Factores asociados a la variabilidad en la utilización de recursos en la consulta de los médicos de atención primaria / Factors associated with variability in the use of resources in primary care clinics

Objetivo. Analizar los factores que influyen en la utilización de recursos en la consulta de los médicos de atención primaria. Métodos. Estudio transversal. Las fuentes de datos fueron el sistema de información Medora-CyL de atención primaria, la tarjeta sanitaria para los denominadores y el registro de personal para variables relativas al médico. Los indicadores de derivaciones al especialista, peticiones al laboratorio, pruebas radiológicas y prescripción de recetas fueron ajustadas para la edad, utilizando como población de referencia la del área. Se realizó un análisis bivariante y multivariante. Resultados. Ser médico fijo, especialista en Medicina Familiar y Comunitaria (MFyC) y trabajar en medio urbano se asocia a una mayor utilización de recursos. Existe alta correlación entre las derivaciones al especialista con solicitudes al laboratorio, pruebas radiológicas, prescripción de recetas y distancia al centro de especialidades (r comprendidos entre 0,28 y 0,84). El ajuste mediante regresión multivariante determinó que los médicos más derivadores, solicitan más pruebas a laboratorio, más radiografías y prescriben más recetas. Ser especialista en MFyC y urbano permanecen como variables asociadas a mayor utilización de pruebas radiológicas y mayor prescripción, pero menor derivación al especialista. La variabilidad explicada va desde un 48% en la prescripción de recetas hasta un 80% en las peticiones a laboratorio. Conclusiones. Cuanto más se deriva al especialista, más peticiones se realizan al laboratorio más radiografías se solicitan y más recetas se prescriben. Los factores implicados son en su mayoría intrínsecos a la práctica del profesional(AU)

Objective. To analyse the factors that influence the use of resources by general practitioners. Methods. Cross-sectional study. The source of data was the General Practitioner's Management Information System Medora-CyL, the personal medical card database for the calculation of denominators, and the registry of personnel for variables related to doctors. The indicators for referrals to specialists, laboratory tests, X-ray requests and the issuing of prescriptions were adjusted for the age, taking the population of the area as a reference. Bivariate and multivariate analyses were performed. Results. Being a permanent general practitioner, specialist in Family and Community Medicine and to work in an urban environment was associated with a greater use of resources. There was a high correlation between referrals to specialists and laboratory requests, radiology tests, prescriptions and distance from the specialist centre (coefficient r between 0.28 and 0.84). Multivariate regression adjustment showed that the general practitioners who made more specialist referrals, also requested further laboratory tests, more X-rays and prescribed more. Being family doctor and working in urban areas remained associated with greater use of X-rays tests and more prescriptions but fewer referrals to specialists. The variability explained ranges from 48% on prescriptions and up to 80% on requests to the laboratory. Conclusion. The more referrals to specialists, the more requests are made to the laboratory, more X-rays are requested and more prescriptions are prescribed. Factors involved are largely intrinsic to the professional practice(AU)

[An exploration of factors that influence the frequency of the use of hospital emergency services and admissions]. / Exploración de algunos factores que influyen en la frecuentación a urgencias del hospital y su ingreso.

OBJECTIVE: To examine how some factors connected with Continuous Care Points (CCP) affect attendance at hospital Casualty departments and admittance from them. DESIGN: Ecological study. SETTING: León Health area. PATIENTS AND OTHER PARTICIPANTS: All the CCP's belonging to the León Health area. MEASUREMENTS AND MAIN RESULTS: Average attendance at hospital Casualties was 15.7 per 1,000 inhabitants per month. Those patients who brought with them a P10 form were more likely to be admitted (39.5% to 26.5%) than those who did not bring this form (p < 0.01). It was concluded from a regression analysis that the distance between the CCP and the hospital decisively affects attendance at hospital Casualties (r = -0.74) and that the admission rate is positively related to distance (r = 0.72) and negatively to the said attendance at Casualties (r = -0.77). CONCLUSION: Use of hospital Casualty departments increases as accessibility (distance) improves. Distance and the ageing of the population are factors which have an important effect on the admission rates from Casualties.