Variability in screening prevention activities in primary care in Spain: a multilevel analysis
| Autor: | Julio Morán, Clara Pareja, Mariona Pons-Vigués, Bonaventura Bolíbar, María Ángeles Nuin, Josep Maria Elorza-Ricart, Magdalena Rosell-Murphy, Jordi Rodríguez, Teresa Rodriguez-Blanco |
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| Jazyk: | angličtina |
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male medicine.medical_specialty Pediatrics Cross-sectional study Population education behavioral disciplines and activities Multilevel analysis Risk Factors Environmental health Epidemiology medicine Prevalence Electronic health records Humans Mass Screening Obesity Mass screening Preventive healthcare Primary health care Aged Dyslipidemias education.field_of_study Primary prevention business.industry Public health Multilevel model Public Health Environmental and Occupational Health Tobacco Use Disorder Middle Aged Primary health services Cross-Sectional Studies Spain Clinical practice variations Hypertension Female Preventive Medicine Biostatistics business Alcohol-Related Disorders Research Article |
| Zdroj: | BMC Public Health |
| ISSN: | 1471-2458 |
| Popis: | Background Despite 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. Methods Multicentre, 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. Results The 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. Conclusions Of 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 material The online version of this article (doi:10.1186/s12889-015-1767-5) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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