[Models to explain and predict medical case-loads: their use in calculating the maximum family medicine list that allows at least ten minutes per consultation]. / Modelos explicativos y predictivos de la carga asistencial médica: aplicación para el cálculo del cupo máximo en medicina de familia que permita un mínimo de diez minutos por consulta.

OBJECTIVE: To calculate the maximum family medicine list that gives at least ten minutes per consultation.Design. Transversal. SETTING: Three health centres. SUBJECTS: 45 826 inhabitants. MEASUREMENTS: We used the appointments made at three centres to calculate the annual time employed per patient and we adjusted it to allocate a minimum of ten minutes per consultation. We established a cubic regression model to predict the mean case-load per age of patient in general medicine and calculated the maximum list if 70% of the working day were dedicated to care. The results contrasted two centres with greater nursing involvement and one with less. We showed the R2 coefficients. We calculated the maximum lists for the health centres of Navarra and showed them in five clusters worked out on the basis of the percentage of patients >=65. RESULTS: Age explained 86.1% of variability in mean case-load at each age (84% in children and 93.5% in adults). According to the mean percentage of those >=65 years old, the average maximum lists for centres with more or less nursing involvement are as follows: 7.0%>=65 (2025 and 1989); 14.0% (1834 and 1715); 21.2% (1691 and 1558); 27.0% (1648 and 1460), 34.0% (1560 and 1340). CONCLUSION: To a great extent, age explains the variability in case-load and lets us calculate the maximum number of patients on the list that still ensures a minimum time for each consultation.

Modelos explicativos y predictivos de la carga asistencial médica: aplicación para el cálculo del cupo máximo en medicina de familia que permita un mínimo de diez minutos por consulta / Models to explain and predict medical case-loads: their use in calculating the maximum family medicine list that allows at least ten minutes per consultation

Objetivo. Estimar el cupo máximo en medicina familiar que permita consultas mínimas de 10 min. Diseño. Transversal. Ámbito. Tres centros de salud. Sujetos. Un total de 45.826 habitantes. Mediciones. A partir de las citas de tres centros estimamos el tiempo anual empleado por paciente y lo ajustamos asignando un tiempo mínimo de 10 min por consulta. Establecemos un modelo de regresión cúbica predictor de la carga de trabajo asistencial media por edad en medicina general y estimamos el cupo máximo si se dedica un 70 por ciento de la jornada laboral a la asistencia. Exponemos los resultados para dos centros con mayor implicación de enfermería en la atención de los pacientes, y otro en que ésta es menor. Presentamos los coeficientes R2. Estimamos los cupos máximos para los centros de salud de Navarra y los mostramos en cinco grupos elaborados a partir del porcentaje de población de 65 años o más. Resultados. La edad explica el 86,1 por ciento de la variabilidad en la carga asistencial media en cada edad (un 84 por ciento en niños y un 93,5 por ciento en adultos). Según el porcentaje promedio de sujetos 65 años de edad los cupos máximos promedios para centros con mayor o menor implicación de enfermería son los siguientes: 7 por ciento (2.025 y 1.989); 14 por ciento (1.834 y 1.715); 21,2 por ciento (1.691 y 1.558); 27 por ciento (1.648 y 1.460); 34 por ciento (1.560 y 1.340). Conclusiones. La edad explica en gran medida la variabilidad de la carga asistencial y permite estimar el cupo máximo de pacientes que asegure un tiempo mínimo por consulta (AU)

[A proposal for capitation payment, based on age, chronicity, and gender, using management databases]. / Una propuesta para el pago capitativo, a partir de edad, cronicidad y género, utilizando bases de datos administrativas.

OBJECTIVES: To propose a case-mix methodology for primary care, based on chronicity, type and age. To describe the explanatory value of these variables in the variability of the medical case-load. DESIGN: Observation, descriptive and retrospective study. SETTING: Primary care. Rochapea Health Centre, Pamplona. MATERIAL AND METHODS: Computer records of all the consultations between January 1996 and June 1997. Dependent variable: case-load. INDEPENDENT VARIABLES: age, type, chronic pathologies (diabetes, lipaemia, chronic neurological diseases, COPD-asthma, chronic psychiatric illnesses, cardiopathy, hypertension, alcohol and other drug abuse). The Kruskal-Wallis test was used to compare work-loads by age groups; and multiple linear regression analysis to calculate the predictive power of the independent variables. RESULTS: Significant differences were observed for age groups. In the multivariate model used for general practitioners, all the variables could be included. They explained 24.2% of the variability in work load (R2). For paediatricians, age and asthma, explaining 23.48%, could also be included. CONCLUSIONS: Age, type and chronicity are useful variables for predicting case load from administrative data bases. They can be used in adjustments for case load applicable to capitation payment systems.

Una propuesta para el pago capitativo, a partir de edad, cronicidad y género, utilizando bases de datos administrativas / A proposal for a capitation payment based on age, chronicity and type, using administrative data bases

Objetivo. Proponer una metodología de case-mix para atención primaria, basada en edad, cronicidad y género. Describir el valor explicativo de estas variables en la variabilidad de la carga de trabajo asistencial médica. Diseño. Estudio observacional, descriptivo, retrospectivo. Emplazamiento. Atención primaria. Centro de Salud Rochapea de Pamplona. Material y métodos. Registros informáticos de todas las consultas entre enero de 1996 y junio de 1997. Variable dependiente: carga de trabajo. Variables independientes: edad, género, patologías crónicas (diabetes, dislipemias, enfermedades neurológicas crónicas, EPOC-asma, enfermedades psiquiátricas crónicas, cardiopatías, hipertensión arterial, abuso alcohol y otras drogas). Se utilizó la prueba de Kruskal-Wallis para comparar cargas de trabajo por grupos de edad y análisis de regresión lineal múltiple para calcular el poder predictivo de las variables independientes. Resultados. Se observaron diferencias significativas por grupos de edad. En el modelo multivariante aplicado a médicos de familia se pudieron incluir todas las variables, explicando un 24,2 por ciento de la variabilidad de la carga de trabajo (R2). Para los pediatras se pudieron incluir la edad y asma, explicando un 23,48 por ciento. Conclusiones. Edad, cronicidad y género son variables útiles para predecir, a partir de bases de datos administrativas, la carga de trabajo asistencial. Permiten su utilización en ajustes por carga asistencial aplicables a sistemas retributivos capitativos (AU)

[The attitudes of primary care physicians towards the opening of health centers]. / Actitudes de los médicos de atención primaria hacia la puesta en marcha de los centros de salud.

OBJECTIVE: To measure doctors' attitudes to the opening of Health Centres. DESIGN: Descriptive study. SITE. Primary Care services on the island of Gran Canaria. PARTICIPANTS: Doctors with tenure. MAIN MEASUREMENTS AND RESULTS: From a self-administered Likert type questionnaire, it could be observed that the proportion of those polled who did not reply was linked to the number who had a "Fiscal Licence" (Odds Ratio O.R. = 6.26), a ratio which did not disappear when stratified by age (O.R. = 5.88 for those less than or equal to 40 and O.R. = 3.08 for those greater than 40). The scale presented high internal consistency (Cronbach alpha 0.937), indicating favorable attitudes from doctors integrated into Health Centres and both positive and negative attitudes in doctors of a traditional cut. Those specialising in Family Medicine, those under 40 years old, those who had no other health job and those connected with Trades Unions showed more favorable attitudes. CONCLUSIONS: Individual and group characteristics are linked to different attitudes. The knowledge, evaluation and behaviour components of doctor's attitudes must be improved, by involving the reference groups of both individuals and groups.

[Risk of pregnancy in adolescence]. / El riesgo de embarazo en la adolescencia.

OBJECTIVE: To describe the frequency and distribution of sexual conduct with risk of pregnancy, the degree of information on sexuality and contraceptive methods. To analyze the relationship between sexual conduct with risk of pregnancy and the most relevant variables of social surroundings of the adolescent: family, friends, school, etc. DESIGN: Descriptive survey by means of a questionnaire. LOCATION: Basic Neighbourhood Health Zone (Gran Canaria). TARGET GROUP: Teenage students aged between 14 and 19. Measurements and main results 21% of the population in the survey have sexual relationships, and out of these, 88% run a high risk of becoming pregnant. The information they have is basically theoretical, and practical knowledge is low. Older adolescents (OR, 1,4/year), males (OR 2.08), those with parents with no qualifications (OR 1.88) and those with parents of a high income bracket (OR 4.11) have the most high-risk sexual relationships. CONCLUSIONS: The importance of high-risk sexual conduct in adolescence is underlined, plus the need for information of adolescents, although it does not seem enough, in order to face sexuality with guarantees.