Nuevo modelo de autogestión profesional en atención primaria / New model of professional self-management in primary care

Objetivo. Analizar las ventajas de un modelo organizativo en atención primaria basado en mayor autonomía de gestión de profesionales respecto al modelo habitual (equipo dirigido por director médico). Mejorar la calidad asistencial y la satisfacción de pacientes y profesionales. Material y métodos. En febrero de 2009 un grupo de 6 médicos de familia y 4 administrativos se organizaron autónomamente para atender a 10.281 usuarios de 32.318 asignados al Centro de Atención Primaria (CAP) Les Corts de Barcelona. Entre marzo y diciembre de 2010 se incorporaron 7 enfermeras, 3 médicos y 2 administrativos más, atendiendo a 16.368 usuarios de 34.423 del centro. El modelo ha priorizado la autogestión de la demanda, autocobertura de profesionales, desburocratización de la consulta, mayor eficiencia y participación en investigación y docencia. Resultados. Resultados asistenciales: 1) Etapa piloto (diciembre/2008 a diciembre/2009): incremento de población atendida, disminución de visitas presenciales, importante aumento de atención no presencial, reducción muy significativa de demora de visita; reducción destacable de productos intermedios; menor utilización de novedades terapéuticas y mayor de medicamentos genéricos. 2) Etapa de consolidación (a diciembre de 2010, respecto a resto de profesionales del CAP): menos visitas presenciales y porcentaje muy superior de no presenciales atendiendo a más población asignada; menor gasto en productos intermedios. Otros resultados: mejora de la satisfacción profesional (cuestionario QVP-35) y participación activa en docencia e investigación. Conclusiones. El modelo ha innovado, mejorando la atención al usuario, dotando la consulta de mayor profesionalidad y aumentando la satisfacción de profesionales. Ha demostrado mayor eficiencia y los resultados obtenidos muestran superioridad al modelo habitual en indicadores de salud (AU)

Objective. To analyse the benefits of a new organisational model in Primary Care based on the empowerment of professional management compared to standard model (team led by medical director). To improve the quality of care, and patient and professional satisfaction. Material and methods. In February 2009 six family physician (FP) and four administrative staff met to create a self-management group to care for the 10,281 population assigned to them. The total catchment population of the Primary Care (PC) centre was 32,318. Additionally, between March and December 2010 three FP, seven nurses and two administrative staff, were included in the self-management group making the total population served by the self-management group of 16,368, compared to 15,950 patients seen using the standard model. The model gave priority to self-demand management, professional self-coverage, to reduce clinic bureaucracy, greater efficiency and participation in research and teaching. Results. 1) Milestone in Pilot Phase (December-2008 to December-2009): increase in attended population, reduction in clinic visits, significant reduction in delay to be visited by a doctor; significant reduction of complementary tests (x-rays, laboratory tests); increase in use of generic drugs and reduction of expensive and new drugs without added value, and active participation in teaching and clinical trials. 2) Consolidation Phase (December-2010, compared to other professionals working in a standard model in the same centre): self-management group reported a lower percentage of clinic visits and a higher percentage of visits resolved through telephoning the clinic. Furthermore, the self-management group achieved better financial results than the control group (additional medical tests, pharmacy budget). The self-management group had improved job satisfaction compared to control group (measured by Professional Questionnaire QoL-35). Conclusions. The new model has increased professional satisfaction and may improve results in some health indicators (accessibility, efficiency, pharmacy budget) compared with the usual clinical practice (AU)

[New model of professional self-management in primary care]. / Nuevo modelo de autogestión profesional en atención primaria.

OBJECTIVE: To analyse the benefits of a new organisational model in Primary Care based on the empowerment of professional management compared to standard model (team led by medical director). To improve the quality of care, and patient and professional satisfaction. MATERIAL AND METHODS: In February 2009 six family physician (FP) and four administrative staff met to create a self-management group to care for the 10,281 population assigned to them. The total catchment population of the Primary Care (PC) centre was 32,318. Additionally, between March and December 2010 three FP, seven nurses and two administrative staff, were included in the self-management group making the total population served by the self-management group of 16,368, compared to 15,950 patients seen using the standard model. The model gave priority to self-demand management, professional self-coverage, to reduce clinic bureaucracy, greater efficiency and participation in research and teaching. RESULTS: 1) Milestone in Pilot Phase (December-2008 to December-2009): increase in attended population, reduction in clinic visits, significant reduction in delay to be visited by a doctor; significant reduction of complementary tests (x-rays, laboratory tests); increase in use of generic drugs and reduction of expensive and new drugs without added value, and active participation in teaching and clinical trials. 2) Consolidation Phase (December-2010, compared to other professionals working in a standard model in the same centre): self-management group reported a lower percentage of clinic visits and a higher percentage of visits resolved through telephoning the clinic. Furthermore, the self-management group achieved better financial results than the control group (additional medical tests, pharmacy budget). The self-management group had improved job satisfaction compared to control group (measured by Professional Questionnaire QoL-35). CONCLUSIONS: The new model has increased professional satisfaction and may improve results in some health indicators (accessibility, efficiency, pharmacy budget) compared with the usual clinical practice.

[Descriptive study of mental disorders in ethnic minorities residing in an urban area of Barcelona]. / Estudio descriptivo de trastornos mentales en minorías étnicas residentes en un área urbana de Barcelona.

AIM: To observe the differences between ethnic groups and the autochthonous population in the frequency of mental disorders. To study epidemiological data and the accuracy of recording of such data. DESIGN: Descriptive study. Setting. Raval Sud Basic Health Care Area. Drassanes Primary Health Care Center, Barcelona, Spain. PATIENTS: A random sample of 112 immigrant patients belonging to ethnic minorities, seen between January 1995 and December 1997, matched for age and sex with autochthonous patients. Interventions. We studied variables related with mental disorders in immigrants. Variables included age, country of origin, reason for immigrating, employment status, marital status, other persons in household, educational level, knowledge of Spanish and toxic habits. We recorded the following impressions of diagnosis: anxiety, depression, somatization, psychosis, personality disorder, number of visits for each diagnosis, treatment, and overall number of visits between January 1995 and December 1997. Statistical studies consisted of descriptive analysis and chi-squared tests. MEASURES AND RESULTS: Mean age was 39 14 years, 52.7% of the immigrant patients were men, 36.6% (95% CI, 27.6-45.5%) were from the Maghreb region, and 23.2% (95% CI, 15.4-31.0%) were Hindustani. 43% (95% CI, 33.6-52.0%) understood Spanish. Smoking was more frequent among autochthonous patients (59.8%; 95% CI, 50.7-68.9%) than in immigrant patients (26.8%; 95% CI, 18.5-34.9%; p < 0.001), as was alcohol abuse (24.1%; 95% CI, 16.1-32.0%, versus 5.4%; 95% CI, 1.1-9.5%; p < 0.001). Depression tended to be more frequent in patients belonging to ethnic groups (15.2%; 95% CI, 8.5-21.8%) than in autochthonous patients (13.4%; 95% CI, 7.0-19.7%; p = ns), as did somatization disorder (10.7%; 95% CI, 4.9-167.4%, versus 6.3%; 95% CI, 1.7-10.7%, p = ns), but was undertreated (19.8%; 95% CI, 2.4-27.2%, versus 32.1%; 95% CI, 23.4-40.7%; p = ns). The total number of visits during the study period was higher in autochthonous patients (1138 versus 1017), as was the number of visits for mental disorders (17.9%; 95% CI, 15.7-20.1%, versus 13%; 95% CI, 1.9-15.0%; p = ns). CONCLUSIONS: There were no differences in the percentages of mental disorder

Estudio descriptivo de trastornos mentales en minorías étnicas residentes en un área urbana de Barcelona / Descriptive study of mental disorders in ethnic minorities residing in an urban area of Barcelona

Objetivo. Observar diferencias entre población étnica y autóctona en la frecuencia de trastornos mentales. Estudiar datos epidemiológicos y su nivel de registro. Diseño. Estudio descriptivo. Emplazamiento. Área Básica de Salud Raval Sud. CAP Drassanes. Barcelona. Pacientes. Muestra aleatoria de 112 pacientes inmigrantes, pertenecientes a minorías étnicas, visitados entre enero de 1995 y diciembre de 1997, apareados por edad y sexo con 112 autóctonos. Intervenciones. Se estudiaron variables relacionadas con patología mental en inmigrantes: edad, origen, motivo de migración, situación laboral, estado civil, convivientes, estudios, conocimiento del castellano y hábitos tóxicos. Se recogieron impresiones diagnósticas como ansiedad, depresión, somatización, psicosis, trastorno de personalidad, número de visitas para cada diagnóstico, tratamientos y número de visitas global entre enero de 1995 y diciembre de 1997. Estudio estadístico: análisis descriptivo y ji-cuadrado. Mediciones y resultados. Edad media, 39 ñ 14; varones, 52,7 por ciento; magrebíes, 36,6 por ciento (27,6-45,5), e indostaníes, 23,2 por ciento (15,4-31). Un 43 por ciento (33,652) comprende el castellano. El tabaquismo es superior en los autóctonos (59,8 por ciento [50,7-68,9] frente 26,8 por ciento [18,5-34,9]; p < 0,001), así como el abuso de alcohol (24,1 por ciento [16,1-32] frente al 5,4 por ciento [1,1-9,5]; p < 0,001). El grupo étnico tiende a presentar mayor porcentaje de depresión (15,2 por ciento [8,5-21,8] frente al 13,4 por ciento [719,7]; p = ns) y trastorno por somatización (10,7 por ciento [4,9-16,4] frente al 6,3 por ciento [1,7-10,7]; p = ns), pero es infratratado (19,8 por ciento [12,4-27,2] frente al 32,1 por ciento [23,4-40,7]; p = ns). El total de visitas es superior en el grupo autóctono (1.138/1.017), así como las visitas por trastornos mentales (17,9 por ciento [15,7-20,1] frente al 13 por ciento [10,9-15], p = ns). Conclusiones. No hay diferencias en el porcentaje de trastornos mentales en inmigrantes, aunque sí tendencia a la depresión y trastorno por somatización. Las características de la población de referencia y el bajo nivel de registro de datos observado podrían sesgar el resultado, influenciado por las dificultades comunicativas de los inmigrantes que dificultan el diagnóstico. Es necesario formar a los profesionales para mejorar su calidad asistencial (AU)