Diagnostic concordance between Primary Care and Mental Health.

To analyse the diagnostic concordance index between Primary Care and Mental Health.

Concordancia diagnóstica entre Atención Primaria y Salud Mental / Diagnostic concordance between Primary Care and Mental Health

Objetivo: Analizar la concordancia diagnóstica entreAtención Primaria (AP) y Salud Mental (SM).Metodología. Estudio descriptivo y retrospectivo realizado en el Centro de SM de Villaverde, Madrid, España.La muestra está conformada por 1050 pacientes adultosnuevos consecutivos derivados desde AP a SM desde eneroa diciembre del año 2016. Se registraron las siguientes variables: Centro de AP de origen de la derivación, edad, sexo,tipo de actividad solicitante en la derivación (Psiquiatría oPsicología), diagnóstico establecido por AP y diagnósticoestablecido por SM.Resultados. La concordancia diagnóstica entre AP y SMpresentó un coeficiente de kappa global de 0,383 (IC 95 %0,333-0,433). Los grupos diagnósticos con menor concordancia fueron el trastorno adaptativo (kappa: 0,200), eltrastorno de ansiedad (kappa: 0,242) y el trastorno afectivodepresivo (kappa: 0,340). Los grupos diagnósticos con mayorconcordancia fueron el trastorno bipolar (kappa: 0,816) y eltrastorno psicótico (kappa: 0,689). El trastorno adaptativofue el diagnóstico más frecuentemente diagnosticado en SMentre los no coincidentes con AP (38,99 %).Conclusiones. La concordancia diagnóstica entre AP ySM es baja, lo cual podría afectar a la calidad asistencialofrecida a los pacientes. Se considera necesario el planteamiento de nuevas estrategias que permitan aumentar estaconcordancia. (AU)

Objetive: To analyse the diagnostic concordance indexbet-ween Primary Care and Mental Health.Methodology. Retrospective and descriptive study inMental Health Centre of Villaverde, Madrid, Spain. The sample consists of 1050 consecutive new adult patients referredfrom Primary Care to Mental Health Center from Januaryto December 2016. The following variables were recorded:Primary Health Center of origin, age, sex, type of activityrequested in the referral (Psychiatry or Psychology), diagnosis established by Primary Care and diagnosis established byMental Health.Results. Diagnostic concordance between Primary Careand Mental Health presented a global kappa coefficient of0.383 (IC 95 % 0.333-0.433). The diagnostic groups with thelowest concordance were adaptive disorder (kappa: 0.200),anxiety disorder (kappa: 0.242) and depressive affective disorder (kappa: 0.340). The diagnostic groups with the highestconcordance were bipolar disorder (kappa: 0.816) and psychotic disorder (kappa: 0.689). Adaptive disorder was themost frequently diagnostic in Mental Health among thosewho did not coincide with Primary Care (38.99 %).Conclusions. Diagnostic concordance between PrimaryCare and Mental Health is low, which could affect the quality of care offered to patients. New strategies are needed to increase this diagnostic concordance. (AU)

Implementación local de la Estrategia de Promoción de la Salud y Prevención en el Sistema Nacional de Salud. Informe SESPAS 2018 / Local implementation of the Strategy for Health Promotion and Prevention in the Spanish National Health System. SESPAS Report 2018

En el marco de la Estrategia de Promoción de la Salud y Prevención en el Sistema Nacional de Salud, la implementación local es una de las líneas consideradas prioritarias. Dicha implementación propone la adhesión voluntaria de las entidades locales para trabajar en promoción de la salud y prevención mediante la realización de dos acciones: la constitución de una mesa de coordinación intersectorial y la identificación de recursos para la promoción de la salud y la prevención en el municipio. La Guía para la Implementación Local de la Estrategia fue aprobada en 2015 por el Consejo Interterritorial del Sistema Nacional de Salud. A fecha de junio de 2018, se han adherido a ella 261 entidades locales, se han identificado 7072 recursos y 9183 actividades, y se han creado 132 mesas intersectoriales

Within the framework of the Prevention and Health Promotion Strategy of the Spanish National Health System, local implementation is considered a priority line of action. Local implementation proposes the voluntary commitment of local entities to the Strategy in order to move forward health promotion and prevention through the implementation of two actions: the creation of a coordinating inter-sectoral body and the identification of local resources for health promotion and prevention. The Guideline for the Local Implementation of the Strategy was adopted in 2015 by the Inter-territorial Council of the National Health System. By June 2018, 261 local entities had committed to the Prevention and Health Promotion Strategy, 7072 resources and 9183 activities had been identified, and 132 inter-sectoral bodies had been created

[Local implementation of the Strategy for Health Promotion and Prevention in the Spanish National Health System. SESPAS Report 2018]. / Implementación local de la Estrategia de Promoción de la Salud y Prevención en el Sistema Nacional de Salud. Informe SESPAS 2018.

Within the framework of the Prevention and Health Promotion Strategy of the Spanish National Health System, local implementation is considered a priority line of action. Local implementation proposes the voluntary commitment of local entities to the Strategy in order to move forward health promotion and prevention through the implementation of two actions: the creation of a coordinating inter-sectoral body and the identification of local resources for health promotion and prevention. The Guideline for the Local Implementation of the Strategy was adopted in 2015 by the Inter-territorial Council of the National Health System. By June 2018, 261 local entities had committed to the Prevention and Health Promotion Strategy, 7072 resources and 9183 activities had been identified, and 132 inter-sectoral bodies had been created.

La evaluación de residentes en las Unidades Docentes de Atención Familiar y Comunitaria de Madrid: ¿qué opinan los residentes y sus tutores? / valuation of residents in Primary Care Teaching Units of Madrid: what do the residents and their tutors think?

INTRODUCCIÓN: La evaluación de residentes es un proceso complejo cuyas herramientas casi nunca generan certezas sobre el nivel competencial del evaluado. En las unidades docentes recae la responsabilidad de proponer la concesión de títulos de especialistas en ciencias de la salud, por ello realizan un esfuerzo continuo para la mejora del proceso dentro del nuevo marco normativo del Real Decreto 183/2008. Para afrontar cambios en el modelo evaluativo de las UUDDMM de AFyC de Madrid exploramos la opinión de tutores y residentes. MATERIAL Y MÉTODOS: Estudio descriptivo transversal mediante encuesta on line a 841 residentes y 832 tutores de Medicina y Enfermería Familiar y Comunitaria. RESULTADOS: La tasa de respuesta fue del 23,8% de los residentes (n=200) y 39,4% de los tutores (n=328). La mayoría realizan 4 o más entrevistas de tutorización anuales cuya principal dificultad declarada es la escasez de tiempo. Demuestran alta satisfacción con ellas por mejorar la relación personal y la calidad de la tutorización. Los residentes no desean sustituirlas por métodos a distancia. Encuentran poco útiles herramientas reflexivas como los incidentes críticos e informes de autorreflexión, a pesar de la alta implicación de sus tutores en esas herramientas. La mayoría considera que las fichas 1 de evaluación de rotaciones no reflejan adecuadamente el aprovechamiento en ellas. Proponen el informe anual del tutor como principal método de evaluación sumativa. CONCLUSIONES: La evaluación de residentes debe sustentarse en la figura del tutor y un conjunto de herramientas, prioritariamente de evaluación formativa, que generen reflexión y un adecuado feed-back para continuar formándose

INTRODUCTION: Assessment of residents is a complex process, for which the evaluation tools hardly ever produce certainty about the competence level. Residents' teaching units have the responsibility of proposing the award of specialist degrees in health sciences, therefore they make a continuous effort to improve the process within the new regulatory framework in Spain. The opinion of tutors and residents were determined in order to address changes in the evaluation model of Primary Care teaching units in Madrid, Spain. MATERIAL AND METHODS: Cross-sectional study based on an online survey of 841 residents and 832 tutors of Family Medicine and Community Nursing. RESULTS: The response rate was 23.8% for residents (n=200) and 39.4% for tutors (n=328). Most of them conducted four or more mentoring interviews per year, for which the main difficulty stated was the lack of time. They showed high satisfaction with these interviews as they improved the relationship and the quality of mentoring. The residents did not want to replace them by distance methods. The residents did not consider reflective tools useful as critical incidents and reports of self-reflection, despite the high involvement of their tutors in those tools. Most considered that official documents to assess training stays do not reflect the benefit that they provide. They propose the annual report of the tutor as the primary method of summative evaluation. CONCLUSIONS: Assessment of residents must be based on the tutor and a set of tools, primarily by formative assessment, that lead to reflection and adequate feed-back to continue their education

Associations between chronic conditions, body functions, activity limitations and participation restrictions: a cross-sectional approach in Spanish non-clinical populations.

OBJECTIVES: To analyse the relationships between chronic conditions, body functions, activity limitations and participation restrictions in the International Classification of Functioning, Disability and Health (ICF) framework. DESIGN: A cross-sectional study. SETTING: 2 geographical areas in the Autonomous Region of Aragon, Spain, namely, a rural area, Cinco Villas, and an urban area in the city of Zaragoza. PARTICIPANTS: 864 individuals selected by simple random sampling from the register of Social Security card holders, aged 50 years and over, positive to disability screening. MAIN OUTCOME MEASURES: ICF Checklist-body function domains, WHO Disability Assessment Schedule 2.0 (WHODAS 2.0, 36-item (WHODAS-36)) global scores and medical diagnoses (chronic conditions) from primary care records. RESULTS: Mild disability (WHODAS-36 level 5-24%) was present in 51.5% of the sample. In the adjusted ordinal regression model with WHODAS-36 as the dependent variable, disability was substantially associated with moderate-to-complete impairment in the following functions: mental, OR 212.8 (95% CI 72 to 628.9); neuromusculoskeletal, OR 44.8 (24.2 to 82.8); and sensory and pain, OR 6.3 (3.5 to 11.2). In the relationship between health conditions and body function impairments, the strongest links were seen for: dementia with mental functions, OR 50.6 (25.1 to 102.1); cerebrovascular disease with neuromusculoskeletal function, OR 5.8 (3.5 to 9.7); and chronic renal failure with sensory function and pain, OR 3.0 (1.49 to 6.4). Dementia, OR 8.1 (4.4 to 14.7) and cerebrovascular disease, OR 4.1 (2.7 to 6.4) were associated with WHODAS-36 scores. CONCLUSIONS: Body functions are heterogeneously linked to limitations in activities and restrictions on participation, with the highest impact being due to mental and musculoskeletal functions. This may be relevant for disability assessment and intervention design, particularly if defined on a body function basis. Control of specific health conditions, such as dementia and cerebrovascular disease, appears to be paramount in reducing disability among persons aged 50 years and over.

Evaluation of an education and training intervention to reduce health care waste in a tertiary hospital in Spain.

BACKGROUND: In recent decades there has been a significant increase in waste generation. Training interventions in advanced health care waste management can improve the segregation of regulated medical waste and reduce volume and costs. METHODS: We carried out a quasi-experimental intervention study with before and after training session analysis to compare waste segregation. Descriptive analysis of the segregated health care waste and an evaluation of the quality of segregation were done. A comparison of monthly average waste to assess the effectiveness of the educational intervention was performed. RESULTS: After the intervention, there was a significant reduction in the monthly average health care waste volume of 6.2%. Statistically significant differences in the infectious waste and genotoxic/pharmaceutical waste weight segregated before and after the intervention (P < .05) were found. Because of the health care waste weight reduction and the improvement of waste classification, a savings cost of €125,205 was achieved. CONCLUSIONS: The health care waste management training improves biomedical waste segregation at the hospital, reducing the health care waste volume and costs as an added value.