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1.
Luis Miguel Azogil-López Juan José Pérez-Lázaro Patricia Ávila-Pecci Esther María Medrano-Sánchez María Valle Coronado-Vázquez 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(5):278-284
Aim
The purpose of this study is to find out whether telephone referral from Primary Health Care to Internal Medicine Consult manages to reduce waiting days as compared to traditional referral. This study also aims to know how acceptable is the telephone referral to general practitioners and their patients.Design
No blind randomized controlled clinical trial.Setting
Northern Huelva Health District.Participants
154 patients.Interventions
Patients referrals from intervention clinicians were sent via telephone consultation, whereas patients referrals from control clinicians were sent by traditional via.Measurements
Number of days from referral request to Internal Medicine Consult. Number of telephone and traditional referrals. Number of doctors and patients denied. Denial reasons.Results
A statistically significant difference was found between groups, with an average of 27 (21-34) days. Among General Practitioners, 8 of the first 58 total doctors after randomization and, subsequently, 6 of the 20 doctors of the test group refused to engage in the trial because they considered “excessive time and effort consuming”. 50% of patients referred by the 14 General Practitioners finally randomized to the intervention group were denied referral by telephone due to patient's complexity.Conclusions
Telephone referral significantly reduces waiting days for Internal Medicine consult. This type of referral did not mean an “excessive time and effort consuming” to General Practitioners and was not all that beneficial to complex patients 相似文献2.
3.
Verónica Tíscar-González Denise Gastaldo Maria Teresa Moreno-Casbas Elizabeth Peter Ascensión Rodriguez-Molinuevo Montserrat Gea-Sánchez 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(5)
Objective
To determine the perception of nurses, doctors, patients and family or relatives being present during cardiopulmonary resuscitation (CPR) in adult patients.Design
A qualitative exploratory study and thematic analysis were developed.Site
Primary Care, Hospital Care and Emergency Service of the Basque Health Service.Participants
The selection of the participants was made through intentional sampling. Four focus groups were developed: one of patients and family, 2 of nurses, and one of physicians.Method
Thematic analysis was performed. Triangulation techniques were used between investigators and investigator-participant member. The Open code 4.1 statistics software was used.Results
Three significant categories were identified: the impact on the family; the weight of ethical and legal responsibility; power, place of death, and cultural assumptions.Conclusions
CPR is a social construct influenced by values which are situated in specific socio-cultural contexts. In this study, patients and family members describe the fear and resistance to being present during CPR. Health professionals consider that their decision is complex, and each case must be assessed independently, and patients and relatives must be integrated into decision-making. Future research should explore in greater depth the subjective experience of relatives who have witnessed CPR and the impact of contextual and sociocultural elements from the perspectives of relatives. 相似文献4.
Cristina Domingo Fernando Aros Agurtzane Otxandategi Idoia Beistegui Ariadna Besga Pedro María Latorre 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(3):142-152
Objective
To assess the efficacy of the ProMIC, multidisciplinary program for patients admitted at hospital because of heart failure (HF) programme, in reducing the HF-related readmission rate.Desing
Quasi-experimental research with control group.Settings
Twelve primary health care centres and 3 hospitals from the Basque Country.Participants
Aged 40 years old or above patients admitted for HF with a New York Heart Association functional class II to IV.Interventions
Patients in the intervention group carried out the ProMIC programme, a structured clinical intervention based on clinical guidelines and on the chronic care model. Control group received usual care.Main measurements
The rate of readmission for HF and health-related quality of lifeResults
One hundred fifty five patients were included in ProMIC group and 129 in control group. 45 rehospitalisation due to heart failure happened in ProMIC versus 75 in control group (adjusted hazard ratio = 0.59, CI 95%: 0.36-0.98; P = .049). There were significant differences in specific quality of life al 6 months. No significant differences were found in rehospitalisation due to all causes, due to cardiovascular causes, visits to emergency room, mortality, the combined variable of these events, the functional capacity or quality of life at 12 months of follow up.Conclusions
ProMIC reduces significantly heart failure rehospitalisation and improve quality of life al 6 months of follow up. No significant differences were found in the rests of variables 相似文献5.
Arleen De León-Robert Isabel Hidalgo-García Juan Gascón-Cánovas José Antón-Botella Carmen López-Alegría Heidi Campusano Castellanos 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(4):208-217
Objective
To identify the most efficient measurement pattern of home blood pressure monitoring (HBPM) for the follow-up of hypertensive patients in primary care.Design
Validation study of a diagnostic test.Setting
Primary care team in Murcia, Spain.Population
One hundred and fifty three hypertensive patients younger than 80 years who met the inclusion criteria, who used HBPM and ambulatory blood pressure monitoring.Main measurements
Performing HBPM for 24 hours. The HBPM protocol consisted of recording 2 measurements in the morning and 2 in the evening for 7 days. With the records obtained, the different HBPM patterns were established (7, 6, 5, 4, 3 days). The ROC curves were used for the analysis, together with the correlation coefficients and the Bland-Altman plots.Results
The best areas under the curve for the systolic pressure of the different HBPM patterns corresponded to the 4-day pattern: 0.837 (0.77-0.90); and the 3 day one: 0.834 (0.77-0.90). As for diastolic pressure, the 7-day pattern had an area under the curve of 0.889 (0.84-0.94); followed by the 3 and 4 days patterns, which had the same statistical result both: 0.834 (0.83-0.94). There were no significant differences between correlation coefficients for systolic and diastolic blood pressures. The 3-day pattern showed a lower dispersion in the Bland-Altman plots.Conclusion
The 3 days HBPM pattern is proposed for the follow-up of the hypertensive patient, since it does not have an inferior efficiency to the other patterns. 相似文献6.
Pablo Alberto Sáinz-Ruiz Jorge Mínguez-Arias José Ramón Martínez-Riera 《Gaceta sanitaria / S.E.S.P.A.S》2019,33(2):134-140
Objective
To describe the functioning and regulations of health councils in La Rioja (Spain) as vehicles for citizen participation in health management.Method
A qualitative analysis was conducted triangulating the national and regional institutional framework reviews of health councils, the official minutes of 58 meetings, and 11 semi-structured interviews with related persons.Results
The analysis revealed a predominantly biomedical-technological standpoint, a lack of training in community participation dynamics, and an absence of structure in council operations. The councils were also found to be over-powered by public healthcare administration and restricted to a role of simply transmitting information, thereby neglecting an opportunity for proactive community involvement.Conclusions
In spite of these shortcomings, community health councils can operate as efficient instruments in health management as long as the necessary political will and appropriate community awareness both exist. 相似文献7.
8.
Isabel Panea Pizarro Ana Teresa Domínguez Martin Vanessa Barragán Prieto Almudena Martos Sánchez Fidel López Espuela 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(3):127-134
Objective
To explore the life experiences on sexual relationships in the third trimester of pregnancy in primiparous women.Design
Phenomenological qualitative study,Site
Cáceres (Extremadura).Participants
Primiparous women in the third trimester of their pregnancy.Methods
We use theoretical sampling, was conducted on pregnant primiparous. The study included 15 participants. The data was collected using in-depth interviews, that were voiced recorded and later transcribed. The analysis was made using Giorgi's proposal.Results
The results show three main points. Fear of doing damage, mediated by the obstetric history and the desire to have the long-awaited child. Exploring new routes: forms of sexual expression are modified by the physical changes, the fears, and the mobility. Highlighting the importance of other displays of affection and love (kisses and caresses). The Sex Taboo: lack of information against sexuality during pregnancy is still common.Conclusions
Women in the third trimester of their pregnancy put aside their sexual appetite and that of their partners, and concentrate in the wellbeing of their new born baby. It highlights the role of the mother before the couple. The more desired and difficult the pregnancy has been, the more the sexual life is reduced. The Health Professionals must advise and inform the couples with an open-minded attitude. 相似文献9.
David Monterde Emili Vela Montse Clèries Luis García Eroles Pol Pérez Sust 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(3):153-161
Objective
To compare the performance in terms of goodness of fit and explanatory power of 2 morbidity groupers in primary care (PC): adjusted morbidity groups (AMG) and clinical risk groups (CRG).Design
Cross-sectional study.Location
PC in the Catalan Institute for the Health (CIH), Catalonia, Spain.Participants
Population allocated in primary care centers of the CIH for the year 2014.Main measurements
Three indicators of interest are analyzed such as urgent hospitalization, number of visits and spending in pharmacy. A stratified analysis by centers is applied adjusting generalized lineal models from the variables age, sex and morbidity grouping to explain each one of the 3 variables of interest. The statistical measures to analyze the performance of the different models applied are the Akaike index, the Bayes index and the pseudo-variability explained by deviance change.Results
The results show that in the area of the primary care the explanatory power of the AMGs is higher to that offered by the CRGs, especially for the case of the visits and the pharmacy.Conclusions
The performance of GMAs in the area of the CIH PC is higher than that shown by the CRGs. 相似文献10.
11.
12.
María del Mar Martín-Rodríguez José Antonio Díaz-Berenguer José Luis Alonso-Bilbao Antonio Cabeza-Mora Francisco Navarro-Vázquez Alberto Espiñeira-Francés Lidia Nuez-Herrera 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(5):300-309
Objective
To estimate the effect of the influenza vaccination in Primary Healthcare workers and the general population vaccinated during the 2015/2016 campaign.Design
Cross-sectional study.Setting
All the Primary Healthcare centres within the Gran Canaria healthcare region.Participants
A total of 1,868 Primary Healthcare workers (33.5% men; 66.5% women) and 795,605 individuals from the general population (49.4% men; 50.6% women).Principal measurements
The outcome variables in Primary Healthcare workers were: influenza cases reported to the Epidemiological Surveillance System, and the sick leave days due to illness. In the general population: reported flu cases and vaccination coverage in connection with the vaccination status of the healthcare professional. The magnitude of association between vaccination and morbidity was estimated applying logistic regression models.Results
Although not statistically significant, healthcare professionals that were not vaccinated had 1.7-fold increase in the risk of having influenza than those vaccinated. In the general population the association was significant in the female population (OR: 1.3; 95% CI: 1.1-1.5). Population coverage was significantly higher when both the doctor and nurse were vaccinated (OR: 1.3; 95% CI: 1.3-1.3), and reported flu cases decreased when the nurse was vaccinated (OR: 0.9; 95% CI: 0.9-0.9).Conclusion
A possible protective effect of influenza vaccination was observed in the general population, as well as an influence of Primary Healthcare workers on the patients regarding this. Even so, the low coverages registered point to a need to implement measures that may lead to a more favourable attitude towards influenza vaccination. 相似文献13.
Objective
Until 2016, around 3 million persons had limited access to health care in Greece due to the economic crisis. We describe a massive solidarity movement of community clinics and pharmacies in Greece.Method
We conducted a survey in 2014-15 and describe the characteristics of community clinics and pharmacies spontaneously established all over Greece after 2008.Results
A characteristic of the 92 active solidarity clinics is autonomous collective functioning, free services, and funding from non-governmental sources. The largest clinics examined more than 500 uninsured or partly insured patients per month. Clinics covered a wide range of clinical and preventive services. Funding, availability of drugs, vaccines, medical material and their legal status were the main problems identified. The solidarity movement involved thousands of health professionals covering essential population needs.Conclusions
The community outpatient clinics were an outstanding example of solidarity and temporarily alleviated the health needs of a large part of the population. 相似文献14.
B. Davido R. Batista H. Fessi H. Michelon L. Escaut C. Lawrence M. Denis C. Perronne J. Salomon A. Dinh 《Médecine et maladies infectieuses》2019,49(3):214-218
Objective
A rapid and worrying emergence of vancomycin-resistant enterococci (VRE) gut colonization is occurring worldwide and may be responsible for outbreaks, especially in healthcare facilities. While no efficient decolonization strategies are recommended, we assessed fecal microbiota transplantation (FMT) to eradicate VRE colonization.Patients and method
Our main objective was to measure the impact of FMT on decolonization of VRE carriers, confirmed by at least two consecutive negative rectal swabs at one-week interval during a 3-month follow-up period. Patients received no antibiotic prior to the FMT.Results
After a month only three patients remained colonized with VRE. Decolonization was associated with 87.5% (n = 7) of success after three months as only one patient remained colonized.Conclusion
Our first results confirm that the FMT seems to be safe, with an impact on VRE colonization over time that may help control outbreaks. 相似文献15.
16.
C. Vandererven A.-P. Bellanger J.-F. Faucher P. Marguet 《Médecine et maladies infectieuses》2017,47(4):261-265
Introduction
Tick bites, which may lead to Lyme disease, often prompt patients to consult their primary care physicians (PCPs). The aim of the present study was to assess how and how often PCPs in the Franche-Comté region of France manage tick bites.Material and methods
Standardized questionnaires were sent to a random sample of 400 PCPs in the Franche-Comté region, requesting their voluntary and anonymous participation. The questionnaires collected socio-demographic details and practice-related information about tick-bite prophylaxis, Lyme serology, and tick-borne encephalitis vaccination.Results
The crude response rate was 54.5% of the PCPs contacted. Tick-bite prophylaxis was prescribed as per current guidelines. However, Lyme serology seemed to be largely overprescribed for tick bites and in case of erythema migrans. A clear lack of knowledge about tick-borne encephalitis vaccination was also observed.Discussion
PCPs provide the first line of care for patients presenting with tick bites. This study showed that although PCPs of the Franche-Comté region manage tick bites as per current guidelines, they need further training on Lyme serology limitations and availability of tick-borne encephalitis vaccination. 相似文献17.
18.
Marta Lima-Serrano José Manuel Martínez-Montilla Ana Magdalena Vargas-Martínez José Antonio Zafra-Agea Joaquín Salvador Lima-Rodríguez 《Gaceta sanitaria / S.E.S.P.A.S》2019,33(3):259-262
Objective
To know the variables present in primary and secondary school students who do not smoke or intend to smoke from a positive health model.Methods
Cross-sectional study with 482 students from Andalusia and Catalonia using a validated questionnaire (ESFA and PASE project). Binary logistic regression analysis was performed.Results
Those who did not intend to smoke viewed smoking unfavourably and had high self-efficacy (p <0.001). In non-consumers, the most associated variables were attitude, social model (p <0.001), and self-efficacy (p =0.005).Conclusions
The results show motivational factors present in students who do not smoke and do not intend to do so. Attitude and self-efficacy are strongly associated with intention and behaviour. This information might be useful for developing positive health promotion strategies from a salutogenesis approach. 相似文献19.
Benoît Lalloué Michael Padget Ian Brownwood Etienne Minvielle Niek Klazinga 《Health policy (Amsterdam, Netherlands)》2019,123(5):441-448
Objective
To examine the variability of hospital performance within and across countries, using 30-day acute myocardial infarction (AMI) mortality, and to study the impact of hospital characteristics on performance.Study setting
Hospital-level adjusted risk standardized mortality rates (RSMR) and hospital characteristics were collected from 10 OECD and two collaborating countries including 1,163 hospitals.Study design
Associations between RSMR and hospital characteristics were studied using univariate and multivariate linear regressions. Clusters of hospitals were created using hierarchical clustering and mortality compared using linear regression.Findings
Wide variation between countries was found for RSMR and hospital characteristics. Regression models showed large country effects. A high volume of AMI admission was associated with lower RSMR in a model using a restricted number of hospital characteristics (?0.83, p?<?0.001) but not in a model using all characteristics (?1.03, p?=?0.06). Analysis within countries supported this association. Hospital clusters showed clear differences in characteristic distributions but no difference in RSMR.Conclusions
The effect of volume may support policies toward a concentration of services within the hospital sector. The effect of other hospital characteristics was inconclusive and suggests the importance of system-wide characteristics or pathways of care (i.e. timeliness and nature of initial response and during transportation to a hospital, transfers between hospitals, post-discharge organization) in explaining variation. 相似文献20.
Miguel Ángel Cantero-Braojos Andrés Cabrera-León María Angeles López-González Luís Angel Saúl 《Atencion primaria / Sociedad Espa?ola de Medicina de Familia y Comunitaria》2019,51(3):162-171