Factores asociados a la variabilidad en la utilización de recursos en la consulta de los médicos de atención primaria / Factors associated with variability in the use of resources in primary care clinics

Objetivo. Analizar los factores que influyen en la utilización de recursos en la consulta de los médicos de atención primaria. Métodos. Estudio transversal. Las fuentes de datos fueron el sistema de información Medora-CyL de atención primaria, la tarjeta sanitaria para los denominadores y el registro de personal para variables relativas al médico. Los indicadores de derivaciones al especialista, peticiones al laboratorio, pruebas radiológicas y prescripción de recetas fueron ajustadas para la edad, utilizando como población de referencia la del área. Se realizó un análisis bivariante y multivariante. Resultados. Ser médico fijo, especialista en Medicina Familiar y Comunitaria (MFyC) y trabajar en medio urbano se asocia a una mayor utilización de recursos. Existe alta correlación entre las derivaciones al especialista con solicitudes al laboratorio, pruebas radiológicas, prescripción de recetas y distancia al centro de especialidades (r comprendidos entre 0,28 y 0,84). El ajuste mediante regresión multivariante determinó que los médicos más derivadores, solicitan más pruebas a laboratorio, más radiografías y prescriben más recetas. Ser especialista en MFyC y urbano permanecen como variables asociadas a mayor utilización de pruebas radiológicas y mayor prescripción, pero menor derivación al especialista. La variabilidad explicada va desde un 48% en la prescripción de recetas hasta un 80% en las peticiones a laboratorio. Conclusiones. Cuanto más se deriva al especialista, más peticiones se realizan al laboratorio más radiografías se solicitan y más recetas se prescriben. Los factores implicados son en su mayoría intrínsecos a la práctica del profesional(AU)

Objective. To analyse the factors that influence the use of resources by general practitioners. Methods. Cross-sectional study. The source of data was the General Practitioner's Management Information System Medora-CyL, the personal medical card database for the calculation of denominators, and the registry of personnel for variables related to doctors. The indicators for referrals to specialists, laboratory tests, X-ray requests and the issuing of prescriptions were adjusted for the age, taking the population of the area as a reference. Bivariate and multivariate analyses were performed. Results. Being a permanent general practitioner, specialist in Family and Community Medicine and to work in an urban environment was associated with a greater use of resources. There was a high correlation between referrals to specialists and laboratory requests, radiology tests, prescriptions and distance from the specialist centre (coefficient r between 0.28 and 0.84). Multivariate regression adjustment showed that the general practitioners who made more specialist referrals, also requested further laboratory tests, more X-rays and prescribed more. Being family doctor and working in urban areas remained associated with greater use of X-rays tests and more prescriptions but fewer referrals to specialists. The variability explained ranges from 48% on prescriptions and up to 80% on requests to the laboratory. Conclusion. The more referrals to specialists, the more requests are made to the laboratory, more X-rays are requested and more prescriptions are prescribed. Factors involved are largely intrinsic to the professional practice(AU)

[Evaluation of infiltration as a routine therapeutic technique in a health center]. / Evaluación de las infiltraciones como técnica terapéutica habitual en un centro de salud.

OBJECTIVE: To describe the use of filtration into the joints and soft tissue in the daily work of a Primary Care clinic. DESIGN: Observational and descriptive study. SETTING: Primary Care. PARTICIPANTS: Patients between 18 and 75, with pathologies that can be filtrated and who had not previously received treatment. MEASUREMENTS AND MAIN RESULTS: 148 filtrations were analysed, with pain and mobility before and after filtration being evaluated. 85.1% of the patients had intense or moderate pain before filtration, dropping to 5.4% a month afterwards (p < 0.05). 55.4% had limited mobility before filtration and 6.1% a month afterwards (p < 0.05). Complications from the technique were observed in 4 cases, but all were of a light character. CONCLUSIONS: The technique is effective and easy to apply in Primary Care, with scarce and light side-effects.