Actividad de enfermería en consultorios del médico y la enfermera de la familia de La Habana / Nursing Activity in Family Doctor's and Nurse's Offices of Havana

RESUMEN Introducción: Se desconoce si el personal de enfermería del consultorio del médico y la enfermera de la familia cumple con las actividades asignadas, ni cómo consume los recursos. Objetivo: Describir las actividades y los recursos consumidos por el personal de enfermería en los consultorios del médico y la enfermera de la familia. Métodos: Investigación descriptiva transversal. Se estudió la totalidad de los consultorios del médico y la enfermera de la familia de tres policlínicos del municipio Diez de Octubre en 2016. Se utilizaron seis indicadores de actividades y cuatro de recursos. Se emplearon la mediana, la media, el mínimo, el máximo y se aplicaron pruebas para comparación de medias y proporciones. Resultados: En dos de los tres policlínicos, menos de la mitad de los consultorios cumplieron el seguimiento del programa materno infantil (mediana 67,69 por ciento y 36,25 por ciento), ninguno cumplió el seguimiento a los grupos especiales (mediana 46,02 por ciento y 38,38 por ciento) ni a los pacientes con enfermedades crónicas (mediana 17,46 por ciento y 1,92 por ciento) o con enfermedades transmisibles (mediana 0,00 por ciento). Solo en un policlínico todos los consultorios cumplieron con la citología vaginal (mediana 117,16). El mayor gasto fue por recursos humanos y fue similar entre las unidades (10122,44 CUP a 10997,29 CUP). Conclusiones: El funcionamiento fue dispar. Si bien hubo consultorios del médico y la enfermera de la familia que cumplieron con la mayoría de las actividades previstas con gastos similares o menores al resto, en otros, el trabajo quedó muy por debajo de lo establecido, aunque con gastos iguales o mayores al resto(AU)

ABSTRACT Introduction: It is unknown if the nursing staff of the family doctor's and nurse's office fulfills the assigned activities, or how they consume the resources. Objective: To describe the activities and resources consumed by the nursing staff of the family doctor's and nurse's office. Methods: Cross-sectional and descriptive research. All the family doctor's and nurse's offices belonging to three outpatient polyclinics of Diez de Octubre Municipality were studied in 2016. Six indicators of activities and four of resources were used. The median, average, minimum, maximum were used, and tests were applied to compare means and proportions. Results: In two of the three outpatient polyclinics, less than half of the medical offices fulfilled the follow-up of the maternal and child program (median 67.69 percent and 36.25 percent), none complied with the follow-up of special groups (median 46.02 percent and 38.38 percent), or to patients with chronic diseases (median 17.46 percent and 1.92 percent) or with communicable diseases (median 0.00 percent). Only for one outpatient polyclinic all the medical offices fulfilled the vaginal cytology (median 117,16). The highest expenditure was in human resources and similar among the units (10122.44 CUP to 10997.29 CUP). Conclusions: The medical office running was uneven. Although there were family doctor's and nurse's offices that fulfilled most of the planned activities with expenses similar or less than the rest, in others, the work was well below what was established, although with expenses equal to or greater than the rest(AU)

Eficiencia de la actividad de enfermería en consultorios del médico y la enfermera de la familia / Efficiency of nursing activities in family doctor's and nurse's offices

RESUMEN Introducción: En Cuba, la enfermera de la familia se distingue por tener múltiples áreas de resultados, para lo cual son necesarios diferentes recursos. Se desconoce si es mucho o poco el recurso consumido de cara a las actividades realizadas. Objetivo: Caracterizar la eficiencia de la actividad de enfermería de consultorios del médico y enfermera de la familia y determinar áreas de mejoramiento para incrementar la eficiencia. Métodos: Estudio descriptivo transversal con la totalidad de consultorios de tres policlínicos del municipio 10 de Octubre. Se resolvió un modelo de análisis envolvente de datos de maximización de resultados y rendimientos constantes a escala con seis indicadores de resultados y cuatro de recursos. Resultados: La media de la eficiencia estuvo entre 86,66 por ciento y 95,63 por ciento. Para mejorar la eficiencia se deben alcanzar valores promedios de cumplimiento del seguimiento para atención materno infantil entre 85,32 por ciento y 88,58 por ciento; para pacientes con enfermedades crónicas entre 8,99 por ciento y 41,67 por ciento; para pacientes con enfermedades transmisibles entre 34,87 por ciento y 54,55 por ciento; para el adulto mayor entre 65,70 por ciento y 90,23 por ciento y para las citologías vaginales entre 91,97 por ciento y 162,72 por ciento. Además, reducir en promedio el gasto en material gastable entre 11,25 por ciento y 47,28 por ciento; en medicamentos entre 15,31 por ciento y 107,22 por ciento y en recursos humanos entre 15,01 por ciento y 32,72 por ciento. Conclusiones: Se determinaron niveles altos de eficiencia técnica pura para la actividad de enfermería en los consultorios, aunque se verificó la presencia de unidades ineficientes. Existen unidades con ineficiencia estructuralmente determinada que para resolverla es necesario un análisis del consumo de recursos(AU)

ABSTRACT Introduction: In Cuba, the family nurse is distinguished by having multiple areas of results for which different resources are necessary. It is unknown whether the resource consumed is much or little in the face of the activities carried out. Objectives: To characterize the efficiency of the nursing activity of doctor's offices and nurse of the family and determined areas of improvement to increase efficiency. Methods: A cross-sectional descriptive study was carried out with all the offices of three polyclinics of the municipality 10 October. A model of data enveloping analysis maximization of results and constant returns to scale was solved using six outputs four inputs. Results: The average efficiency was between 86.66 percent and 95.63 percent. In order to improve efficiency, average compliance values for maternal and child care should be reached between 85.32 percent and 88.58 percent; for patients with chronic diseases between 8.99 percent and 41.67 percent; for patients with communicable diseases between 34.87 percent and 54.55 percent; for the older adult between 65.70 percent and 90.23 percent and for vaginal cytology between 91.97 percent and 162.72 percent and to reduce on average the expenditure on material that can be spent between 11.25 percent and 47.28 percent; in medicines between 15.31 percent and 107.22 percent and in human resources between 15.01 percent and 32.72 percent. Conclusions: High levels of pure technical efficiency were determined for the nursing activity in the clinics, although the presence of inefficient units was verified. There are units with structurally determined inefficiency that, in order to solve it, an analysis of the consumption of resources is necessary(AU)

Satisfacción de los usuarios con la atención en los consultorios médicos. Colón 2015-2016 / User´s satisfaction with medical care in the medical consultations. Colon 2015-2016

Introducción: la evaluación de la satisfacción es de mucha importancia dentro del marco de la medición de la calidad en salud. Si se quiere ofrecer servicios de mayor calidad y crear instituciones de excelencia, entonces, la evaluación de la satisfacción en los usuarios, familiares y proveedores se convierte en una tarea permanente y dinámica. Objetivo: identificar el grado de satisfacción de usuarios con la atención en los consultorios médicos de Colón en el periodo 2015-2016. Materiales y métodos: se realizó un estudio de tipo descriptivo de corte transversal que se incluye en el campo de las investigaciones en sistemas y servicios de salud, la muestra la conformaron 480 usuarios pertenecientes a 32 consultorios médicos. Las dimensiones seleccionadas fueron: condiciones de locales de atención, tiempo de espera, disponibilidad de materiales, medicamentos e instrumentales, calidad de la atención. Resultados: la dimensión condiciones de los locales el 93,1 % de los usuarios reportaron que la limpieza de los consultorios fue buena, el tiempo de espera relacionado con los procederes de enfermería alcanzo el 79.1%, con respeto a la disponibilidad de materiales, medicamentos e instrumentales la variables de puntuación más baja la alcanzó la presencia de instrumentales con el 54,1% y el 81,6 % se encontraron satisfechos con la atención médica recibida. Conclusiones: los usuarios atendidos en los consultorios médicos se encuentran insatisfechos con la atención recibida. Las dimensiones estudiadas fueron evaluadas como no aceptables, solo la variable limpieza estuvo por encima del estándar establecido (AU).

Introduction: satisfaction assessment has great importance in the context of measuring health care quality. If the aim is providing services of higher quality and creating institutions of excellence, the assessment of the users´, relatives´ and providers´ satisfaction becomes a permanent and dynamic task. Objective: to identify the users´ satisfaction level with the health care provided in medical consultations of Colon, in the period 2015-2016. Materials and methods: a cross-sectional, descriptive study was carried out in the field of health care services and systems research. The sample was formed by 480 users who belonged to 32 medical consultations. The selected dimensions were: conditions of the health care places, waiting time, availability of materials, medicines and instruments, health care quality. Results: in the variable ¨conditions of the health care places¨, 93.1 % of the users reported that cleaning in the medical consultations was good; waiting time related with nursing procedures got 79.1 %; with respect to the availability of materials, medicines and instruments, the lowest qualification was for instruments existence, 54.1 %; and 81.6 % of the persons was satisfied with the received medical care. Conclusions: the users attended in the medical consultations are satisfied with the received care. The studied dimensions were evaluated as not acceptable; only the variable cleaning was above the established standard (AU).

Walk-in clinics versus physician offices and emergency rooms for urgent care and chronic disease management.

BACKGROUND: Walk-in clinics are growing in popularity around the world as a substitute for traditional medical care delivered in physician offices and emergency rooms, but their clinical efficacy is unclear. OBJECTIVES: To assess the quality of care and patient satisfaction of walk-in clinics compared to that of traditional physician offices and emergency rooms for people who present with basic medical complaints for either acute or chronic issues. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, six other databases, and two trials registers on 22 March 2016 together with reference checking, citation searching, and contact with study authors to identify additional studies. We applied no restrictions on language, publication type, or publication year. SELECTION CRITERIA: Study design: randomized trials, non-randomized trials, and controlled before-after studies. POPULATION: standalone physical clinics not requiring advance appointments or registration, that provided basic medical care without expectation of follow-up. Comparisons: traditional primary care practices or emergency rooms. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane and the Cochrane Effective Practice and Organisation of Care (EPOC) Group. MAIN RESULTS: The literature search identified 6587 citations, of which we considered 65 to be potentially relevant. We reviewed the abstracts of all 65 potentially relevant studies and retrieved the full texts of 12 articles thought to fit our study criteria. However, following independent author assessment of the full texts, we excluded all 12 articles. AUTHORS' CONCLUSIONS: Controlled trial evidence about the mortality, morbidity, quality of care, and patient satisfaction of walk-in clinics is currently not available.

Use and characteristics of electronic health record systems among office-based physician practices: United States, 2001-2013.

KEY FINDINGS: In 2013, 78% of office-based physicians used any type of electronic health record (EHR) system, up from 18% in 2001. In 2013, 48% of office-based physicians reported having a system that met the criteria for a basic system, up from 11% in 2006. The percentage of physicians with basic systems by state ranged from 21% in New Jersey to 83% in North Dakota. In 2013, 69% of office-based physicians reported that they intended to participate (i.e., they planned to apply or already had applied) in "meaningful use" incentives. About 13% of all office-based physicians reported that they both intended to participate in meaningful use incentives and had EHR systems with the capabilities to support 14 of the Stage 2 Core Set objectives for meaningful use. From 2010 (the earliest year that trend data are available) to 2013, physician adoption of EHRs able to support various Stage 2 meaningful use objectives increased significantly. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 authorized incentive payments to increase physician adoption of electronic health record (EHR) systems (1,2). The Medicare and Medicaid EHR Incentive Programs are staged in three steps, with increasing requirements for participation. To receive an EHR incentive payment, physicians must show that they are "meaningfully using" certified EHRs by meeting certain objectives (3,4). This report describes trends in the adoption of EHR systems from 2001 through 2013, as well as physicians' intent to participate in the EHR Incentive Programs and their readiness to meet 14 of the Stage 2 Core Set objectives for meaningful use in 2013.

Risk of redocumenting penicillin allergy in a cohort of patients with negative penicillin skin tests.

BACKGROUND: Even though electronic documentation of allergies is critical to patient safety, inaccuracies in documentation can potentiate serious problems. Prior studies have not evaluated factors associated with redocumenting penicillin allergy in the medical record despite a proven tolerance with a penicillin skin test (PST). OBJECTIVE: Assess the prevalence of reinstating inaccurate allergy information and associated factors thereof. DESIGN: We conducted a retrospective observational study from August 1, 2012 to July 31, 2013 of patients who previously had a negative PST. We reviewed records from the hospital, long-term care facilities (LTCF), and primary doctors' offices. SETTING: Vidant Health, a system of 10 hospitals in North Carolina. SUBJECTS: Patients with proven penicillin tolerance rehospitalized within a year period from the PST. MEASUREMENTS: We gauged hospital reappearances, penicillin allergy redocumentation, residence, antimicrobial use, and presence of dementia or altered mentation. RESULTS: Of the 150 patients with negative PST, 55 (37%) revisited a Vidant system hospital within a 1-year period, of whom 21 were LTCF residents. Twenty (36%) of the 55 patients had penicillin allergy redocumented without apparent reason. Factors associated with penicillin allergy redocumentation included age >65 years (P = 0.011), LTCF residence (P = 0.0001), acutely altered mentation (P < 0.0001), and dementia (P < 0.0001). Penicillin allergy was still listed in all 21 (100%) of the LTCF records. CONCLUSIONS: At our hospital system, penicillin allergies are often redocumented into the medical record despite proven tolerance. The benefits of PST may be limited by inadequately removing the allergy from different electronic/paper hospital, LTCF, primary physician, and community pharmacy records.

[Fungal and bacterial contamination of 30 general practitioners' consultation room in Franche-Comté (eastern France)]. / Contamination fongique et bactérienne de 30 salles de consultation de cabinets médicaux en Franche-Comté

OBJECTIVE: To evaluate the level of microbial contamination of general pratice environment. METHODS: Ten points, including air, water and surfaces were sampled in general practitioner's consultation room of 30 general practices in Franche-Comté region (eastern France). For each sample, a global microbial count was assessed as well as the presence of potential pathogen microorganisms: Aspergillus fumigatus, Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae. RESULTS: We note that 66.3% of the samples (n=202) were on the target level (<51 ufc/25 cm (2), <101 ufc/m(3), <100 ufc/mL in total bacteria, without pathogenic species and without A. fumigatus respectively on surfaces, air and water, without isolation of coliforme bacteria or P. aeruginosa for 100mL of water). A. fumigatus, S. aureus, P. aeruginosa and Enterobacteriaceae were recovered in 8.0%, 2.1%, 0.7%, 0% respectively. However, 66.7% of air sampling were positive to A. fumigatus with 2 to 12 cfu/m(3). CONCLUSION: This study shows a low level of bacterial contamination of general practitioner's consultation room. A. fumigatus frequency in air samples seems equivalent to that found in housing without air treatment.

Guideline for office spirometry in adults, 2012.

BACKGROUND: Office spirometry remains an integral part of a comprehensive respiratory evaluation and is used to categorise the nature, severity and progression of respiratory diseases and to measure response to treatment. These updated guidelines are aimed at improving the quality, standardisation and usefulness of office spirometry in South Africa. RECOMMENDATIONS: All equipment should have proof of validation regarding resolution and the system's linearity (consistency). Moreover, equipment must be calibrated daily and quality controlled. It is also important to have standard operating procedures in place, including the documentation of ambient conditions and infection control measures. Adequate spirometry relies on a competent operator, accurate equipment, standardised operating procedures, quality control and patient co-operation. The indication for spirometry in a particular patient should be unambiguous and should be documented. Subjects should be appropriately prepared for testing, and patient details must be documented. Forced vital capacity (FVC) manoeuvres (either closed or open circuit) must be performed strictly according to guidelines, and strict quality assurance methods should be in place, including acceptability criteria (for any given effort) and repeatability (between efforts). Testing should continue until at least 3 acceptable curves are produced (with 2 fulfilling repeatability criteria). Other indices are derived from these efforts. CONCLUSION: Test results must be categorised and graded according to current guidelines, taking into account the indication for the test and the appropriateness of reference values.