Ian McWhinney y la importancia de los referentes en medicina de familia para crear una identidad profesional propia / Ian McWhinney and the importance of referents in family medicine in order to create an individual professional identity

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Microtutorías, un nuevo recurso docente / Micro-tutorials: a new teaching resource

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[Substitution of generic for brand medicines in primary care. Factors associated to refuse the change]. / Sustitución de medicamentos de marca por genéricos en atención primaria. Factores asociados al rechazo.

OBJECTIVE: In Spain prescription of generic drugs is still low. We have attempted first to estimate the proportion of patients who switch from brand-name medication to generics once properly informed, and secondly to determine the variables associated with the resistance to make this switch. DESIGN: Cross-sectional study. SETTING: Primary care. PARTICIPANTS: We ask to participate in our study to 360 family doctors, each of them should choose the first 5 patients who take prescribed drugs with generic alternatives. 110 doctors refuse and 48 had incomplete or illegible information. Finally 202 doctors and 1006 patients formed our sample. Main measurements. We estimated the percentage of non acceptance and also the variables associated by bivariate analysis and logistic regression. RESULTS: 13% (11%-15%) of patients were unwilling to switch to generic medicine. Variables associated with non acceptance were old age, having a low educational level and being "retired" --which means not having to pay for drugs. The non acceptance was also higher if the patient did not know what a generic drug was, had never taken a generic drug before, and the doctor that originally prescribed the medicine was a hospital specialist. The two characteristics independently associated to non acceptance were the fact that the patient ignored what a generic drug was (odds ratio [OR]=4,0; 95% CI, 2,6-6,4), and the fact hat the doctor that originally prescribed the drug was not the family doctor but a hospital one (OR=3,7; 95% CI, 2,3-5,8). CONCLUSIONS: The percentage of patients that did not accept switching to generic drugs is very low. To increase the substitution for generics we need to better inform and educate the population and to increase the use of generics in the hospital setting.

Sustitución de medicamentos de marca por genéricos en atención primaria. Factores asociados al rechazo / Substitution of generic for brand medicines in primary care. Factors associated to refuse the change

Objetivo. La prescripción de medicamentos genéricos en España continúa siendo baja. Nuestro objetivo es determinar el porcentaje de pacientes que rechazan la sustitución de un medicamento de marca por un genérico tras el consejo de su médico de familia y determinar los factores asociados con este rechazo. Diseño. Observacional, transversal. Emplazamiento. Centros de atención primaria del territorio nacional. Participantes. Se propuso participar a 360 médicos, que debían seleccionar a los 5 primeros pacientes susceptibles de cambiar la medicación. Un total de 110 médicos no aceptó participar y 48 aportaron datos incompletos o ilegibles. Finalmente se analizan los datos de 202 médicos y 1.007 pacientes. Mediciones principales. Se recogieron variables relacionadas con el paciente y el tratamiento. Se calculó el porcentaje de rechazo y, mediante análisis bivariable y regresión logística, los factores asociados. Resultados. El porcentaje de rechazo fue del 13% (11-15). Los factores asociados con el rechazo al cambio son: la edad avanzada del paciente, el bajo nivel de estudios, ser pensionista, no saber qué es un genérico, no haberlo tomado previamente y que la prescripción se iniciase en el especialista o en urgencias. Las dos variables asociadas de forma independiente con el rechazo son el desconocimiento de qué es un genérico por parte del paciente (odds ratio [OR] = 4,0; intervalo de confianza [IC] del 95%, 2,6-6,4), y que el prescriptor inicial no fuera el médico de familia (OR = 3,7; IC del 95%, 2,3-5,8). Conclusiones. El porcentaje de pacientes que rechazan el cambio es muy bajo. Para facilitar la sustitución por genéricos es necesario insistir en las medidas de educación al paciente y potenciar su utilización en atención especializada

Objective. In Spain prescription of generic drugs is still low. We have attempted first to estimate the proportion of patients who switch from brand-name medication to generics once properly informed, and secondly to determine the variables associated with the resistance to make this switch. Desing. Cross-sectional study. Setting. Primary care. Participants. We ask to participate in our study to 360 family doctors, each of them should choose the first 5 patients who take prescribed drugs with generic alternatives. 110 doctors refuse and 48 had incomplete or illegible information. Finally 202 doctors and 1006 patients formed our sample. Main measurements. We estimated the percentage of non acceptance and also the variables associated by bivariate analysis and logistic regression. Results. 13% (11%-15%) of patients were unwilling to switch to generic medicine. Variables associated with non acceptance were old age, having a low educational level and being "retired" --which means not having to pay for drugs. The non acceptance was also higher if the patient did not know what a generic drug was, had never taken a generic drug before, and the doctor that originally prescribed the medicine was a hospital specialist. The two characteristics independently associated to non acceptance were the fact that the patient ignored what a generic drug was (odds ratio [OR]=4,0; 95% CI, 2,6-6,4), and the fact hat the doctor that originally prescribed the drug was not the family doctor but a hospital one (OR=3,7; 95% CI, 2,3-5,8). Conclusions. The percentage of patients that did not accept switching to generic drugs is very low. To increase the substitution for generics we need to better inform and educate the population and to increase the use of generics in the hospital setting

[The substitution of generic for brand medicines in family medical clinics]. / Sustitución de medicamentos de marca por genéricos en la consulta de atención primaria.

OBJECTIVE: To estimate the percentage of patients who change from current medication to generic medicine once properly informed. DESIGN: Observational, cross-sectional.Setting. Two primary care clinics in Madrid, one rural and the other urban.Participants. Patients who came for their consultation and who take prescribed drugs which have generic alternatives. METHOD: All patients included received a standard 40 second verbal explanation about generics. Later, the researcher filled out a 18 items test. A descriptive analysis was done taking into account frequencies and applying a bivariable analysis comparing the variable <> with the others. RESULTS: 71% of the patients accepted the change to generic medicine, 29% did not. Of the latter, 67.4% said that they preferred to consult with the prescribing physician; 45.1% were of the opinion that it would not have the same effect; a 16.1% said that if it was cheaper, it must be of a worse quality; and another 16.1% said that they would only accept the change if it meant saving some money.The researcher perceived distress and discomfort in 23.4% of the patients. He himself felt satisfied in 83.9% of the cases, indifferent in 12.9% and unsatisfied in 3.2%. CONCLUSION: Providing the adequate information and letting the patients decide for themselves about the substitution of brand for generic drugs resulted in almost three quarters of the cases opting for the change. And this with a minimal professional effort and the added benefit of improving the patient-practioner relationship.

Sustitución de medicamentos de marca por genéricos en la consulta de atención primaria / The substitution of generic for brand medicines in family medical clinics

Objetivo. Determinar el porcentaje de pacientes que tras una explicación adecuada se muestran partidarios de cambiar su medicación habitual por una especialidad farmacéutica genérica (EFG).Diseño. Observacional, transversal. Emplazamiento. En dos centros de salud, uno urbano y otro rural, de la Comunidad Autónoma de Madrid. Participantes. Pacientes que acuden a consulta y son susceptibles de cambiar alguno de los medicamentos que precisan por una EFG. Método. A los pacientes incluidos se les facilitó una misma información verbal de 40 s de duración explicando qué es una EFG. Seguidamente se completó un cuestionario de 18 preguntas. Se analizó de forma descriptiva la muestra calculando frecuencias y aplicando un análisis bivariante relacionando la variable 'aceptación del cambio' con las demás. Resultados. El 71 per cent de los participantes aceptó el cambio a EFG. El 29 per cent que no lo hizo alegó en un 67,4 per cent que prefería consultarlo con el médico que lo prescribió, en un 45,1 per cent que no iba a tener el mismo efecto, un 16,1 per cent creyó que al ser más barato sería peor y otro 16,1 per cent refirió que en caso de que le supusiera más gasto cambiaría. El médico percibió malestar en el paciente en un 23,4 per cent, y se sintió él mismo satisfecho con la entrevista en un 83,9 per cent, indiferente en un 12,9 per cent e insatisfecho en un 3,2 per cent. Conclusiones. Proporcionar información al paciente y permitirle participar en la decisión del cambio de medicación resulta muy ventajoso, ya que así se consigue el cambio en casi tres cuartas partes de los casos con un mínimo desgaste profesional y manteniendo una buena relación médicopaciente (AU)

¿Es posible una ética de la organización en nuestro sistema sanitario? / Could organizational ethics be developed in our health system?

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Cirugía menor de la falange distal de la mano / Fingertip´s ambulatory surgical procedures

La patología de la falange distal de los dedos de la mano es atendida con frecuencia en los Servicios de Urgencias de Atención Primaria. Se trata de procesos médico-quirúrgicos muy habituales y de fácil resolución. En el presente manuscrito se revisan la patología infecciosa y traumática de la falange distal de la mano que requieren un tratamiento quirúrgico que puede ser realizado sin problemas en cualquier Centro de Salud. Consideramos que en un ámbito de primer nivel mínimamente dotado se pueden llevar a cabo, en el área descrita, los siguientes procedimientos: drenajes de colecciones purulentas o hematomas subungueales, exéresis de la uña encarnada, fijación de una avulsión ungueal, sutura de heridas incisas que no afecten al aparato flexo-extensor o al paquete vascular, pérdidas de sustancia del pulpejo sin exposición ósea y si hay disponibilidad de equipo de rayos X, fijación de una fractura de penacho ungueal y el tratamiento conservador del dedo en martillo (AU)

[Nursing care for patients with toxic epidermal necrolysis]. / Cuidados de enfermería en el paciente con necrólisis epidérmica tóxica.

Toxic Epidermal Necrolysis (TEN) is a severe skin disorder characterised by separation of the dermal-epidermal junction, as it is observed in second degree superficial burns, and it may also involve any mucosal surface area (otic, buccal, conjunctival, respiratory, genital). This condition is generally induced by the ingestion of drugs, particularly certain antibiotics, nonsteroidal antiinflammatory drugs, and antiepileptic drugs. Mortality has decreased over the last decades, from 80% to about 25% in recent series. This improvement in survival rate has been related to early diagnosis, management in specialized burn units, proper immunosuppressive treatment and intensive specialised nursing care. The main nursing diagnosis include abnormalities in the skin and mucose membranes integrity, risk of infection, loss of blood volume, risk of hypothermia, acute pain, upper airway insufficiency and anxiety. We here review the nursing care of patients with TEN. We emphasize the daily skin and mucose membranes care, and the prevention of conjunctival sinequiae, including daily conjunctival cleaning and debridement of necrotic tissue and fibrin debris using a handle needle.