[Primary health care product defined by health professionals and users]. / El producto de la atención primaria definido por profesionales y usuarios.

OBJECTIVE: To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation. METHODS: Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: "Which features should be evaluated in the services that should be provided by PHC?". A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account. RESULTS: Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified. CONCLUSION: There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams.

El producto de la atención primaria definido por profesionales y usuarios / Primary health care product defined by health professionals and users

Objetivo: Definir los componentes del producto de la atención primaria de salud (APS) a partir de las opiniones de profesionales y usuarios, para establecer indicadores de evaluación. Métodos: Estudio con metodología cualitativa, con técnicas grupales: grupo nominal (profesionales) y grupos focales (usuarios). Ámbito de realización: APS de Catalunya. Se realizaron 7 grupos: a) médicos de familia y pediatras; b) enfermeras y trabajadoras sociales; c) personal de la unidad de admisión y atención al usuario; d) otros médicos especialistas; e) usuarios, y f) gestores, farmacéuticos y farmacólogos y técnicos de salud. Los participantes respondieron a la pregunta: «Respecto a los servicios que debería ofrecer la APS, ¿cuáles son los aspectos que se deberían valorar?». Se realizó un análisis de contenido. Los datos textuales se descompusieron en unidades, posteriormente agrupadas en categorías, siguiendo el criterio de analogía. Se tuvo en cuenta el contexto de interpretación del equipo investigador. Resultados: Profesionales y usuarios identifican 4 dimensiones del producto de la APS, coincidentes con sus atributos básicos: a) accesibilidad a los servicios; b) coordinación y continuidad del equipo de APS con otros niveles asistenciales; c) relación entre profesionales y usuarios, y d) calidad científico-técnica de los equipos de atención primaria y cartera de servicios. Equidad, satisfacción y eficiencia aparecen en los discursos como ejes transversales de todos los componentes del producto identificados. Conclusión: Hay una gran coincidencia en la definición del producto entre profesionales y usuarios. La relación profesional-paciente aparece como un elemento clave en todos los grupos. Estas 4 dimensiones deberían formar parte de la evaluación de los equipos de APS

Objective: To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation. Methods: Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: «Which features should be evaluated in the services that should be provided by PHC?». A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account. Results: Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified. Conclusion: There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams

Family medicine attributes related to satisfaction, health and costs.

OBJECTIVE: To identify, from a systematic review of the literature, the attributes of Family Medicine (FM) that influence the primary health care outcome as measured by users' satisfaction, improvement in patient health and in costs. DATA SOURCES: Literature search of Medline and the Cochrane library using MeSH terms 'Primary Health' or 'Family Practice' or 'Family Physicians' and 'Outcome Assessment' or 'Process Assessment'. Papers were excluded if they lacked a based on primary data, if no single component of FM was assessed; if indicators of evaluation were not related to health, satisfaction or costs. RESULTS: A total of 356 articles were initially identified and 19 finally met the inclusion criteria. Study methods were a systematic review of randomized control trials, a double-blind randomized trial, 4 systematic reviews of observational studies, 2 cohort studies and 12 descriptive cross-sectional studies. CONCLUSIONS: There was evidence of relationships between the attributes of FM and the service outcomes measured by indicators of satisfaction, health and cost. User satisfaction was associated with accessibility, continuity of care, consultation time and the doctor-patient relationship. Improvement in patient's health was related to continuity, consultation time, doctor-patient relationship and the implementation of preventive activities. Coordination of care showed mixed results with health outcomes. Continuity, consultation time, doctor-patient communication and prevention were cost-effective in the primary care setting.

[Intramuscular route for the administration of the anti-flu vaccine in patients receiving oral anticoagulation therapy]. / Utilización de la vía intramuscular para la administración de la vacuna antigripal en pacientes que reciben anticoagulantes orales.

BACKGROUND AND OBJECTIVE: Comparison of safety and effectiveness of the intramuscular (IM) (deltoid) vs subcutaneous (s.c.) administration of the flu vaccine (FV) in patients on oral anticoagulation therapy. PATIENTS AND METHOD: It was a phase IV, simple blind, 2-parallel groups, randomized trial developed in an urban primary care setting. We included patients taking oral anticoagulation therapy without FV contraindications. The IM administration of the FV in the experimental group was compared with a SC administration in the control group. RESULTS: 59 patients were included. The two groups were comparable at the beginning of the study. INR was not modified following s.c. (p = 0.38) or i.m. (p = 0.49) administration. No systemic side effects were observed. More cutaneous lesions were observed in the S.C. group (71.4%) when compared with the i.m. group (25.8%; p < 0.0001). For the remaining variables, we observed a tendency towards more reported pain in the SC group (35.7 vs 22.6%) and a larger brachial diameter (42 vs 29%) without significant differences. 3.2% of patients in the i.m. group and 7.1% in the s.c. group developed influenza symptoms without significant differences. CONCLUSIONS: Even though the results must be interpreted with caution, currently there appears to be no apparent contraindication for the i.m. administration of the FV. When it is administered subcutaneously, it tends to cause more side effects.

Utilización de la vía intramuscular para la administración de la vacuna antigripal en pacientes que reciben anticoagulantes orales / Intramuscular route for the administration of the anti-flu vaccine in patients receiving oral anticoagulation therapy

FUNDAMENTO Y OBJETIVO: Comparar la seguridad y la efectividad de la administración intramuscular deltoidea de la vacuna antigripal (VAG) respecto a la subcutánea en pacientes que reciben anticoagulantes orales. PACIENTES Y MÉTODO: Ensayo clínico aleatorizado de fase IV, simple ciego, llevado a cabo por un equipo de atención primaria (EAP) urbano en pacientes con anticoagulación oral sin contraindicación para la VAG. Las variables analizadas fueron la edad, el sexo, la diámetro braquial, las lesiones elementales, el dolor (según una escala analógica visual), los efectos secundarios sistémicos, la razón normalizada internacional (INR) y la aparición de episodio gripal hasta junio de 2002. RESULTADOS: Se incluyó a 59 pacientes (28 en los que la VAG se administró por vía subcutánea y 31 por vía intramuscular). No se modificó el INR después de la administración subcutánea (p= 0,38) ni intramuscular (p = 0,49). No se observaron efectos secundarios sistémicos. Se observaron más lesiones cutáneas en la administración subcutánea (71,4%) que en la intramuscular (25,8%) (p < 0,0001), número necesario a tratar (NNT) 2 (intervalo de confianza [IC] del 95%, 1-4). En el resto de variables se observa una tendencia a que el grupo de administración subcutánea presente más dolor (el 35,7 frente al 22,6%) y un mayor diámetro braquial (el 42,9 frente al 29,0%), sin diferencias significativas. Presentaron clínica compatible con gripe un 3,2% del grupo intramuscular y un 7,1% del grupo de administración subcutánea, sin ser diferencias significativas. CONCLUSIONES: Aunque los resultados deben interpretarse de forma prudente, no hay ninguna justificación actual para contraindicar la administración de la vacuna antigripal por vía intramuscular; incluso la administración por vía subcutánea presenta más efectos secundarios

BACKGROUND AND OBJECTIVE: Comparison of safety and effectiveness of the intramuscular (IM)(deltoid) vs subcutaneous (s.c.) administration of the flu vaccine (FV) in patients on oral anticoagulation therapy. PATIENTS AND METHOD: It was a phase IV, simple blind, 2-parallel groups, randomized trial developed in an urban primary care setting. We included patients taking oral anticoagulation therapy without FV contraindications. The IM administration of the FV in the experimental group was compared with a SC administration in the control group. RESULTS: 59 patients were included. The two groups were comparable at the beginning of the study. INR was not modified following s.c. (p = 0.38) or i.m. (p = 0.49) administration. No systemic side effects were observed. More cutaneous lesions were observed in the S.C. group(71.4%) when compared with the i.m. group (25.8%; p < 0.0001). For the remaining variables, we observed a tendency towards more reported pain in the SC group (35.7 vs 22.6%) anda larger brachial diameter (42 vs 29%) without significant differences. 3.2% of patients in theim. group and 7.1% in the s.c. group developed influenza symptoms without significant differences. CONCLUSIONS: Even though the results must be interpreted with caution, currently there appears to be no apparent contraindication for the i.m. administration of the FV. When it is administered subcutaneously, it tends to cause more side effects

[Screening of microfilariasis in blood (Loa Loa) among the immigrant population in endemic areas]. / Cribaje de microfilariasis sanguínea (Loa loa) en la poblacion inmigrante de zonas endemicas.

BACKGROUND: Given the increasing flux of immigrant population from high-risk areas to our country, the need of screening for loasis arises, despite systematic screening being a debated and poorly evaluated practice to which there is no protocol. This study is aimed at identifying the population to which loasis screening would be most appropriate, by drawing a comparison among four alternatives. METHODS: Case and control group study, involving 30 cases (all those who came to our unit for treatment and who tested positive for Loa Loa in a microfilariae in the blood detection test) and 90 control cases (three controls per case from among the subjects having tested negative for microfiliariae in the blood chosen at random without any pairing criteria). RESULTS: Of the 1,638 subjects on whom the microfilariae blood test was performed, 30 tested positive (1.8%; 1.2-2.6%). Of these 30 cases of loasis, 76.7% (23; 57.7-90.1%) had eosinophilia (OR 8.8; 3.3-23.1; p<0.0001) and 30.0% (9; 14.7-49.4%) compatible clinical symptoms (OR 2.8; 1.0-7.5; p=0.04). If we were to apply the screening test to the entire immigrant population coming from endemic areas, we would have to perform 54.6 tests to detect one case. If we were to perform the test on patients showing eosinophilia and/or compatible clinical symptoms, we would have to perform a smaller number of tests for every case detected (NNS=29; IC=21-48), but there would be 16.7% (5; 5.7-34.7%) false negatives. CONCLUSIONS: Conducting a screening test with determination of microfiliariae in the blood on the immigrant population coming from Central and West Africa, independently of the presence of eosinophilia or compatible clinical symptoms, would be indicated, provided that the necessary resources are available.

Cribaje de microfilariasis sanguínea (Loa Loa) en la población inmigrante de zonas endémicas / Screening of microfilariasis in blood (Loa Loa) among the immigrant population in endemic areas

Fundamento: Dada la creciente afluencia de población inmigrante originaria de zonas de riesgo a nuestro país se plantea la necesidad de realizar cribaje para loasis, aunque el cribaje sistemático es una práctica discutida, poco evaluada y aún no protocolizada. El objetivo de este estudio es identificar la población en la que es más adecuado realizar el cribado de loasis, comparando 4 alternativas. Métodos: Estudio de casos y controles, con 30 casos (todos los que consultaron en nuestra Unidad y con un test de detección de microfilaremia positivo para Loa loa) y 90 controles (tres controles por caso de entre los sujetos con microfilaremia negativa, escogidos aleatoriamente y sin criterios de apareamiento). Resultados: De los 1.638 sujetos a los que se realizó la prueba de microfilaremia 30 (1,8%;1,2-2,6%) resultaron positivos. De estos 30 casos con loasis 76,7% (23;57,7-90,1%) presentaban eosinofilia (OR 8,8; 3,3-23,1; p<0,0001) y un 30,0% (9;14,7-49,4%) presentaba clínica (OR 2,8; 1,0-7,5; p=0,04). Si aplicáramos el test de cribado a toda la población inmigrante procedente de áreas endémicas deberíamos realizar 54,6 pruebas para detectar un caso. Si lo realizáramos en sujetos que presentan eosinofilia y/o clínica compatible, el número de pruebas que deberíamos realizar para cada caso detectado sería inferior (NNS=29; IC=21-48) pero habría un 16,7% (5;5,7-34,7%) de falsos negativos. Conclusiones: Estaría indicado practicar un test de cribado con determinación de microfilaremia a la población inmigrante procedente de Africa Central y Oeste, independientemente de la presencia de eosinofilia o clínica compatible, siempre que se disponga de los recursos necesarios (AU)

Background: Given the increasing flux of immigrant population from high-risk areas to our country, the need of screening for loasis arises, despite systematic screening being a debated and poorly evaluated practice to which there is no protocol. This study is aimed at identifying the population to which loasis screening would be most appropriate, by drawing a comparison among four alternatives. Methods: Case and control group study, involving 30 cases (all those who came to our unit for treatment and who tested positive for Loa Loa in a microfilariae in the blood detection test) and 90 control cases (three controls per case from among the subjects having tested negative for microfilariae in the blood chosen at random without any pairing criteria). Results: Of the 1,638 subjects on whom the microfilariae blood test was performed, 30 tested positive (1.8%; 1.2-2.6%). Of these 30 cases of loasis, 76.7% (23;57.7-90.1%) had eosinophylia (OR 8.8; 3.3-23.1; p<0.0001) and 30.0% (9;14.7-49.4%) compatible clinical symptoms (OR 2.8; 1.0-7.5; p=0.04). If we were to apply the screening test to the entire immigrant population coming from endemic areas, we would have to perform 54.6 tests to detect one case. It we were to perform the test on patients showing eosinophylia and/or compatible clinical symptoms, we would have to perform a smaller number of tests for every case detected (NNS=29; IC=21-48), but there would be 16.7% (5;5.7-34.7%) false negatives. Conclusions: Conducting a screening test with determination of microfilariae in the blood on the immigrant population coming from Central and West Africa, independently of the presence of eosinophylia or compatible clinical symptoms, would be indicated, provided that the necessary resources are available (AU)