ABSTRACT
BACKGROUND: The objective of the study was to compare continuity and longitudinality of care in general practice in four European countries with a public salary model. METHODS: Descriptive and prospective study. 63 general practitioners/family physicians working in public health centers registered all encounters (direct and indirect) over a period of one week in Spain, Finland, Portugal and Sweden. RESULTS: 92% of the contacts were office encounters: 75% were direct (face to face), the average number of encounters per doctor, per week was 103. The principal problem was chronic in 42% of cases and acute in 31%. The physician has previous knowledge of the principal problem in 63% of the encounters and previous knowledge of concurrent problems in 79%. In 66% of cases the doctor has previous knowledge of the patient relatives. CONCLUSIONS: The level of continuity and longitudinality is variable; from high to low: Portugal, Spain, Sweden and Finland. In Spain the duration of the encounter is short and repeated prescription are infrequent. In Portugal there are waitings lists which implies low accessibility for acute problems. In Finland general practitioners have no patients lists and the care is des-personalized. In Sweden there are waiting lists and high use of telephone encounters.
Subject(s)
Primary Health Care/standards , Surveys and Questionnaires , Adult , Female , Humans , Male , Pilot Projects , Primary Health Care/economics , Prospective Studies , Salaries and Fringe Benefits , Spain , Time FactorsABSTRACT
BACKGROUND: A wide and expensive supply of electronic medical records obliged us to evaluate them before selecting one. In this study a questionnaire was used to evaluate computerized medical records. MATERIAL AND METHODS: Descriptive and prospective study with personal interviews in which a questionnaire was used, that had been previously published. RESULTS: The 12 questionnaires were completed in 99%. The greatest difficulty for answering the questions was the medical terminology. Four of the twelve computer programs were designed for hospitals, another 4 were designed for health centers and the rest were designed for both hospitals and health centers. The preventive and social data and annex were the more scarce of the elements (47%). Postsells services (100%), the ICE-9-CM classification (75%) and medicals data (51%) were the more frequent elements. CONCLUSIONS: In Spain there are few medical records regulated, and computerized designers do not have a standard model. The sellers of medical record softwares don't have knowledge of medical terminology. Medical record software programs are not designed for specific health settings (health centers or hospitals).
Subject(s)
Medical Records Systems, Computerized , Evaluation Studies as Topic , Prospective Studies , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To quantify and describe consultations carried out with third parties in General Medicine. DESIGN: Prospective and descriptive study. SETTING: Three General Medical consulting rooms in INSALUD's Health Area IV, Madrid. PARTICIPANTS: All those consultations carried out with third parties from 15 February 1993 until 200 cases per doctor had been reached. INTERVENTION AND MAIN RESULTS: The data of the patient, the third party and the meeting were recorded for a total of 603 consultations using a third party. These consultations made up 18% of the total number at the three consulting rooms. According to the criterion of the doctor involved, more than half of these consultations were not clinically justified. People attended fundamentally to obtain prescriptions (76%), notes for short periods of time off work (9.6%) and referral to specialists (8.9%). The third party was usually a woman (62%) and spouse or mother of the patient (45 and 28%, respectively). CONCLUSIONS: In the three General Medical consulting rooms studied, which were organized on the traditional model, third-party consultations are common and clinically unjustified in more than half the instances. These consultations are due fundamentally to difficulties of access to Primary Care services. Increasing the General Practitioner's availability for on-demand consultations could lessen this high incidence of third-party consultations.
Subject(s)
Family Practice/methods , Physician-Patient Relations , Adolescent , Adult , Child , Female , Humans , Male , Middle Aged , Patient Participation/methods , Prospective StudiesABSTRACT
OBJECTIVE: The quantifying, by subject area, of research published in scientific journals on primary health care, in five different cultural/geographic areas. DESIGN: Descriptive study. SETTING: Scientific journals on primary health care. PARTICIPANTS: Original articles published in 1991 in the following journals on primary health care (general practice): Atención Primaria, Canadian Family Physician, Family Practice, Journal of Family Practice and Scandinavian Journal of Primary Health Care. INTERVENTIONS AND MAIN RESULTS: The classification adopted here was that used in the research into primary health care by the Canadian Association of Family Physicians. The five journals between them published 263 original articles. Articles on organisation and provision of health services constituted 42% of the total; next in frequency were articles on epidemiology (18%) and on psychosocial concerns. Methodological studies and research into training and professional kills represent a scarce 6% and 8% respectively. CONCLUSIONS: The most commonly occurring subject in primary health care research is research on services. In the future it would be desirable to develop other areas (the clinical and psycho-social areas, methodology, and training).
Subject(s)
Periodicals as Topic , Primary Health Care , Canada , Periodicals as Topic/statistics & numerical data , Primary Health Care/statistics & numerical data , Research/statistics & numerical data , Scandinavian and Nordic Countries , Spain , United StatesABSTRACT
After the epidemic outbreak of Porphyria Turcica from 1955 to 1961, the porphyrinogenic effect of hexachlorobenzene (HCB) on humans and animals has been fully confirmed. HCB is an environmental contaminant originated from its use as fungicide or obtained as a by product from industrial residues. Measurement of HCB levels in adipose tissue and maternal milk is a useful tool for monitoring its body stores which are clearly higher in Spain than in other European or American countries. At least in the Spanish area of Catalunya, the HCB fat tissue concentration decreased from more than 5 ppm in 1981-1982 to less than 3 ppm in 1986-1987. Porphyria cutanea tarda is a relatively frequent disease in Spain. More than 700 cases were observed in Madrid from 1964 to 1988. Before 1970, less than 10 cases were annually detected, a figure that rose up to 60-70 annual cases from 1977 to 1982 and decreased to less than 25 annual cases from 1985 to 1988. Based on all these previous data, a speculation is tempting: the high and variable incidence of porphyria cutanea tarda in Spain may be related to environmental contamination with HCB.
