XXXIV Congreso semFYC Gran Canaria 2014: "Dejando huella" / semFYC Congress 2014 Gran Canaria: "Making a mark"

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Correlación clínico-patológica en cirugía menor en un área de salud rural / Correlation between clinical and histological diagnosisv in minor surgery in a rural health area

Introducción. La cirugía menor forma parte de las actividades programadas en un número cada vez más creciente de nuestros centros de atención primaria. El objetivo de este trabajo es conocer el grado de correlación entre el diagnóstico clínico previo al proceso de cirugía menor y su concordancia con el resultado de anatomía patológica. Material y método. Para ello realizamos un estudio retrospectivo a partir del Registro de Actividades de Cirugía Menor de un Centro de Salud Rural de la Comarca de Valdejalón de Aragón. Sujetos. Se incluyeron 1.231 pacientes atendidos durante el periodo comprendido entre abril de 1999 y julio del año 2009 a los que se realizaron un total de 1.391 diagnósticos con sus correspondientes actuaciones. Mediciones. Diagnóstico clínico y resultado clínico-patológico. Correlaciones entre ambos Resultados Se remitieron 820 piezas para estudio clínico-patológico (el 59% de las intervenidas). Se valoraron los 11 diagnósticos clínicos y clínico-patológicos principales con los que se construyó una tabla de contingencia. Se obtuvo un coeficiente kappa de 0,638 Conclusiones. Analizados estos resultados y comparándolos con otros trabajos similares realizados en el ámbito de la cirugía menor en atención primaria, podemos afirmar que hay una buena correspondencia entre el diagnóstico clínico inicial y los resultados de anatomía patológica (AU)

Introduction. Minor Surgery is an ever-increasing programmed activity in Primary Health Care Centres. The aim of this paper is to determine the relationship between the clinical diagnosis prior to Minor Surgery and its concordance with the histological results. Material and methods. We carried out a retrospective study using the registered activity log in a Primary Health Care Centre in the region of Valdejalón of Aragón. Subjects. A total of 1231 patients were included between April 1999 and June 2009. A total of 1391 diagnoses were given, together with the corresponding medical care. Measurements. Clinical diagnosis and histological results, and the level of correlation between both. Results. A total of 820 samples were submitted for histological study (59% of the total sample). Eleven of the main clinical and histological diagnoses were evaluated, and a contingency table was prepared. The result of the correlation gave a Kappa coefficient of 0.638. Conclusions. Once the results were analysed and compared to similar studies of Minor Surgery carried out in Primary Care, our results confirm that there is a high correlation between the clinical diagnosis and the histological results (AU)

Impact of the introduction of fee for service payments on types of minor surgical procedures undertaken by general practitioners: observational study.

The 1990 general practitioners (GPs) contract introduced item of service payment for minor surgery, payable for six categories of procedure. Early review showed no substitution of cheaper procedures for more expensive treatments. Detailed payment data from six Health Authorities for the period 1993-2000 show an 11 per cent increase in claims, largely accounted for by the rise in cautery, incorporating cryotherapy. Cryotherapy is no more effective at treating warts than cheap commercially available products, but is quite profitable for GPs. This is yet another example of item of service payment distorting treatment priorities. The new GP contract, and the initiative to develop GPs with special interests in dermatology and minor surgery, will allow primary care trusts to develop minor surgery undertaken by appropriately skilled and experienced GPs, and which reflects the needs of the population.

[Ambulatory surgery, potential implementation for 17 interventions]. / La chirurgie ambulatoire, potentiel de développement de 17 gestes marqueurs.

Out-patient surgical practice, which allows the patient to leave the hospital a few hours after the intervention, is fairly recent in France and has not yet reached its full expansion. The out-patient surgery French Association (Association française de chirurgie ambulatoire-AFCA) proposes to pursue its development in twenty or so surgical acts. We present an overview of the 17 principle acts. We will then assess the possibilities, according to a method used in Quebec, of developing each of these surgical acts. The proportion of out-patient hospitalizations, varies greatly depending on the surgical act considered. Surgery for cataract is frequent (400,000 hospitalizations in 1999), but only one quarter of these acts are managed in an out-patient department. Conversely, the placing of trans-tympanic drains, which represents four-fold less hospitalizations, is performed in out-patient departments in nine cases out of ten. For the same surgical act, the rates of out-patient surgery vary from one establishment to the next: some have high rates, demonstrating the adaptation of their organization to out-patient surgery, others only operate in complete hospital settings, with more or less long hospitalization periods. Among the surgical acts considered, eye surgery, whether for cataract or strabismus, is that which appears to have the best potential for development, in view of a relatively low rate of out-patient surgery and a large proportion of hospitalization periods of one to two days.