title: Variability in screening prevention activities in primary care in Spain: a multilevel analysis.
abstract: 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.
  
  
  RESULTS
  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.
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain. mrosell.mn.ics@gencat.cat.|Equip d'Atenció Primària Serraparera. Institut Català de la Salut, Cerdanyola del Vallès, Spain. mrosell.mn.ics@gencat.cat.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Rosell-Murphy
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain. trodriguez@idiapjgol.org.|Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain. trodriguez@idiapjgol.org.
authors.forename: Teresa
authors.initials: T
authors.lastname: Rodriguez-Blanco
authors.affiliation: Dirección Atención Primaria, Servicio Navarro de Salud - Osasunbidea, Navarra, Spain. jmoranpi@cfnavarra.es.
authors.forename: Julio
authors.initials: J
authors.lastname: Morán
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain. mponsv@idiapjgol.info.|Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain. mponsv@idiapjgol.info.
authors.forename: Mariona
authors.initials: M
authors.lastname: Pons-Vigués
authors.affiliation: SIDIAP, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. jmelorza@idiapjgol.info.
authors.forename: Josep M
authors.initials: JM
authors.lastname: Elorza-Ricart
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain. jrodriguez@idiapjgol.org.|SIDIAP, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain. jrodriguez@idiapjgol.org.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rodríguez
authors.affiliation: Equip d'Atenció Primària La Mina. Institut Català de la Salut, Barcelona, Spain. cpareja.bcn.ics@gencat.cat.
authors.forename: Clara
authors.initials: C
authors.lastname: Pareja
authors.affiliation: Dirección Atención Primaria, Servicio Navarro de Salud - Osasunbidea, Navarra, Spain. ma.nuin.villanueva@cfnavarra.es.
authors.forename: María Ángeles
authors.initials: MÁ
authors.lastname: Nuin
authors.affiliation: Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Av Gran Via de les Corts Catalanes, 587, 08007, Barcelona, Spain. bbolibar@idiapjgol.org.|Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain. bbolibar@idiapjgol.org.
authors.forename: Bonaventura
authors.initials: B
authors.lastname: Bolíbar
mesh_terms: D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000517:prevention & control; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000175:diagnosis / Q000517:prevention & control; D005260:Female; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000517:prevention & control; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D055361:Multilevel Analysis / Q000379:methods*; D009765:Obesity / Q000175:diagnosis / Q000517:prevention & control; D015995:Prevalence; D011315:Preventive Medicine / Q000379:methods / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data*; D012307:Risk Factors; D013030:Spain; D014029:Tobacco Use Disorder / Q000175:diagnosis / Q000517:prevention & control