Patterns of primary care among persons with schizophrenia: the role of patients, general practitioners and centre factors.

BACKGROUND: Patients with schizophrenia and related disorders have more physical problems than the general population. Primary care professionals play an important role in the care of these patients as they are the main entry point into the healthcare system. We aimed to identify patient, general practitioner, and primary care centre factors associated with the number of visits of patients with schizophrenia and related disorders to general practitioners. METHODS: A descriptive, cross-sectional study was conducted in 13 primary care centres belonging to the Clinical Management Unit of Mental Health of the Regional Hospital of Málaga, Spain. The eligible population was composed of patients with schizophrenia and related disorders attending the primary care centres in the study area, and the general practitioners who attend these patients. Our dependent variable was the total number of general practitioner visits made by patients with schizophrenia and related disorders during the 3.5-year observation period. The independent variables were grouped into three: (a) patient variables (sociodemographic and clinical), (b) general practitioner variables, and (c) primary care centre characteristics. Descriptive, bivariate, and multivariate analyses using the random forest method were performed. RESULTS: A total of 259 patients with schizophrenia and related disorders, 96 general practitioners, and 13 primary care centres were included. The annual mean was 3.9 visits per patient. The results showed that younger general practitioners, patients who were women, patients who were married, some primary care centres to which the patient belonged, taking antipsychotic medication, presenting any cardiovascular risk factor, and more frequency of mental health training sessions at the primary care centre were associated with an increased number of visits to general practitioners. CONCLUSIONS: The only general practitioner variable that was associated with the number of visits was age, the older the less contact. There were also patient variables involved in the number of visits. Finally, mental health training for general practitioners was important for these professionals to manage patients with schizophrenia and related disorders.

Estudio psicométrico de un cuestionario sobre las actitudes de los médicos de atención primaria hacia la salud mental: Cuestionario MAPSAM-14 / Psychometrics properties of a questionnaire on the attitudes of general practitioners towards mental health (MAPSAM-14)

Antecedentes: El objetivo de este estudio es la adaptación y el análisis de las propiedades psicométricas de un cuestionario para medir las opiniones y percepciones de los médicos de atención primaria hacia la salud mental. Método: Se trata de un estudio observacional, descriptivo y transversal. Han participado 145 médicos de atención primaria pertenecientes al área de referencia del Hospital Regional de Málaga, que contestaron un cuestionario de 25 items. Con dicho cuestionario se realizó un análisis factorial exploratorio y de consistencia interna. Resultados: Las condiciones de adecuación muestral y esfericidad se cumplieron de forma satisfactoria. En el análisis factorial se obtuvieron 3 dimensiones medidas por 14 items que explican el 55.1% de la varianza total: el cuestionario MAPSAM-14 (Cuestionario de Médicos de Atención Primaria y Salud Mental). Conclusiones: Este cuestionario puede ser una herramienta de rápida aplicación, válida y fiable, para conocer la satisfacción de los médicos de atención primaria respecto a su relación con los equipos de salud mental, sus creencias hacia la enfermedad mental y su percepción del nivel de formación en relación con la esquizofrenia y trastornos afines

Background: The aim of this study is to adapt and analyze the psychometric properties of a questionnaire on the perceptions of general practitioners towards mental health. Method: This is a descriptive crosssectional, observational study. A total of 145 general practitioners from the reference area of Malaga Regional Hospital answered this 25-item questionnaire; a factorial analysis was then conducted and its internal consistency reliability was tested. Results: The adequacy of sampling and sphericity were satisfactorily met. Three dimensions measured by 14 items were found in the factorial analysis explaining 55.1% of its variance: the MAPSAM-14 questionnaire. Conclusions: This questionnaire may be a proper tool with which to determine the satisfaction of general practitioners in relation to mental health services, their beliefs and stigma towards mental illness and their level of training in the field of schizophrenia and related disorders

Telemedicine influence on the follow-up of type 2 diabetes patients.

OBJECTIVE: This study was designed to evaluate the impact of a teleassistance system on the metabolic control of type 2 diabetes patients. RESEARCH DESIGN AND METHODS: We conducted a 1-year controlled parallel-group trial comparing patients randomized (1) to an intervention group, assigned to a teleassistance system using real-time transmission of blood glucose results, with immediate reply when necessary, and telephone consultations, or (2) to a control group, being regularly followed-up at their healthcare center. Study subjects were type 2 diabetes patients >30 years of age followed in the primary care setting. RESULTS: A total of 328 type 2 diabetes patients were recruited from 35 family practices in the province of Málaga, Spain. There was a reduction in hemoglobin A1c after 12 months from 7.62 +/- 1.60% to 7.40 +/- 1.43% (P = 0.027) in the intervention group and from 7.44 +/- 1.31% to 7.35 +/- 1.38% (P = 0.303) in the control group. The difference in the change between groups was not statistically significant. There was also a significant decrease in systolic and diastolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, and body mass index in the intervention group. In the control group, the only significant decline was in low-density lipoprotein cholesterol. CONCLUSIONS: A teleassistance system using real-time transmission of blood glucose results with an option to make telephone consultations is feasible in the primary care setting as a support tool for family physicians in their follow-up of type 2 diabetes patients.