Proper pertussis vaccination will probably not increase vaccination coverage: a case-control study.

Vaccination coverage (VC) against pertussis can increase when management practices and policies at primary care centres (PCCs) are reinforced. From 2011 to 2015, we performed a case-control study to evaluate VC among pertussis patients treated at PCCs in Barcelona, Spain. We recorded pertussis in patients from 8- to 16-year-olds at 52 PCCs. Pertussis cases had laboratory diagnostic and controls were healthy outpatients visiting the same facility for reasons other than cough. DTaP/dTap VC was recorded as either proper vaccination status (five doses recorded) or improper vaccination status (<5 doses recorded). We used a logistic regression model to estimate OR and 95% CI. We included 229 cases and 576 controls. VC was higher in cases (mean 5.01, s.e.: 0.57) than in controls (4.89, s.e.: 0.73). Around 69% of the cases had received DTaP primary immunisation after 2-5 years and 31.4% of cases had the dTap booster immunisation after 7-10 years. The 87% of children 5-9 years were properly vaccinated. We found no protection from becoming ill among properly vaccinated children (OR 1.87; 95% CI 1.22-2.85). The highest VC was observed in patients with confirmed pertussis, which was likely due to a more exhaustive follow-up of the VC in these patients. Being properly vaccinated against pertussis will probably not increase VC.

One consensual depression diagnosis tool to serve many countries: a challenge! A RAND/UCLA methodology.

OBJECTIVE: From a systematic literature review (SLR), it became clear that a consensually validated tool was needed by European General Practitioner (GP) researchers in order to allow multi-centred collaborative research, in daily practice, throughout Europe. Which diagnostic tool for depression, validated against psychiatric examination according to the DSM, would GPs select as the best for use in clinical research, taking into account the combination of effectiveness, reliability and ergonomics? A RAND/UCLA, which combines the qualities of the Delphi process and of the nominal group, was used. GP researchers from different European countries were selected. The SLR extracted tools were validated against the DSM. The Youden index was used as an effectiveness criterion and Cronbach's alpha as a reliability criterion. Ergonomics data were extracted from the literature. Ergonomics were tested face-to-face. RESULTS: The SLR extracted 7 tools. Two instruments were considered sufficiently effective and reliable for use: the Hospital Anxiety and Depression Scale and the Hopkins Symptoms Checklist-25 (HSCL-25). After testing face-to-face, HSCL-25 was selected. A multicultural consensus on one diagnostic tool for depression was obtained for the HSCL-25. This tool will provide the opportunity to select homogeneous populations for European collaborative research in daily practice.

Which DSM validated tools for diagnosing depression are usable in primary care research? A systematic literature review.

INTRODUCTION: Depression occurs frequently in primary care. Its broad clinical variability makes it difficult to diagnose. This makes it essential that family practitioner (FP) researchers have validated tools to minimize bias in studies of everyday practice. Which tools validated against psychiatric examination, according to the major depression criteria of DSM-IV or 5, can be used for research purposes? METHOD: An international FP team conducted a systematic review using the following databases: Pubmed, Cochrane and Embase, from 2000/01/01 to 2015/10/01. RESULTS: The three databases search identified 770 abstracts: 546 abstracts were analyzed after duplicates had been removed (224 duplicates); 50 of the validity studies were eligible and 4 studies were included. In 4 studies, the following tools were found: GDS-5, GDS-15, GDS-30, CESD-R, HADS, PSC-51 and HSCL-25. Sensitivity, Specificity, Positive Predictive Value, Negative Predictive Value were collected. The Youden index was calculated. DISCUSSION: Using efficiency data alone to compare these studies could be misleading. Additional reliability, reproducibility and ergonomic data will be essential for making comparisons. CONCLUSION: This study selected seven tools, usable in primary care research, for the diagnosis of depression. In order to define the best tools in terms of efficiency, reproducibility, reliability and ergonomics for research in primary care, and for care itself, further research will be essential.

The effectiveness of a program of physical activity and diet to modify cardiovascular risk factors in patients with severe mental illness after 3-month follow-up: CAPiCOR randomized clinical trial.

BACKGROUND: The aim of this randomized clinical trial follow-up at three months was to evaluate the effectiveness of an educational intervention with a focus on diet and physical activity (PA) to change the amount of PA, body mass index (BMI) and the waist circumference (WC) in patients with severe mental illness. METHODS: We recruited 332 outpatients with severe mental disorders undergoing treatment with antipsychotic medication from Mental Healthcare Centers of Barcelona. They were randomly assigned to an intervention or a control group. The patients in the intervention group participated in a group PA and diet educational program. The blinded measurements at 0 and 3 months were: the level of PA (IPAQ questionnaire), BMI, WC, blood pressure, dietary habits (PREDIMED questionnaire), quality of life (SF-36 questionnaire) and laboratory parameters (cholesterol, triglycerides, glucose). RESULTS: The average age was 46.7 years and 55% were males. Schizophrenia had been diagnosed in 67.1% of them. At 3 months, the average weekly walking METs rose significantly in the IG 266.05 METs (95%CI: 16.86 to 515.25; P=0.036). The total MET average also rose although not significantly: 191.38 METs (95%CI: 1.38 to 381.38; P=0.086). However, the BMI decreased significantly more in the CG, by 0.26kg/m(2) (95%CI: 0.02 to 0.51; P=0.038), than in the IG. There were no significant differences in the WC. CONCLUSIONS: The short-term results suggest that the intervention increases the level of PA, but does not improve physical or laboratory parameters. TRIAL REGISTRATION: Clinicaltrials.gov NCT01729650 (effectiveness of a physical activity and diet program in patients with psychotic disorder [CAPiCOR]).

[Arterial hypertension and sleep apnea hypopnea syndrome in primary care]. / Hipertensión arterial y síndrome de apneas-hipoapneas del sueño en atención primaria.

INTRODUCTION AND OBJECTIVES: Sleep apnea hypopnea syndrome (SAHS) is frequent in hypertensive patients and plays a role in a greater incidence of cardiovascular morbidity-mortality. This study aims to know the clinical profile of hypertensive patients with SAHS compared to hypertensive patients without SAHS to know which variables should be used to orient their screening from primary care. METHODOLOGY: An observational, descriptive, retrospective study of cases (hypertensive patients with SAHS) and controls (hypertensive patients without) was performed in an urban health care center. Based on a computerized registry of the site, patients diagnosed of SAHS and hypertension over 30 years of age were selected. For each case, one control case of hypertensive patients without SAHS paired by age and gender was randomly obtained. RESULTS: A total of 64 cases and 64 controls were selected. Standing out in the bivariate analysis were greater BMI (34.3±12.8 vs. 28.6±3.6), predominance of obesity (70.3 vs. 35.9%), metabolic syndrome (77.3 vs. 42.2%), consumption of psychopharmaceuticals (19.7 vs. 7.8%) and anithypertensive drugs (26.5 vs. 14.0%), ischemic heart disease (20.3 vs. 9.4%) in the case group versus control group (P<.05 for all the variables). The multivariate analysis showed that only the presence of metabolic syndrome was related with the presence of SAHS in hypertensive patients (OR 4.65; 95% CI: 2.03-10.64; P<.001). CONCLUSIONS: Screening for SAHS should be performed in hypertensive patients seen in primary care if they have metabolic syndrome criteria.

[Satisfaction with primary care nursing: use of measurement tools and explanatory factors]. / Satisfacción con la enfermera en atención primaria: herramientas de medida y factores explicativos.

OBJECTIVES: This study aims to assess the psychometric properties of two measurement tools for patient satisfaction with nursing care in Primary Care, the satisfaction level, and the personal and consultation characteristics associated with its variability. METHODS: Subjects randomly selected in 23 Health Care centres in the Community of Madrid were included. Satisfaction was measured by means of the AMABLE and Baker questionnaires, in which the psychometric properties were evaluated. Sociodemographic characteristics of the consultations, variables related to health status, and other related to the consultation process were collected. An explanatory model using Generalized Estimating Equations was constructed. RESULTS: The 662 subjects expressed a mean satisfaction of 4.95/5 (SD .25) with AMABLE, and 4.83/5 (SD .42) with the Baker questionnaire. AMABLE had a single dimension (Cronbach's alpha .85), and Baker three: professional care (mean 4.76, SD .48 Cronbach's alpha .74), depth of relationship (mean 3.76, SD 1.18, Cronbach's alpha .73), and perceived time (mean 4.42, SD .86, Cronbach's alpha .47). Ageing, a better perception of health status, and appointments arranged by nurses were associated with higher expressed satisfaction. Home care, hospital admissions, delayed consultation, extended family, or high family income were associated with lower satisfaction. CONCLUSIONS: Satisfaction with nurse consultations in Primary Care was very high, and varied depending on personal characteristics and on the type of consultation. The assessed tools allowed this outcome to be measured properly.

Estudio de los trastornos de personalidad y de la utilización de servicios en la población clínica atendida en la red de salud mental de un sector sanitario / Study of personality disorders and the use of services in the clinical population attended in the mental health network of a community area

Introducción. Los trastornos de personalidad (TP) constituyen un problema clínico y asistencial creciente. En España los estudios de los TP y de la utilización de servicios de salud mental (SM) en población clínica son escasos. Sin embargo, estos datos son necesarios para planificar la asistencia de los TP. Método. Se han estudiado todos los pacientes atendidos durante 1 año en el conjunto de los servicios psiquiátricos (n=2.701) y por separado en los servicios hospitalarios (n=193) y ambulatorios (n=2.649). Se han incluido todos los pacientes diagnosticados de TP mediante entrevista clínica (criterios DSM-IV-TR). Se han investigado variables demográficas, clínicas y uso de servicios de SM. Resultados. La proporción de TP en el conjunto de la población atendida fue del 11% (intervalo de confianza [IC] del 95%: 9,8-12,2) y en los servicios hospitalarios y ambulatorios del 17,6% (IC 95%: 12,9-23,6) y 10,3% (IC 95%: 9,2-11,5), respectivamente. Los TP más representados fueron el límite (25,7%), el histriónico (24%) y el obsesivo-compulsivo (6,4%), y el 19,6% fueron TP no especificado. Los TP hicieron una utilización importante de los recursos de salud mental (hospitalarios, ambulatorios y urgencias). Los trastornos del estado de ánimo, de ansiedad y por consumo de sustancias fueron los más comórbidos en el eje I. Conclusiones. El estudio de los TP atendidos en los servicios de SM de un distrito sanitario mediante evaluación clínica es un instrumento económico, sencillo y reproducible para planificar la asistencia de los TP (AU)

Introduction. Personality disorders (PD) are a growing clinical and health care problem. In Spain, the studies of PD and utilization of the Mental Health Services(MHS) in the clinical population are scant. However, these data are necessary in the planning of MHS for PD. Method. We studied all the patients attended throughout one year in all the psychiatric departments (n=2701), and separately in the inpatient (n=193) and outpatient (n=2649) psychiatric services. All the patients diagnosed with PD by clinical interview (DSM-IV-TR criteria) were included. Demographic and clinical variables as well as use of MHS were studied. Results. The proportion of PD in the population attended was 11% (95% CI: 9.8%-12.2%) and in the inpatient and outpatient psychiatric services 17.6% (95% CI: 12.9%-23.6%) and 10.3% (95% CI: 9.2%-11.5%), respectively. The most representative PD were borderline (25.7%), histrionic (24%) and obsessive-compulsive (6.4%) and 19.6% were not otherwise specified PD. PD accounted for an extensive use of mental health resources (inpatient, outpatient and emergency units). The most comorbid conditions in axis I were affective, anxiety and substance-related disorders. Conclusions. The study of PD attended in the MHS in a community area by means of clinical evaluation is an economical instrument, which is easily applied and replicated in planning of MHS for PD (AU)

Study of personality disorders and the use of services in the clinical population attended in the mental health network of a community area.

INTRODUCTION: Personality disorders (PD) are a growing clinical and health care problem. In Spain, the studies of PD and utilization of the Mental Health Services (MHS) in the clinical population are scant. However, these data are necessary in the planning of MHS for PD. METHOD: We studied all the patients attended throughout one year in all the psychiatric departments (n=2701), and separately in the inpatient (n=193) and outpatient (n=2649) psychiatric services. All the patients diagnosed with PD by clinical interview (DSM-IV-TR criteria) were included. Demographic and clinical variables as well as use of MHS were studied. RESULTS: The proportion of PD in the population attended was 11% (95% CI: 9.8%-12.2%) and in the inpatient and outpatient psychiatric services 17.6% (95% CI: 12.9%- 23.6%) and 10.3% (95% CI: 9.2%-11.5%), respectively. The most representative PD were borderline (25.7%), histrionic (24%) and obsessive-compulsive (6.4%) and 19.6% were not otherwise specified PD. PD accounted for an extensive use of mental health resources (inpatient, outpatient and emergency units). The most comorbid conditions in axis I were affective, anxiety and substance-related disorders. CONCLUSIONS: The study of PD attended in the MHS in a community area by means of clinical evaluation is an economical instrument, which is easily applied and replicated in planning of MHS for PD.

[Variability in psychiatric medical practice evaluated by studying short-term psychiatric rehospitalization]. / Variabilidad en la práctica medicopsiquiátrica evaluada mediante el estudio de los reingresos psiquiátricos a corto plazo.

INTRODUCTION: Variability in medical practice can detect deficiencies in medical care quality. This study was designed to determine variations in psychiatric practice by studying short-term rehospitalization (SRH) that could result in differences in quality of psychiatric care. METHODS: Data on 894 consecutive admissions to an inpatient unit from March to December 2001 were collected. Readmissions over the next 90 days or less (SRH) were analyzed. The database was reviewed in order to extract information about several variables: age, gender, period from the first admission, number of previous admissions, interval between initial discharge and readmission, psychiatric diagnosis, aftercare provided by the mental health centers (MHC) and psychiatrist-associated variables. Differences between SRH and the other admissions were examined. RESULTS: There were significant variations in the aftercare provided by the MHC (p = 0.028). There were also variations in the psychiatrist responsible for the inpatient unit (p = 0.03), in the reference psychiatrist in a MHC (p = 0.007), but not in the emergency unit. CONCLUSIONS: This short-term rehospitalization study showed variations in quality of aftercare and in psychiatrist associated variables. Both these findings warrant further investigation that pays specific attention to staff attitudes, system barriers and facilitators of psychiatric care.

The cost of inadequate prescriptions for hypolipidaemic drugs. VICAF Group.

BACKGROUND: The high consumption of hypolipidaemic agents warrants the study of the costs caused by these medicines being inadequately prescribed. OBJECTIVE: To quantify the economic cost generated in 1 year in primary care by inadequate (or unnecessary) prescriptions for hypolipidaemic drugs. METHODS: A cross-sectional study based on hypolipidaemic drug prescriptions for a population of pensioners ordered during 1 year by 49 family physicians from 4 health areas in Madrid, Spain. Each doctor completed a data collection sheet for each patient for whom a hypolipidaemic agent was prescribed. The adequacy of each prescription was evaluated according to 2 quality levels: for level 1, it was necessary to have knowledge of the following parameters: total cholesterol level at the start of treatment, low density lipoprotein cholesterol (LDL-C) level, whether dietary intervention preceded pharmacological treatment, patient age and risk factors; for level 2, it was not necessary to have knowledge of either diet before pharmacological treatment or LDL-C levels. Inadequate expenditure was quantified by physician, by type of doctor who initiated the pharmacological treatment (the family physician, specialist, other doctor), therapeutic group and agent. STUDY PERSPECTIVE: Primary healthcare management of 4 public health areas. RESULTS: The cost of inadequate prescriptions for hypolipidaemic drugs reached 116,480.60 US dollars ($US; 1997 values) for quality level 1 and $US37,893.37 for level 2. 12.3% of the health professionals ordered all their prescriptions inadequately (level 1). Of the total inadequate prescription expenditure, 20.4% represented treatments initiated by family physicians and 35.3% by specialists (level 1). Statins made up 78.2% of the total cost; the inadequate expenditure for this therapeutic group reached $US88,797 (level 1). Of the prescriptions for fibrates, 88% were inadequate (level 1). CONCLUSIONS: In this study, 67% of prescriptions for hypolipidaemic medicines were ordered inadequately in the pensioner population, which represents a considerable pharmacological expenditure. This percentage and the mean cost per inadequate prescription was higher if a specialist was the professional initiating the treatment. Therefore, it is necessary to run pharmaceutical prescription quality programmes with both primary care physicians and specialists involved.

Validez de un indicador de calidad de prescripción farmacológica en pacientes con hiperlipemia / Validity of an indicator of the quality of pharmacological prescription in patients with hyperlipaemia

Objetivos. El sistema informático de facturación de recetas (SIFAR) permite la obtención de indicadores para el estudio y seguimiento de la utilización de medicamentos en las áreas de atención primaria del INSALUD. Concretamente, estudiamos el indicador referido al consumo de hipolipemiantes en población pensionista (CHPP), no validado y cuyo valor es esperable que disminuya al incrementarse la calidad. El objetivo es estimar la correlación del indicador de prescripción de hipolipemiantes del SIFAR con el porcentaje de hipolipemiantes correctamente prescritos en pensionistas (PCP). Diseño. Estudio descriptivo de correlación entre 2 indicadores de prescripción farmacológica. Emplazamiento. Cuatro áreas de salud de Madrid. Participantes. Se estudian las prescripciones de 49 médicos generales, elegidos aleatoriamente a partir de 3 estratos definidos por el valor del indicador. Cada médico rellena un protocolo de datos por cada paciente pensionista al que prescribe un hipolipemiante durante el período del estudio. Mediciones y resultados principales. Se comparan los indicadores CHPP y PCP mediante correlación de Spearman. Se han recogido 6.779 prescripciones correspondientes a 1.125 pacientes de los 49 médicos que participaron. El porcentaje medio de envases de hipolipemiantes correctamente prescritos es del 31,9 por ciento, cifra que asciende al 77,5 por ciento si no se exige tener constancia del valor LDL. Las correlaciones obtenidas entre el CHPP y el PCP son cercanas a cero. Conclusiones. El indicador CHPP del SIFAR no discrimina la calidad de prescripción de hipolipemiantes en mayores de 64 años (AU)

[The quality of the drug treatment in hyperlipemia patients from 4 health areas. The VICAF Group]. / Calidad del tratamiento farmacológico en pacientes con hiperlipemia de 4 áreas de salud. Grupo VICAF.

OBJECTIVE: To calculate how suitable the lipid-lowering treatment prescribed for pensioners in primary care clinics in four health areas is. DESIGN: Cross-sectional descriptive study of quality of pharmacological treatment. SETTING: Four primary care health districts, INSALUD, Madrid. PARTICIPANTS: 1125 patients registered with 49 doctors, chosen at random on the basis of three strata defined by the value of the lipid-lowering drug indicator of prescription. For a year, each doctor filled in a protocol of variables for each pensioner to whom he/she prescribed a lipid-lowering drug. MEASUREMENTS AND MAIN RESULTS: An automated algorithm was designed to evaluate the suitability of the drugs treatment for each patient, according to scientific criteria including: cholesterol levels, LDL, age, and risk factors. Quality of prescription was finally measured for 1009 patients. The indication of the treatment was due to primary prevention in 65% of cases. 32% of patients were correctly treated. If LDL compliance was not demanded, the suitability figure rose to 77%. Drug treatment was more suitable when the doctor him/herself administered it (as against another doctor or a specialist; p = 0.001) or when the patient was on the list of the prescribing doctor (p < 0.0001). Proper indication was lower in patients over 74 (p < 0.0001). CONCLUSIONS: The quality of lipid-lowering drug prescription for pensioners in primary care clinics in four health districts, as a function of the criteria defined above, could be improved. LDL is the factor which most affects the procedure.

Calidad del tratamiento farmacológico en pacientes con hiperlipemia de 4 áreas de salud / Quality of pharmacological treatment of patients with hyperlipaemia from four health districts

Objetivo.Estimar la adecuación del tratamiento hipolipemiante prescrito a pensionistas en consultas de atención primaria de 4 áreas de salud. Diseño. Estudio descriptivo transversal de calidad del tratamiento farmacológico. Emplazamiento. Cuatro áreas de salud de atención primaria. INSALUD. Madrid. Sujetos. Un total de 1.125 pacientes adscritos a 49 médicos, elegidos aleatoriamente a partir de 3 estratos definidos por el valor del indicador de prescripción de hipolipemiantes. Cada médico rellenó un protocolo de variables por cada pensionista al que indicó un hipolipemiante durante un año. Mediciones y resultados principales. Se elaboró un algoritmo automatizado para valorar la adecuación del tratamiento farmacológico de cada paciente, según criterios científicos teniendo en cuenta: niveles de colesterol, LDL, edad y existencia de factores de riesgo. La calidad de la prescripción se midió finalmente en 1.009 pacientes. La indicación del tratamiento se debió a prevención primaria en un 65 por ciento de los casos. El 32 por ciento de pacientes estaba correctamente tratado. Si no se exige la cumplimentación de LDL, el porcentaje de adecuación asciende al 77 por ciento. El porcentaje de tratamiento farmacológico adecuado fue superior cuando lo realizó el propio facultativo (frente a otro facultativo o al especialista; p = 0,001) y cuando el paciente pertenecía al propio cupo del médico prescriptor (p < 0,0001). La correcta indicación fue menor en pacientes mayores de 74 años (p < 0,0001). Conclusiones.La calidad de la indicación de hipolipemiantes a pensionistas en consultas de atención primaria de 4 áreas de salud, en función de los criterios previamente definidos, es mejorable, siendo la LDLel factor que más influye en el proceso (AU)

[Job satisfaction among primary care professional in area 10 Insalud, Madrid]. / Satisfaccion laboral de los profesionales de Atención Primaria del Area 10 del Insalud de Madrid.

BACKGROUND: The implementation of a total quality model requires ascertaining the degree of employee job satisfaction. Our aim is to ascertain the overall degree of satisfaction and determine its components employed in Primary Care District No. 10. METHODS: Descriptive cross-sectional study conducted in Spanish National Health Institute Primary Health Care District No. 10 in Madrid. A total of 668 health care and non health care professionals are employed in this District. A Font Rojas satisfaction questionnaire adapted by J. Aranaz was used to gauge the degree of job satisfaction on a 1-5 scale (1 being the lowest degree of satisfaction and 5 the highest). RESULTS: Eighty percent of the population answered the questionnaire. The average satisfaction mark was 3.12 (Standard Error SE = 0.017). The aspects ranked the lowest were the stress involved in the job, averages 2.30 (SE = 0.041) and professional promotion an average of 2.42 (SE = 0.038). The aspect valued most highly was that of professional skill, averaging 4.01 (SE = 0.058). CONCLUSIONS: These professional are satisfied to an average degree with their work. On comparing this study with one conducted in this same District in 1992, we have drawn the conclusion that the aspects of work-related stress and professional promotion continue to be those ranked the lowest, which should lead to corrective measures being taken on the part of the management teams.

[Effectiveness of brief medical counseling to reduce drinkers' alcohol consumption]. / Efectividad del consejo médico breve para reducir el consumo de alcohol en bebedores.

OBJECTIVE: To evaluate the effectiveness of medical counselling in reducing alcohol consumption in male heavy drinkers. DESIGN: A controlled, randomised, simple-blind intervention study. SETTING: Four Primary Care teams in Area 10, Madrid. PATIENTS: 152 men who attended for on-demand treatment from the four teams and whose alcohol consumption was over 21 International Units (IU) a week. INTERVENTION: Brief medical counselling backed up by didactic material. Two questionnaires on alcohol consumption in IU, consumption habits and problems related to alcohol were administered, separated by an interval of between 6 and 18 months. Non-parametric tests for paired samples (McNemar) were applied. RESULTS: 60% answered the second questionnaire. Neither sociodemographic nor health habit differences were found between those who responded and those who did not, except for social class. There were no appreciable differences between the intervention and control groups. The percentage of drinkers above 35 IU decreased significantly in the intervention group. CONCLUSIONS: The intervention was clearly effective in reducing the percentage of drinkers whose weekly consumption was over 35 IU.

[The efficiency of organizational measures in improving the management of the prior appointment program]. / Efectividad de medidas organizativas en la mejora de la gestión del Programa de Cita Previa.

OBJECTIVES: To estimate the organisational impact of the volume of appointments processed in the Primary Care (PC) Administration Units (AU) of Area 10, and to evaluate the effectiveness of organisational measures to correct the excess of appointments processed at particular times of day. DESIGN: Before-and-after intervention study. SETTING: AU of 16 PC teams from Madrid's Area 10. PARTICIPANTS: All the appointments made for users by 78 clerks in the 16 AU in the Area during the two weeks of the study. INTERVENTIONS: Strengthening of administrative staff dealing with the appointment system; and an information campaign for users about the system. MEASUREMENTS AND RESULTS: The percentage of appointments processed by AU was broken down for morning and afternoon, by the way the appointment was made (telephone/counter) and by the scheduling of the list. The hourly development was analysed by a graph. A mean number of appointments per clerk per day was found. The above figures were compared for before and after intervention. CONCLUSIONS: The work load caused by the appointment system was redistributed by internal organisational measures, since user habits did not alter.

[The study of occupational satisfaction and its determining factors among health professionals working in one of the areas in Madrid]. / Estudio de la satisfacción laboral y sus determinantes en los trabajadores sanitarios de un área de Madrid.

BACKGROUND: It is well known that job satisfaction influences health care services quality. The aim of this study is to evaluate sanitary workers' job satisfaction and to determine its components, in a sanitary district institutions: primary health care centres, speciality centres and district hospital. METHODS: A cross-sectional study was designed. The sample is proportional, stratified and randomized. It is composed of 947 workers, 460 of which are speciality care workers (SCW) (from a total study population of 1579 people), and 486 are primary care workers (PCW) (the whole population of PCW) from the tenth sanitary area of Madrid. We have used two questionnaires: the first one is Font-Roja's questionnaire which consists of 27 items that are evaluated through a Likert 1-5 scale. The second questionnaire consists of independent variables: socio-demographic and job variables. We have made an exploratory factorial analysis of various satisfaction components. We have evaluated the relationship between each dimension and the independent variables. RESULTS: 255 professionals of SCW (55.4% of the whole) and 357 of PCW (73.9% of the whole) answered the questionnaire. The dimensions that reached the lowest score were these factors: stress related with job and professional promotion (this factor was lowest in nurses and administrative worker). There are significant differences with respect to studied factors, professional level, and kind of job. CONCLUSIONS: We have found a half way satisfaction level in this sanitary district health care workers. Our results suggest that modifications in management and working conditions are needed, according to satisfaction dimension scores.

[Assessment of job satisfaction of the nursing staff]. / Evaluación de la satisfacción del personal de enfermería.

OBJECTIVE: To find the overall and specific levels of job satisfaction of nursing staff in an Area's Health Institutions. DESIGN: Descriptive study of a crossover type of a population base. SETTING: Primary (PC) and Specialist (SC) Care within INSALUD in Madrid's Area 10. PARTICIPANTS: Nursing staff with at least six months in their post. All 147 working in PC were included and a random sample of 130 from SC. INSTRUMENT: The Font-Roja questionnaire, which measures overall job satisfaction and a series of specifics, was used. MEASUREMENTS AND MAIN RESULTS: 68.2% replied. By means of a factorial analysis of the main components, 9 dimensions explaining 59.2% of the variance were obtained. There was average general job satisfaction (3.05 +/- 0.35). The most valued dimension was that which referred to work content (4.01 +/- 0.59) and the least valued was tension associated with the job (2.47 +/- 0.70). CONCLUSIONS: Nursing staff at both levels of Health Care are less satisfied in the areas of "tension associated with work," "promotion prospects" and "over-work". The greatest satisfaction was found in "work content" and "relationships with colleagues". PC nursing staff showed greater satisfaction in "communication with superiors", "satisfaction with the post", "tension associated with the job" and "professional autonomy." Temporary scored higher than permanent staff in "satisfaction with the post" and "tension associated with the post." In general the afternoon shift provides most satisfaction.