Efectividad de un nuevo modelo de derivación telefónica compartida entre atención primaria y atención hospitalaria / Effectiveness of a new model of telephone derivation shared between primary care and hospital care

Objetivo: Averiguar si la derivación telefónica desde Atención Primaria a consultas externas de Medicina Interna (CCEE de MI) reduce días de espera, con respecto a la derivación presencial. Averiguar la aceptación de la consulta telefónica por parte de los médicos de familia (MF) de Atención Primaria y de sus pacientes. Diseño: Ensayo clínico controlado aleatorizado sin enmascaramiento. Emplazamiento: Área de Gestión Sanitaria Norte de Huelva. Participantes: Ciento cincuenta y cuatro pacientes. Intervenciones: Los pacientes de los MF del grupo experimental fueron derivados vía telefónica (salvo cumplimiento criterios exclusión) y los del grupo control vía presencial. Mediciones: Número de días desde la solicitud de derivación hasta la consulta en MI. Número de derivaciones telefónicas y presenciales. Número de médicos y de pacientes rechazados. Causas de los rechazos. Resultados: Diferencia estadísticamente significativa, estimándose en 27 (21-34) días entre ambos grupos. De los 58 MF, 8 prealeatorización, y 6 de los 20 asignados al grupo experimental rechazaron participar por «suponer consumo excesivo de tiempo y esfuerzo». Para un 50% de los pacientes derivados por los 14 MF que quedaron finalmente en el grupo experimental se rechazó la vía telefónica, siendo la complejidad de los pacientes la principal causa. Conclusiones: La derivación telefónica reduce considerablemente los días de espera para CCEE de MI, elimina las principales barreras de la consulta telefónica a tiempo real, no supuso un mayor gasto de tiempo ni de esfuerzo para los médicos y no se consideró tan beneficiosa en pacientes complejo

Aim: The purpose of this study is to find out whether telephone referral from Primary Health Care to Internal Medicine Consult manages to reduce waiting days as compared to traditional referral. This study also aims to know how acceptable is the telephone referral to general practitioners and their patients. Design: No blind randomized controlled clinical trial. Setting: Northern Huelva Health District. Participants: 154 patients. Interventions: Patients referrals from intervention clinicians were sent via telephone consultation, whereas patients referrals from control clinicians were sent by traditional via. Measurements: Number of days from referral request to Internal Medicine Consult. Number of telephone and traditional referrals. Number of doctors and patients denied. Denial reasons. Results: A statistically significant difference was found between groups, with an average of 27 (21-34) days. Among General Practitioners, 8 of the first 58 total doctors after randomization and, subsequently, 6 of the 20 doctors of the test group refused to engage in the trial because they considered "excessive time and effort consuming". 50% of patients referred by the 14 General Practitioners finally randomized to the intervention group were denied referral by telephone due to patient's complexity. Conclusions: Telephone referral significantly reduces waiting days for Internal Medicine consult. This type of referral did not mean an "excessive time and effort consuming" to General Practitioners and was not all that beneficial to complex patients

[Effectiveness of a new model of telephone derivation shared between primary care and hospital care]. / Efectividad de un nuevo modelo de derivación telefónica compartida entre atención primaria y atención hospitalaria.

AIM: The purpose of this study is to find out whether telephone referral from Primary Health Care to Internal Medicine Consult manages to reduce waiting days as compared to traditional referral. This study also aims to know how acceptable is the telephone referral to general practitioners and their patients. DESIGN: No blind randomized controlled clinical trial. SETTING: Northern Huelva Health District. PARTICIPANTS: 154 patients. INTERVENTIONS: Patients referrals from intervention clinicians were sent via telephone consultation, whereas patients referrals from control clinicians were sent by traditional via. MEASUREMENTS: Number of days from referral request to Internal Medicine Consult. Number of telephone and traditional referrals. Number of doctors and patients denied. Denial reasons. RESULTS: A statistically significant difference was found between groups, with an average of 27 (21-34) days. Among General Practitioners, 8 of the first 58 total doctors after randomization and, subsequently, 6 of the 20 doctors of the test group refused to engage in the trial because they considered "excessive time and effort consuming". 50% of patients referred by the 14 General Practitioners finally randomized to the intervention group were denied referral by telephone due to patient's complexity. CONCLUSIONS: Telephone referral significantly reduces waiting days for Internal Medicine consult. This type of referral did not mean an "excessive time and effort consuming" to General Practitioners and was not all that beneficial to complex patients.

Estudio sobre la accesibilidad y tolerabilidad del uso de implantes hormonales subdérmicos en una población de exclusión social en Sevilla / Accesibility and tolerability on the use of subcutaneous hormone implants in a socially excluded population

Objetivo: Conocer la aceptabilidad y la tolerabilidad del uso del implante subcutáneo en una población de exclusión social (población del Vacie).Diseño:Estudio de cohortes prospectivo con estudio de seguimiento. Emplazamiento: Centro de salud de Pino Montano B, en Sevilla.Participantes:66 mujeres en entre 15-49 años a las que se les insertó el implante subcutáneo, de las cuales el 44,6% son del Vacie, y 55,4% no son del Vacie. Intervención: Cuestionario preimplante, colocación del implante y seguimiento con cuestionario a los 3 meses post-implante. Mediciones: Estudio de variables sociodemográficas con tablas de N frecuencias. Contraste de la variable tolerabilidad con la variable procedencia: Vacie/no Vacie mediante ji cuadrado y la aceptabilidad con tablas N de frecuencias. Resultados: No existe relación estadísticamente significativa entre la tolerabilidad del método entre poblaciones (p=0,618) con un RR 1,33 (0,430-4,134) de que las mujeres que no son del Vacie fueron menos tolerantes que las del Vacie. Un 93,1% del Vacie y 88,9% de las que no son del Vacie se volverían a implantar el método pasados los 3 años de caducidad. En el Vacie un 84,7% y en las que no son del Vacie un 82,4% consideraron que el método es sobresaliente. Conclusiones: El implante podría considerarse seguro, tolerable y aceptado como método anticonceptivo sin diferencias entre culturas(AU)

Objective: To determine the aceptability and tolerability of subcutaneous implants used in a socially excluded population from El Vacie, Seville. Design: Prospective cohort study with follow-up. Setting: Pino Montano B Outpatient Department in Seville, Spain. Participants: A total of 66 females between 15-49 years who had a subcutaneous implant inserted, of whom 44.6% were from El Vacie (a shantytown outside Seville, Spain). Interventions: Pre-implant questionnaire, placing of the implant and a post-implant questionnaire 3 months later. Main measurements: A study of the sociodemographic variables with frequency tables. Comparison of the tolerability with the place of residence variable (from El Vacie/not from El Vacie) using the Chi squared statistic, and the acceptability with frequency tables. Results: There were no statistically significant differences between the tolerability variables studied (P=.618), with a (relative risk) RR of 1.33 (0.430-4.134). The women not from El Vacie were less tolerant than the women from El Vacie. The great majority of women (93.1% El Vacie women and 88.9% non-El Vacie women) would come back to use this contraceptive method again after it expires in 3 years, and 84.7% of El Vacie women and 82.4% of those not from El Vacie considered the method as excellent. Conclusions: Subcutaneous hormone implants were a safe, tolerable and acepted method with no cultural differences(AU)