Brotons C, Iglesias M, Martin-Zurro A, Martin-Rabadan M, Gene J
Cardiology Department, University Vall d'Hebron General Hospital, Barcelona, Spain.
Fam Pract. 1996 Apr;13(2):144-51. doi: 10.1093/fampra/13.2.144.
Since January 1989 the Spanish Society of Family and Community Medicine has supported the Program of Prevention and Health Promotion (PAPPS) with the following objectives: to detect possible difficulties in the implementation of recommendations especially among asymptomatic low-risk adults and children in Spain, to disseminate those recommendations, and to encourage research in prevention and health promotion in primary care.
We wished to evaluate the implementation of PAPPS in primary care practices.
A retrospective audit of medical records in practices enrolled in the programme was carried out. From 166 primary care practices widely distributed in Spain 21,631 patients were selected using systematic sampling.
Age was positively associated with correct performance in the adult population, while in the paediatric population it was negatively associated. Females had higher probability than males of having blood pressure measurement (OR 1.34, 95% CI 1.24-1.45) and smoking counselling (OR 1.38, 95% CI 1.33-1.43) correctly performed. Practices not using the preventive chart had a lower probability than user practices of correctly performing blood pressure measurement (OR 0.69, 95% CI 0.62-0.76), alcohol counselling (OR 0.66, 95% CI 0.60-0.73) and smoking counselling (OR 0.69, 95% CI 0.63-0.76). Non-teaching practices had a higher probability than teaching centres of correct performance of blood pressure measurement (OR 1.47, 95% CI 1.35 to 1.59), alcohol counselling (OR 1.67, 95% CI 1.54 to 1.79) and smoking counseling (OR 1.39, 95% CI 1.29 to 1.51).
There is an unequal level of performance depending on the procedure and on the target population. A preventive chart might be useful in improving implementation of periodic health maintenance. Teaching centres with training physicians need to put more emphasis on prevention and health promotion activities.
自1989年1月以来，西班牙家庭与社区医学协会一直支持预防与健康促进项目（PAPPS），其目标如下：发现建议实施过程中可能存在的困难，尤其是在西班牙无症状的低风险成年人和儿童中；传播这些建议；鼓励开展初级保健中的预防与健康促进研究。
我们希望评估PAPPS在初级保健机构中的实施情况。
对参与该项目的机构中的病历进行回顾性审核。从西班牙广泛分布的166家初级保健机构中，采用系统抽样法选取了21631名患者。
在成年人群中，年龄与正确执行情况呈正相关，而在儿童人群中则呈负相关。女性接受血压测量（比值比1.34，95%置信区间1.24 - 1.45）和吸烟咨询（比值比1.38，95%置信区间1.33 - 1.43）的正确执行概率高于男性。未使用预防图表的机构正确执行血压测量（比值比0.69，95%置信区间0.62 - 0.76）、酒精咨询（比值比0.66，95%置信区间0.60 - 0.73）和吸烟咨询（比值比0.69，95%置信区间0.63 - 0.76）的概率低于使用预防图表的机构。非教学机构正确执行血压测量（比值比1.47，95%置信区间1.35至1.59）、酒精咨询（比值比1.67，95%置信区间1.54至1.79）和吸烟咨询（比值比1.39，95%置信区间1.29至1.51）的概率高于教学中心。
根据操作程序和目标人群的不同存在执行水平不平等的情况。预防图表可能有助于改善定期健康维护的实施。有培训医师的教学中心需要更加重视预防和健康促进活动。
