Vacunación antigripal en pacientes nonagenarios. Una elevada cumplimentación. Réplica de los autores / Flu Vaccination of Patients Over 90. High Compliance. Response from the authors

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Validez de la historia clínica y sistemas de información en los estudios de actividad asistencial en atención primaria / Validity of clinical records and information systems in the studies of health-care delivery in primary care

Objetivo. Validar el grado de registro del proceso clínico asistencial en la historia clínica (HC) y la actividad asistencial en la hoja de actividad (HA). Construir una guía de recomendaciones sobre la validez de estos documentos para el registro de la actividad. Tipo estudio. Observacional, transversal, multicéntrico. Emplazamiento. Cuatro consultas médicas de 12 centros de salud de la Comunidad Valenciana. Participantes. Un total de 2.051 visitas, 284 historias y 407 hojas de actividad. Mediciones y resultados principales. Se validó la información registrada por los médicos en la HC y HA, por observadores externos que recogen directamente en consulta toda la actividad asistencial de la jornada. Se analiza: a) en la HC, cumplimentación del SOAP; b) en la HA, media por profesional y día de pacientes citados, sin cita, domicilios y duración de las consultas; c) información de los documentos validados con respecto a la organización de las consultas; d) análisis de la actividad asistencial según su previsibilidad y contenido clínico, y e) guías de práctica clínica con indicadores de validez, utilidad clínica e índice de fiabilidad (kappa). Conclusiones. Los documentos validados no reflejan adecuadamente la realidad de la demanda sanitaria. Se detecta un sesgo de infrarregistro y problemas de validez que pueden limitar su utilización como fuente de información para la planificación y gestión sanitaria

Objectives. To examine how well the clinical process was recorded in the clinical history (CH), and care delivery on the activity sheet (AS). To assemble a series of recommendations on the validity of these documents for recording health care delivery. Design. Multi-centred, observational, and cross-sectonal study. Setting. Four medical clinics at 12 health centres in the Community of Valencia, Spain. Participants. There were 2051 attendances, with 284 CH and 407 AS involved. Main measurements and results. The information recorded by doctors in the CH and on the AS was validated by external observers who collected directly at the consultation the working day's entire care activity. The following was analysed: 1) in the CH, filling out of the "SOAP" form (basic info.); 2) on the AS, mean per professional per day of scheduled and on-demand patients, home visits and length of consultations; 3) information in the documents validated on the organisation of consultations; 4) analysis of care delivery according to how predictable it is and its clinical content; 5) clinical practice guidelines with validity and clinical usefulness indicators and reliability index (kappa). Conclusions. The documents validated do not properly reflect the reality of health care demand. There was an under-recording bias and validity problems that may limit their usefulness as sources of information for health care planning and management

[Flu vaccination in primary care: analysis of the process and proposals for increasing coverage]. / Vacunación antigripal en atención primaria: análisis del proceso y propuestas para aumentar las tasas de cobertura.

INTRODUCTION: Flu vaccination (FV) in elderly patients at risk is linked to a 50%-60% reduction in hospital admissions and up to an 80% drop in deaths from complications arising from the illness. Equally clear benefits have been found for other risk groups, such as patients with chronic cardiovascular or respiratory diseases. The vaccine is cost-effective for both the elderly and other risk groups. Despite this, vaccination rates are low, even among health staff. OBJECTIVES: To update our knowledge of FV by means of a review of the bibliography and to describe a series of interventions that have proved successful in increasing vaccination rates. PROGRAMME: To discover procedures, the following factors were analysed: the environment, patients and health professionals that condition vaccination, the characteristics of the health-care organisation for the vaccination campaign, and the clinical organisation of risk groups required. DISCUSSION: After this analysis, certain communicated strategies that manage to increase vaccination coverage and others that could be introduced into primary care were discussed. We conclude that, given the clinical evidence available and the ease of introducing certain other interventions, improvement of flu vaccination procedures and increased vaccine coverage of patients at risk is not only advisable, but is an ethical imperative. Improvements that are within the possibilities of every primary care clinic could be introduced.

Vacunación antigripal en atención primaria: análisis del proceso y propuestas para aumentar las tasas de cobertura / Flu vaccination in primary care: analysis of the procedures and proposals for extending coverage

Introducción. La vacunación antigripal (VAG) en ancianos de riesgo se asocia con una reducción del 50-60% de las hospitalizaciones y hasta el 80% de los fallecimientos derivados de las complicaciones de la enfermedad. Se han descrito igualmente claros beneficios para otros grupos de riesgo, como los pacientes con enfermedades crónicas cardiovasculares o respiratorias. La vacuna tiene una buena relación coste-beneficio, tanto en ancianos como en otros grupos de riesgo. Pese a ello, se observan bajas tasas de vacunación, incluso entre el propio personal sanitario. Objetivos. Actualizar los conocimientos sobre la VAG mediante una revisión de la bibliografía y describir una serie de intervenciones que han sido ensayadas con éxito para aumentar las tasas de esta vacunación. Programa. Para conocer el proceso se analizan los factores del entorno, de los pacientes y de los profesionales sanitarios que condicionan la vacunación, las características de la organización asistencial que disponemos para la campaña vacunal, y la necesaria organización clínica sobre los grupos de riesgo. Discusión. Tras este análisis es posible la discusión de algunas estrategias comunicadas que han conseguido incrementar la vacunación, y proponer otras que serían posibles en el ámbito de nuestra atención primaria. Nuestra conclusión es que, dada la evidencia clínica disponible y la alta aplicabilidad en la práctica de algunas intervenciones implementadoras es, además de aconsejable, éticamente exigible abordar la mejora del proceso de vacunación antigripal y el aumento de las coberturas vacunales en pacientes de riesgo, pudiendo introducir mejoras dentro de las posibilidades de cada puesto asistencial de atención primaria

Introduction. Flu vaccination (FV) in elderly patients at risk is linked to a 50%-60% reduction in hospital admissions and up to an 80% drop in deaths from complications arising from the illness. Equally clear benefits have been found for other risk groups, such as patients with chronic cardiovascular or respiratory diseases. The vaccine is cost-effective for both the elderly and other risk groups. Despite this, vaccination rates are low, even among health staff. Objectives. To update our knowledge of FV by means of a review of the bibliography and to describe a series of interventions that have proved successful in increasing vaccination rates. Programme. To discover procedures, the following factors were analysed: the environment, patients and health professionals that condition vaccination, the characteristics of the health-care organisation for the vaccination campaign, and the clinical organisation of risk groups required. Discussion. After this analysis, certain communicated strategies that manage to increase vaccination coverage and others that could be introduced into primary care were discussed. We conclude that, given the clinical evidence available and the ease of introducing certain other interventions, improvement of flu vaccination procedures and increased vaccine coverage of patients at risk is not only advisable, but is an ethical imperative. Improvements that are within the possibilities of every primary care clinic could be introduced

[Can we improve influenza vaccination rates in older people with chronic diseases?]. / Podemos mejorar las tasas de vacunación antigripal en los ancianos con enfermedades crónicas?

OBJECTIVE: To determine the proportion of older patients (>or= 65 years) with chronic diseases served by the health center studied here who were not vaccinated during the 2001-2002 influenza vaccination campaign, and to find out why they were not vaccinated. DESIGN: Observational, descriptive, retrospective study. SETTING: The urban health center serving Area 19 in the Community of Valencia (eastern Spain). PARTICIPANTS: Of the 29757 inhabitants served by this center (10.4% >or= 65 years), we included 3868 patients registered in chronic disease care programs and 2980 registered in the influenza vaccination program. We found 853 older patients with chronic diseases who were not vaccinated. MAIN MEASURES: Vaccination rate for patients with chronic diseases, for older patients, and for older patients with chronic diseases. Audit of the medical records to identify the reasons why some patients in the latter group were not vaccinated. RESULTS: The vaccination rates were 52.12% (95% CI, 50.4-53.9) for older patients, 26.96% (95% CI, 25.6-28.4) for patients with chronic diseases, and 54.43% (95% CI, 51.4-57.5) for older patients with chronic diseases. Of the 853 older patients with chronic diseases who were not vaccinated, 48.17% came to the center at least once during the vaccination campaign, 27.34% had not come to the center since more than 1 year before the campaign, and the cause for nonvaccination was recorded for only 10.4%. CONCLUSIONS: Coverage for influenza vaccination in older patients with chronic diseases was low. Intervention to increase vaccination rates is possible in groups of patients for whom accessibility is good.

¿Podemos mejorar las tasas de vacunación antigripal en los ancianos con enfermedades crónicas? / Can we improve influenza vaccination rates in older people with chronic disease?

Objetivo. Determinar la proporción de pacientes ancianos (≥ 65 años) adscritos al centro de salud estudiado, con alguna enfermedad crónica y que no fueron vacunados en la campaña antigripal 2001-2002, y conocer el porqué. Diseño. Observacional, descriptivo, retrospectivo. Emplazamiento. Centro de salud urbano del Área 19 de la Comunidad Valenciana. Participantes. De los 29.757 habitantes adscritos (10,4% ancianos), se incluyó a3.868 pacientes registrados en los programas de crónicos y a 2.980 en el de vacunación antigripal (VAG), y se encontró a 853pacientes crónicos ancianos no vacunados. Mediciones principales. Tasa de VAG en crónicos, ancianos y crónicos ancianos. Auditoría de historias clínicas para conocerlas causas de la falta de vacunación en estos últimos. Resultados. La tasa de VAG en los pacientes ancianos fue del 52,12% (intervalo de confianza [IC] del 95%, 50,4-53,9), en los pacientes crónicos fue del 26,96% (IC del95%, 25,6-28,4) y en los pacientes ancianos crónicos del 54,43% (IC del 95%, 51,4-57,5).De los 853 ancianos crónicos no vacunados, el 48,17% acudió al menos una vez al centro de salud durante la campaña de vacunación. El 27,34% hacía más de 1 año que no acudía al centro de salud y sólo en el 10,4%se había documentado la causa de la falta de vacunación. Conclusiones. La cobertura de VAG en ancianos y crónicos es baja. Es posible intervenir en grupos accesibles de pacientes para incrementar la tasa de vacunación

Objective. To determine the proportion of older patients (≥ 65 years) with chronic diseases served by the health center studied here who were not vaccinated during the2001-2002 influenza vaccination campaign, and to find out why they were not vaccinated. Design. Observational, descriptive, retrospective study. Setting. The urban health center serving Area19 in the Community of Valencia (eastern Spain).Participants. Of the 29 757 inhabitants served by this center (10.4% ≥ 65 years), we included3868 patients registered in chronic disease care programs and 2980 registered in the influenza vaccination program. We found 853older patients with chronic diseases who were not vaccinated. Main measures. Vaccination rate for patients with chronic diseases, for older patients, and for older patients with chronic diseases. Audit of the medical records to identify the reasons why some patients in the latter group were not vaccinated. Results. The vaccination rates were 52.12%(95% CI, 50.4-53.9) for older patients,26.96% (95% CI, 25.6-28.4) for patients with chronic diseases, and 54.43% (95% CI, 51.4-57.5) for older patients with chronic diseases. Of the 853 older patients with chronic diseases who were not vaccinated, 48.17%came to the center at least once during the vaccination campaign, 27.34% had not come to the center since more than 1 year before the campaign, and the cause for non-vaccination was recorded for only 10.4%.Conclusions. Coverage for influenza vaccination in older patients with chronic diseases was low. Intervention to increase vaccination rates is possible in groups of patients for whom accessibility is good

[Characteristics of health care demand in family medicine clinics in a health area of the community of Valencia]. / Características de la demanda sanitaria en las consultas de medicina de familia de un área de salud de la Comunidad Valenciana.

OBJECTIVE: To measure with primary data the kinds of family doctor consultations, the reasons for them and the interruptions. DESIGN: Observational, transversal, and multi-centred study. SETTING: All the health centres in Area 17 of the Community of Valencia. PARTICIPANTS: Representative sample of 2051 patients belonging to 20 family medicine lists at the 13 health centres in the Area, selected by sampling stratified for health centres and randomised by medical key. MAIN MEASUREMENTS: All the activity occurring during the working day was monitored by an outside observer in the consulting room, who recorded the types of consultation (prior appointment, on-demand, scheduled, urgent, at home, by phone or through a family member) and the reasons for them (as a function of their clinical content for acute pathology, chronic pathology or preventive activities, bureaucratic-administrative reasons or to collect test results). The interruptions to the consultation were recorded. The means, percentages and 95% confidence limits were calculated. RESULTS: Women occasioned 57.5% (95% CI, 55.4-59.6) of demand; and the elderly, 35.9% (33.6%-38.2%). Mean attendance time was 5.38 +/- 4.45 minutes. 23.6% (25.4%-21.8%) attended without prior appointment; in 14.7% (16.2%-13.2%) a family member attended; 6.6% (7.7%-5.5%) were urgent; and 0.7% (1.1%-0.3%) were telephone consultations. 65.3% (67.4%-63.2%) of consultations were bureaucratic, and preventive measures were taken only in 3.4% (4.2%-2.6%). 21.8% (23.6%-20%) of patients consulted for clinical + bureaucratic reasons; and 35.5% (37.6%-33.4%), solely for bureaucratic reasons. In 12% (13.4%-10.6%) there were interruptions, mainly for phone calls (3.9%). CONCLUSION: The over-65s caused over a third of all consultations. There was a high attendance without a prior appointment. There were few preventive activities. In consultations, bureaucratic activity takes up more time than clinical activity (care and prevention).

Características de la demanda sanitaria en las consultas de medicina de familia de un área de salud de la Comunidad Valenciana / Characteristics of health care demand in family medicine clinics in a health area of the Community of Valencia

Objetivo. Cuantificar con datos primarios los tipos, motivos e interrupciones en las consultas de medicina de familia. Diseño. Estudio observacional, transversal y multicéntrico. Emplazamiento. Todos los centros de salud del Área 17 de la Comunidad Valenciana. Participantes. Muestra representativa de 2.051pacientes pertenecientes a 20 consultas de medicina familiar en los 13 centros de salud del área, seleccionados por muestreo estratificado por centros de salud y aleatorio por clave médica. Mediciones principales. Se recogió mediante un observador externo en la consulta toda la actividad generada durante la jornada laboral, registrando los tipos de consulta (cita previa, demanda, programada, urgente, domicilio, telefónica o por familiar) y los motivos (en función de su contenido clínico para una enfermedad aguda o crónica, actividades preventivas, burocrático administrativo, o recoger resultados de pruebas). Se registraron las interrupciones en la consulta. Se calcularon las medias y los porcentajes, así como intervalos de confianza (IC) del 95%.Resultados. Las mujeres ocasionan el 57,5%(IC del 95%, 55,4-59,6) de la demanda y los ancianos generan el 35,9% (IC del 95%,33,6-38,2%). El tiempo medio asistencial fue de 5,38 ± 4,45 min. El 23,6% (25,4-21,8%)acude sin cita previa, el 14,7% (16,2-13,2%)acude en lugar de un familiar, el 6,6% (7,7-5,5%) solicita una visita urgente y el 0,7%(1,1-0,3%) mantiene una visita telefónica. Un65,3% (67,4-63,2%) de las consultas son burocráticas y sólo en el 3,4% (4,2-2,6%) se realizan actividades preventivas. El 21,8%(23,6-20%) de los pacientes consultan por algún aspecto clínico y burocrático y el 35,5%(37,6-33,4%) sólo por un tema burocrático. En el 12% (13,4-10,6%) se produjeron interrupciones, fundamentalmente por llamadas telefónicas (3,9%).Conclusión. La población mayor de 65 años genera más de un tercio de las consultas. Se detecta un elevado porcentaje de visitas sin cita previa. Se realizan pocas actividades preventivas. La actividad burocrática de las consultas es mayor que la actividad clínica(asistencial y preventiva)

Objective. To measure with primary data the kinds of family doctor consultations, the reasons for them and the interruptions. Design. Observational, transversal, and multicentred study. Setting. All the health centres in Area 17 of the Community of Valencia. Participants. Representative sample of 2051patients belonging to 20 family medicine listsat the 13 health centres in the Area, selected by sampling stratified for health centres andrandomised by medical key. Main measurements. All the activity occurring during the working day was monitored by an outside observer in the consulting room, who recorded the types of consultation (prior appointment, on-demand, scheduled, urgent, at home, by phone or through a family member)and the reasons for them (as a function of their clinical content for acute pathology, chronic pathology or preventive activities, bureaucratic administrative reasons or to collect test results).The interruptions to the consultation were recorded. The means, percentages and 95%confidence limits were calculated. Results. Women occasioned 57.5% (95% CI,55.4-59.6) of demand; and the elderly, 35.9%(33.6%-38.2%). Mean attendance time was5.38±4.45 minutes. 23.6% (25.4%-21.8%)attended without prior appointment; in 14.7%(16.2%-13.2%) a family member attended;6.6% (7.7%-5.5%) were urgent; and 0.7%(1.1%-0.3%) were telephone consultations.65.3% (67.4%-63.2%) of consultations were bureaucratic, and preventive measures were taken only in 3.4% (4.2%-2.6%). 21.8%(23.6%-20%) of patients consulted for clinical+ bureaucratic reasons; and 35.5% (37.6%-33.4%), solely for bureaucratic reasons. In 12%(13.4%-10.6%) there were interruptions, mainly for phone calls (3.9%).Conclusion. The over-65s caused over a third of all consultations. There was a high attendance without a prior appointment. There were few preventive activities. In consultations, bureaucratic activity takes up more time than clinical activity (care and prevention)

[Validity of clinical records and information systems in studies of health-care delivery in primary care]. / Validez de la historia clínica y sistemas de información en los estudios de actividad asistencial en atención primaria.

OBJECTIVES: To examine how well the clinical process was recorded in the clinical history (CH), and care delivery on the activity sheet (AS). To assemble a series of recommendations on the validity of these documents for recording health care delivery. DESIGN: Multi-centred, observational, and cross-sectonal study. SETTING: Four medical clinics at 12 health centres in the Community of Valencia, Spain. PARTICIPANTS: There were 2051 attendances, with 284 CH and 407 AS involved. Main measurements and results. The information recorded by doctors in the CH and on the AS was validated by external observers who collected directly at the consultation the working day's entire care activity. The following was analysed: 1) in the CH, filling out of the "SOAP" form (basic info.); 2) on the AS, mean per professional per day of scheduled and on-demand patients, home visits and length of consultations; 3) information in the documents validated on the organisation of consultations; 4) analysis of care delivery according to how predictable it is and its clinical content; 5) clinical practice guidelines with validity and clinical usefulness indicators and reliability index (kappa). CONCLUSIONS: The documents validated do not properly reflect the reality of health care demand. There was an under-recording bias and validity problems that may limit their usefulness as sources of information for health care planning and management.

[Influence of physician and physician list characteristics on influenza vaccination rates in older people in a health care area in the community of Valencia, Spain]. / Influencia de las características de los médicos y del cupo en la vacunación antigripal de ancianos en un área de salud de la comunidad Valenciana.

OBJECTIVE: To identify the characteristics of physicians and the patients on their list related with rates of influenza vaccination in older people, and to quantify influenza vaccination coverage in this population group. DESIGN: Observational, cross-sectional, multicenter population-based study with primary data. PARTICIPANTS: All health centers in the health care area that used computerized registries of influenza vaccinations. Vaccination records were analyzed for 73 physicians who had been at their present post for at least 2 years prior to the study, and for 19 457 older people who were vaccinated during the 2001-2002 vaccination campaign. SETTING: Primary health care area number 19. MAIN MEASURES: Physician's age and sex, whether the physician was certified as a specialist in family and community medicine, teaching accreditation, permanent or temporary post, length of time in present post, years of professional practice, type of health center administration, total number of patients in the physician's list, population and percentage of the population >65 years old in the physician's list, influenza vaccination rate referred to the total number of patients on the physician's list. The criterion evaluated was the influenza vaccination rate in older people. Descriptive analysis, bivariate analysis and multivariate analysis were used. A P value < .05 was considered statistically significant, and 95% confidence intervals were calculated. RESULTS: The overall influenza vaccination rate in older people (>65 years) was 50.9%, with considerable variability between physicians (from 18% to 77%). Vaccination rates were lowest in physicians who had been in their current post for longer (P=.001), with larger patient lists (P=.03), with more older people in their list (P=.000), and with larger proportions of older people in their list (P=.001). Lower rates of vaccination in older people were also associated with lower proportions of all patients on the list being vaccinated (P=.000). No significant associations were found for any of the other variables. After multivariate analysis only the percentage of older people on the physician's list remained significantly associated with vaccination rate. CONCLUSIONS: Influenza vaccination rates for older people were low and similar to rates reported earlier for this region of Spain. The percentage of older people in the list was the only explanatory variable in the model, and was inversely proportional to vaccination coverage.

[Validity of the non-mydriatic camera for diabetic retinopathy screening and analysis of retinopathy risk indicators]. / Validez de la cámara no midriática en el cribado de la retinopatía diabética y análisis de indicadores de riesgo de la retinopatía.

PURPOSE: Analysis of the validity of the non-mydriatic camera in detecting diabetic retinopathy and severity levels which can be referred to the ophthalmologist. Analysis of risk indicators of diabetic retinopathy which help increase the sensitivity of the screening: development time of prolonged diabetes (more than 20 years); poor metabolic control (HbA1C > 10%). METHOD: A cross-sectional study was designed to determine the validity of a diagnostic test (non-mydriatic fundus camera Topcon model TRC-NW6S). As criteria for evaluation we used validity indicators, predictive values, indicators of clinical use, and concordance. SETTING: Primary Care. Patients with severe cataracts were excluded. The sample size was 376 eyes of 188 type-2 diabetic patients. RESULTS: With reference to the distribution of diabetic retinopathy we found that 41.25% had a variable level of retinopathy. The validity indicators analysed improved as the number of fundus fields studied increased, obtaining sensitivity levels of greater than 75%; specificity greater than 95%; positive predictive values greater than 90% and almost perfect concordance when two or three fundus fields were used. CONCLUSIONS: The analysis of retinal photography in digital format can be considered a valid method with respect to the gold standard, and the severity indicators analysed can play a guiding role in obtaining greater prevalences of derivable diabetic retinopathy, but cannot be used as an isolated test for making clinical decisions.

[Clinical management of consultations: clinical content and predictability (SyN-PC Study)]. / Gestión clínica de la consulta: previsibilidad y contenido clínico (estudio SyN-PC).

OBJECTIVES: To describe care activity as a function of the nature of the consultation (predictability) and the needs of the patients (clinical content). To analyse the relationship of these with the characteristics of the consultation, of the patient and of the centre. DESIGN: Multi-centre, descriptive, observational study. SETTING: Primary care. Area 17 of the Health Department of the Community of Valencia, with 197316 inhabitants and 12 health centres. PARTICIPANTS: Information gathering in real time by outside observer. Stratified randomised sampling of 2051 patients who gave rise to 3008 reasons for medical consultation. MAIN MEASUREMENTS: Predictable consultations (Pr): their content can be foreseen (check-ups, picking up results). Unpredictable consultations (Unp): we cannot predict their content (acute problems may arise unexpectedly). These include urgent consultations. Administrative consultations (Ad): bureaucratic tasks (prescriptions, repeat sick-notes, sick certificates). Care consultations (Car): prevention, diagnosis and treatment of the illness, or monitoring of it. Variables here are the patient, the doctor and the consultation. RESULTS: 60% (1809) (95% CI, 58.69%-61.59%) of the reasons were Pr and 40% (1199) (95% CI, 36.6%-43.12%) were Unp. 50% (1509) (95% CI, 47.26%-53.06%) were Car, and 50% Ad (1499) (95% CI, 46.34%-53.39%). 40% (1189) (95% CI, 37.78%-41.28%) were Pr-Ad and only 21% (620) (95% CI, 19.16%-22.06%) were Pr-Car. 30% (889) (95% CI 27.92 %-31.18%) were Unp-Car, and 10% (310) (95% CI, 9.22%-11.4%) Unp-Ad. 48% of patients with a single reason for attendance were Pr-Ad (577) (95% CI, 44.25%-52.05). Teaching centres and computerised ones had less Pr-Ad load. Pr-Ad consultations increased with patient's age and with case-load. CONCLUSIONS: Almost 40% of the reasons for consultation are Pr-Ad, which implies inadequate clinical management. An intervention is needed to free up medical time consumed by bureaucratic questions, so that this time can be devoted fully to health-care tasks.

Gestión clínica de la consulta: previsibilidad y contenido clínico (estudio SyN-PC) / Clinical management of consultations: clinical content and predictability (SyN-PC study)

Objetivo. Describir la actividad asistencial en función de la naturaleza de la consulta (previsibilidad) y las necesidades de los pacientes (contenido clínico). Analizar la relación con las características de la consulta, del paciente y del centro. Diseño. Estudio observacional descriptivo multicéntrico. Emplazamiento. Atención primaria. Área 17 de la Conselleria de Sanidad de la Comunidad Valenciana. Población de 197.316 habitantes. Trece centros de salud. Participantes. Recogida de información en tiempo real por un observador externo. Muestreo aleatorio estratificado de 2.051 pacientes que ocasionaron 3.008 motivos de consulta médica. Mediciones principales. Consulta previsible (Pr): se puede prever su contenido (revisiones, recogida de resultados). Consulta imprevisible (Ip): no podemos prever su contenido (problemas agudos) y surgen inesperadamente. Engloba la consulta urgente. Consulta administrativa (Ad): tareas burocráticas (recetas, partes de confirmación, certificados). Consulta asistencial (As): prevenir, diagnosticar y tratar la enfermedad, o realizar seguimiento de ésta. Variables del paciente, el centro y la consulta. Resultados. El 60 por ciento (n = 1.809; IC del 95 por ciento, 58,69-61,59 por ciento) de los motivos fueron previsibles y el 40 por ciento (n = 1.199; IC del 95 por ciento, 36,6-43,12 por ciento), imprevisibles. El 50 por ciento (n = 1.509; IC del 95 por ciento, 47,26-53,06 por ciento) fueron consultas asistenciales y el 50 por ciento (n = 1.499; IC del 95 por ciento, 46,34-53,39 por ciento), administrativas. El 40 por ciento (n = 1.189; IC del 95 por ciento, 37,78-41,28 por ciento) fueron previsibles-administrativas y tan sólo un 21 por ciento (n = 620; IC del 95 por ciento, 19,1622,06 por ciento) resultaron de carácter previsible asistencial. El 30 por ciento (n = 889; IC del 95 por ciento, 27,92-31,18 por ciento) fueron de carácter imprevisible asistencial y el 10 por ciento (n = 310; IC del 95 por ciento, 9,2211,4 por ciento), imprevisibles-administrativas. En los pacientes con un único motivo, el 48 por ciento (n = 577; IC del 95 por ciento, 44,25-52,05 por ciento) fueron consultas previsibles-administrativas. Los centros docentes o informatizados tienen menos carga de consultas previsibles-administrativas. Éstas aumentan con la edad del paciente y con la presión asistencial. Conclusiones. Casi un 40 por ciento de los motivos de consulta son previsibles-administrativos, lo que implica una gestión clínica inadecuada. Sería necesaria una intervención que permitiera liberar tiempo médico consumido en asuntos burocráticos para dedicarlo a la tarea asistencial propiamente dicha (AU)

Características de la demanda sanitaria médica en atención primaria de un área de salud de la ComunidadValenciana (estudio SyN-PC) / Characteristics of the demand for medical attention in primary care of a health area in the community of Valencia (SYN-PC-STUDY

Objetivo. Cuantificar con datos primarios los tipos, motivos y diagnósticos de consulta, la actividad preventiva y el diagnósticos de enfermedad por aparatos. Validar el registro en la historia clínica, y en la hoja de trabajo del médico (SIGAP), los tipos y motivos de consulta. Diseño. Estudio observacional, transversal y multicéntrico. Se recoge la actividad asistencial realizada en consulta durante dos días de enero de 2002.Emplazamiento. Todos los Centros de Salud del Área 17 de la Comunidad Valenciana. Participantes. Muestra representativa de 2.051 pacientes pertenecientes a 20 consultas médicas de un equipo de atención primaria de los centros anteriormente reseñados, seleccionadas por muestreo estratificado por centros de salud. Mediciones principales. Se recogió la actividad generada durante la jornada laboral estructurándola en: a) actividad asistencial (horario, edad, sexo, código de historia, tipo y motivo de consulta, especificando la actividad asistencial, preventiva o burocrática); b) actividad generada por el motivo principal de la visita (anamnesis, exploración y pruebas complementarias); c) plan de actividades (medidas higienicodietéticas, fármacos y derivaciones); d) uso de la historia clínica según apartados SOAP, y e) interrupciones en consulta. Discusión. El estudio de la actividad asistencial y su correlación con la actividad registrada en la historia clínica con datos primarios permite una aproximación fiel a nuestra realidad asistencial. Estos resultados pretenden poner de manifiesto, por un lado, la utilidad de las auditorías de historias clínicas como método de cuantificación de la actividad asistencial, así como detectar los patrones de consumo de recursos sanitarios, paso previo para la gestión de forma eficiente en atención primaria (AU)

Vacunación antigripal en personal sanitario: ¿problema de concienciación o de conciencia? / Anti-flu vaccination in health staff: problem of consciousness-raising or of conscience?

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