[Analysis of the relationship between primary care doctors and the pharmaceutical industry]. / Análisis de la relación entre el médico de atención primaria y la industria farmacéutica.

OBJECTIVES: To describe the type of relationship between primary care family doctors (PCDs) and the pharmaceutical industry (PI) and its representatives in Aragon, to describe doctors' attitudes to this relationship and to find out how doctors behave towards offers from the industry. DESIGN: Descriptive cross-sectional study, through a self-filled questionnaire with closed replies, of a representative sample of the population under study. SETTING AND PARTICIPANTS: Family doctors working in primary care teams throughout Aragon. RESULTS: The reply rate of 28.17% maintained the study's representativity. Differences in the kind of relationship between PCDs and PI were found in gender (greater relationship of male doctors) and setting (it was greater in urban areas). Doctors working in centres with teaching credentials and woman doctors had a more critical attitude. The tendency to collaborate with the industry's offers was greater in the rural areas and among men. The group of doctors that interacted most with the industry tended to collaborate more with the proposals of the PI. No relationship was found between attitude and conduct of PCDs. CONCLUSIONS: Results confirm both the starting hypotheses: a) the nature of relationships between PCDs and the PI and its representatives affects prescribing behaviour, and b) there are differences between what doctors think they should do and what they really do in their dealings with the PI.

[Working out a questionnaire to study the relationship between doctors and the drug industry]. / Elaboración de un cuestionario para el estudio de la relación entre el médico y la industria farmacéutica.

OBJECTIVE: To work out and validate a questionnaire that can be self-filled and has closed answers to describe: 1) the kind of relationship between family doctors and the pharmaceutical industry; 2) the attitude of family doctors towards this relationship, and 3) the conduct of family doctors when faced with concrete offers from the industry. DESIGN: Cross-sectional study. PARTICIPANTS: Representative sample of family doctors working in primary care teams in Aragon, stratified by province, rural or urban setting and sex. MAIN MEASUREMENTS: A questionnaire with closed answers that can be self-filled was worked out. It had 55 items on three scales. It was referred to a group of experts in methodology, administration, health law and Bioethics, for an appraisal of its contents, criteria and construction. It was then re-sent to three of them for appraisal of the stability of their scoring. RESULTS: The questionnaire was valid in contents, criteria and construction. The results of the re-test sent to a part of the total sample gave information on replies' stability and served as a measurement of the reliability of the questionnaire. CONCLUSIONS: The questionnaire worked out met established psychometric criteria. The analysis of its results after its distribution to a representative sample of Aragonese family doctors may contribute previously unknown information on their attitudes to the drug industry.

[Mid-term evaluation of a help program for smokers]. / Evaluación a medio plazo de un programa de ayuda a los fumadores.

BACKGROUND: Medical counsel to smokers is an intervention that has proved useful to motivate smokers to stop smoking. This study pretends evaluate the long-term impact (2 years and 9 months) of systematic and structured health counsel on the smoke habit from the primary health care. MATERIAL AND METHODS: In April 1990, in four primary care centers from Barcelona and Zaragoza, Spain, a program of systematic counselling to stop smoking with an offer of subsequent follow-up was initiated in all adult smokers (15-65 years of age). According to the answer, every patient was classified on one of seven established categories that allowed a individualized follow-up. Data from the total population included in the program from the beginning till January 1993, are analyzed. RESULTS: From 683 known smokers (59.2% males and 40.8% women), 20 were excluded for different reasons and 343 were included in the program (56.4% cover). Average age of included smokers was 35.1 years (SE = 0.6) and average number of visits of 5.3 (SE = 0.2) which was significantly higher than those not included in the program (33.4; SE = 0.6, and 2.7; SE = 0.1). An average follow-up of 14.3 months (SE = 0.5) and of 2.6 (SE = 0.1) interventions on each individual were done. The average daily number of cigarettes was 18.4 (SE = 0.6) in the initial period and 13.3 (SE = 0.6) on the last program evaluation. The final answers showed a 18.1% of quitters and a decrease of more than 50% on the initial consume on 32.6%. In 12% the answer was negative. CONCLUSIONS: Programs of systematic help for smokers show a higher level of favourable responses than does normal counselling.

[The evaluation of the preventive services for the pediatric population in Agaronese health centers]. / Evaluación de las actividades preventivas en poblagión infantil de centros de salud aragoneses.

BACKGROUND: We have shown the coverage of periodic health examinations made in children aged between 0 and 14 years old in Aragón during 1991, comparing with results obtained at national level and results obtained during 1990. METHODS: A descriptive transversal study was developed by reviewing clinic records of 9 primary health centers selected by systematic sampling. Sampling consisted on 436 histories. RESULTS: Main results were: age of child in the first visit: 83.5% below 1 month; metabolic disease screening: no data on 31.8%; DTP-polio: no data on 20.9%; triple viric: no data on 24.3%. CONCLUSIONS: Obtained data showed better results than those at national level. We should improve the metabolic diseases screening and vaccinations recording system.

[The appropriateness of emergency referrals sent from primary care to a general hospital]. / Adecuación de los volantes urgentes remitidos desde atención primaria a un hospital general.

OBJECTIVE: Study of the degree of completeness of slips sent to forward patients from primary medical care to emergency units of the corresponding general hospital. DESIGN: This is a statistical descriptive and inferential study. SITE. The study was carried out in the general hospital allocated to Zaragoza Health Area III. PATIENTS: Included in the study are all patients sent by primary medical care for evaluation by the urgency unit in the internal medicine section. MAIN MEASUREMENTS AND RESULTS: 415 urgent treatment slips were analysed, evaluating the completion rate and the degree of correctness in relation to their source as either rural or urban. With regards the degree of completion (clinical history, antecedents, examination) and correct functioning at the visit to family doctor stage, there are highly significant differences between those sent from all other such centres (p less than 0.01). Only in the case of 8 slips were physical examinations completed for the presenting ailment: 7 came from urban health centres and 1 from rural health centres. Diagnostic impressions and observations were absent from 62.2% of the slips. CONCLUSIONS: While overall there is no difference between those sent from rural and urban centres, there were differences when those sent from urban health centres were compared with those sent by all other health centres.