Fiabilidad de un cuestionario empleado para la aplicación en el seguimiento longitudinal de la opinión y percepciones de la medicina de familia de los estudiantes de medicina de la Universidad de Zaragoza

AimFamily medicine deals with certain aspects and perspectives that are often left behind in the training of other levels of care, thus the need for medical students to make contact with Primary Care is of increasing importance. The aim of this study is to evaluate the reliability of the questionnaire of the UNIMEDIFAM group (FIS PI070975) for the long-term outcome of expectations and knowledge about family medicine.DesignReliability of a questionnaire.SettingUniversity of Zaragoza.Participants371 students from the 1^st, 3^rd, 5^th, and 6^th years.MethodThe internal consistency of the questionnaire was determined using Cronbach's alpha coefficient, and the stability using the test-retest.ResultsOn scale A of the questionnaire we found that three of 19 items were unstable, in 8 of 26 on scale B, and 3 of 38 items on scale C. The Cronbach's alpha value of scale A was 0.722, 0.861 on scale B, and 0,663 on scale C.ConclusionsThe 3 scales are within the appropriate values, except scale C, which is very close. The findings of this validation process can serve as a reference that may be extrapolated to the UNIMEDIFAM national questionnaire.     

El consumo sanitario inapropiado y la trivialización de la medicina

One of the main problems of our health care system is its excessive use. The most evident results of this misuse are the waste of resources and the iatrogenic consequences that are not justified by any expectations in health improvement. Among the possible causes of this inappropriate use, the trivialization of medical practice should be emphasized. This entails not only a loss of respect and consideration, but facilitates and even stimulates reckless use. Although patients and health care workers are both responsible for this recklessness, politicians and health care managers should be held responsible more so. Without a real emancipation allowing health care users and the population to control the factors that determine their health, it is unlikely that the inappropriate use of health resources and its associated iatrogenic consequences will be reduced.     

Evaluación de una intervención comunitaria para incrementar la cobertura vacunal de la gripe en mujeres embarazadas

ObjectiveTo know the impact of the educational intervention carried out on the professionals of a basic health area and their community participation group, which make up the intervention group (IG), and to analyze its repercussion on the vaccination coverage achieved for influenza in the risk group (pregnant and puerperal women) comparing it with its neighboring basic zone, which makes up the control group (CG), during the 2019/20 vaccination season.DesignQuasi-experimental study of community intervention.SiteTwo basic health zones belonging to the Elche-Crevillente health department, Spain.ParticipantsPregnant and postpartum women from 2 basic health areas and the community participation group. Health professionals directly related to the flu vaccination campaign.InterventionsTraining session for the IG prior to the 2019/20 flu campaign.Main measurementsAttitudes towards influenza vaccination in health professionals through the validated CAPSVA questionnaire and the vaccination coverage of pregnant and postpartum women through the Nominal Vaccine Registry and their acceptance of the vaccine in the midwife's office.ResultsThe influenza vaccination coverage data recorded in Nominal Vaccine Registry for pregnant and puerperal women was 26.4% (n = 207) in the IG and 19.7% (n = 144) in the CG (p = 0.001), with an incidence ratio of 1.34, thus achieving 34% more vaccination in the IG. Acceptance for vaccination in the midwife's office was also high, with 96.5% immunization in IG vs. 89.0% in CG, with a RR = 1.09 (95% CI 1.01-1.62).ConclusionsJoint training strategies for professionals and community assets improve the results of vaccination coverage.     

Evaluación de la efectividad de un programa de mindfulness y autocompasión para reducir el estrés y prevenir el burnout en profesionales sanitarios de atención primaria

Objective

To evaluate the effectiveness of a Mindfulness and Self-Compassion Program on the levels of stress and burnout in Primary Care health professionals.

Empatía médica en residentes y tutores de medicina familiar y comunitaria. La visión del profesional y del paciente

AimTo determine the degree of clinical empathy among family medicine residents and tutors. To gauge whether there is a relationship between physicians’ self-perceived empathy levels and their patients’ assessments.Study designObservational, cross-sectional survey.LocationPrimary Care Teaching Unit. Madrid.ParticipantsA survey was sent by email to all the Teaching Unit's family medicine tutors and residents. Responses were received from 50 residents (39.4%) and 41 tutors (45%). In addition, 428 patients were opportunistically recruited at a healthcare centre and their doctors were also interviewed.Primary measurement instrumentsEmpathy was measured using the Jefferson Scale of Empathy and the Jefferson Scale of Patient Perceptions of Physician Empathy.ResultsThe tutors scored 2.53 points higher for cognitive empathy than the residents (P = .04). Emotional empathy scores declined among older tutors (r =  −0.32; P = .05). The Spanish students (82% of the total) without previous work experience scored higher for overall empathy (P = .02). Final-year residents recorded significantly worse empathy assessments than the other residents. A positive correlation (r = 0.72; P = .01) was observed between physicians’ self-perceived empathy and their patients’ perceptions.ConclusionsResidents with previous work experience, final-year residents and those of Latin American origin score lower for empathy. There is a strong relationship between physicians’ self-perceived empathy and their patients’ views of their empathy levels.     

Desarrollo de estándares para la educación y formación en medicina familiar y comunitaria – contribuciones de la WONCA IberoAmérica (CIMF)

The WONCA Education Working Party (WEP) is developing a set of standards for medical student education, postgraduate training in family medicine / general practice and continuing professional development for family doctors. At this point the contributions by WONCA world regions are very important, and for this reason the main objective of this report is to present the standards developed by the Iberoamerican WONCA Region (CIMF). To be comprehensive and effective, standards should reflect regional realities and so the contributions from CIMF may reinforce and strengthen the key initiative of WEP and the implementation of the standards throughout the world.     

Evaluación de la efectividad de los programas de vacunación

Vaccines have contributed enormously to reducing the incidence of many communicable diseases. The protective efficacy of a vaccine refers to the health effects of the vaccine applied in optimal, ideal conditions, whereas the effectiveness of a vaccination program refers to the health effects of vaccination in the vaccinated individuals in clinical practice or within public health programs, which may differ widely from optimal conditions. Vaccine efficacy is estimated by randomized clinical trials. In contrast, effectiveness can be measured by various types of epidemiological studies: randomized community trials, in which the target vaccine is randomly assigned to a group and disease incidence in this group is compared with that of an unvaccinated group; cohort studies, which are observational epidemiological studies in which the vaccination status is known in healthy vaccinated (vaccinated cohort) and unvaccinated (unvaccinated cohort) people and the occurrence of the disease in the two groups is studied; and observational case-control studies, in which two groups are selected; one with the disease under investigation (cases) and the other without (controls), and vaccination histories are investigated in the two groups. Vaccine effectiveness may also be estimated by comparing attack rates in epidemic outbreaks or secondary attack rates in the home, or by screening.     

Evaluación del impacto de un plan multisectorial de promoción de la salud y el bienestar social en Andalucía

ObjectiveTo evaluate the impact of the Plan for the promotion of personal autonomy and prevention of disability in Andalusia (2016-2020) in 13 public administrations during the first year of its implementation; and to analyse the usability and feasibility of the impact assessment ladder used.MethodThe Plan addresses the promotion of personal autonomy and the prevention of disabilities and dependencies through a multisectoral approach. It is structured in strands or lines of work, objectives and actions that have been assessed through the Adoption Impact Ladder (AIL). The analysis of the face validity, feasibility and inter-rater reliability of the impact assessment ladder was carried out in 30 actions of the Plan that were rated by 20 experts from the 13 ministries and public agencies involved in the Plan, and an external rater.Results176 actions and programmes were launched in 2017. Of these, 67.2% were implemented during the first year. Only one of the 16 objectives had no action initiated during the first year. Moreover, 7 out of 15 objectives implemented were fully multisectoral involving more than three Regional Ministries. The face validity, feasibility and inter-rater reliability of the AIL were good (κ: 0.72).ConclusionsThis Plan has provided a novel framework to coordinate a broad range of proposed policies and actions within the public administration of Andalusia. For the first time, a multisectoral impact analysis has been conducted providing an effective guide for monitoring, planning and setting public priorities in health, social services, ageing and disabilities.     

Opiniones y percepciones de los pacientes sobre su participación en la toma de decisiones en las consultas de medicina de familia

ObjectivesTo find out the views of the patient on their participation in decision making (DM) when visiting their family physician.DesignA cross-sectional, qualitative and quantitative study.Setting and participantsPatients attending their family doctors in diverse geographical Health Centres.MeasurementsPersonal interviewing using different kinds of questions (close-ended, close-ended with options and open-ended questions).ResultsPatients participation: 658 (52 ± 17.4 years, 62% females, consulting with 97 doctors (from urban centres: 36 (458); rural centres: 22 (200). Most patients (94%; 620) declared to be satisfied with DM and up to 41% (266) thought that DM should be taken only by the doctor. Nevertheless, after the consultation 60% of patients (360) confirmed that they would have liked the physician to have asked them for their opinion, but the doctor did not encourage them to do this. Furthermore, patients considered information, discussion about options, ways to make decisions, medical advice, active listening and empathy as key aspects to encourage them to participate.ConclusionsAfter a medical consultation, most patients wanted to give their opinion about the proposals of treatment. Nevertheless, they felt that their doctors offered them these opportunities on very few occasions. Some types of questions are better than others in detecting of these kinds of needs, and are more useful to design strategies for involving patients in the DM process.     

El cambio de paradigma en la prevención de ictus en la fibrilación auricular. Retos y oportunidades emergentes para el médico de familia

Atrial fibrillation (AF), is the most prevalent sustained arrhythmia in general population, affecting up to 10% in patients of advanced age. AF doubles overall mortality and increases up to 5–6 times the risk of stroke, which have the characteristic of being particularly harmfull. The basis of treatment on AF are the rhythm or rate control and the prevention of thromboembolism. For the latter purpose the treatments that have been most effective are oral acticoagulants. For decades and until just a few years ago, the only oral drugs available for this purpose have been the anti-vitamin K, mainly represented in our country by acenocoumarol and lesser extent by warfarin. These drugs have been shown to reduce strokes and mortality compared to placebo and with antiplatelet drugs, so have been and continue to be the standard treatment and the comparator for all antithrombotic drugs in patients with AF. The variability in the therapeutic response, their food and drugs interactions and their narrow therapeutic window that entail the need to frequently monitoring, has led to look for new drugs that, at least maintaining their advantages, where able to avoid some of the drawbacks.Currently we have a number of new drugs that meet these premises, although they have the disadvantage of a higher direct cost. The arrival of these new oral anticoagulants (NOAC) make necessary to know them well, reach a consensus for a correct use and to make changes in the clinical management of these patients when they are used.In this article we review the indications and way of use of the different options (classics and news) of antithrombotic therapy in patients with AF, the situation of anticoagulated patients in our country, the characteristics of the NOAC, its recommendations for use and the challenges to that are subjected family physicians regarding these changes.     

Asociación entre el humo ambiental de tabaco y el estado de salud en la población infantil

ObjectiveThis study aimed to estimate the association between second-hand smoke (SHS) exposure in children and asthma, wheezing and perceived health.MethodA cross-sectional study based on a telephone survey was performed on a representative sample of 2411 children under 12 years old in Spain. Exposure to SHS in private and public settings, and the prevalence of asthma, wheezing and perceived poor health were described. The association between health indicators and SHS exposure was analyzed using multivariate Poisson regression models with robust variance according to age and educational level.ResultsThe prevalence of SHS exposure in children was 29.2% in private settings and 42.5% in public settings. There was no association between SHS exposure and asthma, wheezing and perceived poor health in children ≤5 years. In children aged 6-11 years with parents with primary/secondary education, presenting asthma (adjusted prevalence ratio [aPR]: 2.1; 95% confidence interval [95%CI]: 1.2-3.8) and worse perceived health (aPR: 1.6; 95%CI: 1.1-2.1) were positively associated with SHS exposure in private settings. In children with parents with university studies, a negative association between SHS exposure and asthma (aPR: .3; 95%CI: 0.1-0.7) and wheezing (aPR: 0.3; 95%CI: 0.1-0.8) was observed.ConclusionsThere are differences in the association between SHS exposure and asthma, wheezing and poor perceived health according to educational level. Interventions with an equity perspective aimed at reducing SHS exposure in childhood should be implemented.     

Utilización de servicios sanitarios por parte de las poblaciones inmigrante y nativa en la Comunidad Autónoma de la Región de Murcia

ObjectiveTo analyze the patterns of utilisation for three types of public health services (outpatient specialist visits, emergency visits and hospitalisations) in the Comunidad Autónoma de la Región de Murcia. We examine the differences between the average rates of utilization of these services among natives and non-Spanish immigrants, and whether these differences are due to differences in demographic structure, or to different behaviour between these groups.MethodsWe use econometric models for utilisation to exploit administrative records on health care utilisation and the well established Oaxaca decomposition method. This splits average rates of utilisation and/or average health expenditure into two components: the first one stands for the part of the difference that can be attributed to differential patterns of behaviour among the two groups; the second one represents the part of the difference in average expenditure that can be attributed to the fact that average demographic characteristics among both groups differ.ResultsThe rates of use of outpatient specialist visits, emergencies and hospital nights by the native population are greater than the corresponding rates for the immigrant population. For individuals aged between 20 to 40 years old, the utilisation rates of African and Latin-American females are higher than those for native females. The average health expenditure of native males is greater than that of immigrants. The difference is mainly due to different demographic features among the native and immigrant populations, except for the «rest of Europe» group, whose individuals show a different behaviour. In fact, among the 20 to 40 age group, the average health expenditure of native females equals that of Latin-American women, which is in turn below that of African females.ConclusionsIn this paper we show that the remarkable differences in the age-gender balance among different (in terms of nationality) groups of insured residents in Murcia has a considerable effect on consumption of health services and therefore on the average health care expenditure attributable to these groups.