Assistance to the puerperium and the construction of a flow chart for nursing consultation / Assistência puerperal e a construção de um fluxograma para consulta de enfermagem

Abstract Objectives: to identify the main complaints and problems presented by women in the puerperium during nursing consultations and create a care flow chart. Methods: descriptive, cross-sectional exploratory study with quantitative treatment of data conducted in a private hospital in Brazil, with a sample of 114 women. Results: of the puerperal women evaluated, 57.9% were primiparous and 66.7% reported not having received guidance about the puerperal period. Cesarean sections occurred in 89.5% of the sample, and 80.7% of the women presented difficulties inherent to the care given to the newborn or self-care. All mothers were breastfeeding and 42.1% of them reported difficulties in this process. Among breast complications, 30.7% corresponded to fissures. In view of the needs observed in the nursing consultation, women received guidelines from the nurses, and were referred for specialized evaluation when pertinent. Conclusions: it was observed that problems and complaints presented by women in the puerperium were related with care to the newborn, breastfeeding, emotional state and family support. Health professionals who give puerperal consultations should consider the sociocultural environment in which the puerperal woman is inserted in order to link their beliefs with science.

Resumo Objetivos: identificar as principais queixas e problemas apresentados por mulheres no puerpério durante a consulta de enfermagem e elaborar um fluxograma de atendimento. Métodos: estudo descritivo, exploratório transversal com tratamento quantitativo dos dados. Realizado em hospital privado do interior paulista entre os meses de outubro a dezembro de 2016, com uma amostra de 114 mulheres. Resultados: das puérperas avaliadas, 57,9% eram primíparas e 66,7% referiram não ter recebido orientação sobre o período puerperal. A cesariana ocorreu em 89,5% da amostra e 80,7% das mulheres apresentaram dificuldades inerentes aos cuidados dispensados ao recém-nascido ou ao seu autocuidado. Todas as mulheres praticaram o aleitamento materno e 42,1% destas relataram dificuldades em amamentar. Dentre as complicações mamárias, 30,7% correspondeu às fissuras. Conclusões: observou-se que os problemas e queixas mais comuns no puerpério estão relacionados ao cuidado com o recém-nascido, aleitamento, estado emocional e suporte familiar. O profissional da saúde que realiza a consulta puerperal deve considerar o meio sociocultural em que a puérpera está inserida a fim de atrelar as suas crenças à ciência, de modo a obter sucesso nas orientações.

Análisis de la consulta enfermera de Atención Primaria en la Comunidad de Madrid (España) / An analysis of primary nurse consultation in the Community of Madrid

Objetivo: Analizar las características de la consulta enfermera en Atención Primaria e identificar los factores asociados a los diferentes tipos de actividad. Método: Estudio observacional multicéntrico transversal sobre 662 consultas de 164 enfermeras diferentes (23 centros de salud, Comunidad de Madrid). La consulta se clasificó según una propuesta de consenso en: «actividades de prevención» (AdP), «déficit de autocuidados» (DA), «afrontamiento y adaptación» (AyA) y «procedimientos diagnósticos y terapéuticos» (PDyT). Se recogieron características sociodemográficas, de necesidad en salud y relativas a la consulta. Se hizo un análisis inferencial bivariante y se construyeron modelos multivariantes explicativos. Resultados: El 63,6% (IC del 95%: 59,9-67,3%) de las consultas fueron PDyT. En el 24,3% (IC del 95%: 21,0- 27,7%) de los casos la consulta era a demanda. No hubo diferencias en el tipo de consultas por género (p = 0,858), ni para inmigrantes (p = 0,428). Los sujetos de clases sociales superiores ocuparon con más frecuencia consultas de AdP (p = 0,007). No había otras diferencias en accesibilidad. Las consultas de PDyT se relacionaron con la existencia de hospitalizaciones previas (OR: 1,191; IC del 95%: 1,088-1,304), o el uso previo de servicios (consulta enfermera OR: 1,002, IC del 95%: 1,000-1,003; consulta médica OR: 1,003, IC del 95%: 1,000-1,006). Conclusiones: La consulta enfermera en nuestro medio se dirige preferentemente a la realización de procedimientos y predomina la consulta autoconcertada respecto a la demanda. No se detectan inequidades en la accesibilidad, pero el tipo de atención para diferentes grupos sociales no fue homogéneo

Objective: to analyse the characteristics of primary care nurse consultation and to identify the factors associated with different types of activity. Method: A cross-sectional multicentre observational study in 23 health centres (Community of Madrid), on 164 different nurses. The consultation was classified according to a consensus proposal in: "preventive activities" (PA), "self-care deficit" (SD), "coping and adaptation" (CA) and "diagnostic and therapeutic procedures" (DTP). Sociodemographic characteristics, health needs, and consultation characteristics were collected. A bivariate inferential analysis was made, and explanatory multivariate models were constructed. Results: Of the total consultations 63.6% (95% CI: 59.9-67.3%) were classified as DTP. The consultation was directly requested by the patient in 24.3% (95% CI: 21.0- 27.7%) of the cases. There were no differences in the type of consultations by gender (P=.858), or for immigrants (P=.428). Subjects from higher social classes more frequently attended PA consultations (P=.007). There were no other differences in accessibility. The DTP consultations related to previous hospitalizations (OR: 1.191, 95% CI: 1.088-1.304), or the previous use of services (nurse consultation OR: 1.002, 95% CI: 1.000-1.003, medical consultation OR: 1.003, 95% CI: 1.000-1.006). Conclusions: The nurse consultation is mainly aimed at carrying out procedures and previously arranged consultation prevails over patient demanded consultation. No inequities in accessibility were detected, but the type of care for different social groups was not homogeneous

Consulta de enfermería para la preparación de colonoscopia virtual. Ensayo clínico abierto, aleatorizado y controlado / Nursing consultation for the preparation of virtual colonoscopy. Open, randomized and controlled clinical trial

Las limitaciones de la colonoscopia virtual radican en la complejidad del cumplimiento de las instrucciones de preparación previa, con modelos diferentes para diabéticos y no diabéticos, y diferente producto laxante empleado, sintomatología y duración. Este estudio diseña una intervención enfermera que minimiza los rechazos de pacientes que, por mala limpieza del colon, no pueden realizar la colonoscopia virtual. Método. Se distribuyen de forma aleatoria los pacientes que cumplen los criterios de inclusión en dos grupos: • Grupo control: se siguen según el protocolo previo del servicio. • Grupo intervención: acudieron a una consulta de enfermería previa a la colonoscopia virtual, donde se les realiza una encuesta sobre su salud y se determina y explica detalladamente el mejor protocolo de preparación del colon para cada paciente, así como el proceso de colonoscopia virtual. Objetivo. Comprobar la efectividad de una consulta de enfermería para la preparación de colonoscopias virtuales en términos de aumento de la tasa de colonoscopias virtuales interpretables o de calidad. Resultados. Se redujo significativamente la puntuación en ansiedad de los pacientes tras la consulta (6.5 +/-2.5 antes frente a 5.5+/-2.4 después; p < 0.001). El grupo intervención redujo en casi un 4 % el número de pruebas complementarias precisadas por el grupo control. La recitación de pacientes fue un 6 % inferior en el grupo intervención que en el grupo control. Conclusiones. Se podría producir un ahorro de 15 990 euros anuales, puesto que se redujo la recitación de pacientes y la realización de pruebas diagnósticas complementarias al nivel del grupo intervención (AU)

The limitations of virtual colonoscopy lie on the complexity of patient’s previous preparation process. There are different models for diabetic and non-diabetic patients, and these models also differ depending on the laxative product used, the symptomatology and its duration. This study designs a nursing intervention to minimize refusal of patients who, due to bad colon cleansing, cannot be subject to a virtual colonoscopy. Method. Patients who met the inclusion criteria were randomized into two groups. • Control group: patients were treated according to the previous protocol of service. • Experimental group: patients attended a nurse consultation appointment prior to the virtual colonoscopy, where nurses implemented a questionnaire about the patients’ health and determined the best protocol for bowel preparation according to each patient, explaining the process in detail. The virtual colonoscopy procedure was also clarified during the nursing appointed consultation. Objective. To determine the effectiveness of nursing work in the preparation of virtual colonoscopy in terms of increasing the rate of interpretable or high-quality virtual colonoscopies. Results. The anxiety score for patients was significantly reduced after the nursing consultation (6.5 +/-2.5 before vs. 5.5 +/- 2.4 after; p < 0.001). The experimental group showed a reduction of almost 4 % in number of complementary tests necessary for the control group. The reappointment of patients in the experimental group was 6 % lower than in the control group. Conclusions. The experimental group showed that savings of 15.990€ a year could be achieved by reducing both: reappointment of patients and need for complementary diagnostic tests (AU)

Consulta de enfermería y adherencia terapéutica del paciente en hemodiálisis / Nursing consultation and therapeutic adherence of the hemodialysis patient

Introducción: Al entrevistar a un paciente en la sala de hemodiálisis se producen muchas interferencias en la comunicación ya que simultáneamente atendemos a otros pacientes y se presentan complicaciones que tendremos que resolver de forma inmediata. Mediante la consulta de enfermería se pretende evitar esto, y darle el valor y tiempo que tienen las intervenciones enfermeras que son parte del tratamiento. Debemos asegurar que el paciente recibe instrucciones terapéuticas correctamente escritas, revisarlas y verificarlas con él para poder hacer un ajuste de niveles de comprensión, además de motivarlo y corresponsabilizarlo para lograr la adquisición de conductas implicadas en su autocuidado. Objetivo: Evaluar el efecto de la consulta de enfermería al paciente renal en hemodiálisis sobre el cumplimiento terapéutico. Material y Método: Estudio observacional longitudinal prospectivo de cohorte. Muestra de 42 pacientes en programa de hemodiálisis desde enero a junio 2014. Los pacientes seleccionados para la consulta son aquellos para los que la investigadora del estudio es enfermera referente y colaboradora (Grupo A). Se recogen datos de las diferentes variables revisando las historias clínicas y mediante la entrevista con el paciente y cuidador principal. Resultados: Encontramos diferencias significativas al comparar las variables estudiadas entre el Grupo A y Grupo B (resto pacientes) en cuanto al fósforo y cumplimiento farmacológico, pero no se encontraron en cuanto al potasio aunque la tendencia es a mejorar los niveles. Conclusiones: La consulta de enfermería mejora la adherencia terapéutica en dieta y medicación, relacionándose con un mayor tiempo de dedicación al tratamiento y mayor contacto con el cuidador principal (AU)

Introduction: When interviewing a patient in the hemodialysis room, there is a lot of interference in communication since we simultaneously attend to other patients and present complications that we should solve immediately. Nursing consultation is intended to avoid this and give the value and time that nurses have interventions, which are part of the treatment. We must ensure that the patient receives correctly written therapeutic instructions, check and verify them with him in order to adjust comprehension levels, motivate and co-responsibility for achieving the acquisition of behaviors involved in self-care. Objective: To evaluate the effect of the nursing consultation on the therapeutic compliance in the renal patient on hemodialysis. Material and Method: A prospective longitudinal observational cohort study. Sample of 42 patients in hemodialysis program from January to June 2014. Patients selected for the consultation are those that the researcher of the study is referring nurse and collaborator (Group A). Data are collected from the different variables by reviewing the medical records and by interviewing the patient and primary caregiver. Results: Significant differences were found when comparing the variables studied between Group A and Group B (rest patients) in terms of phosphorus and pharmacological compliance, but were not found in terms of potassium although the tendency is to improve levels. Conclusions: The nursing consultation improves the therapeutic adherence in diet and medication, being related to a greater time of dedication to the treatment and greater contact with the main caregiver (AU)

Resultados de una Consulta de Enfermería de Tabaquismo en un hospital de tercer nivel / Results of a Smoking Habit Nursing Consultations in a tertiary hospital

Objetivo. Analizar resultados de consulta monográfica de enfermería para tratamiento del tabaquismo en un hospital de tercer nivel. Pacientes. Fumadores remitidos del propio centro, atención primaria, Salud Laboral y trabajadores del hospital. Método. Se diseña consulta monográfica con enfermera especializada en tabaquismo. Visitas protocolizadas, presenciales y telefónicas. Seguimiento total durante 12 meses. Apoyo médico para consulta y prescripción de tratamientos. Variables: edad, sexo, cigarrillos/día, edad de inicio, intentos de abandono, tabaquismo en entorno, peso, antecedentes y tratamiento, dependencia con test de Fagërstrom y cooximetría. Análisis estadístico: estudio de cohortes retrospectivo 2010-2013. Comparación entre grupos realizada mediante test de Logrank, y la probabilidad de abstinencia con método de Kaplan-Meier. Resultados. 362 fumadores (53 ± 12 años), test Fagërstrom de 7 ± 2, cooximetría 23,3 ± 14 ppm, media de 36 ± 11 años fumando, edad inicio 16 ± 4 años, e intentos previos abandono en 85% de casos. Tratamientos farmacológicos: vareniclina (65%) y TSN (25%) y solo apoyo en consulta (10%). Tras 12 meses de seguimiento, abstinencia del 33% de los pacientes, ganancia de peso media tras abandono: 2,5 kg en mujer y 3,3 en varón sin diferencias significativas según tratamiento. Conclusiones. La consulta protocolizada de enfermería obtiene resultados similares a los observados en unidades más complejas y de mayor coste, a pesar de ser pacientes reincidentes y con alta dependencia (AU)

Objective. Analyze results of monographic consultation from nursing department for treatment of smoking habit in a tertiary hospital. Patients. Smokers referred from the primary care, occupational health and hospital workers site of the center. Method. A monographic consultation was designed with nurses specialized in smoking habit. On-site protocolized and telephone visits. Total follow-up during 12 months. Medical support for treatment consultation and prescription. Variables: age, gender, cigarettes/day, age of initiation, attempts to quit smoking, smoking in the setting, weight, backgrounds and treatment, dependence with Fagërstrom test and cooximetry. Statistical analysis: 2010-2013 retrospective cohort study. Comparison between groups performed using Log rank Test and the likelihood of abstinence with the Kaplan-Meier method. Results. 362 smokers (53 ± 12 years), Fagërstrom test from 7 ± 2, cooximetry 23.3 ± 14 ppm, mean of 36 ± 11 years smoking, age of initiation 16 ± 4 years, and previous attempts to stop smoking in 85% of the cases. Drug treatments: varenicline (65%) and NRT (25%) and only support in consultation (10%). After 12 months of follow-up, abstinence in 33% of the patients, weight gain after quitting smoking: 2.5 kg in women and 3.3 in men, without significant differences according to the treatment. Conclusions. Protocolized nursing consultation obtains similar results to those observed in more complex units having a higher cost, in spite of being patients with recurrence and high dependence (AU)

Registro y control informático del tratamiento anticoagulante oral en Atención Primaria / Registration and computer control of oral anticoagulant therapy (OAT) in primary health care

Se calcula que en España 13.2 personas por cada 1000 habitantes reciben diariamente inhibidores de vitamina K como tratamiento anticoagulante oral por riesgo e enfermedad tromboembólica. Clásicamente, el control del tratamiento anticoagulante ha sido una labor de hematología por medio de un análisis de la extracción venosa de la sangre del enfermo, cuya pauta de tratamiento los pacientes la recogen en sus centros de salud horas después. En los últimos años, los equipos de Atención Primaria de la mayoría de los servicios sanitarios de España han sido instruidos para el empleo e interpretación, de forma autónoma, de coagulómetros portátiles y para el uso de programas informáticos que permiten el registro y control, en la correspondiente historia clínica electrónica, de los datos obtenidos, el cálculo de dosis y la programación de las citaciones de revisión. La historia clínica informatizada puede disponer de distintas secciones que permiten estas gestiones, como es el caso del módulo propio para el control y seguimiento de los pacientes en tratamiento con anticoagulación oral disponible en OMI-ap Aragón. Este módulo permite el seguimiento, dentro del programa, así como realizar auditorías clínicas, mediante el propio aplicativo TAO, lo que evita la pérdida de la perspectiva del paciente que sucedía con anterioridad a este sistema, al precisar de otras bases de registro ajenas al programa. La finalidad de este trabajo es presentar al lector esta herramienta habitual de la consulta de enfermería de Atención Primaria y describirlo, así como los pasos previos y posteriores al empleo de este módulo incluido en OMI-ap (AU)

It is estimated that in Spain 13.2 persons per 1000 inhabitants received daily vitamin K antagonists as oral anticoagulant therapy risk of thromboembolic disease. Classically control Anticoagulant Therapy has been a labor of hematology through an analysis of patient ́s venous blood and whose treatment regimen was collected, hours later, by each person in their Health Centers. In recent years, Primary Health Care Teams, of most Spanish Health Services, have been instructed to use and interpret, independently, portable coagulometers and the use of computer programs that allow the registration in the corresponding electronic medical records and control of the data, the calculation of doses and programming citations revision. The clinical history may have different sections that allow these activities as the module for control and monitoring of patients on oral anticoagulation available on OMI-ap Aragon. This module allows tracking, within the program, and clinical audits performed by the application TAO itself, avoiding the loss of the patient’s perspective, that previously happened to this system to specify other recording bases outside the program. The purpose of this paper is to present the reader with this common tool Primary Care nursing practice, describing the program as well as before and after the use of this module included in IMO-ap steps (AU)

Rol de enfermería en la consulta de prediálisis en el paciente con enfermedad renal cónica avanzada / Nursing role in predialysis visit in patients with advanced chronic kidney disease

Introducción: El paciente con enfermedad renal crónica (ERC) tiene necesidades concretas de cuidado que conllevan al profesional de enfermería nefrológica a generar una atención integral e individualizada con el fin de detectar y disminuir riesgos a través de la consulta predialítica y educar a los profesionales del área de la salud acerca de su labor en dicha actividad. Objetivo: Identificar y evaluar la efectividad de la consulta predialítica realizada por el profesional de enfermería en pacientes diagnosticados con enfermedad renal crónica, a través de la revisión sistemática de la literatura. Metodología: Búsqueda electrónica en base de datos PUBMED, Meta buscadores como google académico, Epistemonikos, Scielo, Bireme, y CUIDEN. Se consideraron 47 artículos de los cuales 22 son cuantitativos y 25 cualitativos, en pacientes adultos de 18 a 80 años, entre los años 2005-2015. Resultado: La consulta predialítica permitirá realizar intervenciones de diagnóstico temprano, educación y evaluación durante las primeras etapas de la ERC, reduciendo la morbi-mortalidad, retrasando la progresión de la enfermedad, por lo cual es necesario rediseñar los programas de gestión en enfermedades crónicas, enfatizando la colaboración de una red sanitaria liderada por el profesional de enfermería especialista que gestione los recursos existentes para el manejo de esta patología. Conclusión: La consulta predialitica ofrece beneficios tangibles al enfermo renal en las áreas de prevención de la ERC, adherencia a las recomendaciones del profesional de salud y la elección de la terapia (AU)

Introduction: Patients with chronic kidney disease have specific care needs that lead to professional nephrology nursing to generate a comprehensive and individualized attention in order to identify and reduce risks through predialysis consultation and educate other healthcare professionals about their work in the activity. Objective: To identify and evaluate the effectiveness of predialysis consultation by nurses in patients diagnosed with chronic kidney disease, through the systematic review of the literature. Methodology: Electronic search of PubMed database, Meta search engines like Google Scholar, Epistemonikos, Scielo, Bireme, and care. 47 articles, 22 were quantitative and 25 qualitative, in adults 18 to 80 and between 2005-2015 were considered Result: The predialysis consultation would help to make early diagnosis interventions, education and evaluation during the firsts stages of CKD, reducing morbidity and mortality, slowing the disease progression, making it necessary to redesign programs in chronic disease management, emphasizing the collaboration of a network led by the health professional specialist nurses to manage existing resources to the management of this condition. Conclusion: The query proves that predyalisis consultation provides tangible benefits to renal patients in the areas of prevention of CKD, adherence to the recommendations of the health professional and the choice of therapy (AU)

[Guideline implementation study on asthma: Results of a pragmatic implementation approach]. / Leitlinien-Implementierungs-Studie Asthma (L.I.S.A.): Ergebnisse eines pragmatischen Implementierungsansatzes.

OBJECTIVE: Knowledge transfer from theory to practice in healthcare systems poses a challenge worldwide. Typical examples include national disease management guidelines. The present study contributes towards improving implementation strategies for an asthma guideline. METHODS: A guideline implementation strategy was examined in a four-armed, non-randomised, controlled intervention study with an additional control group. The study participants were general practitioners and paediatricians recruited from primary care quality circles. All study participants attended an interactive seminar on the evidence-based recommendations for patients with asthma. In addition, the participants were asked to choose among the following options: no further intervention, additional e-learning, training of their practice nurses, or e-learning and training of their practice nurses. The success of the intervention was measured by questionnaire (and the success rate expressed as a percentage). RESULTS: About one third of all participants (n=313) opted for the combination of an interactive seminar and a training of practice nurses; two third preferred the classic way of continuing medical education with an interactive seminar without a further intervention. Just 10 % of the physicians participated in e-learning. Independently of their choice for continuing medical education, all participants demonstrated an increase in knowledge about asthma and an improvement in the management of asthma. The physicians exhibited an average increase in both categories of about 10 % of the percentage values, compared to an increase of about 28 % among the practice nurses without continuing medical education. CONCLUSIONS: The physicians' free choice of the educative modules might be an integral part of successful implementation strategies. However, this will require a change of focus from general continuing medical education packages to a more individualised culture of continuing professional development in Germany.

[Patient safety in general practice]. / Patientensicherheit in der Hausarztpraxis.

INTRODUCTION: So far, there has been a lack of systematic data regarding critical incidents and safety climate in Swiss primary care offices. Therefore, a survey was conducted amongst physicians and nurses ("MPA") working in Swiss German primary care offices leading to a subsequent project on the telephone triage. METHODS: Using a standardised questionnaire, healthcare professionals in primary care offices have been surveyed to determine safety risks and safety climate in their offices. The questionnaire consisted of safety-climate items as well as descriptions of 23 safety incidents. These incidents were rated in terms of frequency (appearance in the office during the past 12 months) and severity (harm associated with the last occurrence in the office). In addition, physicians and nurses answered an open-ended question referring to patient safety risks they would wish to eliminate in their offices. In the subsequent project, interviews and group discussions have been conducted with physicians and nurses in order to perform a process analysis of the telephone triage and to develop a tool that may help primary care offices to strengthen telephone triage as a secure process. RESULTS: 630 physicians and nurses (50.2% physicians, 49.8% nurses) participated in the study. 30% of the physicians and 17% of the nurses observed at least one of the 23 incidents in their offices on a daily or weekly basis. Errors in documentation were reported most frequently. As regards severity, the triage by nurses at the initial patient contact, errors in diagnosis, failure to monitor patients after therapeutic treatment in the office, and errors regarding the medication process were shown to be the most relevant. Most frequently participants wanted to eliminate the following risks to patient safety in their offices: medication (28% of all mentions), medical procedures in the office (11%) and telephone triage (7%). Participation in team meetings and quality circles proved to be relevant predictors of the safety climate dimension "team-based error prevention". Differences between occupational groups were found regarding safety incidents as well as safety climate. CONCLUSION: The results of this study show the telephone triage to be a relevant area of patient safety in primary care that has not been focused on so far. In order to enhance safety of the triage process a new project was initiated. The result of the project is a triage guide for primary care offices. This guide supports physicians and nurses in a joint and critical examination of office structures and processes related to telephone triage. The systematically observed differences between occupational groups indicate that the entire office team need to be involved when analysing safety risks and taking action to improve patient safety. Only in doing so, risks can be identified comprehensively. Moreover, measures can be taken that are relevant to and supported by all healthcare professionals working in a primary care office. This approach of involving the entire team forms the basis for the guide on telephone triage.

Variables que condicionan la utilización de la consulta de enfermería en centros de salud de la Comunidad de Madrid / Differences in the nursing consultation utilization in primary care, Spain

Fundamentos: Diferentes condiciones de utilización de servicios sanitarios pueden originar situaciones de falta de equidad. El objetivo del trabajo es conocer si existen diferencias en el uso de la consulta de enfermería en atención primaria. Métodos: Estudio multicéntrico transversal en 23 centros de salud de la Comunidad de Madrid. Se incluyó a 662 sujetos. Se recogieron variables relativas al centro de salud, de la consulta de enfermería, características sociodemograficas y de necesidad en salud. Se estudiaron la calidad de vida y la satisfacción de los sujetos. Las variables se clasificaron, según el modelo «conductual», en predisponentes, facilitadoras o de necesidad. Se construyeron modelos multivariantes explicativos. Resultados: Vivir en zonas de renta alta y la edad se asociaron con aumentos del 17% (IC95%: 0,4-36,9%) y del 11,0% por cada década (IC95%: 6,2-16,2) de las consultas/año de enfermería. De los factores facilitadores, cada minuto añadido de duración de la consulta se asoció con un aumento del 2,0% (IC95%: 1,2-2,9%) en las consultas/año, cada nueva consulta médica se asociaba con un aumento del 2,7% (IC95%: 2,1-3,2%) y la demora en conseguir cita superior a un día supuso una disminución del 32,8% (IC95%: 19,3-44,1%) del número de consultas. Cada condición crónica, que expresa necesidad en salud, se asoció con un incremento del número de consultas del 4,8% (IC 95%: 1,7-8,0%). La mejor percepción de la calidad de vida se asoció con una reducción de las consultas de un 5,4% (IC95%: 1,0-8,7%). Conclusión: Las diferencias en el uso de la consulta de enfermería responde a criterios de necesidad, pero también está influenciada por condiciones de accesibilidad(AU)

Background: Different conditions in health services utilization may create situations of inequity. The objective was analyze the differences of nurse consultation utilization in primary care. Methods: Cross-sectional study, in 23 health centres in Madrid. Environmental variables, consultation characteristics, socio-demographic and health need characteristics were collected. The quality of life and satisfaction were also studied. The variables were classified according to the «behavioral model» in predisposing, enabling or need variables. Explanatory multivariate models were constructed (Generalized-Estimating-Equations). Results: The higher income areas and aging, predisposing factors, were associated with increases of 17% (95% CI: 0.4 to 36.9%) and 11.0% per decade (95% CI: 6.2 - 16.2) in nursing consultations per year. Among enabling factors, each additional minute of consultation length was associated with an increase of 2.0% (95% CI :1.2-2, 9%) in number of nurse consultations, each new medical consultation was associated with a increase of 2.7% (95% CI: 2.1-3.2%) and the delay in getting appointment over a day, represented a decrease of 32.8% (95% CI: 19.3 to 44.1%) in the total nursing consultations. Each chronic condition, which expresses the need health, was associated with an increase in the number of visits of 4.8% (95% CI: 1.7 to 8.0%). The improved perception of quality of life was associated with a reduction of 5.4% (95% CI 1.0 to 8.7%) of the consultations. Conclusion: The difference of the use of primary care nurse consultations is based on health need criteria, but is also influenced by accessibility conditions(AU)

Consulta de enfermería de alta resolución en atención primaria / Nursing consultation, high-resolution primary

Antecedentes / Justificación. Existe un incremento de la visita espontánea y una necesidad de gestión eficaz de la misma. Para ello se creó la «Consulta d’Infermeria d’Alta Resolución» (CIAR), dotando a enfermería de mayor autonomía. Objetivos. Demostrar la capacidad de enfermería en la resolución de la visita espontánea, conocer las demandas más frecuentes y en cuáles es más resolutiva. Averigüar la concordancia entre el motivo de visita apuntado en admisiones y el real. Descripción. Estudio descriptivo transversal. En CIAR, una enfermera de atención primaria atiende a pacientes adultos que solicitan visita espontánea, sin ningún tipo de preselección. Se analizan resultados de ocho meses de consulta. Las visitas se realizaron siguiendo protocolos elaborados en el centro. Resultados. Enfermería resolvió un 63% de las mismas; el 37% conjuntamente. La resolución autónoma aumenta hasta el 75,7% en el último mes. Los motivos más frecuentes son: administrativos, patología respiratoria y otorrinolaringología. Enfermería resolvió autónomamente 98% de las visitas administrativas, 80% de las heridas/quemaduras, 72% de las odontalgias y entre 50% y 60% de problemas ginecológicos/contracepción de emergencia, oftalmológicos, de medicina interna y digestivos. Con la implantación del protocolo de rinofaringitis aguda la resolución de enfermería pasó de 4,9% a 78,3%. La concordancia entre el motivo percibido en admisiones y el real, es del 96%. Conclusiones. Enfermería está altamente cualificada para la gestión de la visita espontánea obteniendo excelentes resultados. Los protocolos son de gran ayuda en la resolución de enfermería y ésta mejora cuanta más experiencia se adquiere(AU)

Background / Rationale. There is an increase of spontaneous consultation and a need for effective management of it. For this reason we created the «High Resolution Nursing Consultation» (CIAR), giving nurses greater autonomy. Objectives. We aim to demonstrate the ability of nursing in the resolution of spontaneous consultation as well as to know demands more frequent and what is more resolving and to find out the correlation between the reason for visit registered at admissions and real. Description. Cross sectional study. In CIAR, a primary care nurse serves adult patients who requested spontaneous consultation, without any preselection. We analyze results of eight months of consultation. The visits were performed according to protocols developed in the center. Results. Nursing resolved 63% of them, 37% jointly. Independent resolution increased to 75.7% in the last month. The most common reasons were: administrative, respiratory disease and otolaryngology. Nursing decided autonomously 98% of administrative visits, 80% of wounds / burns, 72% of the toothache and between 50% and 60% of GYN / emergency contraception, ophthalmology, internal medicine and digestive. With the implementation of the protocol of acute nasopharyngitis nursing resolution increased from 4.9% to 78.3%., the correlation between the reason for visit registered at admissions and real was 96%. Conclusions. Nursing is highly qualified for the management of spontaneous consultation with excellent results. Protocols are of great help in the resolution of nursing and it improves with the experience acquired(AU)

Multidisciplinary chronic pain management in a rural Canadian setting.

INTRODUCTION: Chronic pain is prevalent, complex and most effectively treated by a multidisciplinary team, particularly if psychosocial issues are dominant. The limited access to and high costs of such services are often prohibitive for the rural patient. We describe the development and 18-month outcomes of a small multidisciplinary chronic pain management program run out of a physician's office in rural Alberta. METHODS: The multidisciplinary team consisted of a family physician, physiatrist, psychologist, physical therapist, kinesiologist, nurse and dietician. The allied health professionals were involved on a part-time basis. The team triaged referral information and patients underwent either a spine or medical care assessment. Based on the findings of the assessment, the team managed the care of patients using 1 of 4 methods: consultation only, interventional spine care, supervised medication management or full multidisciplinary management. We prospectively and serially recorded self-reported measures of pain and disability for the supervised medication management and full multidisciplinary components of the program. RESULTS: Patients achieved clinically and statistically significant improvements in pain and disability. CONCLUSION: Successful multidisciplinary chronic pain management services can be provided in a rural setting.

Infertility case management: improving both short-term and long-term outcomes while reducing costs.

PURPOSE/OBJECTIVES: Infertility is a growing medical condition as more women are desirous of having children at an older age. It is estimated to be a $3 billion business, and, while infertility treatment is a for-profit commercial endeavor, the product is noncommercial (baby or babies). The treatment process may be complicated with overutilization, drug wastage, and adverse outcomes. High-order multiple gestations may result in preterm births, chronic adult diseases, and lifelong neurological impairments (such as cerebral palsy). The total national cost of infertility treatment unfortunately equals the cost of providing care to these babies in the nursery and neonatal intensive care unit. This article explores the potential benefit of the integration of information technology with clinical case management to reduce overall cost and improve provider accuracy. PRIMARY PRACTICE SETTING(S): Office-based telephonic nurse case management and pharmacology management practice. FINDINGS/CONCLUSIONS: The article demonstrates that the challenging integration of information technology with clinical case management is very effective and improves provider accuracy, resulting in the best transfer of real-time information. The case management program at Women's Integrated Network Healthcare has been shown to lower infertility treatment costs by 30% to 40% and lower the numbers of high-order multiple gestations. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Eighty-one percent of the cost reduction is related directly to case management, not reduction in physician fees or unit pharmaceutical costs. Case management can improve effectiveness and quality of conception, and there is a reduction in high-order multiple gestations. It was also found that, by expanding infertility benefits and including case management as the pivotal element, payers and employers could recognize significant savings and, more importantly, the women and families would benefit.

Family practice/Primary health care nurses in Nova Scotia.

The authors describe a study that was designed to explore the current role of family practice/primary health care (FP/PHC) nurses in Nova Scotia. A survey was created and mailed to FP/PHC nurses. Forty-one returned surveys met the criteria of the study. Twenty-two of these nurses were contacted for a followup telephone interview. The findings confirm that FP/PHC nurses working in N.S. are key members of the collaborative health-care team and, although they are often underutilized, they perform key functions such as triage, health education and immunization. Most FP/PHC nurses are underpaid and often work with little or no job security. FP/PHC nurses indicated that they are isolated in their practice and could benefit from networking and educational opportunities with their peers. They are frustrated that they cannot bill the provincial medical insurance plan for basic nursing services. The study results indicate a need to better define scope of practice and highlight the need for leadership and support for the role of FP/PHC nurses in N.S.

Time-efficient strategies to ensure vaccine risk/benefit communication.

Vaccine risk/benefit communication is a mandatory requirement set forth by the National Childhood Vaccine Injury Act and is essential in enabling parents to make an informed decision about having their children vaccinated. This article is designed to improve vaccine risk/benefit communication in pediatric primary care. Current research related to previous efforts used to educate parents about vaccine safety are reviewed. Time-efficient strategies to improve vaccine risk/benefit communication are recommended. An example of an open communication letter and a list of reputable vaccine information resources are also provided.