Tratamiento farmacológico de la EPOC en dos niveles asistenciales. Grado de adecuación a las normativas recomendadas
Drug treatment of chronic obstructive pulmonary disease on two levels of patient care: degree of compliance with recommended protocols
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Rodríguez González-Moro, P. de Lucas Ramos, J. Molina París" "autores" => array:5 [ 0 => array:3 [ "nombre" => "J." "apellidos" => "de Miguel Díez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "J.L." "apellidos" => "Izquierdo Alonso" "email" => array:1 [ 0 => "jia01gu@saludalia.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "J.M." "apellidos" => "Rodríguez González-Moro" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "P." "apellidos" => "de Lucas Ramos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "J." "apellidos" => "Molina París" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Neumología. Hospital General Universitario Gregorio Marañón. Madrid. España" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Sección de Neumología. Hospital General Universitario de Guadalajara. Guadalajara. España" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Salud Francia. Área Sanitaria 9. Fuenlabrada. Madrid. España" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Correspondencia: Sección de Neumología. Hospital General Universitario de Guadalajara.Donantes de Sangre, s/n. 19002 Guadalajara. España" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Drug treatment of chronic obstructive pulmonary disease on two levels of patient care: degree of compliance with recommended protocols" ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2002-07-03" "fechaAceptado" => "2002-11-19" "PalabrasClave" => array:2 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec190330" "palabras" => array:4 [ 0 => "EPOC" 1 => "Atención primaria" 2 => "Neumología" 3 => "Tratamiento" ] ] ] "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec190329" "palabras" => array:3 [ 0 => "Chronic obstructive pulmonary disease" 1 => "Pneumology" 2 => "Treatment" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los objetivos de este estudio fueron identificar las pautas de tratamiento farmacológico que reciben los pacientes con enfermedad pulmonar obstructiva crónica (EPOC) estable en España, tanto en atención primaria como en neumología, determinar su adecuación a las recomendaciones actuales y evaluar las diferencias existentes en ambos niveles de asistencia</p> <span class="elsevierStyleSectionTitle">Pacientes Y Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se trata de un estudio observacional, descriptivo y multicéntrico. La selección de la muestra se realizó mediante un muestreo aleatorio estratificado por población regional entre médicos de familia y neumólogos de todo el territorio nacional</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">De los 898 sujetos reclutados, sólo 568 (63,2%) cumplían criterios de diagnóstico de EPOC, 100 en atención primaria y 460 en neumología (en 8 casos el nivel de atención era desconocido). De ellos, 144 tenían una obstrucción leve-moderada y en 416 era grave. Los fármacos más utilizados fueron el bromuro de ipratropio (77,8%), los agonistas β-adrenérgicos inhalados de corta duración (65,8%), los corticoides inhalados (61,0%), los agonistas β-adrenérgicos de larga duración (46,4%) y las teofilinas (41,3%). Por niveles de atención, los fármacos más pautados en atención primaria fueron los agonistas β-adrenérgicos inhalados de corta duración, y en neumología, los anticolinérgicos. En el primer nivel asistencial prácticamente no se observaron diferencias en las pautas de tratamiento según la gravedad de la EPOC, el grado de disnea y la calidad de vida de los pacientes. En el ámbito de la neumología las diferencias fueron más consistentes. En ambos casos, la prescripción fue más frecuente en los enfermos con una EPOC grave. El dispositivo de inhalación más usado en atención primaria fue el Turbohaler®, frente al cartucho presurizado en neumología</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los tratamientos empleados en los pacientes con EPOC no se ajustan fielmente a las normativas vigentes, sobre todo en atención primaria. Existen diferencias en las pautas de prescripción según el nivel de asistencia</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The aims of this study were to identify the drug treatment protocols applied by primary care physicians or pneumologists for patients with stable chronic obstructive pulmonary disease (COPD) in Spain, to determine the agreement between prescription practices and current recommendations and to assess differences between the two levels of patient care</p> <span class="elsevierStyleSectionTitle">Patients And Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">The study was observational, descriptive and multicenter. A stratified random sample of patients treated by family physicians or pneumologists was taken for every region in Spain</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Five hundred sixty-eight (63.2%) of the 898 subjects fulfilled COPD diagnostic criteria; 100 were treated by primary care physicians and 460 by pneumologists. In 8 cases the caregiver was unknown. Obstruction was mild-to-moderate in 144 cases and severe in 416. The drugs most commonly prescribed were ipratropium bromide (77.8%), inhaled short-acting beta(2) agonists (65.8%), inhaled corticosteroids (61.0%), long-acting beta(2) agonists (46.4%) and theophyllines (41.3%). Primary care physicians prescribed inhaled short-acting β-agonists most often, whereas pneumologists prescribed anticholinergics most often. In the primary care setting, no differences in treatment protocols were observed based on severity of COPD, degree of dyspnea or quality of life. More consistent differences were seen in treatment by pneumologists. In both settings, prescription was more frequently given when COPD was severe. The most commonly prescribed inhalation device was the Turbuhaler® in primary care and the pressurized canister in pneumology</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Treatments prescribed for COPD patients do not follow current guidelines strictly, particularly in the primary care setting. Different prescription protocols are used at the different levels of patient care</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:27 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 3 | 7 |
| 2024 October | 36 | 18 | 54 |
| 2024 September | 49 | 16 | 65 |
| 2024 August | 79 | 46 | 125 |
| 2024 July | 46 | 17 | 63 |
| 2024 June | 57 | 25 | 82 |
| 2024 May | 57 | 32 | 89 |
| 2024 April | 40 | 30 | 70 |
| 2024 March | 47 | 33 | 80 |
| 2024 February | 33 | 44 | 77 |
| 2024 January | 0 | 4 | 4 |
| 2023 December | 0 | 1 | 1 |
| 2023 November | 0 | 6 | 6 |
| 2023 October | 0 | 3 | 3 |
| 2023 September | 0 | 3 | 3 |
| 2023 August | 0 | 1 | 1 |
| 2023 April | 0 | 2 | 2 |
| 2023 March | 5 | 3 | 8 |
| 2023 February | 33 | 25 | 58 |
| 2023 January | 29 | 28 | 57 |
| 2022 December | 37 | 27 | 64 |
| 2022 November | 32 | 22 | 54 |
| 2022 October | 32 | 35 | 67 |
| 2022 September | 24 | 22 | 46 |
| 2022 August | 29 | 61 | 90 |
| 2022 July | 35 | 64 | 99 |
| 2022 June | 33 | 46 | 79 |
| 2022 May | 32 | 36 | 68 |
| 2022 April | 39 | 31 | 70 |
| 2022 March | 38 | 40 | 78 |
| 2022 February | 33 | 24 | 57 |
| 2022 January | 28 | 29 | 57 |
| 2021 December | 10 | 33 | 43 |
| 2021 November | 22 | 41 | 63 |
| 2021 October | 20 | 55 | 75 |
| 2021 September | 25 | 57 | 82 |
| 2021 August | 17 | 33 | 50 |
| 2021 July | 25 | 39 | 64 |
| 2021 June | 46 | 41 | 87 |
| 2021 May | 39 | 43 | 82 |
| 2021 April | 33 | 57 | 90 |
| 2021 March | 43 | 30 | 73 |
| 2021 February | 52 | 21 | 73 |
| 2021 January | 22 | 24 | 46 |
| 2020 December | 31 | 27 | 58 |
| 2020 November | 24 | 21 | 45 |
| 2020 October | 32 | 12 | 44 |
| 2020 September | 19 | 13 | 32 |
| 2020 August | 27 | 6 | 33 |
| 2020 July | 32 | 22 | 54 |
| 2020 June | 18 | 11 | 29 |
| 2020 May | 22 | 18 | 40 |
| 2020 April | 21 | 4 | 25 |
| 2020 March | 23 | 24 | 47 |
| 2020 February | 21 | 15 | 36 |
| 2020 January | 38 | 34 | 72 |
| 2019 December | 27 | 16 | 43 |
| 2019 November | 9 | 13 | 22 |
| 2019 October | 11 | 20 | 31 |
| 2019 September | 20 | 12 | 32 |
| 2019 August | 13 | 15 | 28 |
| 2019 July | 26 | 17 | 43 |
| 2019 June | 21 | 10 | 31 |
| 2019 May | 38 | 34 | 72 |
| 2019 April | 48 | 28 | 76 |
| 2019 March | 19 | 12 | 31 |
| 2019 February | 19 | 18 | 37 |
| 2019 January | 14 | 9 | 23 |
| 2018 December | 15 | 18 | 33 |
| 2018 November | 19 | 19 | 38 |
| 2018 October | 42 | 21 | 63 |
| 2018 September | 22 | 10 | 32 |
| 2018 May | 6 | 1 | 7 |
| 2018 April | 6 | 15 | 21 |
| 2018 March | 4 | 8 | 12 |
| 2018 February | 7 | 10 | 17 |
| 2018 January | 8 | 10 | 18 |
| 2017 December | 14 | 13 | 27 |
| 2017 November | 9 | 4 | 13 |
| 2017 October | 9 | 13 | 22 |
| 2017 September | 6 | 6 | 12 |
| 2017 August | 16 | 19 | 35 |
| 2017 July | 18 | 12 | 30 |
| 2017 June | 42 | 22 | 64 |
| 2017 May | 20 | 8 | 28 |
| 2017 April | 5 | 5 | 10 |
| 2017 March | 12 | 10 | 22 |
| 2017 February | 8 | 7 | 15 |
| 2017 January | 14 | 15 | 29 |
| 2016 December | 42 | 18 | 60 |
| 2016 November | 48 | 17 | 65 |
| 2016 October | 54 | 29 | 83 |
| 2016 September | 46 | 25 | 71 |
| 2016 August | 33 | 6 | 39 |
| 2016 July | 34 | 7 | 41 |
| 2016 June | 36 | 11 | 47 |
| 2016 May | 46 | 12 | 58 |
| 2016 April | 26 | 2 | 28 |
| 2016 March | 23 | 4 | 27 |
| 2016 February | 34 | 5 | 39 |
| 2016 January | 43 | 21 | 64 |
| 2015 December | 39 | 16 | 55 |
| 2015 November | 69 | 27 | 96 |
| 2015 October | 117 | 2 | 119 |
| 2015 September | 136 | 0 | 136 |
| 2015 August | 129 | 0 | 129 |
| 2015 July | 109 | 0 | 109 |
| 2015 June | 77 | 0 | 77 |
| 2015 May | 131 | 0 | 131 |
| 2015 April | 101 | 0 | 101 |
| 2015 March | 163 | 0 | 163 |
| 2015 February | 93 | 0 | 93 |
| 2015 January | 101 | 0 | 101 |
| 2014 December | 111 | 0 | 111 |
| 2014 November | 106 | 0 | 106 |
| 2014 October | 165 | 0 | 165 |
| 2014 September | 133 | 0 | 133 |
| 2014 August | 116 | 0 | 116 |
| 2014 July | 119 | 0 | 119 |
| 2014 June | 122 | 0 | 122 |
| 2014 May | 125 | 0 | 125 |
| 2014 April | 123 | 0 | 123 |
| 2014 March | 135 | 0 | 135 |
| 2014 February | 116 | 0 | 116 |
| 2014 January | 76 | 0 | 76 |
| 2013 December | 56 | 0 | 56 |
| 2013 November | 61 | 0 | 61 |
| 2013 October | 84 | 0 | 84 |
| 2013 September | 74 | 0 | 74 |
| 2013 August | 51 | 0 | 51 |
| 2013 July | 69 | 0 | 69 |
| 2013 June | 54 | 0 | 54 |
| 2013 May | 54 | 0 | 54 |
| 2013 April | 38 | 0 | 38 |
| 2013 March | 17 | 0 | 17 |
| 2000 January | 6175 | 0 | 6175 |
Show all
