Variability in screening prevention activities in primary care in Spain: a multilevel analysis

Abstract

BackgroundDespite evidence of the benefits of prevention activities, studies have reported only partial integration and great variability of screening in daily clinical practice. The study objectives were: 1) To describe Primary Health Care (PHC) screening for arterial hypertension, dyslipidaemia, obesity, tobacco use, and excessive alcohol consumption in 2008 in 2 regions of Spain, based on electronic health records, and 2) To assess and quantify variability in screening, and identify factors (of patient, general practitioners and PHC team) associated with being screened, that are common throughout the PHC population.MethodsMulticentre, cross-sectional study of individuals aged ≥16 years (N = 468,940) who visited the 426 general practitioners (GPs) in 44 PHC teams in Catalonia and Navarre in 2008. Outcomes: screening for hypertension, dyslipidaemia, obesity, tobacco use, and excessive alcohol consumption. Other variables were considered at the individual (sociodemographics, visits, health problems), GP and PHC team (region among others). Individual and contextual factors associated with the odds of being screened and the variance attributable to each level were identified using the SAS PROC GLIMMIX macro.ResultsThe most prevalent screenings were for dyslipidaemia (64.4%) and hypertension (50.8%); the least prevalent was tobacco use (36.6%). Overall, the odds of being screened were higher for women, older patients, those with more comorbidities, more cardiovascular risk factors, and more frequent office visits, and those assigned to a female GP, a GP with a lower patient load, or a PHC team with a lower percentage of patients older than 65 years. On average, individuals in Navarre were less likely to be screened than those in Catalonia. Hypertension and dyslipidaemia screenings had the least unexplained variability between PHC teams and GPs, respectively, after adjusting for individual and contextual factors.ConclusionsOf the studied screenings, those for obesity, tobacco, and alcohol use were the least prevalent. Attention to screening, especially for tobacco and alcohol, can be greatly improved in the PHC setting.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1767-5) contains supplementary material, which is available to authorized users.

The impact of general practitioners’ gender on process indicators in Hungarian primary healthcare: a nation-wide cross-sectional study

“…According to the international literature, there is solid evidence that the physician’s gender influences the effectiveness of medical care in primary healthcare (PHC) 5–9. Female physicians in primary care tend to deliver more preventive services,10–18 they have better adherence to guidelines of chronic diseases8 19 and they achieve better intermediate treatment outcomes (blood pressure, haemoglobin A1c (HbA1c) and cholesterol level), compared with their male colleagues 20 21…”

<p>Evaluating the Effectiveness of an Additional Risk Minimization Measure to Reduce the Risk of Prescribing Mirabegron to Patients with Severe Uncontrolled Hypertension in Four European Countries</p>

“…[17][18][19][20] The incomplete information on blood pressure values in the electronic healthcare records in our study was consistent with other reports. [21][22][23][24] All four countries included in this study have guidelines recommending regular blood pressure measurements for chronic diseases such as diabetes and cardiovascular disease. 9,10,22,25 The Netherlands, 26 the UK 27 and Spain, 28 but not Finland, use monitoring of risk factors such as BP as indicators to monitor the quality of care for chronic diseases.…”

“…[21][22][23][24] All four countries included in this study have guidelines recommending regular blood pressure measurements for chronic diseases such as diabetes and cardiovascular disease. 9,10,22,25 The Netherlands, 26 the UK 27 and Spain, 28 but not Finland, use monitoring of risk factors such as BP as indicators to monitor the quality of care for chronic diseases. This is consistent with the observed higher proportion of patients without recorded blood pressure measurements in Finland.…”

Screening and care for alcohol use disorder in France: expectations, barriers and levers using a mixed-methods approach

“…Linking more PWAUD to healthcare constitutes a major clinical and public health challenge. The following individual and contextual factors have been identified as barriers to receiving care for PWAUD in Europe: i) many people are not aware that they have unhealthy alcohol use [9]; ii) screening for AUD in primary care is rare [10,11]; iii) a great deal of stigma is attached to AUD (despite alcohol being strongly integrated into several European cultural patterns) [12]; iv) many PWAUD do not wish to be totally abstinent [13]. With regard to the latter point, it is important to underline that reduced drinking is only slowly becoming an acceptable therapeutic goal in AUD care in France for health professionals and PWAUD [14][15][16] .…”