Coordinación asistencial entre atención primaria y especializada. Satisfacción con el proyecto especialista consultor / Coordination between primary and specialist care. Satisfaction with the consulting specialist project

Conocer la satisfacción de los médicos con el proyecto especialista consultor en el Área 7, y su opinión respecto a éste. Explorar la opinión de estos médicos sobre los problemas y soluciones en la relación entre atención primaria (AP) y atención especializada (AE). Material y métodos: Estudio descriptivo transversal mediante cuestionario autoadministrado. Población de estudio: Médicos de AP del Área 7 de Madrid (n=304). Variables Demográficas y profesionales, relacionadas con la satisfacción con el desarrollo del proyecto, relacionadas con la percepción general del proyecto, el beneficio potencial para los pacientes y con la opinión acerca de las dificultades en la relación AP-AE y las posibles soluciones. Resultados: La tasa de respuesta fue del 56% (contestaron el cuestionario 170 médicos). Respecto a la satisfacción con el proyecto, la puntuación global fue de 8,9 sobre 10. Al 83% de los médicos de AP les resultó fácil el contacto con el especialista de referencia, y el 90% refirió que las cuestiones planteadas se habían resuelto de forma satisfactoria. La herramienta peor valorada para establecer comunicación fue el teléfono. El 27% de los médicos de AP refirió registrar las actividades del proyecto siempre y el 39%, casi siempre. Resultados: En cuanto a la opinión sobre el proyecto, los encuestados reconocieron el mayor beneficio potencial para el proceso diagnóstico y valoraron la necesidad del proyecto en el área con un 9, su utilidad con 9,1 y la prioridad con un 8,7. El 74% de los médicos opinó que sería de interés incorporar un consultor de otra especialidad. Resultados: Los problemas de coordinación AP-AE priorizados fueron la falta de comunicación y diálogo y la masificación de la asistencia. La solución más valorada fue la historia única informatizada (AU)

Objective: To find out the level of satisfaction and opinions of doctors on the specialist consultant project (SCP) in Area 7. To report on these opinions on the difficulties and possible solutions in inter-relationships between of primary health care and specialised care. Material and Methods: Transversal descriptive study using a self-administered questionnaire. Study population: Doctors working in a primary health care district of Madrid (Area 7). Variables: Demographic and professional variables, including their satisfaction after the implementation of the SCP, their general opinion of SCP, potential benefits and their opinions on the difficulties and possible solutions in interrelationships between primary health care and specialised care. Results: A total of 170 (56%) doctors working in primary health care responded. As regards satisfaction with the SCP, the overall score in the evaluation was 8.9, (0 to 10). The majority of primary health care doctors (83%) found it easy to contact the specialist and 90% said that problems were solved satisfactorily. The telephone was the worst communication tool. Only 27% of primary health care doctors said they always register SCP activities, and 39% register them almost always. Results: They thought that the most useful part of this project was the potential benefit on diagnosis. The SCP need score was 9, SCP usefulness 9.1 and priority 8.7. A large majority (74%) of primary health care doctors thought it would be of great interest to incorporate consultants from other specialisations. Results: The main coordination problems found where the lack of communication, and overcrowding. The most valued solution to these problems is the computerised clinical history (AU)

[Coordination between primary and specialist care. Satisfaction with the consulting specialist project]. / Coordinación asistencial entre atención primaria y especializada. Satisfacción con el proyecto especialista consultor.

OBJECTIVE: To find out the level of satisfaction and opinions of doctors on the specialist consultant project (SCP) in Area 7. To report on these opinions on the difficulties and possible solutions in inter-relationships between of primary health care and specialised care. MATERIAL AND METHODS: Transversal descriptive study using a self-administered questionnaire. STUDY POPULATION: Doctors working in a primary health care district of Madrid (Area 7). VARIABLES: Demographic and professional variables, including their satisfaction after the implementation of the SCP, their general opinion of SCP, potential benefits and their opinions on the difficulties and possible solutions in interrelationships between primary health care and specialised care. RESULTS: A total of 170 (56%) doctors working in primary health care responded. As regards satisfaction with the SCP, the overall score in the evaluation was 8.9, (0 to 10). The majority of primary health care doctors (83%) found it easy to contact the specialist and 90% said that problems were solved satisfactorily. The telephone was the worst communication tool. Only 27% of primary health care doctors said they always register SCP activities, and 39% register them almost always. They thought that the most useful part of this project was the potential benefit on diagnosis. The SCP need score was 9, SCP usefulness 9.1 and priority 8.7. A large majority (74%) of primary health care doctors thought it would be of great interest to incorporate consultants from other specialisations. The main coordination problems found where the lack of communication, and overcrowding. The most valued solution to these problems is the computerised clinical history. CONCLUSIONS: Doctors are very satisfied with this project. They considered the project to be very useful, necessary and a priority, with high potential benefit in several areas of patient care. As quality improvement areas we stress the importance of continuing to promote SCP, of adequate telephone communications and to assess a new easy to fill-in register system.

[Oral anticoagulation treatment in patients with non-valvular auricular fibrillation]. / Tratamiento anticoagulante oral en pacientes con fibrilación auricular no valvular.

OBJECTIVES: To evaluate the knowledge, attitudes and difficulties of family doctors in the indication of oral anti-coagulation treatment (OCT) in patients with non-valvular auricular fibrillation (NVAF). DESIGN: Transversal descriptive study.Setting. Area 11 of Madrid primary care.Participants. 250 doctors by simple randomised sampling. MAIN MEASUREMENTS: After a pilot study at a health centre, mailing of a questionnaire with a subsequent re-mailing. This collected social and personal details, knowledge of the question, attitudes and difficulties. RESULTS: 157 (62.8%) replied; 91 were women (58.0%); mean age was 39 (SD, 6.0). 97 had reviewed the question recently (61.8%). 110 thought that the anti-aggregation criteria were clear (70.1%; CI, 62.2-77.0%), 107 that the oral anti-coagulation criteria were (68.2%; CI, 60.2-75.2%), 132 that the OCT risks were (84.1%; CI, 77.2-89.2%), and 74 that risk factors of cerebrovascular accident were clear (47.1%; CI, 39.2-55.2%). Initially 96 doctors gave anti-aggregants and referred to cardiology (61.1%; CI, 53.0-68.7%), and 29 began OCT (18.5%; CI, 12.9-25.6%). 134 thought that we avoided initiating OCT (85.3%; CI, 78.6-90.3%), giving as the main reasons the difficulty of monitoring and of requesting further tests, the risks involved and OCT not being up-to-date. CONCLUSIONS: Most professionals have the criteria for OCT in NVAF clear, although they continue to avoid the initiation of OCT. The majority approach is to give anti-aggregants and refer to Cardiology, given the risk of the therapy and the difficulties involved in monitoring and requesting further tests.

Tratamiento anticoagulante oral en pacientes con fibrilación auricular no valvular / Oral anti-coagulation treatment in patients with non-valvular auricular fibrilation

Objetivo. Evaluar los conocimientos, actitudes y dificultades de los médicos de familia para la indicación de tratamiento anticoagulante oral (TAO) en pacientes con fibrilación auricular no valvular (FANV).Diseño. Estudio descriptivo transversal. Emplazamiento. Área 11 de Atención Primaria de Madrid. Participantes. Muestra de 250 médicos por muestreo aleatorio simple. Mediciones principales. Envío de un cuestionario con un reenvío posterior, tras "pilotaje" previo en un centro de salud, que recogía variables sociodemográficas, conocimientos sobre el tema, actitudes y dificultades. Resultados. Contestaron 157 personas (62,8 per cent), 91 mujeres (58,0 per cent), con una edad media de 39 años (desviación estándar [DE], 6,0). De ellas, 97 han revisado el tema recientemente (61,8 per cent). Creen que están claros los criterios de antiagregación 110 encuestados (70,1 per cent; intervalo de confianza [IC], 62,2-77,0); los de anticoagulación oral 107 (68,2 per cent; IC, 60,275,2); los riesgos del TAO 132 (84,1 per cent; IC, 77,2-89,2), y los factores de riesgo de accidente cerebrovascular 74 (47,1 per cent; IC, 39,2-55,2). Inicialmente antiagregan y derivan a cardiología 96 de los encuestados (61,1 per cent; IC, 53,0-68,7) e inician TAO 29 (18,5 per cent; IC, 12,9-25,6). Creen que evitamos iniciar TAO 134 de los encuestados (85,3 per cent; IC, 78,6-90,3), señalando como principales causas la dificultad del seguimiento y para solicitar pruebas complementarias, los riesgos y la falta de actualización. Conclusiones. La mayoría de los profesionales tiene claros los criterios de TAO en la FANV, aunque siguen evitando iniciar TAO, siendo la actitud mayoritaria antiagregar y derivar a cardiología, debido al riesgo de esta terapia y a la dificultad para hacer el seguimiento y solicitar pruebas complementarias (AU)

[The effects of long-term captopril treatment on the evolution of urinary albumin excretion in patients with non-insulin-dependent diabetes mellitus]. / Efectos del tratamiento a largo plazo con captopril sobre la evolución de la excreción urinaria de albúmina en pacientes con diabetes mellitus no insulinodependiente.

OBJECTIVES: To identify diabetics not dependent on insulin (DNDI) who are carriers of clinical proteinuria and microalbuminuria susceptible to captopril treatment and to evaluate the evolution of the urinary excretion of albumin (UEA) rate after three years of follow-up. DESIGN: A prevalence study followed by an intervention and follow-up over 3 years. SETTING: The urban Health Centre "San Agustín" in Burgos. PATIENTS: 107 DNDI included in the "Diabetes programme". INTERVENTIONS: Patients with increased UEA were treated with 25 mg of captopril (Capoten) every 12 hours for 3 years. MEASUREMENTS AND RESULTS: A steady drop in the UEA of patients with microalbuminuria was observed in their third year of treatment (p = 0.01). 5 patients (41.6%) became negative (p = 0.01). CONCLUSIONS: Captopril treatment reduced levels of UEA in DNDI who had high UEA. Significantly, evolution to clinical proteinuria of patients with persistent microalbuminuria was avoided.

[Hospital oxygen therapy: routine or ignorance?]. / Oxigenoterapia hospitalaria: rutina o desconocimiento?

To determine how oxygen therapy is being used in general surgery (GS), internal medicine (IM) and pneumology (PN) units of Hospital General Yagüe in Burgos (Spain), as well as to study patient compliance with treatment. Cross-sectional descriptive study. Case histories taken on 2 randomly chosen days one month apart were reviewed. For patients receiving oxygen therapy we analyzed both physician and nursing records on diagnosis, flow, route, form of oxygen administration (continuous-discontinuous), determining the agreement of medical records with what was actually used by the patient. Baseline pulse oximetry readings were available for all patients. One hundred one patients were enrolled in the study. The most frequently recorded diagnosis was chronic obstructive pulmonary disease (COPD). Therapy was prescribed based on gasometric criteria in 62.5% of IM patients, 73.1% of PN patients and 23% of GS patients. The route and flow were recorded mainly in IM and PN wards, but not in GS; form of administration, however, was recorded for only 2 patients. We found agreement between physician and nursing orders in 26.8% in the IM ward, in 60% in the PN unit and in 5.3% of GS cases. The administrative route ordered was that which was actually used in 80% in PN 42.9% in IM and 10.5% in GS. The patients received oxygen fewer days than prescribed (a coefficient of 1 for days ordered/days used in 54.5%).(ABSTRACT TRUNCATED AT 250 WORDS)