Effectiveness of an educational intervention to improve the safety culture in primary care: a randomized trial.

BACKGROUND: Fostering a culture of safety is an essential step in ensuring patient safety and quality in primary care. We aimed to evaluate the effectiveness of an educational intervention to improve the safety culture in the family and community medicine teaching units in an Atlantic European Region. METHODS: Randomized study conducted in family and community medicine teaching units in Galicia (Spain). Participants were all fourth-year residents and their tutors (N = 138). Those who agreed to participate were randomized into one of two groups (27 tutors/26 residents in the intervention group, 23 tutors/ 23 residents in the control one).All were sent the Survey on Patient Safety Culture. After that, the intervention group received specific training in safety; they also recorded incidents over 15 days, documented them following a structured approach, and had feedback on their performance. The control group did not receive any action. All participants completed the same survey four months later. Outcome measures were the changes in safety culture as quantified by the results variables of the Survey: Patient Safety Grade and Number of events reported. We conducted bivariate and adjusted analyses for the outcome measures. To explore the influence of participants' demographic characteristics and their evaluation of the 12 dimensions of the safety culture, we fitted a multivariate model for each outcome. RESULTS: Trial followed published protocol. There were 19 drop outs. The groups were comparable in outcome and independent variables at start. The experiment did not have any effect on Patient safety grade (- 0.040) in bivariate analysis. The odds of reporting one to two events increased by 1.14 (0.39-3.35), and by 13.75 (2.41-354.37) the odds of reporting 3 or more events. Different dimensions had significant independent effects on each outcome variable. CONCLUSION: A educational intervention in family and community medicine teaching units may improve the incidents reported. The associations observed among organizational dimensions and outcomes evidence the complexity of patient safety culture measurement and, also, show the paths for improvement. In the future, it would be worthwhile to replicate this study in teaching units from different settings and with different health professionals engaged. TRIAL REGISTRATION: It was retrospectively registered with ( ISRCTN41911128 , 31/12/2010).

También es una dislipemia / It is also a dyslipidemia

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Prevención de la enfermedad cardiovascular en atención primaria: comparación de la función SCORE para países europeos de bajo riesgo con la tabla calibrada para España / Prevention of cardiovascular disease in primary care: a comparison of the function SCORE for low risk European countries with the calibrated SCORE for Spain

Introducción. Estudio comparativo de 2 ecuaciones de valoración del riesgo de mortalidad cardiovascular (RCV): función SCORE para países europeos de bajo riesgo y función SCORE calibrada para España, para conocer el perfil de riesgo de los pacientes de nuestro centro de salud y valorar las diferencias entre ambos métodos. Material y métodos. Estudio descriptivo transversal, de un cupo de pacientes de un centro de salud, seleccionándose los de edades comprendidas entre los 35-74 años y sin evento cardiovascular (n=398 pacientes). Se calculó el RCV mediante las 2 ecuaciones, se evaluaron las diferencias de clasificación obtenidas con ambas tablas de manera continua y la distribución de pacientes en cada grupo de riesgo. Resultados. La muestra estudiada presenta un perfil global de RCV bajo. Ambos métodos de estimación de riesgo presentaron una buena correlación (coeficiente de Pearson de 0,975, p<0,001). El RCV promedio estimado por la función SCORE calibrada para España fue superior al RCV estimado por la función SCORE europea (2,04 frente a 1,46%, p<0,001). El SCORE calibrado para España clasificó con un riesgo alto (mortalidad ≥ 5% en 10 años) al 12,9% de los pacientes (frente al 7% del SCORE europeo de países de bajo riesgo). Conclusiones. Aunque ambos métodos de estimación de RCV presentan buena correlación, el SCORE calibrado para España clasifica a los pacientes con un RCV un 28% superior al SCORE europeo. Deben realizarse más estudios de poblaciones locales para una correcta estimación del RCV (AU)

Introduction. This is a comparative Study of two cardiovascular risk (CVR) functions; the SCORE for European countries of low risk and the calibrated SCORE for Spain and the objective is to determine the risk profile and evaluate the differences between both methods. Material and methods. This is a descriptive cross-sectional study of a group of patients in our healthcare area. We selected those with ages between 35-74 years and without any previous cardiovascular event (n=398 patients). The CVR was calculated by both equations, evaluating the differences of classification obtained with both methods. Results. The studied sample had a low CVR profile. Both methods of estimation of risk correlated well (Pearson's coefficient of 0.975, P<.001). The average CVR estimated by the function SCORE calibrated for Spain was higher than the CVR estimated by the European SCORE (2.04 vs. 1.46%, P<.001). The Spanish calibrated SCORE predicted a high risk (mortality risk ≥5% in 10 years) for 12.9% of the patients (vs. 7% of the European SCORE). Conclusions. Although both methods of CVR estimation had a good correlation, the calibrated SCORE for Spain obtained a CVR 28% higher than the European SCORE. More studies of local populations must be performed for a correct estimation of the CVR (AU)

Aprendiendo a ayudar a aprender. Historia de 10 añosde formación de tutores de residentes en Galicia / Learning to help to learn. The history of 10 years of resident tutors’ training in Galicia

Introducción. La formación de los tutores de residentes se ha configurado como uno de los ejes sobre los que recae la calidad del proceso formativo de los especialistas sanitarios. Objetivo. Describir y analizar las características de las acciones de formación de tutores en los 10 últimos años en Galicia, como base del aprendizaje reflexivo para la mejora. Materiales y métodos. Revisión de los programas, contenidos, materiales utilizados, características y procedencia de los participantes, contenidos de los proyectos docentes elaborados y encuestas de valoración. Resultados. Se describen los datos de las 8 ediciones del ‘curso de metodología docente y de evaluación para tutores’. Realizaron la formación86 facultativos. La distribución de participantes por especialidades y áreas sanitarias no se corresponde con el peso de éstas en el sistema asistencial y docente. Las especialidades con más tutores participantes fueron Medicina Familiar y Comunitaria, Anestesiología y Obstetricia-Ginecología. Los 10facultativos que participaron como docentes estaban en ese momento en ejercicio de su responsabilidad en formación de residentes. Entre los contenidos de los proyectos docentes desarrollados destacan cuantitativamente los dedicados a mejorar la organización de rotaciones o la adaptación de los programas de la especialidad a los centros o unidades, y los dedicados a la mejora metodológica del aprendizaje de habilidades. Se incorporaron nuevas herramientas de evaluación formativa aprendidas durante el curso a muchos de estos proyectos. En las encuestas de valoración final, el curso fue valorado satisfactoriamente por los alumnos, considerando que su contenido era útil para su actividad profesional. (..) (AU)

Introduction. The training of the tutors of residents has been formed as one of the axes on which there relapses the quality of the formative process of the medical specialists. Aim. To describe and to analyze the characteristics of the activities of tutors’ training in last 10 years in Galicia, as the basis for reflective learning for improvement. Materials and methods. Are view of programs, contents, materials, characteristics and origin of the participants and content of teaching projects elaborated. Results. We describe the information of the 8 editions of the ‘course of teaching and evaluation methodology for tutors’. 86 professionals achieved this training. The participants ‘distribution by specialties and health areas does not match the weight of those in the health care and the training systems. The specialties with more tutors participants were Familiar and Communitary Medicine, Anesthesiology and Obstetrics-Gynaecology. The 10 clinic professionals who took part as teachers were at that time in exercising their responsibility in residents’ training. Among the contents of the teaching developed projects, stand out quantitatively those focused on improving the organization of rotations or to adapt programs of the specialty to the centers or units, and those devoted to the methodological improvement of learning skills. New formative assessment tools learned during the course were incorporated into many of these projects. In the final questionnaire the course was reported positively by the participants and the contents were considered useful for their professional activity. Conclusions. To know the health areas and specialties in which incorporation to this training has been (..) (AU)

Guía de Dislipemias semFYC 2ª. edición: ¿era necesaria? / Was the second edition of the semFYC Guide to Lipaemia necessary?

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[Hirsutism due to a late-onset of hydroxylase-21 deficit: apropos of 4 cases]. / Hirsutismo por déficit de 21-hidroxilasa de comienzo tardío: a propósito de cuatro casos.

OBJECTIVE: To present four cases of Hirsutism due to a late-starting deficit of Hydroxylase-21. DESIGN: Retrospective, descriptive study. SETTING: Primary Care team. PATIENTS AND OTHERS PARTICIPANTS: Four women (21, 22, 32 and 36 years old) were studied because they presented hirsutism. MEASUREMENTS AND MAIN RESULTS: All the patients had begun to be hirsute at puberty. Three had regular cycles and one, irregular. Two women (32 and 36) had had various children. In all the cases the hirsutism was moderate. One woman suffered severe acne. Basal testosterone was only high in one case; DHEA-S in two. The values of basal 17-OH-Progesterone were high in three women. The ACTH stimulation test showed positive for three patients: it was not performed on the fourth due to her very high levels of 17-OH-Progesterone. CONCLUSIONS: Late-starting Hydroxylase-21 deficit is a frequent cause of hirsutism in Primary Care. It must be considered and investigated as a cause when faced with a clinical picture compatible with benign hirsutism, in order to advise the woman on the best treatment and avoid iatrogenic attitudes.