patients treated and they all were of age.
Two consecutive BP measures were made and measurement devices used in this process by physicians were booked.
In this study participated 3592 PC physicians, BP were measured to 14,137 subjects. To a 69.8% of subjects BP were measured with a mercury sphygmomanometer; 16.5% with an electronic device; 11.8% with an aneroid manometer; and a 1.9% were measured with more than one measurement method. In rural environmental, electronic devices and aneroid manometer were used more, and some differences were noted in the different self ruled community in our country. There were differences in BP values in order to measurement methods, a third measurement was made often by physicians who managed electronic devices, and utilization of digits 0 and 5 was higher when measurement method was not an electronic device.
In PC office, mercury sphygmomanometer is being used preferably and that aneroid manometers are still in use. Their utilization involves important bias in measurement process, so that electronic devices should be promoted.
Atención Primaria 10/2005; 36(5):248-53. · 0.63 Impact Factor
ABSTRACT: To investigate the behaviour of primary care (PC) physicians on inadequate hypertension control.
Cross-sectional and multicentric study.
PC clinics in the whole of Spain.
Patients > or =18 years old who followed pharmacological antihypertensive treatment since at least 3 months before, selected by a consecutive sampling.
Blood pressure measured by family doctors. The therapeutic diagram used before and after the visit was registered, and in those cases in which some kind of modification was adopted, the reasons why.
12,754 hypertensive patients were included. The average age was 63.3+/-10.9 years (57.3% women). A 65% lived in urban areas and the 35% in semi-urban o rural areas. The 63.9% (95% confidence interval, 63.1%-64.8%) showed a bad control of hypertension. The majority of the patients followed a therapeutic regimen of monotherapy (56%) being the ACE inhibitors the most prescribed drug (34.8%), followed by the calcium antagonist (21.3%), and angiotensin II antagonists (17.4%). The percentage of patients with inadequate control of the blood pressure, in which the therapeutic behaviour was modified was 18.3% (95% confidence interval, 17.5%-19.1%) (a change of drug in 47%, association in 34.7% and an increase in the dose in 18.3%). The main reasons for which the therapeutic behaviour was modified was because no drug efficacy (63.7%) and the presence of adverse events (5.5%). The price of the therapy originated 1.2% of the modifications.
PC physicians behaviour was conservative in uncontrolled hypertension cases. Amongst the doctors who modified their behaviour, by inadequate blood pressure control, the change of drug was the decision most adopted.
Atención Primaria 10/2005; 36(4):204-10. · 0.63 Impact Factor
ABSTRACT: Scarce information is available on the clinical characteristics and risk factors of patients with chronic heart failure (CHF) attended in Primary Care (PC) setting. The aim of this study was to analyze the clinical characteristics of this population in PC.
Multicenter, cross-sectional study in patients with CHF, consecutively recruited by 232 physicians in PC. The collected data included sociodemographic, etiologic, clinical and therapeutic variables.
Eight hundred forty seven (847) patients were included (age 73.0 +/- 9.6 years; 50.5% men). Of these, 84.3% had arterial hypertension (AHT), 59.2% hypercholesterolemia and 34.9% diabetes mellitus. The most frequent associated clinical disorders were ischemic heart disease (40.1%) and peripheral artery disease (28.6%). In 69.6% of the patients the physicians knew the type of dysfunction (32.4% systolic, 37.2% diastolic). The main etiologies of CHF were the hypertensive cardiomyopathy (75.0%) and ischemic heart disease (40.1%); the most frequent trigger factor was atrial fibrillation (43.9%). Loop diuretics (72.3%) and angiotensin-converting enzyme inhibitors (60.9%) were the treatments used most and 6.7% of the patients were receiving treatment with beta blockers.
AHT appears to be primary cause of CHF in PC. Diastolic dysfunction is more frequent than the systolic one, and the PC physicians do not know the cause of the ventricular dysfunction in one third of the cases. Loop diuretics and angiotensin-converting enzyme inhibitors were the most frequently used in these patients; the use of beta blockers in CHF is very scarce in PC.
Revista Clínica Española 207(7):337-40. · 2.01 Impact Factor
ABSTRACT: There is a need for more information on therapeutic inertia in blood pressure (BP) treatment. The purpose of this study was to determine the therapeutic behaviour and associated factors of Primary Care (PC) physicians on uncontrolled hypertensive patients.
Cross-sectional multicentre study of patients with hypertension attending Spanish PC centres. Data was collected from patients (social-demographics, clinical status and treatment), as well as data from physicians (medical practice, background and therapeutic behaviour) were collected. Uncontrolled BP was considered when average BP values where ≥140/90mmHg.
A total of 12,961 patients (52.0% women) were included. The mean age was 66.3 (SD 11.4) years, and mean number of years from diagnosis of hypertension was 9.1 (6.7) years. Almost two-thirds (62.4%) of the patients were taking a combined blood pressure treatment, (44.2% with two drugs and 18.2% with three drugs, or more). An uncontrolled BP was observed in 38.9% (95% CI: 38.1-39.7) of patients. Treatment was changed by physicians in 41.8% (95% CI: 40.4-43.2) out of 5,036 uncontrolled patients. Adding another drug was the most frequent behaviour (55.6%). The physician's perception of good BP control in uncontrolled patients, together with the presence of combined blood pressure treatment, were the two variables most strongly associated with therapeutic inertia.
The Spanish PC Physician modified antihypertensive treatment in only 4 out of 10 uncontrolled patients. The physician's perception of good BP control was the variable most strongly associated with therapeutic inertia.
SEMERGEN - Medicina de Familia 39(1):3-11.