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.     

Sesiones docentes en Atención Primaria. Experiencia en los centros de un Área de Madrid

Those responsible for teaching of primary care teams of Area 7 of Madrid have noted a significant disparity in the organisation of teaching sessions. Therefore, the Madrid Area 7 Commission for Teaching and Research organised an idea-sharing day. This article aims to show the different organisational forms, model sessions, the benefits of education sessions, perceived problems and suggestions for improvement. Finally there is a decalogue, which can serve as a guide for organising teaching sessions in primary care.     

Mapas conceptuales para el diagnóstico de enfermedades raras en atención primaria

Rare diseases are a real public health problem for hospitals and also for primary care. We describe some metaphor-based diagnosis procedures, such as: “When you hear hoof beats don’t always think horses, sometimes they could be zebras”, or that one about the antiquarian who recognised a museum masterpiece while walking in the Rastro (Madrid). The “lightning diagnoses” by Skoda are an important historic record.T. Greenhalgh has tried to cover the gap between evidence based medicine and the intuitive diagnosis. We point out some clinical epidemiology rules in order to improve their early detection by family practitioners and paediatricians. In our opinion, the training in the diagnosis of rare diseases has to be different for primary care level and for hospital doctors. Concept maps are useful for diagnosis in primary care clinics.     

Recomendaciones para el cribado de enfermedad infecciosa,salud mental y mutilación genital femenina en pacientes inmigrantes atendidos en Atención Primaria

Immigrant health status may be improved if certain health conditions are identified early through the implementation of a screening program. This document presents the recommendations resulting from the Screening in immigrant population project (CRIBMI) aimed at implementing a screening program for infectious diseases (HIV, HBV, HCV, tuberculosis, strongyloidiasis, schistosomiasis and Chagas disease), as well as female genital mutilation and mental health (MH) in migrant population at Primary Care level. Screening recommendations were based on: coming from an endemic country for strongyloidiasis, schistosomiasis, and Chagas diseases; on a threshold level of prevalence for HIV (> 1%), HBV (> 2%), and HCV (> 2%), and on incidence (> 50 cases/100,000-inhabitants) for active tuberculosis in immigrants with < 5 years in Europe. Exploring the risk of FGM is recommended in women from countries where this practice is prevalent. Evaluation of MH status is recommended for people from areas of conflict and violence.     

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.     

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.

Incremento de la participación de Atención Primaria en la asistencia al virus de la inmunodeficiencia humana: opinan los profesionales de las unidades hospitalarias

AimTo determine the opinions of infectious diseases professionals on the possibilities of monitoring patients with HIV in Primary Care.DesignQualitative study using in-depth interviews.LocationInfectious Diseases Unit in the University Hospital «Virgen de la Victoria» in Málaga.ParticipantsHealth professionals with more than one year experience working in infectious diseases. A total of 25 respondents: 5 doctors, 15 nurses and 5 nursing assistants.MethodConvenience sample. Semi-structured interviews were used that were later transcribed verbatim. Content analysis was performed according to the Taylor and Bogdan approach with computer support. Validation of information was made through additional analysis, expert participation, and feedback of part of the results to the participants.ResultsHospital care professionals considered the disease-related complexity of HIV, treatment and social aspects that may have an effect on the organizational level of care. Professionals highlighted the benefits of specialized care, although opinions differed between doctors and nurses as regards follow up in Primary Care. Some concerns emerged about the level of training, confidentiality and workload in Primary Care, although they mentioned potential advantages related to accessibility of patients.ConclusionsPhysicians perceive difficulties in following up HIV patients in Primary Care, even for those patients with a good control of their disease. Nurses and nursing assistants are more open to this possibility due to the proximity to home and health promotion in Primary Care.     

Visión crítica y argumentación sobre los programas de atención de la cronicidad en Atención Primaria y Comunitaria

The detailed analysis of the chronic care plans developed by the Spanish regional health services show a surprising level of uniformity in their design and deployment, despite differences between these services. The reviews about theoretical models that support it and tools they develop does not provide conclusive evidence to support the chronic care models achieve better results than another alternatives of care.Although the whole Spanish chronic care plans includes assessment proposals no rigorous studies on their effect have been published to date.Given that, on the contrary, there is a strong and repeated evidence that health systems with Primary Care high performance obtains better outcomes, it is necessary to ask about the need to look for alternative models, when the proposed goals could be reached strengthen Primary Care.