La investigación en atención primaria como área de conocimiento. Informe SESPAS 2012 / Research in primary care as an area of knowledge. SESPAS Report 2012

La atención primaria de salud ofrece grandes oportunidades para la investigación. Constituye un área de conocimiento propio, que es necesario desarrollar para mejorar la calidad de sus servicios y la salud de los pacientes. Estas oportunidades son únicas para la investigación clínica de base poblacional, con un enfoque de promoción de la salud y de prevención de la enfermedad, ya sea primaria, secundaria o terciaria. Es prioritario investigar en el desarrollo del modelo biopsicosocial de atención, nuevos modelos de atención integrada y atención comunitaria. Cabe destacar la actividad y la estructura generada por la Red de Investigación en Actividades Preventivas y de Promoción de la Salud (redIAPP), que ha atraído a su alrededor gran parte de la actividad investigadora en atención primaria de salud en nuestro país. A pesar del esfuerzo de diversas instituciones y fundaciones, así como de unidades docentes y de investigación, el desarrollo de la investigación no ha alcanzado el volumen, la relevancia, la calidad y el impacto deseables. La presencia de los profesionales de atención primaria de salud en las estructuras de investigación sigue siendo escasa, y la inversión en proyectos y líneas de investigación propias es pobre. Para poder invertir esta situación se precisa una serie de medidas: consolidar estructuras organizativas de apoyo específicas, con adecuada dotación de personal y recursos económicos; facilitar que los profesionales puedan compatibilizar su labor clínica con una dedicación específica a la investigación, para que elaboren proyectos relevantes y consoliden líneas de investigación estables de contenidos acordes con el área de conocimiento propio, y que se apliquen a la mejora de la calidad y a la innovación de los servicios de atención primaria de salud (AU)

Primary care offers huge potential for research. This setting is an area of knowledge that must expand to improve the quality of its services and patients’ health. Population-based clinical studies with a focus on health promotion and primary, secondary and tertiary disease prevention offer unique research opportunities. Developing research in the biopsychosocial model of clinical practice and new models of integrated healthcare and community care is therefore a priority. The framework and activities carried out by the Research Network in Preventive Activities and Health Promotion have been instrumental in the development of research in primary care in Spain. Despite the efforts invested by various institutions, foundations, teaching and research departments in primary care research, the projected outputs in terms of volume, quality and impact have not been achieved. The involvement of primary care professionals in research platforms is insufficient, with scarce contribution toward investment in specific primary care research projects. To change the current status of research in primary care, a number of measures are required, namely, the consolidation of research organisms specific to primary care with adequate allocation of funding and staff, and the allocation of specific time for research to primary care professionals to enable them to produce significant projects and consolidate established research lines in their areas of expertise, with applications mainly in quality improvement and innovation of primary care services (AU)

[Implementation of preventive activities by family and community medicine residents in primary care clinics]. / Grado de implementación de actividades preventivas por parte de los médicos residentes de Medicina Familiar y Comunitaria en las consultas de Atención Primaria.

OBJECTIVE: To determine the level of preventive activities carried out by Family and Community Medicine medical residents during their stay in the Health Centre, as well as to estimate the time involved in carrying them out. DESIGN: Cross-sectional, descriptive, observational study. SETTING: Teaching Health Centres in the Central- Cordoba and Guadalquivir Primary Care Districts. PARTICIPANTS: Forty medical residents and 384 clinical interviews with patients who were seen at the clinic. MAIN MEASUREMENTS: The consultations were video recorded and looked at by three medical residents who recorded the preventive activities carried out according to the 2005 PAPPS (Health Promotion and Disease Prevention Activities) recommendations, as well as the time employed in performing these activities. RESULTS: No preventive activities were performed in 72.1% (95% CI: 67.6 to 76.5%) of the consultations. The most frequent activities were secondary prevention (70.1%), mainly the taking of blood pressure (8.1%). The mean consultation time when there were no preventive activities carried out was 5.6 min (SD=3.1), whilst in those that did perform them it was 7.04 min (SD=3.05) (P<0.0001). CONCLUSIONS: The performing of preventive activities by medical residents in Primary Care clinics is very limited. A consultation that includes preventive activities requires a significantly longer time than in those that do not include them.