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.     

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.     

Efectividad del Mini-Mental en la detección del deterioro cognitivo en Atención Primaria

ObjectiveTo evaluate the diagnostic accuracy (DA) of the Mini-Mental State (MMS) for the detection of cognitive impairment (CI) in Primary Care (PC) and to determine the best conditions of use for that purpose.DesignPooled analysis of two prospective, double blind, studies on the evaluation of diagnostic tools with complete verification that were conducted in Madrid and Granada (Spain).SettingThe MMS was administered in PC and the final cognitive diagnosis (gold standard) was made in Specialized Care.ParticipantsSubjects with cognitive complaints or suspected of having CI were consecutively recruited in the PC clinic.Principal measuresThe DA of the MMS was evaluated using the area under the receiver operating characteristic (ROC) curve (AUC). The best cut-off point was selected according to the ratio of cases correctly classified (RCC) and to the kappa index. Direct (MMSd) and age- and education-adjusted (MMSa) total scores were analyzed separately.ResultsIn the total sample of 360 subjects (214 CI), the DA of the MMSd was significantly superior to that of the MMSa (0.84 ± 0.02 vs 0.82 ± 0.02, p ≤ .001). The yield obtained by the best cut-off point of the MMSd (22/23) was modest (RCC 0.77, kappa 0.52 ± 0.05) and was not improved by any MMSa cut-off point.ConclusionThe DA of the MMS for detection of CI in PC was modest and did not improve with adjustment of the score by age and education. The best cut-off point was 22/23, inferior to the usually recommended cut-off.     

Competencia en Práctica Basada en la Evidencia y factores asociados en las enfermeras de Atención Primaria en España

ObjectiveTo describe the Evidence-Based Practice (EBP) competency level in Primary Care (PC) nurses in Spain and to determine the associated factors.DesignCross-sectional, national survey design, carried out between January and March 2020.SettingPC in Spain.ParticipantsSeven hundred eighty PC active nurses in the National Health Service with at least one year of professional experience.Main measurements(1) Sociodemographic, professional and access to scientific information variables; (2) outcome variable: EBP competency (attitude, knowledge, skills and utilization) assessed through the EBP-COQ Prof© questionnaire. Bivariate and multiple lineal regression analyses were carried out.ResultsThe mean score for the EBP competency of the PC nurses was 131.5 (standard deviation [SD] 17.0), according to dimensions: attitude 36.8 (SD 3.6); knowledge 38.2 (SD 8.9); skills 23.0 (SD 3.5); and utilization 33.3 (SD 6.1). The number of articles read in the last month has showed the most influence on all the EBP-COQ Prof© dimensions, followed by EBP training (more than 150 h) and nursing students mentoring. The education level (master, specialist and doctorate) is associated with knowledge and skills dimensions, meanwhile belonging to a BPSO® center is associated with the EBP utilization.ConclusionsThese findings can guide PC service managers to plan strategies that improve the EBP competency level of the nurses, aimed mainly at achieving real application in clinical practice. However, it is necessary to consider the possible impact of selection bias on the results.     

Atención sociosanitaria en una residencia urbana sanitarizada y el papel de Atención Primaria. Estudio cualitativo con residentes,familiares y profesionales

AimTo identify the elements involved in adequate health and social care for old people living in nursing homes, determine their possible barriers and enablers and define primary care's role in it.DesignQualitative study with phenomenological approach.SettingState funded private nursing home and its corresponding primary care center in the southeastern urban area of Madrid.ParticipantsElderly residents, their relatives, and professionals from the nursing home and the primary care center.MethodFive focus groups were conducted between November 2019 and January 2020, with semi-structured interviews based on the variables of analysis and themes related to the objectives. The sessions were recorded and transcribed. An open and axial coding was performed to identify categories after a triangulation of the data.ResultsThe elements of adequate care identified are individualized care, promotion of autonomy, adequate information to residents and relatives, quality of services, coordination between professionals, and a continuous end of life care. The main barriers are the deficit of professionals, the differences in expectations between users and workers, and the organizational gap between the healthcare system and nursing homes providing healthcare services. The role identified for primary care is mostly bureaucratic.ConclusionsIt is necessary to continue exploring these elements and to outline the role of primary care in nursing homes with different characteristics.     

Diseño y validación de un cuestionario sobre las actitudes ante la prevención y promoción de la salud en atención primaria (CAPPAP)

ObjectiveTo develop and validate a questionnaire to measure attitudes towards prevention and health promotion.DesignCross-sectional study for the validation of a questionnaire.LocationPrimary Health Care (autonomous community of Andalusia, Spain).Participants282 professionals (nurses and doctors) belonging to the Public Health System.Main measurementsContent validation by experts, ceiling effects and floor effects, correlation between items, internal consistency, stability and exploratory factor analysis.ResultsThe 56 items of the tool (CAPPAP) obtained, including those from the review of other tools and the contributions of the experts, were grouped into 5 dimensions. The percentage of expert agreement was over 70% on all items, and a high concordance between prevention and promotion item was obtained, thus, duplicates were removed leaving a final tool with 44 items. The internal consistency, measured by Cronbach's alpha, was 0.888. The test retest indicated concordance from substantial to almost perfect. Exploratory factor analysis identified five factors that accounted for 48.92% of the variance.ConclusionsCAPPAP is a tool that is quick and easy to administer, that is well accepted by professionals, and that has acceptable psychometric results, both globally and at the level of each dimension.     

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.