Effectiveness of a training program for the management of risky alcohol use in primary care professionals based on motivational interviewing / Eficacia de un programa de formación para el manejo del consumo de riesgo de alcohol en profesionales de atención primaria basado en la entrevista motivacional

Objective: To assess the effectiveness of a training program for Primary Care (PC) professionals developed to increase knowledge, attitudes, and skills for managing patients with risky alcohol use and in the motivational interview. Design: Multicenter, two-arm parallel, randomized, open-label controlled clinical trial. Setting: PC of the Andalusian Health Service. Participants: The study was completed by 80 healthcare professionals from 31 PC centers. Interventions: In both experimental and control groups, a workshop on managing patients with risky alcohol consumption and the resolution of two videotaped clinical cases with standardized patients were conducted. The experimental group attended a workshop on motivational interviewing. Main measurements: Knowledge about managing risky alcohol use, clinical performance in patients with this health problem, and assessment of the motivational interview. Results: Mean age was 39.50±13.06 – SD – (95% CI: 36.59–42.41); 71.3% (95% CI: 61.1–80.9%) were women. The average score of both groups in the knowledge questionnaire before the training program was 15.10±4.66, becoming 21.99±3.93 points after the training (95% CI: 5.70–7.92; p<0.001). The experimental group showed an average score of 18.53±13.23 before the intervention with the motivational interview and 28.33±11.86 after this intervention (p=0.002). In contrast, no significant variation was found in the score of the control group. Conclusions: A training program aimed at PC professionals designed to increase knowledge on how to manage risky alcohol use and acquire communication skills in motivational interviewing is effective.(AU)

Objetivo: Evaluar la efectividad de un programa de formación para profesionales de Atención Primaria (AP) para incrementar conocimientos, actitudes y habilidades en el manejo de pacientes con consumo de riesgo de alcohol y en la entrevista motivacional. Diseño: Ensayo clínico controlado, abierto, aleatorizado, multicéntrico, paralelo de dos brazos. Emplazamiento: Centros de AP del Servicio Andaluz de Salud. Participantes: Fue completado por 80 profesionales sanitarios de 31 centros. Intervenciones: En el grupo experimental y en el control se realizó un taller de manejo de pacientes con consumo de riesgo de alcohol y la resolución de dos casos clínicos videograbados con pacientes estandarizados. El grupo experimental asistió a un taller sobre entrevista motivacional. Mediciones principales: Conocimiento sobre el manejo del consumo de riesgo de alcohol, desempeño clínico en pacientes con este problema de salud y valoración de la entrevista motivacional. Resultados: La edad media fue 39.50±13,06 -DE- (IC 95%: 36,59-42,41); El 71,3% (IC 95%: 61,1%-80,9%) eran mujeres. La puntuación media en el cuestionario de conocimientos antes del programa de formación fue de 15,10±4,66, siendo 21,99±3,93 puntos después del entrenamiento (IC 95%:5,70-7,92; p<0,001). La puntuación promedio del grupo experimental antes de la intervención con la entrevista motivacional era de 18,53±13,23 y después de 28,33±11,86 (p=0,002). No se encontró variación significativa en la puntuación del grupo control. Conclusiones: Un programa de formación para profesionales de AP, para incrementar el conocimiento sobre cómo gestionar el consumo de riesgo de alcohol y adquirir habilidades comunicativas en la entrevista motivacional es efectivo.(AU)

Primary Care Professionals' Empathy and Its Relationship to Approaching Patients with Risky Alcohol Consumption.

The aim of this study was to estimate the level of empathy among primary care (PC) health professionals and its relationship with their approach to patients at risk due to alcohol consumption. This is an observational, descriptive, and multicenter study that included 80 PHC professionals. The professionals completed a questionnaire comprising socio-occupational questions and inquiries regarding their actions when dealing with patients suspected of risky alcohol consumption. The Jefferson Scale of Empathy was used to measure their level of empathy and was completed by 80 professionals, of whom 57.5% were family physicians, 10% were nurses, and 32.5% were family- and community-medicine residents. The mean age was 39.5 ± 13.1 (SD) (range of 24-65 years) and 71.3% were females. The mean empathy level score was 112.9 ± 11.1 (95% CI: 110.4-115.4; range: 81-132 points). Actions that stood out for their frequency were providing health advice in the general population, offering advice to pregnant women, and recommending abstinence to users of hazardous machinery or motor vehicles. The level of empathy was associated with age (p = 0.029), the health center's scope (p = 0.044), systematic alcohol exploration (p = 0.034), and follow-ups for patients diagnosed with risky consumption (p = 0.037). The mean score obtained indicated a high level of empathy among professionals. Professionals with greater empathy more frequently conducted systematic screening for risky alcohol consumption.

Effectiveness of a training program for the management of risky alcohol use in primary care professionals based on motivational interviewing.

OBJECTIVE: To assess the effectiveness of a training program for Primary Care (PC) professionals developed to increase knowledge, attitudes, and skills for managing patients with risky alcohol use and in the motivational interview. DESIGN: Multicenter, two-arm parallel, randomized, open-label controlled clinical trial. SETTING: PC of the Andalusian Health Service. PARTICIPANTS: The study was completed by 80 healthcare professionals from 31 PC centers. INTERVENTIONS: In both experimental and control groups, a workshop on managing patients with risky alcohol consumption and the resolution of two videotaped clinical cases with standardized patients were conducted. The experimental group attended a workshop on motivational interviewing. MAIN MEASUREMENTS: Knowledge about managing risky alcohol use, clinical performance in patients with this health problem, and assessment of the motivational interview. RESULTS: Mean age was 39.50±13.06 - SD - (95% CI: 36.59-42.41); 71.3% (95% CI: 61.1-80.9%) were women. The average score of both groups in the knowledge questionnaire before the training program was 15.10±4.66, becoming 21.99±3.93 points after the training (95% CI: 5.70-7.92; p<0.001). The experimental group showed an average score of 18.53±13.23 before the intervention with the motivational interview and 28.33±11.86 after this intervention (p=0.002). In contrast, no significant variation was found in the score of the control group. CONCLUSIONS: A training program aimed at PC professionals designed to increase knowledge on how to manage risky alcohol use and acquire communication skills in motivational interviewing is effective.

Effectiveness of a brief motivational intervention in the management of risky alcohol use in primary care: ALCO-AP20 study protocol.

Background: Motivational interviewing (MI) could be a method for minimizing alcohol-related harm. The study aims to assess the effectiveness of a brief intervention, based on a MI, in patients with risky alcohol use attended in Primary Care (PC). Materials and methods: A cluster-randomized, two-arm parallel, multicenter, open-label, controlled clinical trial. Fifty PC healthcare professionals from the province of Córdoba (Spain) will be randomized to one of the two study groups: (1) Experimental Group (EG): MI-based approach; (2) Control Group (CG): Usual care based on health advice. EG intervention: Professionals will receive a training program focused on MI, consisting of a training workshop and the use of pre- and post-workshop questionnaires to measure knowledge and skills acquired, as well as the degree of empathy, with a videotape of the health professionals with standardized patients, before and after the workshop, and subsequent training feedback. CG intervention: Workshop on the management of risky alcohol use based on health advice; participants will also complete the pre-and post-workshop questionnaires and be videotaped. Study population: Patients ≥ 14 years old with risky alcohol consumption (28 Standard Drink Units-SDU-/week in men and 17 SDU/week in women) or excessive alcohol use (≥ 6 SDU in men or ≥ 4 SDU in women, in less than 2 h). It would be necessary to include 110 subjects/group to find a difference of 20% between the percentage of patients in abstinence between EG (37%) and CG (20%), alpha error of 5%, and statistical power of 80%. Assuming a loss rate of 5% and the cluster design effect, the number of subjects to be recruited is estimated at 197/group. The follow-up period will be 12 months. The primary outcome variables will be the self-reported alcohol use level and the Alcohol Use Disorders Identification Test (AUDIT) questionnaire score. Discussion: The study aims to demonstrate the effectiveness of the motivational approach in the comprehensive treatment of the patient with risky alcohol use, improving the empathy of the healthcare professionals and strengthening the healthcare professional-patient relationship to achieve the behavioral change of the patients with this problem in primary care consultations. Clinical trial registration: ClinicalTrials.gov.

Training health providers to address unhealthy alcohol use in primary care: a cross-sectional, multicenter study.

BACKGROUND: Health professionals' training is a key element to address unhealthy alcohol use in Primary Care (PC). Education about alcohol use can be effective in improving PC provider's knowledge and skills addressing alcohol-related problems. The aim of the study was to evaluate the training of health professionals to address unhealthy alcohol use in PC. METHODS: An observational, descriptive, cross-sectional, multicenter study was performed. LOCATION: PC centres of the Spanish National Health System (SNHS). PARTICIPANTS: Family physicians, residents and nurses completed an online questionnaire that inquired about their training (none, basic, medium or advanced), knowledge and preventive practices aimed at reducing unhealthy alcohol use. The study population was recruited via random sampling, stratified by the regions of the SNHS's PC centre, and by email invitation to members of two Spanish scientific societies of Family Medicine. RESULTS: A total of 1760 professionals participated in the study. Sixty-seven percent (95% CI: 67.5-71.8) reported not having received specific training to address unhealthy alcohol use, 30% (95% CI: 27.4-31.7) reported having received basic training, and 3% (95% CI: 2.3-4.0) medium/advanced training. The training received was greater in younger providers (p < 0.001) who participated in the PAPPS (Preventive Activities and Health Promotion Programme) (p < 0.001). Higher percentages of providers with intermediate or advanced training reported performing screening for unhealthy alcohol use (p < 0.001), clinical assessment of alcohol consumption (p < 0.001), counselling of patients to reduce their alcohol intake (p < 0.001) or to abstain, in the cases of pregnant women and drivers (p < 0.001). CONCLUSION: Our study reveals a low level of training among Spanish PC providers to address unhealthy alcohol use. A higher percentage of screening, clinical assessment and counselling interventions aimed at reducing unhealthy alcohol use was reported by health professionals with an intermediate or advanced level of training.

[Clinical-epidemiological characteristics of the atrial fibrillation in patients 65 years of age or older diagnosed in primary care.] / Características clínico-epidemiológicas de la fibrilación auricular en pacientes de 65 años o más diagnosticados en Atención Primaria.

OBJECTIVE: The identification of atrial fibrillation in older patients who come to Primary Care consultations is a topic of interest that has been scarcely studied. The objective of this work was to estimate the frequency of new cases of atrial fibrillation and to analyze the clinical-epidemiological characteristics of patients 65 years of age or older, detected in Primary Care in Spain. METHODS: An observational, descriptive, national, multicenter study was carried out in 48 health centers, in which 218 doctors and 101 Primary Care nurses recruited 7,068 patients, who underwent an arterial pulse and an electrocardiogram. in case of being abnormal or doubtful, determining the presence of atrial fibrillation and other rhythm disorders, symptoms and signs compatible with atrial fibrillation and comorbidity and cardiovascular risk factors. A univariate, bivariate and multivariate analysis (multiple logistic regression) was performed. RESULTS: The patients had a mean age of 74.41±6.78 (DT) years. 2.3% presented atrial fibrilation (95% CI: 2.0-2.7), being its frequency higher in men (2.9%; p<0.001), and as age increased (p<0.001). The most frequent symptoms present among patients with atrial fibrillation were palpitations (Odds Ratio -OR-=3.50; 95% CI: 2.28-5.37), dyspnea (OR=2.71; 95% CI: 1.87-3.90), general discomfort (OR=2.32, 95% CI: 1.15-4.63), and dizziness (OR=1.80, 95% CI: 1.20-3.51). The 21.8% were asymptomatic. CONCLUSIONS: The frequency of new cases of atrial fibrillation in the Spanish population of 65 years or older is high, being higher in men and increasing with age. Two out of ten patients are asymptomatic. Palpitations and dyspnea are the predominant symptoms in patients with atrial fibrillation.

OBJETIVO: La identificación de fibrilación auricular en los pacientes mayores es un tema que ha sido escasamente estudiado. El objetivo de este estudio fue estimar la frecuencia de nuevos casos de fibrilación y analizar las características clínico-epidemiológicas de los pacientes de 65 años o más detectados en Atención Primaria en España. METODOS: Se llevó a cabo un estudio observacional, descriptivo de ámbito nacional, multicéntrico, en 48 centros de salud, en el que 218 médicos y 101 enfermeras de Atención Primaria captaron a 7.068 pacientes, a los que se les realizó la toma del pulso arterial y un electrocardiograma en caso de ser anormal o dudoso, determinando la presencia de fibrilación auricular y otros trastornos del ritmo, síntomas y signos compatibles, así como comorbilidad y factores de riesgo cardiovascular. Se realizó un análisis univariado, bivariado y multivariado (regresión logística múltiple). RESULTADOS: Los pacientes tenían una media de edad de 74,41±6,78 (DT) años. El 2,3% presentó fibrilación auricular (IC95%: 2,0-2,7), siendo su frecuencia superior en los hombres (2,9%; p<0,001), y más aún conforme aumentaba la edad (p<0,001). Los síntomas más frecuentemente presentes entre los pacientes con fibrilación auricular fueron las palpitaciones (Odds Ratio -OR-=3,50; IC95%: 2,28-5,37), la disnea (OR=2,71; IC95%: 1,87-3,90), el malestar general (OR=2,32; IC 95%:1,15-4,63) y el mareo (OR=1,80; IC95%:1,20-3,51). Un 21,8% eran asintomáticos. CONCLUSIONES: La frecuencia de nuevos casos de fibrilación auricular en la población española de 65 años o más es elevada, siendo superior en los hombres e incrementándose con la edad. Dos de cada diez pacientes son asintomáticos. Las palpitaciones y la disnea constituyen los síntomas preponderantes en los pacientes con fibrilación auricular.

Características clínico-epidemiológicas de la fibrilación auricular en pacientes de 65 años o más diagnosticados en atención primaria / Clinical-epidemiological characteristics of the atrial fibrillation in patients 65 years of age or older diagnosed in primary care

OBJETIVO: La identificación de fibrilación auricular en los pacientes mayores es un tema que ha sido escasamente estudiado. El objetivo de este estudio fue estimar la frecuencia de nuevos casos de fibrilación y analizar las características clínico-epidemiológicas de los pacientes de 65 años o más detectados en Atención Primaria en España. MÉTODOS: Se llevó a cabo un estudio observacional, descriptivo de ámbito nacional, multicéntrico, en 48 centros de salud, en el que 218 médicos y 101 enfermeras de Atención Primaria captaron a 7.068 pacientes, a los que se les realizó la toma del pulso arterial y un electrocardiograma en caso de ser anormal o dudoso, determinando la presencia de fibrilación auricular y otros trastornos del ritmo, síntomas y signos compatibles, así como comorbilidad y factores de riesgo cardiovascular. Se realizó un análisis univariado, bivariado y multivariado (regresión logística múltiple). RESULTADOS: Los pacientes tenían una media de edad de 74,41±6,78 (DT) años. El 2,3% presentó fibrilación auricular (IC95%: 2,0-2,7), siendo su frecuencia superior en los hombres (2,9%; p < 0,001), y más aún conforme aumentaba la edad (p < 0,001). Los síntomas más frecuentemente presentes entre los pacientes con fibrilación auricular fueron las palpitaciones (Odds Ratio -OR-=3,50; IC95%: 2,28-5,37), la disnea (OR=2,71; IC95%: 1,87-3,90), el malestar general (OR=2,32; IC 95%:1,15-4,63) y el mareo (OR=1,80; IC95%:1,20-3,51). Un 21,8% eran asintomáticos. CONCLUSIONES: La frecuencia de nuevos casos de fibrilación auricular en la población española de 65 años o más es elevada, siendo superior en los hombres e incrementándose con la edad. Dos de cada diez pacientes son asintomáticos. Las palpitaciones y la disnea constituyen los síntomas preponderantes en los pacientes con fibrilación auricular

OBJECTIVE: The identification of atrial fibrillation in older patients who come to Primary Care consultations is a topic of interest that has been scarcely studied. The objective of this work was to estimate the frequency of new cases of atrial fibrillation and to analyze the clinical-epidemiological characteristics of patients 65 years of age or older, detected in Primary Care in Spain. METHODS: An observational, descriptive, national, multicenter study was carried out in 48 health centers, in which 218 doctors and 101 Primary Care nurses recruited 7,068 patients, who underwent an arterial pulse and an electrocardiogram. in case of being abnormal or doubtful, determining the presence of atrial fibrillation and other rhythm disorders, symptoms and signs compatible with atrial fibrillation and comorbidity and cardiovascular risk factors. A univariate, bivariate and multivariate analysis (multiple logistic regression) was performed. RESULTS: The patients had a mean age of 74.41±6.78 (DT) years. 2.3% presented atrial fibrilation (95% CI: 2.0-2.7), being its frequency higher in men (2.9%; p < 0.001), and as age increased (p < 0.001). The most frequent symptoms present among patients with atrial fibrillation were palpitations (Odds Ratio -OR-=3.50; 95% CI: 2.28-5.37), dyspnea (OR=2.71; 95% CI: 1.87-3.90), general discomfort (OR=2.32, 95% CI: 1.15-4.63), and dizziness (OR=1.80, 95% CI: 1.20-3.51). The 21.8% were asymptomatic. CONCLUSIONS: The frequency of new cases of atrial fibrillation in the Spanish population of 65 years or older is high, being higher in men and increasing with age. Two out of ten patients are asymptomatic. Palpitations and dyspnea are the predominant symptoms in patients with atrial fibrillation

Efectividad de programas formativos orientados al consumo de alcohol en atención primaria: revisión sistemática / Effectiveness of training programs on alcohol consumption in the Primary Care setting: Systematic review

Objetivo: Evaluar la efectividad de actividades formativas dirigidas a sanitarios de atención primaria sobre el manejo de pacientes con problemas de consumo de alcohol. Diseño: Revisión sistemática cualitativa de ensayos clínicos controlados aleatorizados. Fuentes de datos: Trip Database, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, Web of Science, Scopus, Alcohol and Alcohol Problems Science Database-ETOH y FAMILY RESOURCES DATABASE. La búsqueda se realizó en junio de 2017. Selección de estudios: Muestra final n = 3. Se incluyeron: ensayos clínicos controlados aleatorizados, indexados hasta el 30 de mayo de 2017, con objetivo evaluar la efectividad de actividades formativas orientadas a profesionales de atención primaria en el abordaje de pacientes con problemas de consumo de alcohol. Extracción de datos: Las medidas fueron expresadas en términos de efectividad de la aplicación de la actividad formativa: nivel de implementación global, cribado de consumo de alcohol, intervención de pacientes con consumo de riesgo y nivel de apoyo requerido. Resultados: Tres ensayos clínicos controlados aleatorizados, publicados desde 1999 a 2004, fueron incluidos. Tanto el cribado, como las técnicas de intervención breve, experimentaron un incremento de su aplicación en los tres estudios, tras el desarrollo de los programas formativos. Se consiguieron resultados significativos en términos de efectividad en 2 de los 3 ensayos seleccionados, tanto en la detección de consumidores de riesgo, como en la intervención breve. Conclusión: El desarrollo de programas formativos en el abordaje de pacientes con problemas de consumo de alcohol constituye una estrategia efectiva para los profesionales de atención primaria, permitiendo la implementación del cribado poblacional y de técnicas de intervención breve

Objective: To evaluate the effectiveness of training activities directed at Primary Health Care personnel on the management of patients with alcohol consumption problems. Design: A systematic review of randomised controlled trials. Data sources: Trip Database, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, Web of Science, Scopus, Alcohol and Alcohol Problems Science Database - ETOH and FAMILY RESOURCES DATABASE. The search was performed in June 2017. Study selection: The final sample was n = 3 studies. Randomised controlled trials, indexed until 30 May 2017, with the objective of assessing the effectiveness of training programs directed at Primary Care providers in the management of patients with alcohol abuse disorder were included. Data extraction: The main variables were expressed in terms of effectiveness of the training program: level of global implementation, screening of alcohol consumption, intervention in patients with a consumption risk, and level of support required. Results: Three Randomised controlled trials, published from 1999 to 2004, were included. Both screening and short intervention techniques showed an increase of its application in the three studies after the development of the three training programs. Statistical significance in terms of effectiveness was achieved in 2 of the 3 selected trials: both in detection of risk consumers, and in short intervention. Conclusion: The development of training programs in the management of patients with alcohol abuse disorder is an effective strategy for Primary Care providers, allowing the implementation of population screening, as well as the application of intervention techniques

Prevalence of hazardous alcohol use among Spanish primary care providers.

BACKGROUND: Alcohol use by health care professionals is one of the potential factors that may affect the prevention of hazardous drinking in Primary Care (PC). The objective of the study was to estimate the prevalence of hazardous alcohol use by PC professionals and assess the existing relationship between socio-demographic and occupational variables of PC professionals and their alcohol use. METHODS: A descriptive, cross-sectional, observational, multicenter study was performed. LOCATION: PC sites of the Spanish National Health Care System (NHS). PARTICIPANTS: Physicians and nurses, who completed an online questionnaire intended to identify the pattern of hazardous alcohol use through the AUDIT-C test. The study population was recruited through random sampling stratified by regions of the PC sites in the NHS. The primary measurements: Frequency of alcohol use, number of drinks containing alcohol on a typical day, frequency of six or more drinks on one occasion. RESULTS: One thousand seven hundred sixty professionals completed the questionnaire. Hazardous alcohol use was detected in 27.80% (95% CI: 25.5-29.7) of PC providers. The prevalence of hazardous alcohol use was higher in males (34.2%) [95% CI: 30.4-37.6] and professionals aged 56 years or over (34.2%) [95% CI: 28.2-40.2]. The multiple logistic regression analysis revealed a higher hazardous use in males (OR = 1.52; 95% CI: 1.22-1.90), PC physicians (OR = 1.42; 95% CI: 1.01-2.02) and professionals with more time worked (OR = 1.03; 95% CI: 1.01-1.05). CONCLUSION: Our study shows the current prevalence of hazardous alcohol use among Spanish PC providers, revealing a higher percentage of hazardous alcohol use in healthcare professionals compared to the Spanish general population. Further interventions are required to increase the awareness of negative consequences derived from alcohol use among PC professionals and its impact on the clinical setting.

Impact of a primary care training program on the prevention and management of unhealthy alcohol use: A quasi-experimental study.

OBJECTIVE: To assess the impact of a training program targeted to Primary Care (PC) professionalson the acquisition of communication skills, attitudes, and knowledge about the prevention and management of unhealthy alcohol use. METHODS: A quasi-experimental, pre- and post-intervention study was performed in PC centers of Cordoba (Spain). Family doctors, residents and nurses participated in the study. The intervention was based on a motivational interviewing training program, which consisted in a workshop on learning skills, attitudes and knowledge about the alcohol management. PC providers were videotaped with a standardized patient in order to check the clinical and communication competencies acquired. A descriptive, bivariate and multivariate analysis was carried out (p < 0.05). RESULTS: PC providers' communication skills and attitudes showed significant improvements in the variables studied (p < 0.001), as well as in the clinical interview evaluation parameters. CONCLUSION: The present study reveals the impact of a training program targeted to PC professionals on communication skills, attitudes, and knowledge about the prevention and management of patients with unhealthy alcohol use. PRACTICE IMPLICATIONS: Training activities targeted to PC providers represent a valuable strategy to improve communication skills, attitudes and knowledge of these professionals in their clinical practice.

Alcohol consumption in Spanish primary health care providers: a national, cross-sectional study.

AIM: To estimate the prevalence of alcohol consumption and analyse the drinking patterns among primary healthcare (PHC) providers. DESIGN: Observational, cross-sectional, descriptive study. SETTING: PHC centres in the Spanish National Health System (SNHS). PARTICIPANTS: Doctors and nurses who completed an online questionnaire which explored their alcohol intake, using the Alcohol Use Disorders Identification Test (AUDIT-C) alcohol assessment tool. The study population was recruited by random sampling stratified by regions of the SNHS PHC centres. PRIMARY AND SECONDARY OUTCOME MEASURES: Frequency of alcohol consumption, number of alcohol drinks on a typical day, frequency of more than six standard drinks (SDs) intake. RESULTS: A total of 1760 PHC providers completed the questionnaire. The frequency of alcohol consumption was: abstention (12%, 95% CI 10.4% to 13.5%); one or less SDs/month (26%, 95% CI 23.8% to 27.9%); 2-4 SDs/month (32.2%, 95% CI 29.7% to 34.1%); 2-3 SDs/week (17.9%, 95% CI 16.0% to 19.6%); four or more SDs/week (11.9%, 95% CI 10.3% to 13.3%). The number of drinks on a typical day was: none (45.6%, 95% CI 42.9% to 47.6%); 1-2 drinks (47.3%, 95% CI 23.8% to 27.9%); 3-4 drinks (6.5%, 95% CI 5.3% to 7.6%). The percentage of hazardous drinking, according to AUDIT-C criteria, was 32% (95% CI 26.7 to 37.3), with a greater frequency of intake in older professionals (p<0.001), in contrast to a higher number of drinks consumed on a typical day by younger providers (p<0.001). Intake was higher among males (p<0.001), primary care physicians (p<0.001) and resident trainers (p<0.001). CONCLUSIONS: Our study discloses the most up-to-date portrait of current alcohol consumption among Spanish PHC providers, showing a higher prevalence of alcohol intake, compared with the general population. Preventive strategies should be implemented to improve the awareness and training of PHC professionals towards alcohol consumption.

[Effectiveness of training programs on alcohol consumption in the Primary Care setting: Systematic review]. / Efectividad de programas formativos orientados al consumo de alcohol en atención primaria: revisión sistemática.

OBJECTIVE: To evaluate the effectiveness of training activities directed at Primary Health Care personnel on the management of patients with alcohol consumption problems. DESIGN: A systematic review of randomised controlled trials. DATA SOURCES: Trip Database, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, Web of Science, Scopus, Alcohol and Alcohol Problems Science Database - ETOH and FAMILY RESOURCES DATABASE. The search was performed in June 2017. STUDY SELECTION: The final sample was n=3 studies. Randomised controlled trials, indexed until 30 May 2017, with the objective of assessing the effectiveness of training programs directed at Primary Care providers in the management of patients with alcohol abuse disorder were included. DATA EXTRACTION: The main variables were expressed in terms of effectiveness of the training program: level of global implementation, screening of alcohol consumption, intervention in patients with a consumption risk, and level of support required. RESULTS: Three Randomised controlled trials, published from 1999 to 2004, were included. Both screening and short intervention techniques showed an increase of its application in the three studies after the development of the three training programs. Statistical significance in terms of effectiveness was achieved in 2 of the 3 selected trials: both in detection of risk consumers, and in short intervention. CONCLUSION: The development of training programs in the management of patients with alcohol abuse disorder is an effective strategy for Primary Care providers, allowing the implementation of population screening, as well as the application of intervention techniques.

Opportunistic screening for atrial fibrillation versus detecting symptomatic patients aged 65 years and older: A cluster-controlled clinical trial. / Cribado oportunista de fibrilación auricular frente a detección de pacientes sintomáticos de 65 años o más: ensayo clínico controlado por clúster.

OBJECTIVE: The goal of this study was to assess the effectiveness of opportunistic screening through pulse palpation in the early detection of atrial fibrillation in subjects aged≥65 years versus detection through an active search for patients with symptoms and/or complications and sequelae associated. MATERIAL AND METHODS: This was a cluster randomized controlled trial performed in 48 primary care centers of the Spanish National Healthcare System. A total of 368 physicians and nurses were randomized. The researchers in the experimental group (EG) performed opportunistic screening for auricular fibrillation, whereas the researchers in the control group (CG) actively searched for symptomatic patients. An ECG was performed on patients found to have an irregular heartbeat to confirm the diagnosis of auricular fibrillation. RESULTS: A total of 5,465 patients with a mean age of 75.61 years were recruited for the EG, and 1,525 patients with a mean age of 74.07 years were recruited for the CG. Of these, 58.6% were female, without significant differences between groups. Pulse was irregular in 4.3 and 15.0% of the patients in the EG and the CG, respectively (P<.001). A total of 164 new cases of atrial fibrillation were detected (2.3%), 1.1% in the EG and 6.7% in the CG (adjusted OR: 0.29; 95% CI 0.18-0.45). CONCLUSIONS: Case finding for atrial fibrillation in patients aged≥65 years with symptoms or signs suggestive of atrial fibrillation is a more effective strategy than opportunistic screening through pulse palpation in asymptomatic patients. TRIAL REGISTRATION: The trial is registered in ClinicalTrials.gov (NCT01291953; February 8, 2011).

Cribado oportunista de fibrilación auricular frente a detección de pacientes sintomáticos de 65 años o más: ensayo clínico controlado por clúster / Opportunistic screening for atrial fibrillation versus detecting symptomatic patients aged 65 years and older: A cluster-controlled clinical trial

Objetivo: El objetivo de este estudio fue evaluar la eficacia del cribado oportunista a través de la palpación del pulso para la detección de fibrilación auricular en sujetos asintomáticos de edad ≥ 65 años frente a la búsqueda activa de pacientes de la misma edad con síntomas y/o complicaciones y secuelas asociadas. Material y métodos: Se realizó un ensayo clínico controlado aleatorizado por clúster en 48 centros de atención primaria del Sistema Nacional de Salud español. Se aleatorizó a un total de 368 médicos y enfermeras. Los investigadores del grupo experimental (GE) realizaron el cribado oportunista para la fibrilación auricular, mientras que los investigadores del grupo control (GC) realizaron una búsqueda activa en pacientes sintomáticos. Se realizó un ECG en los pacientes que tenían un pulso irregular para confirmar el diagnóstico de fibrilación auricular. Resultados: Un total de 5.465 pacientes con una edad media de 75,61 fueron seleccionados para el GE y 1.525 pacientes para el GC, con una edad media de 74,07 años. El 58,6% eran mujeres, sin diferencias significativas entre los grupos. El pulso era irregular en el 4,3 y el 15% de los pacientes del GE y el GC, respectivamente (p < 0,001). Se detectaron un total de 164 nuevos casos de fibrilación auricular (2,3%), el 1,1% en el GE y el 6,7% en el GC (OR ajustada 0,29; IC 95% 0,18-0,45). Conclusiones: La búsqueda activa, a través de la palpación del pulso, de fibrilación auricular en pacientes de edad ≥ 65 años con síntomas o signos indicativos es una estrategia más eficaz que el cribado oportunista en pacientes asintomáticos. Registro del ensayo clínico: Registrado en ClinicalTrials.gov (NCT01291953; 8 de febrero de 2011) (AU)

Objective: The goal of this study was to assess the effectiveness of opportunistic screening through pulse palpation in the early detection of atrial fibrillation in subjects aged ≥ 65 years versus detection through an active search for patients with symptoms and/or complications and sequelae associated. Material and methods: This was a cluster randomized controlled trial performed in 48 primary care centers of the Spanish National Healthcare System. A total of 368 physicians and nurses were randomized. The researchers in the experimental group (EG) performed opportunistic screening for auricular fibrillation, whereas the researchers in the control group (CG) actively searched for symptomatic patients. An ECG was performed on patients found to have an irregular heartbeat to confirm the diagnosis of auricular fibrillation. Results: A total of 5,465 patients with a mean age of 75.61 years were recruited for the EG, and 1,525 patients with a mean age of 74.07 years were recruited for the CG. Of these, 58.6% were female, without significant differences between groups. Pulse was irregular in 4.3 and 15.0% of the patients in the EG and the CG, respectively (P < .001). A total of 164 new cases of atrial fibrillation were detected (2.3%), 1.1% in the EG and 6.7% in the CG (adjusted OR: 0.29; 95% CI 0.18-0.45). Conclusions: Case finding for atrial fibrillation in patients aged ≥ 65 years with symptoms or signs suggestive of atrial fibrillation is a more effective strategy than opportunistic screening through pulse palpation in asymptomatic patients. Trial registration: The trial is registered in ClinicalTrials.gov (NCT01291953; February 8, 2011) (AU)

European Code Against Cancer: what does the Spanish population know and think about its recommendations?

The aim of this study was to evaluate the Spanish population's knowledge of and beliefs regarding the European Code Against Cancer (ECAC) recommendations. This was a cross-sectional, observational, multicentric study that used self-administered surveys. Ten individuals, between the ages of 15 and 69 years old, were enrolled by each participating primary care professional in their respective surgery consultations. This study used 2058 individuals who were recruited by 205 professionals from 106 health centres. Their average age was 41.5 years (52.2% women). The majority believe that smoking [94.1%; 95% confidence interval (CI): 93.1-95.2], sun exposure (91%; 95% CI: 89.7-92.3) and alcoholism (72.1%; 95% CI: 70.1-74.1) are factors related to cancer. The least relevant are infection by the hepatitis B virus (25.7%; 95% CI: 23.8-27.7) and having multiple sexual partners (25%; 95% CI: 23.1-26.9). In all, 86.7% (95% CI: 85.2-88.2) had never heard about the ECAC. Patients adequately identify the carcinogenic effect of tobacco, alcohol or sun exposure. Moreover, they inadequately identify having hepatitis B and multiple sexual partners as being related to cancer. A large majority of individuals have not heard of the ECAC, which raises the need to conduct outreach campaigns at an institutional level and/or through scientific associations and activities promoting health education among primary care professionals.

Valoración de la relación clínica centrada en el paciente: análisis de las propiedades psicométricas de la escala CICAA / Evaluation of the patient centered clinical relationship: analysis of psychometric properties using the CICAA scale

Objetivo: Analizar las propiedades psicométricas de una escala de valoración de la comunicación clínica centrada en el paciente. Diseño: Estudio observacional de validación de un instrumento de medida. Emplazamiento: Centros de salud y consultas externas hospitalarias. Participantes: Tres investigadores valoraron independientemente entrevistas videograbadas de diferentes submuestras: profesionales sanitarios (médicos residentes de medicina de familia, médicos de familia, médicos de atención especializada, enfermeras de atención primaria), pacientes reales que consultan por problemas de salud crónicos y agudos, y pacientes estandarizados. Mediciones principales: Dimensionalidad (análisis factorial exploratorio), consistencia interna (alfa de Cronbach), concordancia intraobservador e interobservador (índice kappa, coeficiente de correlación intraclase [CCI] y generalizabilidad), sensibilidad al cambio (prueba de la t de Student) y validez convergente con el cuestionario GATHA (coeficiente de correlación de Pearson). Resultados: Se han identificado 6 factores que explican el 66,0% de la varianza. La consistencia interna global del test fue α=0,94. La concordancia global intraobservador, medida con el CCI, osciló entre 0,94 y 0,97, mientras que la concordancia global interobservador estuvo entre 0,82 y 0,90. El número de cuestionarios a cumplimentar por evaluador para obtener una reproducibilidad adecuada (generalizabilidad) osciló entre 6 y 12. No se alcanzó significación estadística al comprobar la sensibilidad al cambio. La escala CICAA y el cuestionario GATHA presentaron una correlación de 0,67.ConclusionesLa escala CICAA es una herramienta genérica de valoración de la comunicación clínica centrada en el paciente que puede utilizarse en diferentes contextos y situaciones clínicas, ya que demuestra ser fiable, válida y eficiente (AU)

Objective: To analyse the psychometric properties by a scale for evaluating patient centered clinical communication. Design: Validation and observational study of a measurement tool.SettingHealth centres and hospital outpatient clinics.ParticipantsThree researchers independently evaluated video recorded interviews of different sub-samples: health professionals (family medicine medical residents, family doctors, specialist care physicians, and primary care nurses), actual patients who consulted for chronic or acute health problems, and standardised patients. Primary measurements Dimensionality (exploratory factor analysis), internal consistency (alpha de Cronbach), intra- and inter-observer agreement (Kappa index, intraclass correlation coefficient [ICC], generalisability), sensitivity to change (Student t test) and convergent validity with the GATHA questionnaire (Pearson correlation coefficient). Results: Six factors have been identified that explain 66.0% of the variance. The overall internal consistency of the test was α=0.94. The overall intra-observer agreement, measured with the ICC, varied between 0.94 and 0.97, whilst the inter-observer was between 0.82–0.90. The number of completed questionnaires required for the evaluator to obtain adequate reproducibility (generalisability) varied between 6 and 12. Statistical significance was not obtained when testing the sensitivity to change. The CICAA scale and the GATHA questionnaire had a correlation of 0.67.ConclusionsThe CICAA scale is a generic patient centered clinical communication evaluation tool that may be used in different clinical contexts and situations, since it has shown to be reliable, valid and efficient (AU)

[Evaluation of the patient centered clinical relationship: analysis of psychometric properties using the CICAA scale]. / Valoración de la relación clínica centrada en el paciente: análisis de las propiedades psicométricas de la escala CICAA.

OBJECTIVE: To analyse the psychometric properties by a scale for evaluating patient centered clinical communication. DESIGN: Validation and observational study of a measurement tool. SETTING: Health centres and hospital outpatient clinics. PARTICIPANTS: Three researchers independently evaluated video recorded interviews of different sub-samples: health professionals (family medicine medical residents, family doctors, specialist care physicians, and primary care nurses), actual patients who consulted for chronic or acute health problems, and standardised patients. PRIMARY MEASUREMENTS: Dimensionality (exploratory factor analysis), internal consistency (alpha de Cronbach), intra- and inter-observer agreement (Kappa index, intraclass correlation coefficient [ICC], generalisability), sensitivity to change (Student t test) and convergent validity with the GATHA questionnaire (Pearson correlation coefficient). RESULTS: Six factors have been identified that explain 66.0% of the variance. The overall internal consistency of the test was alpha=0.94. The overall intra-observer agreement, measured with the ICC, varied between 0.94 and 0.97, whilst the inter-observer was between 0.82-0.90. The number of completed questionnaires required for the evaluator to obtain adequate reproducibility (generalisability) varied between 6 and 12. Statistical significance was not obtained when testing the sensitivity to change. The CICAA scale and the GATHA questionnaire had a correlation of 0.67. CONCLUSIONS: The CICAA scale is a generic patient centered clinical communication evaluation tool that may be used in different clinical contexts and situations, since it has shown to be reliable, valid and efficient.

Efectividad de un curso de pregrado sobre medicina de familia. Validez y fiabilidad de un test de concordancia script / Effectiveness of a family medicine undergraduate course. Validity and reliability of a concordance script test

Introducción: La medicina de familia tiene una presencia cada vez más amplia en el pregrado, siendo necesario la exploración de las estrategias metodológicas, evaluativas y de aplicación práctica eficaces y aceptables. Objetivos: comprobar la efectividad de un curso de pregrado sobre los principales problemas clínicos de la medicina familiar. Conocer la validez y fiabilidad de un test para valorar la aplicación de los conocimientos a situaciones prácticas. Material y Métodos: estudio quasi-experimental "antes-después". Población de estudio: 20 estudiantes. Programa educativo: curso de 60 horas con objetivos en el área de conocimientos, razonamiento clínico, toma de decisiones y comunicación; metodología basada en problemas. Mediciones: preguntas de elección múltiple (PEM), simulaciones escritas (test "concordancia scripts" (CS) y pacientes estandarizados ("CC"). Diseñaron los tests de CS 10 médicos de familia (validez de consenso y aparente). Se valoró la comunicación clínica con un caso clínico común videograbado, de bajo nivel de dificultad representado por un paciente estandarizado utilizando el cuestionario GATHA. La satisfacción de los estudiantes con el curso fue medida con un cuestionario diseñado al efecto. Se midió la consistencia interna y la fiabilidad del test de CS. Resultados: Las diferencias entre las situaciones antes y después (Wilcoxon) fueron: PEM: 14,45ñ2,7 - 17,2ñ2,4 (p=0,003); CS: 15,97ñ1,56 -17,93ñ2,16 (p<0,0001) y CC: 14,45ñ3,8- 18,55ñ3,3 (p=0,001). El test de CS tenía un alfa de Cronbach de 0,96 y un Coeficiente de Correlación Intraclase de 0,7876. Alto grado de satisfacción con los contenidos teórico-prácticos, metodología y profesorado. Conclusiones: Curso factible y muy bien aceptado, los estudiantes mejoran significativamente no solo en conocimiento sino en la aplicación del mismo a situaciones prácticas y en habilidades de razonamiento clínico, toma de decisiones y comunicación después del curso. El test de CS es un test válido y fiable (AU)