Utilización de prácticas inefectivas en atención primaria: opinión de los profesionales / Use of ineffective practices in primary health care: professional opinions

Objetivo. Estimar la frecuencia de prácticas inefectivas en la atención primaria (AP) en función de la opinión de profesionales clínicos, así como valorar la importancia, consecuencias y factores que pueden estar contribuyendo a su mantenimiento. Material y métodos. Encuesta de opinión online a una muestra de conveniencia de 575 profesionales de la AP seleccionados a partir de artículos publicados en los últimos años de las revistas Atención Primaria y Semergen. Resultados. Respondieron 212 encuestados (37%). Para el 70,6% (IC 95%: 64,5-73,7) el problema de las prácticas inefectivas resultó frecuente o muy frecuente en AP y la importancia fue valorada con una puntuación media de 7,3 (DE = 1,8) sobre 10. Las principales consecuencias de las prácticas inefectivas fueron poner en peligro la sostenibilidad del sistema (48,1%; IC 95%: 41,2-54,9) y el daño a los pacientes (32,1%; IC 95%: 25,7-38,5). Contribuyeron a su mantenimiento los propios pacientes (28%; IC 95%: 22,6-35,0), la carga de trabajo (26,4%; IC 95%: 20,3-32,5) y la falta de formación continuada (19,3%; IC 95%: 13,9-24,7). Los procesos clínicos con mayor grado de utilización inadecuada fueron la prescripción de antibióticos en determinadas infecciones, la periodicidad del cribado del cáncer de cérvix, el control farmacológico de la diabetes tipo 2, la utilización de psicofármacos en ancianos y el uso de analgésicos en pacientes con hipertensión o insuficiencia renal. Conclusiones. La utilización de intervenciones inefectivas en AP fue apreciada como un problema muy relevante que afectaría a muchos pacientes, pondría en peligro la sostenibilidad del sistema y causaría daño a los pacientes (AU)

Objective. To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. Material and methods. An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. Results. A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD] = 1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. Conclusions. The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients (AU)

[Use of ineffective practices in Primary Health Care: professional opinions]. / Utilización de prácticas inefectivas en atención primaria: opinión de los profesionales.

OBJECTIVE: To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. MATERIAL AND METHODS: An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. RESULTS: A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD]=1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. CONCLUSIONS: The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients.