Lifestyle interventions for cancer prevention in primary care: Differences between family physicians and nursing professionals.

RATIONALE, AIMS, AND OBJECTIVES: Prevention offers the most cost-effective long-term strategy for cancer control. The objective of this study was to ascertain opinions, attitudes, and professional practices towards cancer prevention among primary care professionals and to assess differences between family physicians (FP) and nursing professionals (NP). METHOD: A cross-sectional study was performed in 2012 in the Community of Madrid. A random sample of 3586 professionals received an online questionnaire about opinions/attitudes, training, and interventions in cancer prevention. The chi-square test was used to analyse the association of the profession with all the variables. Factors associated with the usual practice of individual, group, and community interventions were analysed using multivariate logistic regression, with separate models for FP and NP. RESULTS: The response rate was 39.4% (N = 1413). Approximately 90% of the participants attributed "sufficient/high" utility to individualized counselling. NP attributed higher utility to group and community interventions than FP (70.1% vs 60.1% and 64.9% vs 57.7%, respectively, P-value < 0.01). The usual practice of group and community interventions was more frequent among NP. The practice of group and community interventions was associated with knowledge of resources for prevention, specific training in group interventions, and the utility attributed to these methods. Among FP, the ability to dispense effective health advice and the utility attributed to this advice were associated with the usual practice of the three interventions. CONCLUSIONS: Group and community interventions are rarely practised, especially among FP. Actions targeting improved ability and knowledge could lead to higher involvement in the promotion of health. It would also be necessary to intervene in the examination of the utility of such interventions.

Solicitud de serologías de VIH en atención primaria: encuesta a profesionales de Medicina y de Enfermería / Request for HIV serology in primary care: A survey of medical and nursing professionals

Introducción: En la Comunidad de Madrid existe un 42,7% de retraso diagnóstico de VIH. La atención primaria es la puerta de entrada al sistema sanitario y se desconoce la frecuencia de serologías solicitadas por estos profesionales. Los objetivos fueron conocer la frecuencia y factores asociados a la solicitud de serologías de VIH por profesionales de medicina y de enfermería de atención primaria de la Comunidad de Madrid. Método: Mediante encuesta on-line, se preguntó por la solicitud de serologías para VIH en los últimos 12 meses, a profesionales que participaron en el estudio de evaluación de estrategias de diagnóstico precoz de VIH en consultas de atención primaria de la Comunidad de Madrid (ESTVIH). La asociación entre la solicitud de serologías y las características sociodemográficas y de práctica clínica de los profesionales se cuantificó mediante odds ratio ajustadas (ORa) según regresión logística. Resultados: Se obtuvieron 264 encuestas (59,5% medicina). El 82,2% de profesionales medicina y el 18,7% de enfermería refirieron haber solicitado alguna serología de VIH en los últimos 12 meses (mediana de 15 y 2 serologías solicitadas, respectivamente). En medicina esta petición se asoció con sexo masculino (ORa: 2,95; IC95%: 0,82-10,56) y estar entrenado para dar consejo pre-post prueba de VIH (ORa: 2,42; IC95%: 0,84-6,93); en enfermería se asoció con edad (<50años; ORa: 2,75; IC95%: 0,97-7,75) y tiempo trabajado en atención primaria (>13años; ORa: 3,02; IC95%: 1,07-8,52). Conclusión: Es necesario promover la solicitud de pruebas de VIH y el entrenamiento pre-post prueba de VIH en profesionales de medicina y enfermería de atención primaria

Introduction: In the Community of Madrid there is 42.7% late HIV diagnosis. Primary care is the gateway to the health system and the frequency of serological tests requested by these professionals is unknown. The objectives were to establish the frequency of requests for HIV serology by medical and nursing primary care professionals in the Community of Madrid and the factors associated with these requests. Method: An 'on-line' survey was conducted, asking professionals who participated in the evaluation study of strategies to promote early diagnosis of HIV in primary care in the Community of Madrid (ESTVIH) about the number of HIV-serology tests requested in the last 12 months. The association between HIV-serology requesting and the sociodemographic and clinical practice characteristics of the professionals was quantified using adjusted odds ratios (aOR) according to logistic regression. Results: 264 surveys (59.5% physicians). Eighty-two point two percent of medical and 18.7% of nursing professionals reported requesting at least one HIV-serology in the last 12 months (median: 15 and 2 HIV-serology request, respectively). The doctors associated the request with: being male (aOR: 2.95; 95% CI: 0.82-10.56), being trained in pre-post HIV test counselling (aOR: 2.42; 95% CI: 0.84-6.93) and the nurses with: age (<50 years; aOR: 2.75; 95% CI: 0.97-7.75), and number of years working in primary care (>13 years; aOR: 3.02; 95% CI: 1.07-8.52). Conclusion: It is necessary to promote HIV testing and training in pre-post HIV test counselling for medical and nursing professionals in primary care centres

Request for HIV serology in primary care: A survey of medical and nursing professionals. / Solicitud de serologías de VIH en atención primaria: encuesta a profesionales de Medicina y de Enfermería.

INTRODUCTION: In the Community of Madrid there is 42.7% late HIV diagnosis. Primary care is the gateway to the health system and the frequency of serological tests requested by these professionals is unknown. The objectives were to establish the frequency of requests for HIV serology by medical and nursing primary care professionals in the Community of Madrid and the factors associated with these requests. METHOD: An 'on-line' survey was conducted, asking professionals who participated in the evaluation study of strategies to promote early diagnosis of HIV in primary care in the Community of Madrid (ESTVIH) about the number of HIV-serology tests requested in the last 12 months. The association between HIV-serology requesting and the sociodemographic and clinical practice characteristics of the professionals was quantified using adjusted odds ratios (aOR) according to logistic regression. RESULTS: 264 surveys (59.5% physicians). Eighty-two point two percent of medical and 18.7% of nursing professionals reported requesting at least one HIV-serology in the last 12 months (median: 15 and 2 HIV-serology request, respectively). The doctors associated the request with: being male (aOR: 2.95; 95% CI: 0.82-10.56), being trained in pre-post HIV test counselling (aOR: 2.42; 95% CI: 0.84-6.93) and the nurses with: age (<50 years; aOR: 2.75; 95% CI: 0.97-7.75), and number of years working in primary care (>13 years; aOR: 3.02; 95% CI: 1.07-8.52). CONCLUSION: It is necessary to promote HIV testing and training in pre-post HIV test counselling for medical and nursing professionals in primary care centres.

Influence of primary care professionals on early detection of breast cancer: different perception between family physicians and nursing professionals.

The aim of this study was to assess the level of self-perceived influence on early detection of breast cancer among nurses and family physicians (FP) working in primary care and to identify the factors associated with a lower perception in each group. In the Autonomous Community of Madrid, an online questionnaire on cancer prevention was sent to a random sample of primary care professionals (3586 FP and nurses). The data included sex, age, profession, years in primary care, specific postgraduate training, and opinions and attitudes toward cancer prevention. A descriptive analysis was carried out. Factors associated with a low/null self-perceived influence on early detection of breast cancer were analyzed separately for FP and nurses with multivariate logistic regression models. In all, 76.4% of the participants considered that their influence on the early detection of breast cancer was enough/high. FP attributed to themselves a higher influence than nurses (enough/high: 86.0 vs. 64.6%, P<0.01), and a lower perception was associated with a low/null perceived utility of their individual intervention [odds ratio (OR): 6.42, 95% confidence interval (CI) 2.77-14.85]. Among nurses, also associated with this low/null perceived utility [adjusted odds ratio (aOR): 2.81, 95% CI 1.37-5.77] were the absence of postgraduate training in the matter (aOR: 2.56, 95% CI 1.05-6.25), and a low/null perception of feasibility of prevention programs in their centers (aOR: 1.93, 95% CI 1.25-2.98). Primary care professionals perceive their activity in the early detection of breast cancer as relevant, especially FP. To increase knowledge of the utility of individual interventions, specific training and improvement of the feasibility of these programs could enhance this perception.

Participation and factors associated with late or non-response to an online survey in primary care.

RATIONALE, AIMS AND OBJECTIVES: Online surveys have several advantages, but a low response rate is common and it is uncertain how results are affected. Response inducement techniques can be used to overcome this problem. The objectives of this study were to describe the percentage of change in the response rate after reminders and to analyse the characteristics associated with non-response and late response based on the survey results, as well as by applying archival and extrapolation techniques. METHOD: In the Autonomous Community of Madrid, an online questionnaire about cancer prevention was sent to a random sample of primary care health professionals (3586 physicians and nurses). Two reminders were sent later. The percentage of change in response rates after reminders, global and by demographic and health care characteristics of participants; and factors associated with non-response and late response were analysed using response rates and odds ratios (ORs). RESULTS: After the reminders, the response rate increased from 22.6% to 32.9% and to 39.4%. Non-response was associated with age [OR: 3.14; confidence interval (CI) 95%: 2.23-4.42 for aged >60 years], gender and functional area. Further, a higher response rate after reminders was observed in professionals with heavier workloads (OR: 1.46; CI 95%: 1.08-1.97) and in those who stated a lower relevance of cancer prevention in primary care. CONCLUSIONS: After electronic reminders, the response rate increased, especially among professionals with the highest workloads and a minor interest in the survey topic. However, possible bias associated with non-response remains and the factors behind this should be examined in future research.

Targeted rapid HIV testing in public primary care services in Madrid. Are we reaching the vulnerable populations?

OBJECTIVES: To describe the population targeted for the rapid HIV testing program delivered via socio-culturally adapted services in primary care centers and to assess factors associated with uptake of first-time testing. METHODS: This was a descriptive cross-sectional study. We analyzed consultations between April 29, 2010 and May 31, 2012. We assessed the differences in age, origin, education, and sexual history between men who have sex with men (MSM), heterosexual men (HM), and women, using a two-sided independent t-test and Chi-square statistics. Factors associated with first-time testing were analyzed by logistic regression. RESULTS: Of 1940 consultations, 45.1% were HM, 25.4% MSM, and 29.5% women; 35.4% were immigrants, 2.5% were or had been sex workers, and 15.4% had visited one. The test was reactive in 2.1%. Up to 44.2% had never been tested. The probability of being tested for the first time increased in HM, women, populations from the Indian Subcontinent, those with no casual sexual partners, those whose partner's serostatus was unknown, and those with no history of other sexually transmitted infections. CONCLUSIONS: This program managed to reach a high proportion of vulnerable people. First time HIV testing rates were high.