La evaluación futura de las Unidades Docentes de Medicina Familiar y Comunitaria / The future evaluation of the Training Units in Family and Communitary

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[Validity of recording preventive activities in medical histories: consumption and antismoking counseling]. / Validez del registro de las actividades preventivas en las historias clínicas: consumo y consejo antitabaco.

OBJECTIVE: To compare the percentage of tobacco consumers obtained by checking Primary care clinical notes (PCCN) with the percentage obtained by a telephone poll of the same people. To compare the record of tobacco counselling in the PCCN with that discovered by polling. DESIGN: Crossover and descriptive study. SETTING: Two urban health districts. PATIENTS: Random sample of 450 with PCCN and between 15 and 75 years-old. MEASUREMENTS AND RESULTS: A telephone questionnaire with data on tobacco consumption and smokers' perceptions of anti-tobacco counselling. Data obtained from checking the PCCN were: age, gender, basic care unit, number of attendances, pathologies and related risk factors, tobacco consumption and counselling. Tobacco consumption did not figure in 51% of the PCCN. Out of the 108 smokers identified by telephone polling, only 61 had this fact in their PCCN. 55 of these smokers said they had been counselled, which was only recorded on 11 occasions in the PCCN. The probability of receiving counselling increased when patient was over 45, when there were pathologies or related risk factors, with frequency of attendance and with each daily cigarette smoked. CONCLUSIONS: The PCCN substantially under-record tobacco consumption and, especially, counselling. The smokers who receive most counselling are those have already, most probably, smoked for a long time.

[Effectiveness of an anti-influenza vaccination program in 4 primary care centers]. / Efectividad de un programa de vacunación antigripal en cuatro centros de atención primaria.

A influenza immunization programme held in 4 health centres is evaluated, by testing the hypothesis that programme compliance lowers their hospital admissions and mortality. A cohort of 4,558 people over 65 belonging to 4 "Baix Llobregat" health centres was followed-up during 7 months. The population covered by immunization programme (43.8%) showed a hospital admission rate (6.2%) lower than the non immunized one (4.3%). Nevertheless, the cardiorespiratory disease admission rate in the whole sample (2.0% in immunized and 1.3% in non immunized), and in females (1.3% in immunized and 1.2 in non immunized) didn't show differences between covered and non covered by the programme. Mortality is lower in compliant (0.8% in immunized, and 1.9% in non immunized), but it's due to a higher death rate in the counted unimmunized, non demanding, and non hospital admitted population. If we interpret these data as the immunization covered population is more health services consumer, we can consider that at least in women, the programme has a contention effect for cardiorespiratory disease hospital admission. The mortality drop can not be attributed to immunization but it will be due to the health centers incapacity for reaching the high risk population of the assigned community. On the basis of these results, health centers should reconsider the need for continuing carry out these immunizations programmes. Primary Health care teams should establish programmes that would allow them to cover the assigned community health needs, even for non demanded services.