Best practice: quality assessment outcomes of the Practice Enhancement Program among family physicians in Saskatchewan, Canada.

Increased family physician workloads have strained primary care. The objective of this study was to describe the frequency and types of quality concerns identified among Saskatchewan's family physicians, changes in these concerns over time, associated physician characteristics, and recommendations made for improvement. In this repeated cross-sectional study (1997-2020), we examined family physician assessment reports from the Saskatchewan Practice Enhancement Program, a mandatory practice review strategy, for quality concerns on three outcomes: care, medical record, and facility. We recorded demographic and practice characteristics, the presence or absence of quality concerns, and the type of recommendations made. Concern incidence was calculated both overall and across subperiods, and three outcome-specific multiple logistic regression models were developed. Recommendations made were quantified, and their nature was evaluated using thematic analysis. Among 824 assessments, 20.8% identified concerns, with a statistically significant increase in 2015-20 over earlier years (14.2% versus 43.4%, P < .001). Corresponding proportions also significantly increased within each quality outcome (6.0%-37.1%, P < .001 for care concerns; 12.7%-19.6%, P = .03 for medical record concerns; 3.9%-21.0%, P < .001 for facility concerns). We found statistically significant adjusted associations between care concerns and both urban location [odds ratio (OR): 2.2; 95% confidence interval (CI): 1.30, 3.8] and international medical training (OR: 2.4; 95% CI: 1.34, 4.2); facility concerns and solo practice (OR: 2.5 95% CI: 1.10, 5.7); and medical record concerns and male gender (OR: 1.88; 95% CI: 1.09, 3.3), solo practice (OR: 1.67; 95% CI: 1.01, 2.7), and increased age. Reflecting a statistically significant interaction found between age as a continuous covariate and time period, older physicians were more likely to have a medical record concern in later years (OR: 1.072; 95% CI: 1.026, 1.120) compared to earlier ones (OR: 1.021; 95% CI: 1.001, 1.043). Among physicians where a concern was identified, recommendations most frequently pertained to documentation (91.2%), chronic disease management (78.2%), cumulative patient profiles (62.9%), laboratory investigations (53.5%), medications (51.8%), and emergency preparedness (51.2%). A concerning and increasing proportion of family physicians have quality gaps, with identifiable factors and recurring recommendations. These findings provide direction for strategic support development.

Safety considerations with the current ambulatory trends: more complicated procedures and more complicated patients.

In the last quarter of a century, the backdrop of appropriate ambulatory and office-based surgeries has changed dramatically. Procedures that were traditionally done in hospitals or patients being admitted after surgery are migrating to the outpatient setting and being discharged on the same day, respectively, at a remarkable rate. In the face of this exponential growth, anesthesiologists are constantly being challenged to maintain patient safety by understanding the appropriate patient selection, procedure, and surgical location. Recently published literature supports the trend of higher, more medically complex patients, and more complicated procedures shifting towards the outpatient arena. Several reasons that may account for this include cost incentives, advancement in anesthesia techniques, enhanced recovery after surgery (ERAS) protocols, and increased patient satisfaction. Anesthesiologists must understand that there is a lack of standardized state regulations regarding ambulatory surgery centers (ASCs) and office-based surgery (OBS) centers. Current and recently graduated anesthesiologists should be aware of the safety concerns related to the various non-hospital-based locations, the sustained growth and demand for anesthesia in the office, and the expansion of mobile anesthesia practices in the US in order to keep up and practice safely with the professional trends. Continuing procedural ambulatory shifts will require ongoing outcomes research, likely prospective in nature, on these novel outpatient procedures, in order to develop risk stratification and prediction models for the selection of the proper patient, procedure, and surgery location.

Design and Evaluation of an Electronic Information Exchange System Connecting Laboratories and Physicians' Offices.

Laboratory services are a crucial part of medical care and contribute to physicians' treatment-related decision-making. However, paper-based information exchanges between physicians' offices and laboratories waste physicians' time and prevent them from using outpatient test results in a timely and effective manner. To solve this problem, improve the safety and quality of patient care, and save patients' time and energy, the present study developed a web-based system for electronic information exchange between laboratories and offices in Microsoft Visual Studio with the ASP.net technology and the Microsoft SQL Server database. The developed web-based software met the needs of the users and stakeholders (physicians, laboratory personnel, and patients) in the laboratory service cycle. To evaluate the software, user satisfaction was assessed in terms of user interface, operational functionality, and system performance, indicating the acceptability of all the criteria from the viewpoint of the stakeholders. The developed web-based software enables electronic communication between offices and laboratories (two important healthcare bases), establishes information exchange (sending requests and receiving laboratory results) between these two bases, and also notifies the patients. The software gained the overall satisfaction of the users, and this highlights the need for electronic communications in the healthcare domain.

Finding Primary Care-Repurposing Physician Registration Data to Generate a Regionally Accurate List of Primary Care Clinics: Development and Validation of an Open-Source Algorithm.

BACKGROUND: Some Canadians have limited access to longitudinal primary care, despite its known advantages for population health. Current initiatives to transform primary care aim to increase access to team-based primary care clinics. However, many regions lack a reliable method to enumerate clinics, limiting estimates of clinical capacity and ongoing access gaps. A region-based complete clinic list is needed to effectively describe clinic characteristics and to compare primary care outcomes at the clinic level. OBJECTIVE: The objective of this study is to show how publicly available data sources, including the provincial physician license registry, can be used to generate a verifiable, region-wide list of primary care clinics in British Columbia, Canada, using a process named the Clinic List Algorithm (CLA). METHODS: The CLA has 10 steps: (1) collect data sets, (2) develop clinic inclusion and exclusion criteria, (3) process data sets, (4) consolidate data sets, (5) transform from list of physicians to initial list of clinics, (6) add additional metadata, (7) create working lists, (8) verify working lists, (9) consolidate working lists, and (10) adjust processing steps based on learnings. RESULTS: The College of Physicians and Surgeons of British Columbia Registry contained 13,726 physicians, at 2915 unique addresses, 6942 (50.58%) of whom were family physicians (FPs) licensed to practice in British Columbia. The CLA identified 1239 addresses where primary care was delivered by 4262 (61.39%) FPs. Of the included addresses, 84.50% (n=1047) were in urban locations, and there was a median of 2 (IQR 2-4, range 1-23) FPs at each unique address. CONCLUSIONS: The CLA provides a region-wide description of primary care clinics that improves on simple counts of primary care providers or self-report lists. It identifies the number and location of primary care clinics and excludes primary care providers who are likely not providing community-based primary care. Such information may be useful for estimates of capacity of primary care, as well as for policy planning and research in regions engaged in primary care evaluation or transformation.

Condiciones de empleo y precariedad laboral de los médicos de México: análisis basado en una encuesta nacional / Job conditions and precarious work among Mexican physicians: an analysis based on a national survey / Condições de emprego e precariedade laboral dos médicos do México: análise baseada em pesquisa nacional

El objetivo fue describir las características socioeconómicas y condiciones de empleo del personal médico en México. Estudio transversal con base en la Encuesta Nacional de Ocupación y Empleo (ENOE) de México, de los 4 trimestres de 2019 y el primer trimestre de 2020. Incluimos a todos los médicos con estudios universitarios concluidos. La variable precariedad laboral acumulada fue construida como la suma de cinco variables binarias relacionadas con el salario mínimo, jornada laboral, carencias de contrato, de seguridad y de prestaciones sociales. Con esta suma no ponderada, clasificamos las condiciones laborales en baja (1), media (2 a 3), alta (4 a 5), y ausencia de precariedad laboral (0). En el sector público, 13,4% y 3,3% de los médicos tienen precariedad laboral media y alta, respectivamente; los porcentajes son mayores en el sector privado, 38,5% y 7,7% (p < 0,01), respectivamente, debido principalmente a las carencias de contrato escrito y seguro médico. Estas condiciones se exacerban en las mujeres que trabajan en los consultorios médicos de las empresas del sector privado donde 75,2% y 6% de ellas tienen precariedad media y alta, respectivamente, mientras que en los hombres los porcentajes son 15,6 y 7,7%, respectivamente, (p < 0,01). Existe precariedad laboral en el sector salud mexicano; las condiciones laborales de los médicos del sector privado son más precarias que en el sector público, particularmente en los consultorios del sector privado, donde las mujeres están más expuestas a empleos precarios.

The study aimed to describe the socioeconomic characteristics and job conditions of medical personnel in Mexico. This was a cross-sectional study based on the Mexican National Occupational and Employment Survey (ENOE) for all four quarters of 2019 and the first quarter of 2020. We included all physicians who had concluded their university training. The variable "cumulative precarious labor" was constructed as the sum of five binary variables related to minimum wage, workweek, and lack of employment contract, job security, and labor benefits. Using this unweighted sum, we classified their labor conditions as absence of (0) or low (1), medium (2 to 3), or high (4 to 5) precarious labor. In the public sector, 13.4% and 3.3% of physicians were engaged in medium or high precarious labor, respectively; the percentages were higher in the private sector, with 38.5% and 7.7% (p < 0.01), respectively, due mainly to the lack of formal contracts and medical insurance. These conditions were exacerbated in women working in medical offices in private-sector companies, where 75.2% and 6% worked in medium or high precarious conditions, respectively, while the proportions in men were 15.6% and 7.7%, respectively (p < 0.01). Precarious labor exists in the Mexican health sector; labor conditions for physicians are more precious in the private sector than in the public sector, especially in private-sector offices where female physicians are more exposed to precarious employment.

O objetivo era descrever as características socioeconômicas e as condições de emprego dos médicos no México. Estudo transversal com base na Pesquisa Nacional de Ocupação e Emprego (ENOE) do México, nos quatro trimestres de 2019 e no primeiro trimestre de 2020. Incluímos todos os médicos com estudos universitários concluídos. A variável da precariedade laboral acumulada foi construída como a soma de cinco variáveis binárias relacionadas com o piso salarial, a jornada de trabalho, a falta de contrato, segurança e benefícios sociais. Com esta soma não ponderada, classificamos as condições de trabalho em baixa (1), média (2 a 3), alta (4 a 5), e ausência de precariedade laboral (0). No setor público, 13,4% e 3,3% dos médicos estão em situação de precariedade laboral média e alta, respectivamente; os percentuais são mais elevados no setor privado, com 38,5% e 7,7% (p < 0,01), respectivamente, devido principalmente à inexistência de contrato escrito e de seguro médico. Estas condições se agravam para as mulheres que trabalham nos consultórios médicos das empresas do setor privado, onde 75,2% e 6% delas sofrem precariedade média e alta, respectivamente, ao passo que para os homens, os percentuais são de 15,6% e 7,7%, respectivamente, (p < 0,01). Existe precariedade laboral no setor da saúde mexicano; as condições de trabalho dos médicos do setor privado são mais precárias do que no setor público, em especial, nos consultórios do setor privado onde as mulheres estão mais expostas a empregos precários.

Intervención de enfermería sobre conocimientos de dengue sustentada en la teoría de Swanson / Nursing intervention on knowledge about dengue based on Swanson's theory

RESUMEN Fundamento: la infección del dengue puede cursar en forma asintomática o expresarse con un espectro clínico amplio que incluye las expresiones graves y las no graves. Objetivo: evaluar la intervención de Enfermería sobre conocimientos en dengue sustentada en la teoría de Swanson. Métodos: investigación cuantitativa de diseño pre experimental con pre y post test, contextualizada en el consultorio del médico y enfermera de la familia No. 5 del Policlínico Dr. Rudesindo Antonio García del Rijo del municipio y provincia Sancti Spíritus, desde noviembre 2018 a noviembre de 2019. Variables de estudio: nivel de conocimientos de los pacientes sobre dengue, edad, sexo, escolaridad. Se utilizó entrevista estructurada a los pacientes, para conocer el conocimiento sobre la enfermedad, después de aplicada la intervención se compararon las proporciones poblacionales mediante Prueba de McNemar. Resultados: el grupo más representativo estuvo comprendido entre las edades de 45-54 años y de sexo masculino. El nivel de escolaridad secundaria terminada representa la mayor cantidad de individuos. Una vez concluidas las actividades educativas los pacientes incluidos en la investigación alcanzaron resultados adecuados. Los resultados obtenidos son alentadores, se elevó el nivel de conocimientos de los pacientes después de la intervención. Conclusiones: la intervención de enfermería resultó efectiva en el incremento del nivel de conocimientos sobre dengue en pacientes de un consultorio médico de la familia.

ABSTRACT Background: Dengue infection can be asymptomatic or express itself with a broad clinical spectrum that includes severe and non-severe expressions. Objective: to evaluate the Nursing intervention on knowledge in dengue based on Swanson's theory. Methods: quantitative research of pre-experimental design with pre and post test, contextualized in the Family Physician and Nurse Office No. 5 of the Dr. Rudesindo Antonio García del Rijo Polyclinic of the municipality and province of Sancti Spíritus, in the period of November 2018 to November 2019. Study variables: level of knowledge of patients about dengue, age, sex, education. A structured interview with the patients was used to learn about the knowledge about the disease. After the intervention was applied, the population proportions were compared using the McNemar test. Results: the most representative group was between the ages of 45-54 years and male sex. The level of completed secondary schooling represents the largest number of individuals. Once the educational activities were completed, the patients included in the research achieved adequate results. The results obtained are encouraging, significantly raising the level of knowledge of the patients after the intervention. Conclusions: the nursing intervention was effective in increasing the level of knowledge about dengue in patients from a family doctor's office.

Waiting time and medical consultation length in Manaus metropolitan region, Brazil: a cross-sectional, population-based study, 2015 / Tiempo de espera y duración de la consulta médica en la región metropolitana de Manaus, Brasil: estudio transversal de base poblacional, 2015 / Tempo de espera e duração da consulta médica na região metropolitana de Manaus, Brasil: estudo transversal de base populacional, 2015

Objective. To analyze the waiting time and the duration of medical consultations in Manaus metropolitan region, Brazil. Methods. Cross-sectional study conducted with adults living in the region in 2015. The waiting time for consultation and the duration of the consultation in minutes were self-reported by the participants. The analysis was performed by Tobit regression and weighted by the complex design. Results. 4,001 individuals were interviewed. The average waiting time was 125.4 minutes (95%CI 120.2;130.5), while consultation lasted an average of 52.5 minutes (95%CI 48.0;57.0). Women, poor people, low-educated people, indigenous individuals, countryside residents, people without health insurance, and individuals consulted by gynecologists waited longer for the consultation (p <0.05). Consultation time was shorter with non-white people, with poor health status and with health insurance (p <0.05). Conclusion. The length of the medical consultation was on average half the waiting time. Social inequalities were observed in these times.

Objetivo. Analisar o tempo de espera e a duração de consulta médica na região metropolitana de Manaus, Brasil. Métodos. Estudo transversal, realizado com adultos residentes na região em 2015. O tempo de espera para consulta e a duração da consulta, em minutos, foram referidos pelos participantes. A análise foi realizada por regressão de Tobit e ponderada pelo desenho amostral. Resultados. Foram entrevistados 4.001 indivíduos. O tempo médio de espera foi de 125,4 minutos (IC95%120,2;130,5), enquanto a consulta durou, em média, 52,5 minutos (IC95%48,0;57,0). Mulheres, pessoas pobres, pessoas com baixa escolaridade, indígenas, residentes em municípios do interior, sem seguro de saúde e atendidos por ginecologistas esperaram mais pela consulta (p<0,05). O tempo de consulta foi menor em pessoas não brancas, com estado de saúde ruim e com plano de saúde (p<0,05). Conclusão. A consulta médica durou, em média, metade do tempo de espera. Observaram-se iniquidades sociais nesses períodos de tempo.

Efecto de un programa de educación diabetológica en pacientes adultos de la consulta ambulatoria en un hospital nacional peruano / Effect of a diabetes education program on adult patients in the outpatient clinic of a peruvian national hospital

RESUMEN Introducción. La diabetes tipo 2 es un problema de salud pública cuyo manejo es muy complejo, reconociéndose múltiples problemas y limitaciones para un adecuado control de la enfermedad. Objetivo. Determinar el efecto de un programa educativo añadido al tratamiento habitual, en el control de los pacientes con diabetes tipo 2 de la consulta especializada ambulatoria en un hospital nacional peruano. Métodos. Se realizó un estudio longitudinal analítico de tres meses de seguimiento, cincuenta pacientes consecutivos con diabetes tipo 2 no controlada que se atendían en la consulta ambulatoria del servicio de endocrinología aceptaron participar voluntariamente en las 4 sesiones grupales (5-8 participantes, 1sesión/semana). Se aseguró la disponibilidad de la medicación antidiabética, así como el mantenimiento de las dosis farmacológicas prescritas desde tres meses antes de la intervención y durante el periodo de seguimiento. Se determinaron los cambios en los niveles de HbA1c, glicemia en ayunas y perfil lipídico, antes y 3 meses después de la intervención. Resultados. Del total de pacientes que aceptaron participar, 41 completaron todas las sesiones y sus resultados fueron analizados. La cuarta parte eran varones. Luego de los tres meses de la intervención educativa, la HbA1c disminuyó -1,7%, la glicemia en ayunas -59mg/dL y el colesterol LDL -23mg/Dl, siendo los cambios significativos en los grupos de mayores de 45 años y con más de 5 años de diagnóstico. Conclusiones. El programa de educación diabetológica, añadido al manejo habitual, tuvo un efecto beneficioso temprano en el control de los pacientes con diabetes tipo 2 en un hospital nacional peruano.

ABSTRACT Introduction. Type 2 diabetes is a public health problem whose management is very complex, recognizing multiple problems and limitations for an adequate control of the disease. Objective. To determine the effect of educational program added to the usual treatment, in the control of patients with type 2 diabetes in a peruvian national hospital. Methods. A longitudinal analytical study of three months of follow-up was conducted. Fifty consecutive patients with uncontrolled type 2 diabetes who were treated in the outpatient clinical of the endocrinology service agreed to voluntarily participate in the four sessions in groups of 5-8 participants (1session/week). The availability of antidiabetic medication was assured, as well as the maintenance of the prescribed pharmacological doses from three months before the intervention and during the follow-up period. Changes in HbA1c levels, fasting blood glucose and lipid profile were determined before and 3 months after the intervention. Results. Of the total of patients who agreed to participate, 41 completed all sessions and their results were analyzed. The fourth part were males. After three months of the educational intervention: HbA1c decreased -1,7%, fasting blood glucose -59mg/dL and LDL cholesterol -23mg/dL; being the significant changes in the groups of over 45 years and with more than 5 years of diagnosis. Conclusions. The diabetes educational program added to the usual management had an early beneficial effect in the control of patients with type 2 diabetes in a peruvian national hospital.

Tempo de espera e duração da consulta médica na região metropolitana de Manaus, Brasil: estudo transversal de base populacional, 2015 / Tiempo de espera y duración de la consulta médica en la región metropolitana de Manaus, Brasil: estudio transversal de base poblacional, 2015 / Waiting time and medical consultation length in the Manaus metropolitan region, Brazil: a cross-sectional, population-based study, 2015

Objetivo; Analisar o tempo de espera e a duração de consulta médica na região metropolitana de Manaus, Brasil. Métodos: Estudo transversal, realizado com adultos residentes na região em 2015. O tempo de espera para consulta e a duração da consulta, em minutos, foram referidos pelos participantes. A análise foi realizada por regressão de Tobit e ponderada pelo desenho amostral. Resultados: Foram entrevistados 4.001 indivíduos. O tempo médio de espera foi de 125,4 minutos (IC95% 120,2;130,5), enquanto a consulta durou, em média, 52,5 minutos (IC95% 48,0;57,0). Mulheres, pessoas pobres, pessoas com baixa escolaridade, indígenas, residentes em municípios do interior, sem seguro de saúde e atendidos por ginecologistas esperaram mais pela consulta (p<0,05). O tempo de consulta foi menor em pessoas não brancas, com estado de saúde ruim e com plano de saúde (p<0,05). Conclusão: A consulta médica durou, em média, metade do tempo de espera. Observaram-se iniquidades sociais nesses períodos de tempo.

Objetivo: Analizar el tiempo de espera y la duración de la consulta médica en la región metropolitana de Manaus, Brasil. Métodos: Estudio transversal realizado con adultos que viven en la región en 2015. El tiempo de espera y la duración de la consulta en minutos fueron informados por los participantes. El análisis se realizó mediante regresión de Tobit y ponderado por el diseño amostral. Resultados: 4,001 personas fueron entrevistadas. El tiempo de espera promedio fue de 125,4 minutos (IC95% 120,2;130,5) y la consulta duró un promedio de 52,5 minutos (IC95% 48.0;57.0). Mujeres, personas pobres, con baja educación, indígenas, residentes del interior, sin seguro médico y atendidas por ginecólogos esperaron más tiempo para la consulta (p<0.05). El tiempo de consulta fue más corto con personas no blancas, con mala salud y con seguro de salud (p<0.05). Conclusión: La duración de la consulta médica fue, en promedio, la mitad del tiempo de espera. Se observaron desigualdades sociales en estes tiempos.

Objective: To assess waiting times and length of medical consultations in the Manaus metropolitan region, Brazil. Methods:This was a cross-sectional study conducted with adults living in the region in 2015. Waiting time for consultation and length of consultation in minutes were reported by the participants. Analysis was performed using Tobit regression and weighted by the sample design. Results: 4,001 individuals were interviewed. Average waiting time was 125.4 minutes (95%CI 120.2;130.5), while consultations lasted an average of 52.5 minutes (95%CI 48.0;57.0). Women, poor people, people with less education, indigenous people, people resident in the state interior, people without health insurance, and individuals seen by gynecologists waited longer for their consultation (p <0.05). Consultation time was shorter for non-White people, those with poor health status and those who had health insurance (p <0.05). Conclusion: On average length of medical consultations was half the waiting time. Social inequalities were observed in these lengths of time.

Understanding the Situated Roles of Electronic Medical Record Systems to Enable Redesign: Mixed Methods Study.

BACKGROUND: Redesigning electronic medical record (EMR) systems is needed to improve their usability and usefulness. Similar to other artifacts, EMR systems can evolve with time and exhibit situated roles. Situated roles refer to the ways in which a system is appropriated by its users, that is, the unintended ways the users engage with, relate to, and perceive the system in its context of use. These situated roles are usually unknown to the designers as they emerge and evolve as a response by the users to a contextual need or constraint. Understanding the system's situated roles can expose the unarticulated needs of the users and enable redesign opportunities. OBJECTIVE: This study aimed to find EMR redesign opportunities by understanding the situated roles of EMR systems in prenatal care settings. METHODS: We conducted a field-based observational study at a Japanese prenatal care clinic. We observed 3 obstetricians and 6 midwives providing prenatal care to 37 pregnant women. We looked at how the EMR system is used during the checkups. We analyzed the observational data following a thematic analysis approach and identified the situated roles of the EMR system. Finally, we administered a survey to 5 obstetricians and 10 midwives to validate our results and understand the attitudes of the prenatal care staff regarding the situated roles of the EMR system. RESULTS: We identified 10 distinct situated roles that EMR systems play in prenatal care settings. Among them, 4 roles were regarded as favorable as most users wanted to experience them more frequently, and 4 roles were regarded as unfavorable as most users wanted to experience them less frequently; 2 ambivalent roles highlighted the providers' reluctance to document sensitive psychosocial information in the EMR and their use of the EMR system as an accomplice to pause communication during the checkups. To improve the usability and usefulness of EMR systems, designers can amplify the favorable roles and minimize the unfavorable roles. Our results also showed that obstetricians and midwives may have different experiences, wants, and priorities regarding the use of the EMR system. CONCLUSIONS: Currently, EMR systems are mainly viewed as tools that support the clinical workflow. Redesigning EMR systems is needed to amplify their roles as communication support tools. Our results provided multiple EMR redesign opportunities to improve the usability and usefulness of EMR systems in prenatal care. Designers can use the results to guide their EMR redesign activities and align them with the users' wants and priorities. The biggest challenge is to redesign EMR systems in a way that amplifies their favorable roles for all the stakeholders concurrently.

Shifting Implementation Science Theory to Empower Primary Care Practices.

Observers of the past 10 to 15 years have witnessed the simultaneous growth of dramatic changes in the practice of primary care and the emergence of a new field of dissemination and implementation science (D&I). Most current implementation science research in primary care assumes practices are not meeting externally derived standards and need external support to meet these demands. After a decade of initiatives, many stakeholders now question the return on their investments. Overall improvements in quality metrics, utilization cost savings, and patient experience have been less than anticipated. While recently conducting a research project in primary care practices, we unexpectedly discovered 3 practices that profoundly shifted our thinking about the sources and directionality of practice change and the underlying assumptions of D&I. Inspired by these practices-along with systems thinking, complexity theory, action research, and the collaborative approaches of community-based participatory research-we propose a reimagining of D&I theory to empower practices. We shift the emphasis regarding the source and direction of change from outside-in to inside-out Such a shift has the potential to open a new frontier in the science of dissemination and implementation and inform better health policy.

Identificación de familias aterovulnerables en un consultorio médico de la Atención Primaria de Salud / Identification of Atherovulnarable Families in Doctor's Office at the Primary Health Care Level

Fundamento: Las enfermedades cardiovasculares se reconocen como un importante problema de salud pública en muchos países en desarrollo y Cuba no es una excepción; la Aterosclerosis es la principal causa de las llamadas "Grandes Crisis Ateroscleróticas". Objetivo: identificar familias aterovulnerables utilizando una tabla cualitativa, buscando señales tempranas y tardías de aterosclerosis, en un consultorio de la atención primaria de salud. Método: Se realizó un estudio explicativo, descriptivo y transversal en una población urbana perteneciente al área de salud Policlínico Docente Dr. Mario Muñoz Monroy, Municipio La Habana del Este, provincia La Habana. Se estudiaron 150 familias con todos sus integrantes (niños a partir de cinco años, adolescentes, jóvenes y adultos) para un total de 465 individuos. Resultados fundamentales: Se encontraron 110 Señales Tempranas de Aterosclerosis en 148 de los individuos trabajados, lo que representó un 74,32 %. Se encontraron 258 señales tardías de aterosclerosis para un 81,38 %. Prevalece el sobrepeso y la obesidad como el factor de riesgo más sobresaliente, seguido de la hipertensión arterial. Existen 15 familias consideradas de muy alta prioridad y 37 familias catalogadas de alta prioridad. Conclusión: El estudio en familias completas, explorando señales tempranas y tardías de aterosclerosis y la utilización de la tabla cualitativa propuesta como una matriz para estratificar a las familias aterovulnerables se puede convertir en una herramienta salubrista eficaz para el equipo básico de salud.

Foundation: cardiovascular diseases are identified as an important public health problem in many countries in development and Cuba is not exempted, atherosclerosis is the main cause of the so called great atherosclerotic crisis. Objective: to use a qualitative table for identifying self-vulnerable families, to look for early and late sings of atherosclerosis, in a doctor's office of the primary health care level. Method: a cross descriptive study was realized in an urban population belonging to the Teaching Polyclinic Dr. Mario Muñoz Monroy, of East Havana. A number of 150 families were studied with all their members for a total of 465 individuals. The study was approached in the period from June 1st to December 31st 2016. The presence of early or subclinical signs of atherosclerosis in children, adolescents and youngsters under 34 years old; other factor were explored as High blood pressure, diabetes mellitus, tobbaccoism, overweightness, obesity and sedentarism. Results: early signs of atherosclerosis were found in 148 of the individuals analyzed which represents 74,32 %. Risk factors of atherosclerosis were found in 317 of the studied adults. Overweightness and obesity prevailed as the most outstanding risk factors, followed by high blood pressure. Fifteen families are considered of a very high priority and 37 families of high priority. Conclusion: complete family study, allows determining early signs and risk factors of atherosclerosis. The use of a qualitative table proposed as a matrix to stratify self-vulnerable families may become an important tool for the basic health group.

Calidad de la receta médica en dos hospitales de Lambayeque y su influencia en la comprensión de la información brindada / Quality of medical prescriptions in two Lambayeque hospitals and its influence in understanding the written information

Objetivos: Estimar la frecuencia de recetas médicas con información completa que se entregan en consulta externa de dos hospitales. Estimar la proporción de pacientes que no comprenden la receta médica en consulta externa de dos hospitales. Materiales y métodos: Estudio descriptivo, observacional, cuantitativo. Se realizó un muestreo en 2 etapas, para la primera se eligieron los 4 servicios con mayor flujo de pacientes, se utilizó muestreo sistemático para la elección de pacientes. Participaron 635 pacientes que acudieron a consulta externa del Hospital Regional Docente Las Mercedes y Hospital Nacional Almanzor Aguinaga Asenjo. Resultados: el 100% de las recetas tenían algún tipo de omisión. El 52,60% del total de los pacientes no entendieron la letra del prescriptor en la receta, las que sirvieron para evaluar la comprensión de la información de la receta resultando que solo el 1,10% de todos los pacientes comprendieron completamente la información acerca de su tratamiento. Conclusiones: El total de las recetas evaluadas presentó información incompleta, por tal motivo, un bajo porcentaje de pacientes que comprendieron las recetas, produciendo un gran desconocimiento por parte de los pacientes acerca de sus tratamientos, por tal motivo los establecimientos públicos de esta investigación deberian realizar una capacitación a través de talleres al personal de salud involucrado en el proceso de atención a los usuarios

Objectives: To estimate the rate of medical prescriptions with complete information issued in the outpatient clinics of two hospitals. To estimate the proportion of patients who do not understand the medical prescriptions in the outpatient clinics of two hospitals. Materials and Methods: This is a descriptive, observational, and quantitative study. A two-stage sampling was carried out. In the first stage, the four services with the largest patient flow were selected, systematic sampling was used for patient selection. There were 635 patients attending the outpatient clinics in Las Mercedes Regional teaching Hospital and Almanzor Aguinaga-Asenjo National Hospital who participated in the study. Results: One-hundred percent (100%) of all prescriptions had some type of omission. More than half (52.60%) of patients were not able to understand the prescriptor writing; and, when assessing understanding the information written on the prescription, it was found that only 1.10% of all patients completely understood the information about their therapy. Conclusions: All the assessed prescriptions had incomplete information, leading to a low percentage of patients understanding prescriptions, and consequently, most patients did not know what their therapy was all about. For this reason, public health facilities should have training workshops for healthcare personnel who are involved in taking care of patients

Avaliação quantitativa da cobertura assistencial médica básica e especializada no município de Caratinga ­ MG / Quantitative assessment of basic and specialized medical assistance coverage in the city of Caratinga -MG

Avaliou-se o quantitativo inerente à cobertura assistencial médica, básica e especializada do município de Caratinga-MG, no período de setembro de 2014 a agosto de 2015. Estudo observacional transversal. Os elementos referenciados foram avaliados por meio de dados secundários do sistema de informação ambulatorial SIA/SUS, referente às 23 equipes da Estratégia Saúde da Família, agregados no seguinte perfil de pacientes: menores de 01 ano, 01 a 04, 05 a 14, 15 a 44, 45 a 59 anos e de 60 anos ou mais. Posteriormente foram avaliados os encaminhamentos aos atendimentos especializados, sendo submetidos a uma análise de parâmetros, de acordo com a Portaria 1101/02 do Ministério da Saúde. Os dados foram calculados através das frequências absolutas e relativas, média e desvio-padrão. Na avaliação para a média e desvio-padrão os resultados apontaram para um superávit nas consultas médicas básicas para os pacientes acima de 60 anos (m=905,4 e dp=347,4), e um déficit no cumprimento dos parâmetros nas consultas médicas básicas das demais faixas etárias: menores de 01 ano (m=101,4 e dp=50,4), 01 a 04 anos (m=191,4 e dp=54,3), 05 a 14 anos (m=375,8 e dp=93,7) e 15 a 59 anos (m=2.200 e dp=533,7). Os encaminhamentos aos atendimentos especializados também apresentaram déficit (m=380,2 e dp=234,2). A cobertura assistencial de consulta médica básica e de encaminhamento ao atendimento especializado no município de Caratinga-MG apresentou um percentual inferior aos parâmetros preconizados pelo Ministério da Saúde, com atendimento em apenas uma faixa etária.

The quantitative of medical, basic and specialized health care coverage was evaluated in the city of Caratinga-MG from September 2014 to August 2015. It is an observational research. The referenced elements were evaluated through secondary data from the outpatient information system - SIA / SUS referring to the 23 teams of the Family Health Strategy, aggregated in the following patients profile: under 1 year, from 01 to 04 years, from 05 to 14 years, 15 to 44 years, 45 to 59 years and 60 years or more. Subsequently, the referrals to the specialized services were evaluated, being submitted to a parameter analysis, in accordance with Ministry of Health Ordinance 1101/02. Data were calculated through the absolute and relative frequencies, mean and standard deviation. In the evaluation for the mean and standard deviation the results pointed to a surplus in basic medical appointments for patients over 60 years (m = 905.4 and dp = 347.4), and a deficit in compliance with the parameters in the basic medical visits (M = 101.4 and dp = 50.4), 01 to 04 years (m = 191.4 and dp = 54.3), 05 to 14 years (m = 375, 8 and dp = 93.7) and 15 to 59 years (m = 2,200 and dp = 533.7). Referrals to specialized care also presented a deficit of (m = 380.2 and dp = 234.2). The assistance coverage of basic medical consultation and referral to specialized care in the city of Caratinga-MG presented a percentage lower than the parameters recommended by the Ministry of Health.

Alfabetización sanitaria y factores relacionados en pacientes que acuden a consulta externa de Medicina Interna en un Hospital Nacional en Lima, Perú / Health literacy and associated factors in patients attending the Outpatient Internal Medicine Service of a national hospital of Lima, Peru

RESUMEN Objetivo Determinar el nivel de alfabetización sanitaria en pacientes de consultorio externo de Medicina Interna de un Hospital Nacional de Lima-Perú en marzo del 2014, determinando factores asociados para una inadecuada alfabetización sanitaria. Materiales y Métodos Estudio descriptivo. Se utilizó el Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) previa validación cultural parcial: Opinión de expertos y medición del coeficiente de correlación. Posteriormente se aplicó en una muestra de 363 pacientes seleccionados mediante muestreo aleatorio simple sistematizado. Resultados Para la validación cultural parcial se modificaron 17 ítems del test original y se obtuvo el coeficiente de Pearson r=0,81. Luego de la validación cultural se aplicó el test, obteniéndose: 73,3 % mujeres, el 14,0% adultos mayores. El 52,6 % tuvo grado de instrucción secundaria. El 35,3 % están afiliados al Seguro Integral de Salud. El 15,20 % no acudió a un establecimiento de salud durante el último año. Las variables: adulto mayor, menor grado de instrucción, tener cobertura de Seguro Integral de Salud (SIS) y menor número de visitas a un establecimiento de salud en el último año tienen asociación significativa respecto a un inadecuado nivel de alfabetización sanitaria (p<0.05). Conclusiones El 34,4 % de pacientes que acudieron a consultorio externo de Medicina Interna del Hospital Nacional Arzobispo Loayza tuvieron una inadecuada alfabetización sanitaria. Variables como: adulto mayor, menor grado de instrucción, tener cobertura de SIS y no acudir a un establecimiento de salud en el último año tienen asociación significativa respecto a una inadecuada alfabetización sanitaria.(AU)

ABSTRACT Objective To determine health literacy in patients attending the Outpatient Internal Medicine Service of a national hospital of Lima, Peru, in March 2014 in order to establish factors associated with inadequate health literacy. Materials and Methods Descriptive study. The Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) was used after partial cultural validation. Expert opinion and measurement of the correlation coefficient were considered. Subsequently, the test was applied in a sample of 363 patients selected by simple systematic random sampling. Results For partial cultural validation, 17 items of the original test were modified and a Pearson correlation coefficient of r=0.81 was obtained. After cultural validation, the test was applied, finding that 73.3 % were women, 14.0 % were seniors, and 52.6 % completed high school. Furthermore, 35.3 % were affiliated to health insurance subsidized by the government (Comprehensive Health Insurance or SIS by its acronym in Spanish). 15.20 % did not use any health service during the past year and 34.4 % had inadequate health literacy. Variables such as senior age, poor education, SIS insurance and fewer visits to health services within the past year have a significant association with inadequate levels of health literacy (p<0.05). Conclusions One third of patients attending the Outpatient Internal Medicine Service of the Hospital Nacional Arzobispo Loayza had inadequate health literacy. Variables such as senior age, poor education, SIS insurance and fewer visits to health services within the past year have a significant association with inadequate levels of health literacy.(AU)

[Working conditions in outpatient clinics adjacent to private pharmacies in Mexico City: perspective of physicians]. / Condiciones de trabajo en consultorios adyacentes a farmacias privadas en Ciudad de México: perspectiva del personal médico.

OBJECTIVE: To analyse the working conditions of physicians in outpatient clinics adjacent to pharmacies (CAFs) and their organizational elements from their own perspective. METHODS: We carried out an exploratory qualitative study. Semi-structured interviews were conducted with 32 CAF physicians in Mexico City. A directed content analysis technique was used based on previously built and emerging codes which were related to the experience of the subjects in their work. RESULTS: Respondents perceive that work in CAFs does not meet professional expectations due to low pay, informality in the recruitment process and the absence of minimum labour guarantees. This prevents them from enjoying the benefits associated with formal employment, and sustains their desire to work in CAF only temporarily. They believe that economic incentives related to number of consultations, procedures and sales attained by the pharmacy allow them to increase their income without influencing their prescriptive behaviour. They express that the monitoring systems and pressure exerted on CAFs seek to affect their autonomy, pushing them to enhance the sales of medicines in the pharmacy. CONCLUSIONS: Physicians working in CAFs face a difficult employment situation. The managerial elements used to induce prescription and enhance pharmacy sales create a work environment that generates challenges for regulation and underlines the need to monitor the services provided at these clinics and the possible risk for users.

Utilización de la informática en la organización de un consultorio del médico de la familia / Arrangement of a Family Doctor's and Nurse's Office using the information technology

Introducción: la informática puede servir de aliada para el trabajo organizativo en los consultorios del médico y la enfermera de la familia. Objetivo: comprobar que el uso de la informática mejora la organización y la calidad de la documentación del consultorio del médico y la enfermera de la familia. Material y método: se realizó una investigación desarrollo del 1ro de noviembre de 2011 al 1ro de febrero de 2012, en el consultorio número 16 del Policlínico Universitario "Hermanos Cruz" de la provincia de Pinar del Río. Lla población de estudio la constituyeron los 753 pacientes dispensarizados en dicho consultorio, los que se encuentran distribuidos en 229 familias. Resultados: con la aplicación de la informática se actualizaron las historias de salud familiar en el consultorio, se señalizaron las historias clínicas y se organizaron por orden alfabético en cada edificio. También se alcanzó el 100% de presencia de historias clínicas, y se obtuvieron los listados estadísticos que facilitan el trabajo del médico y la enfermera de la familia. Conclusiones: la aplicación de la informática permitió un mejor cumplimiento de las funciones del equipo básico de salud.

Introduction: information technology can be an allied to carry out the arrangement and documents in a Family Doctor's and Nurse's Office. Objective: to verify that, the use of information technology improves the organization and the quality of documents in the Family Doctor's and Nurse's Office. Material and Method: a research of development was conducted from November 1st, 2011 to February 1st, 2012 at No-16 Family Doctor's and Nurse's Office belonging to "Hermanos Cruz" University Outpatient Clinic in Pinar del Rio municipality. The population studied was comprised of 753 patients from the mentioned Family Doctor's and Nurse's Office, who were distributed in 229 families. Results: with the application of information technology, health-family history was updated and it was possible to signal and arranged them in alphabetic order for each building, getting the 100% of these clinical histories. Statistical records that facilitate the job of Family Doctors and Nurses were as well achieved. Conclusions: the application of information technology allowed a superior completion of work for the basic team of family doctors and nurses.

Comparison of waiting and consultation times in convenient care clinics and physician offices: a cross-sectional study.

This study measures waiting times and consultation times at convenient care clinics (CCCs), and compares them with equivalent times in traditional, family practice, physician offices. The analysis was limited to conditions most commonly treated at CCCs. It was found that patients using CCCs had significantly shorter waiting times from check-in to seeing a clinician than the equivalent waiting times reported by patients at family practice physicians' offices and that CCC patients had significantly longer consultation times with the clinician than those reported by family practice patients. Applying a correction factor to adjust for potential differences between real waiting times and perceived waiting times did not substantially alter the conclusions. Shorter waiting times may increase satisfaction and thereby encourage patients to seek care; and spending additional time with the clinician may help ensure that all of a patient's concerns or questions are addressed. This study provides objective evidence from a large database that CCCs provide prompt, satisfying care.

Gestión investigativo laboral para estudiantes de la carrera de medicina en el consultorio. Estudio preliminar / Working investigative management for medical students at the medical office: a preliminary study

RESUMEN Con el objetivo de identificar las tendencias existentes acerca de cómo se dirige el PDE de los estudiantes de la Carrera de Medicina de todos los años, a nivel del Consultorio Médico en su componente investigativo laboral, se realizó el presente trabajo utilizando métodos teóricos y empíricos de la investigación, donde empleando el análisis de 2 preguntas en un grupo focal organizado, al respecto, se muestran un número de limitaciones que hacen que la gestión de este proceso sea insuficiente a este nivel, no lográndose la necesaria planificación, organización, regulación y control del proceso, lo cual repercute en la adquisición de las habilidades necesarias por los educandos.

ABSTRACT The present work is aimed at identifying the present trends about how to manage the PDE in medical students at medical office using theoretical and empirical methods for the research using the analysis of 2 questions in a group designed for this purpose . Some limitations as planning, organizations and the control of the process are shown which obstruct the management of this process with some grade of repercussion on the necessary skills for the students.

Prevalence and predictors of white-coat hypertension in a large database of ambulatory blood pressure monitoring

The objective of this study was to determine both the prevalence of white-coat effect and white-coat hypertension [WCH] and which selected clinical variables were predictors of WCH. A total of 2462 patients underwent ambulatory blood pressure monitoring either in borderline hypertension [group 1] or for assessment of antihypertensive treatment [group 2] or for hypotension [group 3]. In the overall population 33.0% of patients showed WCH, 32.8% in group 1 and 37.0% in group 2. In multivariate analysis, sex and grade of hypertension were independent predictors of WCH in groups 1 and 2