Evolución del burnout y variables asociadas en los médicos de atención primaria

PurposeTo analyse the course of burnout and develop an explanatory model.DesignProspective cohort dynamics.SiteAll primary health care centres in Burgos.SubjectsAll physicians except medical emergencies, paediatrics and residents.Main measurementsAnonymous self-report questionnaire: Maslach Burnout Inventory (MBI) and related variables. An analysis was performed using the Student-t, X² test and logistic regression.ResultsThe response rate was 47.76% in 2007, which was lower than that of 2005. There were significant differences between 2005 and 2007, for increases in the percentage of physicians who smoked, postgraduate training, residency, and those who believe that coordination with nursing and specialist care and institutional communication is appropriate. There was an increase in the prevalence of burnout by almost one point compared with 2005, a decrease in maximum burnout and emotional exhaustion (EC), and an increase in depersonalisation (DP) and personal accomplishment (RP). The incidence density of burnout was 1/113. 5 primary care physicians per year. The existence of burnout is associated with the use of chronic medication and inadequate coordination between nursing and EC, and also with the high workload.ConclusionsThe increase in the prevalence found is consistent with the idea of burnout as a dynamic development and the theoretical model described. Stable and quality employment is one way to indirectly mitigate (by encouraging internal communication) professional burnout. In the multivariate analysis, the most critical variable in the onset of burnout is the inadequate coordination with nursing.     

Ecografía abdominal: una herramienta diagnóstica al alcance de los médicos de familia

AimTo assess the impact of training two general practitioners (GPs), on performing low complexity ultrasound examinations of the abdomen with diagnostic competence.Study designA non-randomised, prospective, double blind evaluation study of the acquired competence. Ultrasound examinations were performed successively and independently by the GP and the radiologist, and registered on two sheets of an identical case report form.SettingDepartments of Vic General Hospital and Vic Health Care Centre of the Catalan Health Institute.SubjectsA total of 120 patients who needed a low complexity abdominal ultrasound from a total amount of 868 ultrasound examinations scheduled.Main measurementsThe kappa index of the primary diagnosis (ultrasound diagnostic conclusion), as well as of the ultrasound findings for each abdominal organ was calculated. A good level of training was considered if a minimum kappa index of 0.80 was attained between general practitioner and radiologist.ResultsAfter six month running, an “ad interim” analysis showed a kappa index for the primary ultrasound diagnosis of 0.85. At the end of the study, an overall kappa index of 0.89 (95% CI: 0.82–0.98) was achieved. The agreement by organs was also high (pancreas and spleen excluded), as well as sensitivity (>75%) and specificity (>90%).ConclusionsThe results of the study demonstrate the feasibility of the performance, by trained GPs, of ultrasound examinations of low complexity of the abdomen with diagnostic competence.     

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.     

Prevalencia de síntomas depresivos y diagnóstico de sospecha de depresión en pacientes con EPOC

Objectiveto determine the prevalence of and predictive factors for depression in patients diagnosed with COPD and referred from primary care to pneumology departments, departments that share care for COPD patients.Designobservational, multicentric, prospective with non-probabilistic sample, transversal study.Settingtwo pneumology visit offices at two hospitals offering different levels of care.Participants293 patients diagnosed with COPD in a stable phase of the disease.InterventionsCarryng out common clinical questionnaires in COPD & HADS.Main measurementsDemographic, clinical, and functional variables of COPD, and HADS depression scale.ResultsIncluded were 229 men (78.16%) and 64 women (21.8%), with an average age of 68.2 ± 10.3 years of whom 93 (31.7%) were active smokers and 200 (68.3%) ex-smokers. 19.45% of patients had a previous diagnosis of clinical depression but the HADS test established a diagnosis of suspicion of depression in 32.6%. Predictive factors included: being female, living alone, and variables related to the severity of the disease (FEV1 postbronchodilator, being a high-risk patient, exacerbating phenotype criteria, and C and D GOLD criteria levels).ConclusionsThe prevalence of depression in patients with COPD is high and is infra-diagnosed. The HADS diagnostic test is useful for establishing a diagnosis of suspicion of depression at primary care and pneumology visit offices. There are personal and clinical factors that may be considered predictive and aid healthcare professionals in determining which patients should take the HADS test and, based on results, referring patients to the mental health department to confirm or reject the diagnosis.     

Validez y limitaciones de los métodos para medir la ingesta y la eliminación de sal

High blood pressure (HBP) is the main modifiable cardiovascular risk factor. HBP can be related to high salt intake. To measure intake, not all feeding surveys are comparable and valid. The reference procedure for assessing salt intake consists of measuring the urinary excretion of sodium in urine collected during 24 hours, although alternative methods have been proposed, such as the collection of punctual and timed urine samples. In this review, we analyze which instruments allow the assessment of salt intake and which of them have provided greater validity and reliability through studies of concordance with the elimination of sodium in urine. Current food consumption surveys are inadequate because of their wide variability and relatively low correlation with the elimination of sodium in 24-hour urine. Its main limitation is the need for validation in different population groups. In primary care, salt intake should be assessed by using frequency-of-consumption questionnaires that collect foods with a high salt content, the consumption of preprepared dishes and questions that quantify the addition of salt in the preparation of food or at the table. For the validation of these questionnaires, the standard gold elimination of 24-hour urine sodium adjusted according to creatinine clearance should be used.     

Desarrollo y validación de un cuestionario genérico para la evaluación de la satisfacción de los pacientes crónicos: Cuestionario SAT-Q

ObjectivesTo develop and validate a brief general questionnaire to assess satisfaction in patients with chronic disease.Designepidemiological, observational, multicentre cross-sectional study.Location4 Primary Health Care Centers from the IV Health Area in the Principality of Asturias.SubjectsA total of 202 patients diagnosed with chronic illness who were following a pharmacological regimen for at least one year.MethodsAn extensive literature review was conducted to create an initial item pool of 61 questions regarding patient satisfaction. Then, a forward-backward translation into Spanish was carried out. Next, both the expert (n=8) and patient (n=30) panels led to a new version of 34 items (concerning satisfaction with medication and satisfaction with health service). Finally, scale item reduction (item-total correlation and exploratory factorial analysis —EFA—) and psychometrical validation (feasibility, reliability and criterion validity) of the SAT-Q— were evaluated. Both the SAT-Q and the SF-12 (to assess patient health related quality of life) were applied.ResultsItem reduction analysis resulted in 18 items: general satisfaction with medication (3), adverse-events (3), oversights (2), effectiveness (3), convenience (4) and Health services (3). Internal consistency (Cronbach α) and Intraclass Correlation Coefficients were moderate-high. Moreover, significant positive correlations between SAT-Q scores and SF-12 Physical and Mental Summary Components were found (with the exception of oversights).ConclusionsA brief questionnaire for measuring satisfaction in chronic patients has been developed and preliminary validated.