ABSTRACT
INTRODUCTION: Cancer diagnosis in primary care is an important challenge for general practitioners (GPs) due to the relatively low frequency of any single type of cancer and the heterogeneous signs and symptoms that can be present. In addition to analytical reasoning, GPs may become aware of gut feelings (GFs) as they suspect that a patient may have cancer or another serious disease. We aimed to investigate the prevalence and the predictive value of GFs for the diagnosis of cancer and serious diseases. METHODS AND ANALYSIS: Prospective observational study of diagnostic validity. Participation will be offered to GPs from Majorca and Zaragoza (Spain). They will recruit all patients with a new reason for encounter during one or two workdays. GPs will complete the Gut Feelings Questionnaire (GFQ). Variables regarding patient, GP and consultation will be collected. Two and 6 months after the first visit, incident diagnoses of cancer or other serious diseases, diagnostic tests performed, referrals and new visits will be recorded. Analysis will include a descriptive analysis of the variables and prevalence of GFs, and the sensitivity, specificity, predictive values and likelihood ratios of the GFs (sense of alarm and sense of reassurance) for diagnosing cancer and other serious diseases, as measured with the GFQ. ETHICS AND DISSEMINATION: The study has obtained approval from the Majorcan Primary Care Research Committee and from the Balearic Islands Ethical Committee, with reference number IB 3210/16 PI. The results may help GPs to make more accurate decisions about which patients need further examinations to rule out or to confirm a diagnosis of cancer or a serious disease, and which ones do not. The results will be published as part of the PhD project of the first author and in open access journals, and will be presented at medical conferences.
Subject(s)
Attitude of Health Personnel , Clinical Decision-Making/methods , Early Detection of Cancer/methods , General Practitioners/psychology , Intuition , Neoplasms/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Clinical Protocols , Early Detection of Cancer/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neoplasms/psychology , Primary Health Care , Prospective Studies , Reproducibility of Results , Sensitivity and Specificity , Young AdultABSTRACT
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Subject(s)
Humans , Male , Female , Physicians, Family/ethics , Physicians, Family/psychology , Life Style/ethnology , Health Behavior/ethnology , Nurses, Community Health/ethics , Nurses, Community Health/psychology , Physicians, Family/classification , Physicians, Family/education , Life Style/history , Nurses, Community Health/education , Nurses, Community Health/standardsABSTRACT
OBJETIVOS: Valorar los conocimientos, percepciones, expectativas y actitudes de los profesionales de Atención Primaria (AP) de Mallorca sobre la autonomía de gestión. DISEÑO: Estudio descriptivo transversal, basado en un cuestionario ad hoc, anónimo, y distribuido de forma online, durante junio-julio del 2013. Emplazamiento: AP Mallorca. PARTICIPANTES: Profesionales asistenciales de AP (n = 1.097). Mediciones: Conocimientos sobre autogestión; competencias, requisitos y escenarios de futuro de los centros con autonomía de gestión (CAG); repercusión de la autogestión; disposición a asumir compromisos y riesgos, y a incorporarse a un CAG. RESULTADOS: Tasa de respuesta: 49,8% (546/1.097). El 10,9% mostró un alto nivel de conocimientos sobre autogestión, las principales competencias de un CAG fueron: capacidad de organización interna (87,5%) y de selección del personal (81,1%). Los futuros CAG se preveían con unos profesionales motivados e implicados (72,6%), resultados eficientes (66%), mayor calidad asistencial (59,4%) y mejor formación (52,8%). Los beneficios de la autogestión se consideraron importantes para los distintos profesionales y para la mejora de la AP de Mallorca (46,8%). Los principales requisitos de los CAG fueron disponer de directores capacitados (92,6%), sistemas de asignación presupuestaria (87,5%) y contratos de gestión adecuados (86,1%). Preferían que los CAG dependieran de la Administración (62,7%), y tenían interés personal en incorporarse a un CAG (56,9%), pero sin asumir excesivos compromisos (renuncia al régimen estatutario, riesgo económico). CONCLUSIONES: Estos datos aportan una información de gran importancia, hasta ahora desconocida, que puede contribuir a planificar con una mayor racionalidad y de forma participativa la puesta en marcha de CAG en nuestro medio
OBJECTIVES: To assess the knowledge, perceptions, expectations and attitudes of Primary Care (PC) professionals in Mallorca on managerial autonomy. DESIGN: Cross-sectional study based on an ad hoc, anonymous questionnaire, distributed online, from June-July 2013. LOCATION: PC Mallorca. PARTICIPANTS: PC healthcare professionals (n = 1,097). Measurements: Knowledge of self-management skills, requirements, and future scenarios of the centers with management autonomy (CMA); impact of self-management, commitment and willingness to take risks, and to become a CMA. RESULTS: Response rate: 49.8% (546/1097), with 10.9% showing a high level of knowledge of self-management. The core competencies of a CMA were internal organizational capacity (87.5%) and selection of staff (81.1%). The CMA future was envisaged with motivated and involved professionals (72.6%), efficient results (66%), better quality of care (59.4%), and better training (52.8%). The benefits of self-management were considered important, for individual practitioners and for the improvement of PC in Mallorca (46.8%). The main requirements of the CMA were to have: trained managers (92.6%), budget allocation systems (87.5%), and appropriate management contracts (86.1%). They preferred that the CMA should depend on the Administration (62.7%), and had a personal interest in becoming a CMA (56.9%), but without taking on excessive commitments (waiving statutory regime, financial risk). CONCLUSIONS: These data provide hitherto unknown information of great importance, which could contribute to a more rational planning and participatory implementation of CMA in our midst
Subject(s)
Humans , Male , Female , Primary Health Care/classification , Primary Health Care/ethics , Societies/history , Societies/policies , Health Management , Primary Health Care/economics , Primary Health Care , Societies/legislation & jurisprudence , Societies/methods , Health CentersSubject(s)
Alcoholism/prevention & control , Life Style , Physicians, Family , Smoking Prevention , HumansABSTRACT
OBJECTIVES: To assess the knowledge, perceptions, expectations and attitudes of Primary Care (PC) professionals in Mallorca on managerial autonomy. DESIGN: Cross-sectional study based on an ad hoc, anonymous questionnaire, distributed online, from June-July 2013. LOCATION: PC Mallorca. PARTICIPANTS: PC healthcare professionals (n=1,097). MEASUREMENTS: Knowledge of self-management skills, requirements, and future scenarios of the centers with management autonomy (CMA); impact of self-management, commitment and willingness to take risks, and to become a CMA. RESULTS: Response rate: 49.8% (546/1097), with 10.9% showing a high level of knowledge of self-management. The core competencies of a CMA were internal organizational capacity (87.5%) and selection of staff (81.1%). The CMA future was envisaged with motivated and involved professionals (72.6%), efficient results (66%), better quality of care (59.4%), and better training (52.8%). The benefits of self-management were considered important, for individual practitioners and for the improvement of PC in Mallorca (46.8%). The main requirements of the CMA were to have: trained managers (92.6%), budget allocation systems (87.5%), and appropriate management contracts (86.1%). They preferred that the CMA should depend on the Administration (62.7%), and had a personal interest in becoming a CMA (56.9%), but without taking on excessive commitments (waiving statutory regime, financial risk). CONCLUSIONS: These data provide hitherto unknown information of great importance, which could contribute to a more rational planning and participatory implementation of CMA in our midst.
Subject(s)
Health Personnel , Primary Health Care/organization & administration , Professional Autonomy , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Self Report , Spain , Young AdultABSTRACT
BACKGROUND: Lowering of blood pressure by antihypertensive drugs reduces the risks of cardiovascular events, stroke, and total mortality. However, poor adherence to antihypertensive medications reduces their effectiveness and increases the risk of adverse events. In terms of relative risk reduction, an improvement in medication adherence could be as effective as the development of a new drug. METHODS/DESIGN: The proposed randomized controlled trial will include patients with a low adherence to medication and uncontrolled blood pressure. The intervention group will receive a multifactorial intervention during the first, third, and ninth months, to improve adherence. This intervention will include motivational interviews, pill reminders, family support, blood pressure self-recording, and simplification of the dosing regimen. MEASUREMENT: The primary outcome is systolic blood pressure. The secondary outcomes are diastolic blood pressure, proportion of patients with adequately controlled blood pressure, and total cost. DISCUSSION: The trial will evaluate the impact of a multifactorial adherence intervention in routine clinical practice. Ethical approval was given by the Ethical Committee on Human Research of Balearic islands, Spain (approval number IB 969/08 PI).
