Welcome to the 26th WONCA Europe Virtual Conference Programme Scheduling

Abstract Body

Background and purpose

Overwhelming evidence from clinical trials supports the notion that reduction in LDL-C levels with lipid-lowering agents reduces the risk of developing cardiovascular diseases (CVD) and CVD mortality. However, in the elderly, systematic reviews^1,2 of cohort studies revealed that lower LDL-C levels are associated with higher all-cause mortality, the so called LDL paradox. Our aim was to revisit the association of LDL-C levels with overall mortality in cohorts of healthy younger adults.

Methods

The authors independently searched PubMed for cohort studies with the following keywords: (low-density lipoprotein OR low density lipoprotein) AND mortality NOT animal NOT trial. We excluded non-English reports, studies in geriatric populations or high cardiovascular risk groups, and papers with electronic publication date before 1/1/2010 or after 10/2/2021.

Results

We identified 2 papers including 639.157 individuals from 3 cohorts where all-cause mortality was recorded. In all 3 cohorts, the association between LDL-C levels and the risk of overall mortality was U-shaped, with individuals with LDL-C<70mg/dL having a significantly higher risk for all-cause mortality.

Conclusions

These controversial findings suggest that LDL-C levels below 70mg/dL may be detrimental in the general adult population not taking statins. Further studies are required to understand the mechanism behind this LDL paradox in healthy young adults and in the elderly.

References

¹Ravnskov et al. BMJ Open 2016; 6(6):e010401.

² Oliveira et al. European Geriatric Medicine 2020; 11:S155.

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Background and Aim and learning objectives:

Peripheral neuropathy refers to disorders of the peripheral nervous system. The overall prevalence is 2-4% in the general population and 8% in people older than 55 years. [1] Finding the ethiology of a patient’s peripheral neuropathy can be challenging, so a systematic and logical approach is needed: detailed history of symptoms, family and occupational history and a general and systemic examination [2]. The main purpose of this workshop is to provide an overview of peripheral neuropathy diagnosis as well as some strategies for systematic physical exam.

Methods and timetable.

The workshop will be divided into two parts. The first one, will be an oral presentation where we aim to review the definitions and different causes of peripheral neuropathy, clinical approach and general examination. And a second part, where practitioners will learn how to apply validated questionnaires of diagnosis and severity which are a reliable and valid instrument for assessment of patients neuropathy, and also will have the opportunity to practice and improve the techniques of the physical exam for neurologic examination.

(Proposed) Results / Conclusions:

In the end, we hope that the general physicians can feel more aware about how to perform a reliable examination of peripheral nervous system. An accurate diagnosis it's essential for good management and to delay the progress of the neuropathy.

References:

[1] Martyn CN, Hughes RAC. Epidemiology of peripheral neuropathy. J Neurol Neurosurg Psychiatry 1997; 62: 310–18 . Doi: 10.1136/jnnp.62.4.310

[2] Misra UK, Kalita J, Nair PP. Diagnostic approach to peripheral neuropathy. Ann Indian Acad Neurol. 2008 Apr;11(2):89-97. doi: 10.4103/0972-2327.41875.

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Background and purpose:Healthy cognitive, physical, sexual and psychosocial development is essential for all adolescents to successfully enter adulthood. Effective primary health care services are required to protect adolescents from possible health problems, to reveal unfamiliar diseases, and to perform their treatment and follow-up. The aim of the study is to evaluate adolescents' utilization from primary health care services, nutritional behavior and to examine their relationship with each other.

Method:146 adolescents between the ages of 10-18 were included in this descriptive study. A questionnaire of 15 questions was applied to the participants about their eating habits, knowing the family physician and going to family medicine.

Results:The average age of the participants is 16.4±1.6 and 58.9% are girls. 85.6% of them went to the family doctor to be examined. Nutritional behavior score and going to the family doctor were higher in girls than boys (p<0.001). In obese and overweight patients, the rate of knowing who the family physician is, the score of going to family medicine and the nutritional behavior score were found to be lower than those of normal weight.

Conclusion:In our study, it was observed that adolescents who use primary health care more often had lower rates of obesity and overweight and a healthier diet. In order to get rid of obesity, which is an important public health problem of today, it is necessary to increase the rate of adolescents using primary health care services. Considering factors such as age and gender, healthy eating behaviors should be encouraged and adolescents should be informed more to use primary health care services.

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Background The implementation of monitoring for primary care can contribute to improvement of the quality of diabetes care.

Objectives Our study aimed to describe associations of primary diabetes care performance indicators with structural characteristics of general medical practices (GMP) and socio-economic status of patients.

Methods Using data for adults from 2018 covering the whole country, GMP specific performance indicators standardized by patients’ age, sex, and eligibility for exemption certificate were computed for adults. Linear regression models were applied to evaluate the relationship between GMP specific parameters (list size, settlement type, geographical location, GP vacancy, age of GPs) and patients’ socio-economic status (education, employment, proportion of Roma among adults, housing density) and diabetes care performance indicators.

Results Patients received 58.64% of the required medical interventions. GMP with older-than-65-year GP was associated with lower performance indicators (hemoglobin A1c testing: β= -0.082; serum creatinine checking: β= -0.086; serum lipid status checking: β= -0.082; influenza immunization: β= -0.032). GP vacancy was related to low performance in influenza immunization (β= -0.053). Lower level of patients’ education (hemoglobin A1c testing: ß= -0.108; ophthalmic examination: ß= -0.100; serum creatinine determination: β= -0.103; serum lipid status checking: ß= -0.108; retinopathy surgery: β= 0.043) and small GMP size (retinopathy surgery: β= 0.178; dialysis treatment: β= 0.166) were associated with poor performance indicators.

Conclusion The diabetes care performance in Hungary is significantly determined by socio-economic and structural factors which cannot be influenced by GPs. Therefore, the facilitation of working environment’s improvement could be the primary outcome of implementing diabetes monitoring.

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Background and purpose: The incorrect inhalation technique is a problem in the control of asthma. Demonstrating the use of the inhaler, together with practical training, can help patients control their illness and improve their quality of life.

The objective of this work is to evaluate the technique for using inhaler devices and to increase the proportion of patients with asthma who use the inhaler correctly by 20%.

Methods: Asthma patients from a single Family Medicine Unit were invited to demonstrate inhalation technique. Errors were corrected and one month later, the inhalation technique of patients who had not performed the technique correctly was reviewed.

Results: 41 visits were made. 49% performed the following steps incorrectly: 2.5% did not rotate the device with the lid closed; 2.5% did not start inspiration slowly while activating the device; 19.5% did not perform a slow expiration until the functional reserve capacity; 19.5% did not hold their breath for 5 to 10 seconds after inspiration; and 41.5% did not wash the oral cavity after using the device.

On the 2nd visit, 10% did not hold their breath for five to ten seconds after inspiration, 15% did not exhale slowly until the functional reserve capacity and 15% did not wash the oral cavity after using the device. 35% (7 of 20 users) made no mistakes.

Conclusions: 35% of patients started using the inhaler correctly. The success of this intervention confirms the importance of adequate instruction and the revision of the inhalation technique in the medical appointments with asthmatic patients.

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1, Background and purpose

During the Coronavirus Disease 2019 (COVID-19) pandemic, changes were necessary in the Portuguese Primary Health Care Units organization, given the need to assist patients with suspected COVID-19 symptoms. This led to a decrease in our assistance capacity to other patients, especially those with chronic diseases. To minimize the impact on Chronic Obstructive Pulmonary Disease (COPD) patient’s follow-up, USF Balsa and the University of Algarve developed the MedChronic-Respiratory project, which methods and results are presented here.

2, Methods

All USF-Balsa COPD patients were selected and contacted by telephone, based on a pre-established protocol, designed to provide telephone support, and characterize these patients’ health status, during the lockdown period. The results were recorded and analysed using an Excel spreadsheet.

3. Results

A total of 83 patients were contacted, with ages ranging from 45 to 89 years. Of those, 60 had a COPD Assessment Test score <10 and only 7 had one COPD exacerbation in the last year; 60 were classified as GOLD A. Regarding the therapeutic regimen, 16 used LAMA/LABA, 15 used LABA/ICS, 10 used LAMA; 25 didn’t use any medication. Most patients were very grateful with the contact and agreed with telephone follow-up during the pandemic.

4. Conclusions

This project enabled to maintain the follow-up of our COPD patients, at a time of less medical assistance. This allowed to meet patients’ needs while maintaining support to a group of vulnerable patients.

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Background and purpose:

Menopausal hormone therapy (MHT) use in Australia declined rapidly following 2002 publication of the WHI study, and then plateaued. Since then, findings of follow-up WHI analyses may encourage less restrictive MHT use. We aimed to assess trends in MHT prescribing following the documented plateau in prescribing.

Method:

A longitudinal analysis from the ReCEnT cohort study. In ReCEnT, GP registrars (trainees) document 60 consecutive consultations, six-monthly, on three occasions.

The outcome factor was MHT (estrogen and/or progestogen) prescribed. All menopause-related problems for female patients aged 25 years-or-over were included in the primary analysis. The secondary analysis, of ratio of MHT to non-MHT symptomatic medicines, included only problems for which MHT or non-MHT symptomatic medicines were prescribed. Associations of MHT-prescribing, including year (2010-2019), were assessed by univariate and multivariable logistic regression.

Results:

2,839 registrars documented 1,509 menopause-related problems. For all menopause-related problems, 1169 (75%) patients were prescribed MHT or a non-MHT symptomatic drug. Of these, 965 (82%) were MHT. There was a small reduction in MHT prescribing over time (OR=0.96 [CI=0.91, 1.00] per year), not reaching statistical significance (p=0.078). For the ratio of MHT prescription to non-MHT symptomatic medications, there was no statistically significant change in MHT prescribing (OR=0.95 [CI=0.89, 1.01], p=0.12).

Conclusions:

There was no statistically significant change in MHT prescribing in the period eight-to-17 years following WHI publication. It may still be too early to see a rise in MHT prescribing in response to subsequent follow-up studies, given the generally slow uptake of research evidence into practice.

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Background and Purpose

Osteoporosis is characterized by low mineral bone density and increases the risk of fracture. It affects 10% of the Portuguese population, mainly women. It can be a silent disease, and its diagnostic can be established using Dual Energy X-ray Absorptiometry(DEXA) and the risk of fracture can be stratified using FRAX. With this study we intend to review the diagnostic methods used to diagnosis osteoporosis in a primary care setting.

Methods

Transverse, observational study that includes all the patients with the diagnosis of osteoporosis in two primary care institutions.

Results

From a total of 16500 patients 762 were diagnosed with osteoporosis. This represents a prevalence of 4,61%, of which 95% are women and 5% are men, with an average age of 75 years SD±10. In these patients, the diagnosis was established using DEXA in 32,3%, RX in 8% and FRAX in 0,5%, and in 59,2% the method was unknown. From the latter, 37,2% performed a DEXA and to 1,8% FRAX was applied later on. From those diagnosed using RX, 21,6% ended up performing a DEXA and to 1,6% FRAX was applied later.

Conclusions

Osteoporosis is a challenging diagnosis for the general practitioner(GP), and is greatly underdiagnosed. Although a third of these diagnosis are correctly established using a DEXA, many of them were wrongly established using only X-ray’s. Therefore, it is essential to educate the GP about the correct diagnostic algorithms and teach them how to use newly developed and inexpensive methods like FRAX, in order to improve the quality of healthcare they provide.