Fiabilidad de la retinografía para la detección de retinopatía hipertensiva en Atención Primaria

ObjectiveHigh blood pressure is one of the most prevalent diseases in general adult population. Its importance lies in the complications it causes in target organs such as kidney, heart, brain and eye. The aim of this work is to evaluate the agreement in the evaluation and interpretation of retinographies of hypertensive patients by family doctors and ophthalmologists.Material and methodsThis is a multicentric cross-sectional study in which 976 hypertensive patients from 50 to 70 years old were involved. They were participants of the «Investigating Silent Strokes in Hypertensives: a Magnetic Resonance Imaging Study» (ISSYS project) carried out in primary care centers of Barcelona and who agreed to undergo retinography. Six family physicians and 2 ophthalmologists evaluated the presence of retinal lesions through the Keith-Wagener-Barker criteria.ResultsThe inter/intra-observer Kappa concordance of the evaluations was analyzed. The evaluation of the retinographies under the usual conditions of clinical practice obtained a high subjective component with slight and fair intra-observer concordance values in the Keith-Wagener-Barker criteria. Only the assessment of the microaneurysms showed a moderate concordance and the ratio artery/vein was the worst concordant.ConclusionsThe evaluation of the retinographies in habitual conditions of clinical practice has a high subjective component that is reflected in slight and fair inter-intraobserver concordance values. The use of objective reading systems in the assessment of retinography in hypertensive patients would be useful.     

Protocolo genético en Atención Primaria para enfermedades raras: el síndrome de Wolfram como prototipo

Rare diseases, despite their individual low frequency, affect 7% of the population all combined. Consequently, every primary care practitioner (PCP) will have several of these patients under his care. 80% of rare diseases are genetically determined, which makes genetic counseling fundamental in these cases. The follow-up of patients with Wolfram syndrome (WS) can be used to design a protocol to support these patients, with the participation of researchers and healthcare professionals specialized in WS, the patients themselves and their familial environment. This protocol can be suitable for the diagnosis and management of other diseases as well. The main steps of every genetic clinical procedure are developed in this article, emphasizing the role of PCP in supporting patients and their families and in transmitting genetic information in a comprehensible manner.     

Manejo del consumo de cannabis en población joven en Atención Primaria

Cannabis is currently the most frequently used illicit drug substance in developed societies, just behind legal alcohol and tobacco. In this article clinical implications concerning cannabis use, particularly in young people, are approached. It also points out ways to make a correct diagnosis in Primary Care, with special emphasis on prevention and treatment. This is the first level of care in most cases.     

Oftalmopatía en la diabetes mellitus: detección desde la Atención Primaria de salud

ObjectiveTo study the feasibility of a basic ophthalmological examination for the eye disease in diabetic patients by Primary Health Care (PHC).Patients and methodsA multi-centre prospective study. A sample of 712 type 2 diabetics.InterventionsVisual acuity examination, intraocular pressure measurement and the eye fundus photograph with a non-mydriatic camera taken by an optometrist. The interpretation and subsequent referral to an ophthalmology department by ophthalmologists and general practitioners (GP).ResultsVisual acuity deficiency: GP, 43.7%; ophthalmologist, 36.1%; concordance, 70%; glaucoma suspicion: GP, 8.8%; ophthalmologist, 7.6%; concordance, 94%; diabetic retinopathy: GP, 28.2%; ophthalmologist, 13.4%; concordance, 78%. Ophthalmology Department referral: GP, 56.8%; ophthalmologist, 41.3% (P=0.001).ConclusionsAgreement between GP and ophthalmologist leads to a reliable ophthalmological examination of the diabetic patient in PHC. Despite an over-diagnosis and 16% of non-justified referrals by the GP, Ophthalmology Department referral is avoided in almost half of the diabetic patients.     

Aplicación de la Escala de Tabaquismo para Atención Primaria (ETAP) en la práctica clínica

Objective

To determine if the ETAP smoking scale, which measures accumulated exposure to tobacco, both actively and passively, is applicable and effective in the clinical practice of Primary Care for the prevention of acute myocardial infarction (AMI).Location Barranco Grande Health Centre in Tenerife, Spain.

Hiperfrecuentación en Atención Primaria e hiperfrecuentadores en Urgencias

Objective

To identify predictors of frequent attenders (HF) in Primary Health Care (PHC) centres in a sample of frequent attenders (HF) in Emergency Departments (ED).

Importancia del compromiso del personal sanitario para la satisfacción de los pacientes en Atención Primaria

To know to what extent the organizational commitment of primary care health professionals is important for patient satisfaction. Observational, cross-sectional, quantitative, retrospective, and uncontrolled study. 40 primary care centers belonging to the health area of Gran Canaria. Primary care. 617 health professionals (46% doctors and 54% nurses) and 1,537 users of primary care centers (35.39% men and 64.60% women). Non-probability sampling for convenience. To evaluate organizational commitment, a self-administered questionnaire was used for health professionals in primary care centers. Patient satisfaction was obtained by telephone survey and control variables from secondary sources. The data were analyzed by multiple linear regression. To deepen the results, semi-structured interviews were also used. The socioeconomic environment of the health centers does not influence patient satisfaction. The organizational commitment of the workers has a positive influence on the satisfaction of the users of the health centers. It was also found that the most committed professionals have less availability in their schedules for short-term appointments. The interviews suggest that it is because they spend more time with their patients, which makes them more satisfied. The affective organizational commitment of health professionals is an attitude that allows improving patient satisfaction, therefore, health managers should use practices aimed at strengthening this attitude.     

Declaración de voluntades anticipadas: estudio cualitativo en personas mayores y médicos de Atención Primaria

ObjectivesFirst, to assess knowledge and attitudes of people aged 65 and over to the Advance Directives Document (ADD) and know the role that, in their opinion, a family doctor should play in the early planning of death. Second, to assess the level of knowledge and attitude of primary care physicians to that document, as well as to know the role played by these professionals.DesignQualitative, using discussion groups. Between March and May 2009 4 groups, 2 of physicians and 2 of older people, were formed.SettingCastile-La Mancha Primary Care Setting, Albacete and Guadalajara health areas.Subjects15 people in the groups formed by older people and 13 in the groups of doctors.MethodThe Krueger recommendations (1991) were followed both for the selection of subjects, conducting of the discussion groups and analysis of data.ResultsDoctors and patients have a positive attitude towards the ADD, but lack sufficient information to make more widespread use of it. Ignorance makes it impossible for patients to get information about the document and the lack of time makes it difficult for physicians to raise the issue in the consultation.ConclusionsNeither physicians nor the elderly have enough information regarding ADD, allowing us to recommend carrying out information campaigns and/or specific educational activities. According to physicians, alternatives to primary care consultations should be sought for patients to be informed.