[Implementation of diabetic retinopathy screening using digital retinography in primary care]. / Implantación del cribado de retinopatía diabética mediante retinografía digital en atención primaria.

OBJECTIVE: To improve early detection and monitoring of diabetic retinopathy (DR) in two primary care centers (PCC) using a non-mydriatic retinal camera (NMRC). DESIGN: Prospective longitudinal descriptive study. LOCATION: Area 11 Primary Care, Madrid. PARTICIPANTS: Adult patients with diabetes (DM) without funduscopic examination in the last two years (FO). INTERVENTIONS: Implementation process of screening for DR by NMRC in PCC. Digital photography of the retina made by nursing staff. Interpretation of retinal images by an ophthalmologist. MEASUREMENTS: Number of DM with FO. Number of patients with DR. Metabolic control in the last two years (HbA1c). STUDY PERIOD: September 2009-September 2011. RESULTS: DM increased from 2850 to 3357. The proportion of patients with FO increased from 6.7% (95% CI: 5.7-7.6%) to 32.4% (95% CI: 30.8-34.0%) (P<.001). The prevalence of DR increased from 3.85% (95% CI: 3.14-4.58%) to 4.3% (95% CI: 3.59-4.99%). The percentage of patients with FO and DR decreased from 60% (95% CI: 52.77-67.23%) to 14% (95% CI: 11.87-16.09%) (P<.001). The proportion of DM with HbA1c increased from 21.9% (95% CI: 20.36-23.43%) to 52.4% (95% CI: 50.69-54.10%) (P<.001). The mean HbA1c in patients with DR and without DR was 7.8 (95% CI: 7.50-8.06) and 7.1 (IC95% CI: 7.08-7.22) (P<.001), respectively. CONCLUSIONS: NMRC in PCC is accompanied by an increase in the number of diabetics with FO examination. The implementing of DR screening is possible if an NMRC is available, along with available resources, the motivation of the professionals involved and management commitment. A longer follow-up is required to determine its impact on referral rates to ophthalmology service, and to only refer those with dubious images.

[Organizational procedures and health care management. A point of view from primary care centres]. / Medidas organizativas y práctica asistencial. Una perspectiva desde los centros de salud.

OBJECTIVE: We aimed to know how the directive teams perceive the implementation of organizational procedures in relation with the health care management in the primary care setting. DESIGN: Multicentre cross-sectional descriptive study. SETTING: Area 11 Madrid Primary Care Service, Spain. PARTICIPANTS: All directive teams of primary care centres (PCC) (n=38). MEASUREMENTS: Data were collected with a self-administered semiestructured questionnaire which included 21 main questions about procedures and use of internal organizational measures relating to the health care management in PCC, grouped in five sections: predictable and non predictable consultations(clinical and administrative), clinical schedules and office management. RESULTS: 100% response rate. 69% of PCC use internal procedures and computerized applications for the renewal of medical chronic prescriptions and 55% for temporary disability. 71% show nurse involvement in terms of dispensing medical prescriptions during clinical consultations. 42% keep on performing administrative procedures of specialized care. 21% don't get compliance with routine control of programs and in 29% of consultations duplicity of visits among medicine and nursing are expected. 97% follow a specific process for urgent attention. 84% request subsequent appointment in the previous clinical consultation. 29% have open schedules availables for 6 months. CONCLUSIONS: A wide variability of the implementation of organizational procedures in PCC was observed. Further research is needed to determine whether any organizational and professional changes could contribute to improve efficiency and patient satisfaction.

Implantación del cribado de retinopatía diabética mediante retinografía digital en atención primaria / Implementation of diabetic retinopathy screening using digital retinography in primary care

Objetivo: Mejorar la detección precoz y el seguimiento de la retinopatía diabética (RD) en 2 centros de salud mediante retinografía no midriática (RNM). Diseño: Estudio descriptivo longitudinal prospectivo. Emplazamiento: Área 11 de atención primaria (AP) de Madrid. Participantes: Pacientes diabéticos adultos (DM) sin exploración de fondo de ojo (FO) en los 2 últimos años. Intervenciones: Proceso de implantación del cribado de RD mediante RNM en AP. Fotografía digital de la retina efectuada por personal de enfermería. Interpretación de retinografías por el oftalmólogo. Mediciones: Número de DM con FO. Número de pacientes con RD. Grado de control metabólico en los últimos 2 años (HbA1c). Periodo de estudio: Septiembre de 2009 a septiembre de 2011. Resultados: El número de DM aumentó de 2.850 a 3.357. La proporción de pacientes con FO ascendió del 6,7% (IC 95%: 5,7-7,6%) al 32,4% (IC 95%: 30,8-34,0%) (p<0,001). La prevalencia de RD aumentó de 3,85% (IC 95%: 3,14-4,58%) a 4,3% (IC 95%: 3,59-4,99%). El porcentaje de pacientes con FO y RD disminuyó del 60% (IC 95%: 52,77-67,23%) al 14% (IC 95%: 11,87-16,09%) (p<0,001). La proporción de DM con HbA1c aumentó del 21,9% (IC 95%: 20,36-23,43%) al 52,4% (IC 95%: 50,69-54,10%) (p<0,001). El valor medio de HbA1c en pacientes con RD fue 7,8 (IC 95%: 7,50-8,06) y sin RD, 7,1 (IC 95%: 7,08-7,22) (p<0,001). Conclusiones: La RNM en AP se acompaña de un incremento del número de diabéticos con exploración de FO. Es posible implementar el cribado de RD mediante RNM si se dispone de los recursos necesarios, de la motivación de los profesionales implicados y del compromiso directivo. Un seguimiento más prolongado permitirá conocer su impacto en la tasa de interconsultas a oftalmología, llegando a derivar solo las imágenes dudosas(AU)

Objective: To improve early detection and monitoring of diabetic retinopathy (DR) in two primary care centers (PCC) using a non-mydriatic retinal camera (NMRC). Design: Prospective longitudinal descriptive study. Location: Area 11 Primary Care, Madrid. Participants: Adult patients with diabetes (DM) without funduscopic examination in the last two years (FO). Interventions: Implementation process of screening for DR by NMRC in PCC. Digital photography of the retina made by nursing staff. Interpretation of retinal images by an ophthalmologist. Measurements: Number of DM with FO. Number of patients with DR. Metabolic control in the last two years (HbA1c). Study period: September 2009-September 2011. Results: DM increased from 2850 to 3357. The proportion of patients with FO increased from 6.7% (95% CI: 5.7-7.6%) to 32.4% (95% CI: 30.8-34.0%) (P<0.001). The prevalence of DR increased from 3.85% (95% CI: 3.14-4.58%) to 4.3% (95% CI: 3.59-4.99%). The percentage of patients with FO and DR decreased from 60% (95% CI: 52.77-67.23%) to 14% (95% CI: 11.87-16.09%) (P<.001).The proportion of DM with HbA1c increased from 21.9% (95% CI: 20.36-23.43%) to 52.4% (95% CI: 50.69-54.10%) (P<0.001). The mean HbA1c in patients with DR and without DR was 7.8 (95% CI: 7.50-8.06) and 7.1 (IC95% CI: 7.08-7.22) (P<0.001), respectively. Conclusions: NMRC in PCC is accompanied by an increase in the number of diabetics with FO examination. The implementing of DR screening is possible if an NMRC is available, along with available resources, the motivation of the professionals involved and management commitment. A longer follow-up is required to determine its impact on referral rates to ophthalmology service, and to only refer those with dubious images(AU)

Medidas organizativas y práctica asistencial. Una perspectiva desde los centros de salud / Organizational procedures and health care management. A point of view from primary care centres

ObjetivoConocer la utilización de medidas organizativas relacionadas con la práctica asistencial de los centros de salud (CS) a través de la valoración de las comisiones directivas.DiseñoEstudio multicéntrico, descriptivo, transversal.EmplazamientoÁrea 11 Atención Primaria, Madrid.ParticipantesComisiones Directivas de los Equipos de Atención Primaria (n=38).MedicionesSe utilizó un cuestionario semiestructurado autoadministrado con 21 preguntas principales sobre procedimientos y utilización de medidas organizativas internas relacionadas con la práctica asistencial en los CS, agrupadas en 5 apartados: consultas previsibles y no previsibles (carácter asistencial o administrativo) y gestión de agendas/atención al usuario.ResultadosTasa de respuesta 100%. El 69% dispone de circuito interno y/o aplicación informática para renovación de recetas crónicas y el 55% para incapacidad temporal. En el 71%, las consultas de enfermería participan en emisión y entrega de recetas crónicas. El 42% realiza trámites administrativos atribuibles a atención especializada. El 21% no se ajusta a la frecuencia recomendada de visitas de seguimiento en los programas asistenciales y el 29% duplica la actividad entre medicina y enfermería. El 97% dispone de circuito específico interno para atención urgente. El 84% facilita citación autoconcertada desde las consultas y un 29% tiene agenda disponible para un período superior a 6 meses.ConclusionesExiste variabilidad en la utilización de determinadas medidas organizativas y procedimientos relacionados con la práctica asistencial en los centros de salud. Sería recomendable una mayor investigación para determinar si los cambios organizativos y del profesional pudieran contribuir a una mejor eficiencia y satisfacción del paciente(AU)

ObjectiveWe aimed to know how the directive teams perceive the implementation of organizational procedures in relation with the health care management in the primary care setting.DesignMulticentre cross-sectional descriptive study.SettingArea 11 Madrid Primary Care Service, Spain.ParticipantsAll directive teams of primary care centres (PCC) (n=38).MeasurementsData were collected with a self-administered semiestructured questionnaire which included 21 main questions about procedures and use of internal organizational measures relating to the health care management in PCC, grouped in five sections: predictable and non predictable consultations(clinical and administrative), clinical schedules and office management.Results100% response rate. 69% of PCC use internal procedures and computerized applications for the renewal of medical chronic prescriptions and 55% for temporary disability. 71% show nurse involvement in terms of dispensing medical prescriptions during clinical consultations. 42% keep on performing administrative procedures of specialized care. 21% don’t get compliance with routine control of programs and in 29% of consultations duplicity of visits among medicine and nursing are expected. 97% follow a specific process for urgent attention. 84% request subsequent appointment in the previous clinical consultation. 29% have open schedules availables for 6 months.ConclusionsA wide variability of the implementation of organizational procedures in PCC was observed. Further research is needed to determine whether any organizational and professional changes could contribute to improve efficiency and patient satisfaction(AU)