[Document of wishes stated in advance: attitudes of primary care patients]. / Documento de voluntades anticipadas: actitud de los pacientes de atención primaria.

OBJECTIVE: To find the attitude of health centre patients to the Document of Wishes stated in Advance (DWA).Design. Descriptive cross-sectional study using a specially designed questionnaire. Setting. Urban health centre in Palma de Mallorca. PARTICIPANTS: 132 users of a primary care clinic in Palma de Mallorca, seen between 21/6/2002 and 15/7/2002. Criteria for exclusion: <40 years old, first visit, major physical or psychological disease at time of visit and advanced neoplasia. MAIN MEASUREMENTS: Patients received written information on the DWA along with the self-administered questionnaire that consisted of five closed questions and free comment. RESULTS: 107 questionnaires were received back (81%). 57.6% were women; and mean age was 55 (40-87). 97% thought the DWA was interesting. 39.3% said they would formalise a DWA and a further 39.3% thought it possible they would. If they did so, 88.8% wanted to discuss it with family members and 73.8% with their family doctor. 32.1% had already talked "clearly" with their family members about terminal care, and 31.1% had talked "in general terms". 36.8% said they had not talked about it. 86% found it "not at all uncomfortable" to read the document. 38 respondents wrote comments about a dignified death, freedom to decide, the relevance of the DWA, the importance of being informed and euthanasia. CONCLUSIONS: Participants were clearly in favour of the DWA and many fully intended to formalise it. They wanted to discuss the question with family members and their doctors. Thinking about it did not make them uncomfortable. The recent legalisation of the DWA may help patients and doctors to talk openly about care at the end of life.

Documento de voluntades anticipadas: actitud de los pacientes de atención primaria / Document of wishes stated in advance: attitudes of primary care patients

Objetivo. Conocer la actitud de pacientes ambulatorios acerca del documento de voluntades anticipadas (DVA).Diseño. Estudio descriptivo transversal mediante cuestionario diseñado específicamente. Emplazamiento. Centro de salud urbano de Palma de Mallorca. Participantes. Un total de 132 usuarios de una consulta de atención primaria en Palma de Mallorca, atendidos entre el 21 de junio y el 15 de julio de 2002. Criterios de exclusión: < 40 años de edad, primera visita, importante afección física o psíquica durante la visita y neoplasia avanzada. Mediciones principales. Los pacientes recibieron información escrita sobre el DVA junto con el cuestionario auto administrado que constaba de cinco preguntas cerradas y comentario libre. Resultados. Se recibieron 107 cuestionarios (81 por ciento). El 57,6 por ciento de quienes contestaron fueron mujeres. La mediana de edad fine de 55 (40-87) años. El 97 por ciento consideró interesante el DVA. El 39,3 por ciento aseguró que formalizaría un DVA y otro 39,3 por ciento lo creía posible. En caso de hacerlo, el 88,8 por ciento desearía hablarlo con familiares y el 73,8 por ciento, con el médico de familia. El 32,1 por ciento ya había hablado "claramente" con sus familiares sobre los cuidados finales y el 31,1 por ciento, "por encima". El 36,8 por ciento negó haberlo hablado. Al 86 por ciento no le resultó "nada incómodo" leer el documento. Treinta y ocho participantes escribieron comentarios sobre muerte digna, libertad para decidir, interés del DVA, importancia de estar informados y eutanasia. Conclusiones. Los participantes están claramente a favor del DVA, y se observa una amplia intención de formalizarlo; además, desean tratar el tema con sus familiares y médicos de familia, y pensar en ello no les incomoda. La legalización reciente del DVA puede ayudar a pacientes y médicos a hablar abiertamente sobre los cuidados al final de la vida (AU)

[Site of care provision, etiology and treatment of community-acquired pneumonia in Palma de Mallorca]. / Lugar de atención, etiología y tratamiento de las neumonías adquiridas en la comunidad de Palma de Mallorca.

BACKGROUND: It is not common that community-acquired pneumonias studies include patients non treated in hospital. The objectives were: to determine the cases managed in the ambulatory setting; to describe the clinical features; to identify the aetiological agents, and to describe the treatment, comparing inpatients with outpatients. PATIENTS AND METHODS: Observational prospective study. Population attended at three teaching primary care centers of Palma de Mallorca (60,450 habitants). Patients (> 14 years) were investigated when diagnosticated of community-acquired pneumoniae, from November 1992 to December 1994. Exclussions: HIV infection, patients living in a nursing home and tuberculosis. Data were collected in both Hospital and primary health care centers. Epidemiological, clinical, radiological and laboratory findings were recorded at the initial visit and 21 days after. RESULTS: 91 cases were investigated. 57% were managed at the primary care centers exclusively, 63.3% of the patients who went initially to the hospital were admitted in; but only 10.9% of those who went initially to the primary care centers (p < 0.005). 24 patients were hospitalized. 56 microbiological agents were identified in 48 patients (52.7%): Mycoplasma pneumoniae (10); Streptococcus pneumoniae (9); Influenza B (8); Chlamydia psittacci (7); Influenza A (7); Coxiella burnetii (5); Chlamydia pneumoniae (4); Legionella (3); Adenovirus (2); and Parainfluenza 3 (1). Mycoplasma was predominant in outpatients: 9 cases. S. pneumoniae in inpatients: 5 cases. Eritromycin was the most common treatment prescribed (76.9% of patients), alone or in combination with other antibiotics. Monotherapy was most common at primary care yield (96.7%) than at the hospital (45.2%) (p < 0.005). CONCLUSIONS: Most of the patients with community-acquired pneumonias are managed at primary health care centers. M. pneumoniae is the predominant microbiological agent in outpatients and S. pneumoniae in inpatients. Erithromycin is the most used antibiotic in both groups of patients.