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de Burgos-Lunar C, del Cura-González I, Cárdenas-Valladolid J, Gómez-Campelo P, Abánades-Herranz JC, López-de Andrés A, Sotos-Prieto M, Iriarte-Campo V, Salinero-Fort MA. Real-world data in primary care: validation of diagnosis of atrial fibrillation in primary care electronic medical records and estimated prevalence among consulting patients'. BMC Prim Care 2023; 24:4. [PMID: 36600196 PMCID: PMC9811753 DOI: 10.1186/s12875-022-01961-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Primary care electronic medical records contain clinical-administrative information on a high percentage of the population. Before this information can be used for epidemiological purposes, its quality must be verified. This study aims to validate diagnoses of atrial fibrillation (AF) recorded in primary care electronic medical records and to estimate the prevalence of AF in the population attending primary care consultations. METHODS We performed a cross-sectional validation study of all diagnoses of AF recorded in primary care electronic medical records in Madrid (Spain). We also performed simple random sampling of diagnoses of AF (ICPC-2 code K78) registered by 55 physicians and random age- and sex-matched sampling of the records that included a diagnosis of AF. Electrocardiograms, echocardiograms, and hospital discharge or cardiology clinic reports were matched. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), and overall agreement were calculated using the kappa statistic (κ). The prevalence of AF in the community of Madrid was estimated considering the sensitivity and specificity obtained in the validation. All calculations were performed overall and by sex and age groups. RESULTS The degree of agreement was very high (κ = 0.952), with a sensitivity of 97.84%, specificity of 97.39%, PPV of 97.37%, and NPV of 97.85%. The prevalence of AF in the population aged over 18 years was 2.41% (95%CI 2.39-2.42% [2.25% in women and 2.58% in men]). This increased progressively with age, reaching 16.95% in those over 80 years of age (15.5% in women and 19.44% in men). CONCLUSIONS The validation results obtained enable diagnosis of AF recorded in primary care to be used as a tool for epidemiological studies. A high prevalence of AF was found, especially in older patients.
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Affiliation(s)
- C. de Burgos-Lunar
- grid.411068.a0000 0001 0671 5785Department of Preventive Medicine, Hospital Universitario Clínico de San Carlos, Madrid, Spain ,Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), Madrid, Spain
| | - I. del Cura-González
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), Madrid, Spain ,Research Unit, Primary Health Care Management, Madrid, Spain ,grid.28479.300000 0001 2206 5938Department of Medical Specialties and Public Health, Faculty of Health Sciences Rey Juan Carlos University, Madrid, Spain
| | - J. Cárdenas-Valladolid
- Information Systems Department, Primary Health Care Management, Madrid, Spain ,Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain ,grid.440081.9The Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,grid.464699.00000 0001 2323 8386Alfonso X El Sabio University, Madrid, Spain
| | - P. Gómez-Campelo
- grid.440081.9The Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain
| | | | - A. López-de Andrés
- grid.4795.f0000 0001 2157 7667Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - M. Sotos-Prieto
- grid.5515.40000000119578126Department of Preventive Medicine and Public health, Universidad Autónoma de Madrid, Madrid, Spain ,grid.466571.70000 0004 1756 6246CIBERESP (CIBER of Epidemiology and PublicHealth), Madrid, Spain ,grid.38142.3c000000041936754XDepartment of Environmental Health, Harvard T.H.Chan School of Public Health, Boston, MA USA
| | - V. Iriarte-Campo
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain
| | - M. A. Salinero-Fort
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS-(RICORS), Madrid, Spain ,Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Madrid, Spain ,grid.440081.9The Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain ,grid.464699.00000 0001 2323 8386Alfonso X El Sabio University, Madrid, Spain ,General Subdirectorate of Research and Documentation, Department of Health, Madrid, Spain
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Cárdenas-Valladolid J, López-de Andrés A, Jiménez-García R, de Dios-Duarte MJ, Gómez-Campelo P, de Burgos-Lunar C, San Andrés-Rebollo FJ, Abánades-Herranz JC, Salinero-Fort MA. Effectiveness of standardized nursing care plans to achieve A1C, blood pressure, and LDL-C goals among people with poorly controlled type 2 diabetes mellitus at baseline: four-year follow-up study. BMC Fam Pract 2018; 19:125. [PMID: 30041600 PMCID: PMC6058384 DOI: 10.1186/s12875-018-0800-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 06/21/2018] [Indexed: 11/22/2022]
Abstract
Background No studies that have measured the role of nursing care plans in patients with poorly controlled type 2 diabetes mellitus. Our objectives were firstly, to evaluate the effectiveness of implementing Standardized languages in Nursing Care Plans (SNCP) for improving A1C, blood pressure and low density lipoprotein cholesterol (ABC goals) in patients with poorly controlled type 2 diabetes mellitus at baseline (A1C ≥7%, blood pressure ≥ 130/80 mmHg, and low-density lipoprotein cholesterol≥100 mg/dl) compared with Usual Nursing Care (UNC). Secondly, to evaluate the factors associated with these goals. Methods A four-year prospective follow-up study among outpatients with type 2 diabetes mellitus: We analyzed outpatients of 31 primary health centers (Madrid, Spain), with at least two A1C values (at baseline and at the end of the study) who did not meet their ABC goals at baseline. A total of 1916 had A1C ≥7% (881 UNC versus 1035 SNCP). Two thousand four hundred seventy-one had systolic blood pressure ≥ 130 mmHg (1204 UNC versus 1267 SNCP). One thousand one hundred seventy had diastolic blood pressure ≥ 80 mmHg (618 UNC versus 552 SNCP); and 2473 had low-density lipoprotein cholesterol ≥100 mg/dl (1257 UNC versus 1216 SNCP). Data were collected from computerized clinical records; SNCP were identified using NANDA and NIC taxonomies. Results More patients cared for using SNCP achieved in blood pressure goals compared with patients who received UNC (systolic blood pressure: 29.4% versus 28.7%, p = 0.699; diastolic blood pressure: 58.3% versus 53.2%, p = 0.08), but the differences did not reach statistical significance. For A1C and low-density lipoprotein cholesterol goals, there were no significant differences between the groups. Coronary artery disease was a significant predictor of blood pressure and low-density lipoprotein cholesterol goals. Conclusions In patients with poorly controlled type 2 diabetes mellitus, there is not enough evidence to support the use of SNCP instead of with UNC with the aim of helping patients to achieve their ABC goals. However, the use of SNCP is associated with a clear trend of a achievement of diastolic blood pressure goals.
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Affiliation(s)
- J Cárdenas-Valladolid
- Dirección Técnica de Sistemas de Información, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, C/ San Martín de Porres, 6, 28035, Madrid, Spain. .,Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid, Spain. .,Aging and Fragility in the Elderly Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain. .,MADIABETES Research Group, Madrid, Spain.
| | - A López-de Andrés
- MADIABETES Research Group, Madrid, Spain.,Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - R Jiménez-García
- MADIABETES Research Group, Madrid, Spain.,Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain
| | - M J de Dios-Duarte
- Jefatura de Estudios del Grado en Enfermería, Universidad Alfonso X el Sabio, Villanueva de la Cañada, Madrid, Spain
| | - P Gómez-Campelo
- Aging and Fragility in the Elderly Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,MADIABETES Research Group, Madrid, Spain.,Innate Immunity Group, Hospital La Paz Institute for Health Research (IdiPAZ), La Paz University Hospital, Madrid, Spain.,University Centre of Health Sciences San Rafael-Nebrija, Antonio de Nebrija University, Madrid, Spain
| | - C de Burgos-Lunar
- Aging and Fragility in the Elderly Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,MADIABETES Research Group, Madrid, Spain.,Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Alcorcón, Madrid, Spain.,Dirección General de Salud Pública, Subdirección de Promoción, Prevención y Educación de la Salud, Consejería de Sanidad, Madrid, Spain.,Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain
| | | | - J C Abánades-Herranz
- Aging and Fragility in the Elderly Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,MADIABETES Research Group, Madrid, Spain.,Centro de Salud Monóvar, Madrid, Spain
| | - M A Salinero-Fort
- Aging and Fragility in the Elderly Group, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain.,MADIABETES Research Group, Madrid, Spain.,Dirección General de Salud Pública, Subdirección de Promoción, Prevención y Educación de la Salud, Consejería de Sanidad, Madrid, Spain.,Subdirección General de Investigación. Consejería de Sanidad, Madrid, Spain
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Santos-Sancho JM, López-de Andrés A, Jimenez-Trujillo I, Hernández-Barrera V, Carrasco-Garrido P, Astasio-Arbiza P, Jimenez-Garcia R. Adherence and factors associated with influenza vaccination among subjects with asthma in Spain. Infection 2013; 41:465-71. [PMID: 23404684 DOI: 10.1007/s15010-013-0414-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 01/20/2013] [Indexed: 02/07/2023]
Abstract
PURPOSE Influenza has a high morbidity and mortality rate and an increased risk of complications in vulnerable individuals. Children and adults with asthma have a high risk of complications, hospitalisation and even death. The objectives of this study were as follows: to compare influenza vaccination coverage in Spain in a population of asthmatics aged ≥ 16 years with an equivalent population of non-asthmatics; to identify the factors that influence vaccination coverage among patients with asthma; and to compare coverage during the period 2006/2007 with that of 2009/2010. METHODS We used data from the 2009 European Health Survey (EHS), which included a population of 22,188 individuals (≥ 16 years of age), of whom 1,669 [7.5 %; 95 % confidence interval (CI), 7.13-7.98] had asthma. The dependent variable was the answer (yes/no) to a question asking whether or not the interviewed person had been vaccinated against seasonal (not pandemic) influenza in the previous season. As independent variables, we analysed socio-demographic characteristics, health-related variables and the use of health care services. RESULTS Vaccination coverage was 35.2 % (95 % CI, 32.5-37.9) among asthmatics and 22.1 % (95 % CI, 21.4-22.7) among non-asthmatics (p < 0.001). The probability of being vaccinated is almost twice as high for asthmatics as it is for non-asthmatics [odds ratio (OR), 1.92; 95 % CI, 1.69-2.17]. Among asthmatics, vaccination coverage increased with age, worse self-rated health status and not smoking. No significant change in coverage was observed between the study periods. CONCLUSIONS Seasonal influenza vaccination coverage among Spanish asthmatics is lower than desired and has not improved in recent years. Urgent strategies are necessary in order to increase vaccination coverage among asthmatics.
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Affiliation(s)
- J M Santos-Sancho
- Preventive Medicine and Public Health Department, Faculty of Medicine, Complutense University, Madrid, Spain
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Vázquez-Fernández del Pozo S, Hernández-Barrera V, Carrasco-Garrido P, Alvarez-Martín E, López-de Andrés A, Gil de Miguel A, Jiménez-García R. Influenza vaccination coverage and related factors among Spanish children. J Infect 2007; 54:483-9. [PMID: 17046065 DOI: 10.1016/j.jinf.2006.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Revised: 07/25/2006] [Accepted: 09/04/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To ascertain anti-influenza vaccination coverage and factors associated with anti-influenza vaccination among Spanish children. METHODS We analyzed 6464 children (age under 16 years) included in the Spanish National Health Survey (ENS) for 2003. As a dependent variable, we used the reply ("yes" or "no") to the question: Was your child vaccinated against influenza during the last campaign? We calculated anti-influenza vaccine coverage for the whole population and depending on whether or not the vaccine is recommended due to the fact that the children present an associated chronic condition. We analyzed the influence of sociodemographic variables on vaccination. RESULTS Vaccination coverage in the Spanish infant population was 5.1%, in children with associated conditions it was 17.5%, and 4.4% in healthy children. The only factor significantly associated with anti-influenza vaccination in children with associated conditions was household income: those from homes with a higher level of income were more likely to be vaccinated (OR=4.26). In children for whom vaccination is not recommended, the probability of being vaccinated against influenza is greater in those whose parents had a lower educational level (OR=2.22). CONCLUSIONS Anti-influenza vaccination coverage in the Spanish infant population is very low. There seem to be socio-economic inequalities for receiving this vaccine in Spanish children.
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Affiliation(s)
- S Vázquez-Fernández del Pozo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos. Avda de Atenas s/n, Alcorcón 28922, Spain
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