Desarrollo de una aplicación para teléfonos móviles (app) basada en la colaboración Sociedad Española de Reumatología/Sociedad Española de Medicina de Familia y Comunitaria para derivación de enfermedades autoinmunes sistémicas / Development of an application for mobile phones (App) based on the collaboration between the Spanish Society of Rheumatology and Spanish Society of Family Medicine for the referral of systemic autoimmune diseases from primary care to rheumatology

El diagnóstico y tratamiento de las enfermedades autoinmunes sistémicas (EAS) constituye un reto. Aunque infrecuentes, afectan a cientos de miles de pacientes en España. El médico de familia (MF) se enfrenta a síntomas o signos inespecíficos que hacen sospechar EAS al inicio del proceso, y tiene que decidir a quiénes debería derivar. Para facilitar su reconocimiento y mejorar su derivación, expertos de la Sociedad Española de Medicina de Familia y Comunitaria y de la Sociedad Española de Reumatología seleccionaron 26 síntomas/signos-guía y alteraciones analíticas. Se escogieron parejas de MF y reumatólogo para elaborar algoritmos diagnósticos y de derivación. Posteriormente se revisaron y adaptaron al formato de aplicación para móviles (app) descargable. El resultado es el presente documento de derivación de EAS para MF en formato de papel y app. Contiene algoritmos de fácil manejo utilizando datos de la anamnesis, exploración física y pruebas analíticas accesibles en atención primaria para orientar el diagnóstico y facilitar la derivación a reumatología o a otras especialidades

Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed

Development of an application for mobile phones (App) based on the collaboration between the Spanish Society of Rheumatology and Spanish Society of Family Medicine for the referral of systemic autoimmune diseases from primary care to rheumatology. / Desarrollo de una aplicación para teléfonos móviles (app) basada en la colaboración Sociedad Española de Reumatología/Sociedad Española de Medicina de Familia y Comunitaria para derivación de enfermedades autoinmunes sistémicas.

Management of systemic autoimmune diseases is challenging for physicians in their clinical practice. Although not common, they affect thousands of patients in Spain. The family doctor faces patients with symptoms and non-specific cutaneous, mucous, joint, vascular signs or abnormal laboratory findings at the start of the disease process and has to determine when to refer patients to the specialist. To aid in disease detection and better referral, the Spanish Society of Rheumatology and the Spanish Society of Family Medicine has created a group of experts who selected 26 symptoms, key signs and abnormal laboratory findings which were organized by organ and apparatus. Family doctors and rheumatologists with an interest in autoimmune systemic diseases were selected and formed mixed groups of two that then elaborated algorithms for diagnostic guidelines and referral. The algorithms were then reviewed, homogenized and adapted to the algorithm format and application for cell phone (apps) download. The result is the current Referral document of systemic autoimmune diseases for the family doctor in paper format and app (download). It contains easy-to-use algorithms using data from anamnesis, physical examination and laboratory results usually available to primary care, that help diagnose and refer patients to rheumatology or other specialties if needed.

[Definition, etiology, classification and presentation forms]. / Definición, etiopatogenia, clasificación y formas de presentación.

Osteoarthritis is defined as a degenerative process affecting the joints as a result of mechanical and biological disorders that destabilize the balance between the synthesis and degradation of joint cartilage, stimulating the growth of subchondral bone; chronic synovitis is also present. Currently, the joint is considered as a functional unit that includes distinct tissues, mainly cartilage, the synovial membrane, and subchondral bone, all of which are involved in the pathogenesis of the disease. Distinct risk factors for the development of osteoarthritis have been described: general, unmodifiable risk factors (age, sex, and genetic makeup), general, modifiable risk factors (obesity and hormonal factors) and local risk factors (prior joint anomalies and joint overload). Notable among the main factors related to disease progression are joint alignment defects and generalized osteoarthritis. Several classifications of osteoarthritis have been proposed but none is particularly important for the primary care management of the disease. These classifications include etiological (primary or idiopathic forms and secondary forms) and topographical (typical and atypical localizations) classifications, the Kellgren and Lawrence classification (radiological repercussions) and that of the American College of Rheumatology for osteoarthritis of the hand, hip and knee. The prevalence of knee osteoarthritis is 10.2% in Spain and shows a marked discrepancy between clinical and radiological findings. Hand osteoarthritis, with a prevalence of symptomatic involvement of around 6.2%, has several forms of presentation (nodal osteoarthritis, generalized osteoarthritis, rhizarthrosis, and erosive osteoarthritis). Symptomatic osteoarthritis of the hip affects between 3.5% and 5.6% of persons older than 50 years and has different radiological patterns depending on femoral head migration.

Introducción / Introduction

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Definición, etiopatogenia, clasificación y formas de presentación / Definition, etiology, classification and presentation forms

La artrosis se define como un proceso degenerativo articular, consecuencia de trastornos mecánicos y biológicos que desestabilizan el equilibrio entre la síntesis y la degradación del cartílago articular, estimulando el crecimiento del hueso subcondral y con la presencia de sinovitis crónica. Actualmente se considera a la articulación como una unidad funcional que integra diferentes tejidos, principalmente el cartílago, la sinovial y el hueso subcondral, todos ellos implicados en la patogenia de la enfermedad. Se han descrito diferentes factores de riesgo relacionados con su aparición: los generales no modificables (edad, sexo y genética), los generales modificables (obesidad y factores hormonales) y los locales (anomalías articulares previas y sobrecarga articular), mientras que entre los principales factores relacionados con su progresión destacan los defectos de alineación articular y la artrosis generalizada. Se han propuesto diferentes maneras de clasificar la artrosis, aunque ninguna de ellas tiene gran relevancia para su manejo por el médico de atención primaria: la etiológica (formas primarias o idiopáticas y formas secundarias), la topográfica (localizaciones típicas y atípicas), la de Kellgren y Lawrence (repercusión radiológica) y la del American College of Rheumatology para la artrosis de manos, caderas y rodillas. La artrosis de rodilla tiene una prevalencia del 10,2% en España y muestra una importante disociación clinicorradiológica. La artrosis de manos, con una prevalencia de afectación sintomática de alrededor del 6,2% puede adoptar diferentes formas de presentación (artrosis nodal, artrosis generalizada, rizartrosis y artrosis erosiva). La artrosis sintomática de cadera afecta entre el 3,5 y 5,6% de los mayores de 50 años y tiene diferentes patrones radiológicos en función de la migración de la cabeza femoral

Osteoarthritis is defined as a degenerative process affecting the joints as a result of mechanical and biological disorders that destabilize the balance between the synthesis and degradation of joint cartilage, stimulating the growth of subchondral bone; chronic synovitis is also present. Currently, the joint is considered as a functional unit that includes distinct tissues, mainly cartilage, the synovial membrane, and subchondral bone, all of which are involved in the pathogenesis of the disease. Distinct risk factors for the development of osteoarthritis have been described: general, unmodifiable risk factors (age, sex, and genetic makeup), general, modifiable risk factors (obesity and hormonal factors) and local risk factors (prior joint anomalies and joint overload). Notable among the main factors related to disease progression are joint alignment defects and generalized osteoarthritis. Several classifications of osteoarthritis have been proposed but none is particularly important for the primary care management of the disease. These classifications include etiological (primary or idiopathic forms and secondary forms) and topographical (typical and atypical localizations) classifications, the Kellgren and Lawrence classification (radiological repercussions) and that of the American College of Rheumatology for osteoarthritis of the hand, hip and knee. The prevalence of knee osteoarthritis is 10.2% in Spain and shows a marked discrepancy between clinical and radiological findings. Hand osteoarthritis, with a prevalence of symptomatic involvement of around 6.2%, has several forms of presentation (nodal osteoarthritis, generalized osteoarthritis, rhizarthrosis, and erosive osteoarthritis). Symptomatic osteoarthritis of the hip affects between 3.5% and 5.6% of persons older than 50 years and has different radiological patterns depending on femoral head migration

Prescripción inapropiada de fármacos en personas mayores atendidas en un centro de Atención Primaria según los criterios STOPP-START / Inappropriate prescribing of drugs in older people attending primary care health centres: Detection using STOPP-START criteria

Objetivo. Conocer la prevalencia y características de prescripción inapropiada (PI) de los fármacos en los pacientes mayores de 65 años atendidos por un Equipo de Atención Primaria (EAP), utilizando los criterios STOPP-START. Material y método. Estudio transversal de muestra representativa de pacientes mayores de 65 años con historia activa en 2010, atendidos en 13 consultorios urbanos (muestreo sistemático aleatorizado; prevalencia esperada de PI del 40%; precisión: 5%; nivel de confianza: 95%). Se revisó la prescripción en las historias durante 2010, valorando los criterios STOPP-START. Resultados. Se seleccionaron 363 pacientes (56,7% mujeres); con una edad media de 75,2 años (DE: 7,02). Las enfermedades más frecuentes fueron cardiovascular (76,9%) y osteoarticular (57,6%), y el promedio de fármacos en prescripción crónica fue de 4,9 (DE: 3,32). Se detectó PI en 170 pacientes (46,8%, IC 95%: 41,7-52,0%), 42% en varones (IC 95%: 34,3-49,8%) y 46,6% en mujeres (IC 95%: 39,8-53,4%), sin diferencias entre sexos (p = 0,386) y con una mayor prevalencia si hay polimedicación o comorbilidad (p < 0,001). En cuanto al tipo de PI se cumplían criterios STOPP en 131 pacientes (36,1%, IC 95%: 31,1-41,0%) y START en 73 (20,1%, IC 95%: 16-24,2%), sin diferencias entre sexos (p = 0,623 para STOPP; p = 0,678 para START). Las PI STOPP más frecuentes se observan en indicadores del sistema musculoesquelético (50 pacientes: 38,2%, IC 95%: 29,8-46,5%) y las START en indicadores de endocrinología (38 pacientes: 52,1%, IC 95%: 40,0-63,9%). Conclusiones. La herramienta STOPP-START permite detectar y sistematizar la aplicación de criterios de PI en un porcentaje elevado de pacientes mayores atendidos por un EAP, pudiendo promover estrategias de mejora de la prescripción (AU)

ObjectiveTo determine the prevalence and characteristics of inappropriate prescribing of drugs (IP) in patients >65 years-old evaluated by a primary care team (PCT), using the STOPP-START criteria.Material and methodCross-sectional sample of patients older than 65 years-old with active clinical history in 2010, and who were attended in 13 urban clinics (systematic random sampling, expected IP prevalence of 40%, precision: 5% confidence level: 95%). Requirement was reviewed clinical histories in 2010, using the STOPP-START criteria.ResultsA total of 363 patients were selected (56.7% women), mean age 75.2 years (SD: 7.02). The most frequent diseases were cardiovascular (76.9%) and osteoarticular (57.6%) diseases, and the average number of prescription drugs was 4.9 (SD: 3.32). IP was detected in 170 patients (46.8%; 95% CI: 41.7-52.0%), 42% in men (95% CI: 34.3-49.8%) and 46.6% in women (95% CI: 39.8-53.4%), with no differences between sexes (P=.386), with a higher prevalence if polypharmacy or comorbidity were present (P<.001). The STOPP criteria were met in 131 patients (36.1%; 95% CI: 31.1-41.0%), and START criteria in 73 (20.1%; 95% CI: 16-24.2%), with no difference between sexes (P=.623 for STOPP, and P=.678 for START). The most frequent STOPP criteria were observed in the musculoskeletal system (50 patients, 38.2%; 95% CI: 29.8-46.5%) and START endocrinology indicators (38 patients, 52.1%; 95% CI: 40.0-63.9%).ConclusionsThe STOPP-START tool detected and systematised IP in a high percentage of elderly patients treated by a PCT, and can promote improvement in prescribing strategies (AU)

[Inappropriate prescribing of drugs in older people attending primary care health centres: detection using STOPP-START criteria]. / Prescripción inapropiada de fármacos en personas mayores atendidas en un centro de Atención Primaria según los criterios STOPP-START.

OBJECTIVE: To determine the prevalence and characteristics of inappropriate prescribing of drugs (IP) in patients >65 years-old evaluated by a primary care team (PCT), using the STOPP-START criteria. MATERIAL AND METHOD: Cross-sectional sample of patients older than 65 years-old with active clinical history in 2010, and who were attended in 13 urban clinics (systematic random sampling, expected IP prevalence of 40%, precision: 5% confidence level: 95%). Requirement was reviewed clinical histories in 2010, using the STOPP-START criteria. RESULTS: A total of 363 patients were selected (56.7% women), mean age 75.2 years (SD: 7.02). The most frequent diseases were cardiovascular (76.9%) and osteoarticular (57.6%) diseases, and the average number of prescription drugs was 4.9 (SD: 3.32). IP was detected in 170 patients (46.8%; 95% CI: 41.7-52.0%), 42% in men (95% CI: 34.3-49.8%) and 46.6% in women (95% CI: 39.8-53.4%), with no differences between sexes (P=.386), with a higher prevalence if polypharmacy or comorbidity were present (P<.001). The STOPP criteria were met in 131 patients (36.1%; 95% CI: 31.1-41.0%), and START criteria in 73 (20.1%; 95% CI: 16-24.2%), with no difference between sexes (P=.623 for STOPP, and P=.678 for START). The most frequent STOPP criteria were observed in the musculoskeletal system (50 patients, 38.2%; 95% CI: 29.8-46.5%) and START endocrinology indicators (38 patients, 52.1%; 95% CI: 40.0-63.9%). CONCLUSIONS: The STOPP-START tool detected and systematised IP in a high percentage of elderly patients treated by a PCT, and can promote improvement in prescribing strategies.

["Difficult encounters" in primary care clinic: a patient and doctor perspective]. / <> en consultas de atención primaria: una perspectiva de pacientes y médicos.

OBJECTIVES: To find out the prevalence and causes of "difficult encounters" (DE) in Primary Care clinics from the perspective of the patients and doctors, and to whom the responsibility and concordance of the DE (CDE) between doctors and patients is attributed. DESIGN: Cross-sectional, descriptive. SETTING: Urban health centre. PARTICIPANTS AND METHOD: Four doctors, their 4 residents and patients who went to their clinics (March-May 2007). The doctors selected the DE with qualitative criteria, the patients by means of a non-validated ad hoc questionnaire. VARIABLES: sex and age of the patients, defined DE, causes and responsibility of the DE, changes in doctor due to unease and a perception of a "difficult professional" (DP) by the patient. RESULTS: There were 415 visits; 352 questionnaires (85% participation); 212 (60.2%) women, mean age (SD) 54.7 (18.2) years. DE prevalence: 8.5% according to doctors (95% CI, 5.8-11.9) (main cause: idiosyncrasy of the patient), the cause of unease always being attributed to the patient; 3.1% according to the patients (95% CI, 1.6-5.5) (main cause: lack of empathy by the doctor), the unease being attributed to the doctor in 81% of cases. CDE insignificant (kappa=0.003). Only 15 patients (4.3%) felt uncomfortable in a visit in the last year; 18 (5.1%) considered a change of doctor due to unease (95% CI, 3.1-8); 53 (15.1%) had changed at some point for this reason (95% CI, 11.3-18.8) and 11 (3.1%) considered their doctor to be DP (95% CI, 1.6-5.5). CONCLUSIONS: The prevalence of DE in our clinics is similar to that reported in other studies, but lower than expected for the patients, with an insignificant CDE. Doctors and patients usually attribute the responsibility of the DE to the other party. Few patients consider their doctor to be a DP.

"Encuentros difíciles" en consultas de atención primaria: una perspectiva de pacientes y médicos / “Difficult Encounters” in Primary Care Clinic: a Patient and Doctor Perspective

Objetivos: conocer la prevalencia y las causas de ®encuentros difíciles» (ED) en consultas de atención primaria según pacientes y médicos, a quién se atribuye su responsabilidad y la concordancia de ED entre médicos y pacientes (CED).Diseño: descriptivo transversal.Emplazamiento: centro de salud urbano.Participantes y métodocuatro médicos, sus 4 residentes y los pacientes que acudieron a sus consultas (marzo-mayo de 2007). Los médicos seleccionaron los ED con criterios cualitativos, y los pacientes, mediante un cuestionario ad hoc no validado. Variables: sexo y edad de los pacientes, ED definidos, causas y responsabilidad del ED, cambios de médico por malestar y percepción de ®profesional difícil» (PD) por el paciente.Resultados: 415 visitas; 352 cuestionarios (participación, 85%); 212 (60,2%) mujeres; media±desviación estándar de edad, 54,7±18,2 años. Prevalencia de ED del 8,5%, según los médicos (intervalo de confianza [IC] del 95%, 5,8–11,9) (causa principal: idiosincrasia del paciente), en que se atribuía la causa del malestar siempre al paciente; el 3,1%, según los pacientes (IC del 95%, 1,6–5,5) (causa principal: escasa empatía del médico), en que se atribuía el malestar en un 81% al médico. CED insignificante (κ=0,003); 15 (4,3%) pacientes manifiestan malestar en alguna visita el último año; 18 (5,1%) se plantean cambiar de médico por el malestar (IC del 95%, 3,1–8); 53 (15,1%) han cambiado alguna vez por este motivo (IC del 95%, 11,3–18,8) y 11 (3,1%) consideran a su médico un PD (IC del 95%, 1,6–5,5).Conclusiones: la prevalencia de ED en nuestras consultas es similar a la descrita en otros estudios, pero inferior a la esperada para los pacientes, con una CED insignificante. Médicos y pacientes atribuyen habitualmente la responsabilidad del ED a la parte contraria. Pocos pacientes consideran a su médico un PD(AU)

Objectives: To find out the prevalence and causes of “difficult encounters” (DE) in Primary Care clinics from the perspective of the patients and doctors, and to whom the responsibility and concordance of the DE (CDE) between doctors and patients is attributed.Design: Cross-sectional, descriptive.Setting: Urban health centre.Participants and method: Four doctors, their 4 residents and patients who went to their clinics (March–May 2007). The doctors selected the DE with qualitative criteria, the patients by means of a non-validated ad hoc questionnaire. Variables: sex and age of the patients, defined DE, causes and responsibility of the DE, changes in doctor due to unease and a perception of a “difficult professional” (DP) by the patient.Results: There were 415 visits; 352 questionnaires (85% participation); 212 (60.2%) women, mean age (SD) 54.7 (18.2) years. DE prevalence: 8.5% according to doctors (95% CI, 5.8–11.9) (main cause: idiosyncrasy of the patient), the cause of unease always being attributed to the patient; 3.1% according to the patients (95% CI, 1.6–5.5) (main cause: lack of empathy by the doctor), the unease being attributed to the doctor in 81% of cases. CDE insignificant (κ=0.003). Only 15 patients (4.3%) felt uncomfortable in a visit in the last year; 18 (5.1%) considered a change of doctor due to unease (95% CI, 3.1–8); 53 (15.1%) had changed at some point for this reason (95% CI, 11.3–18.8) and 11 (3.1%) considered their doctor to be DP (95% CI, 1.6–5.5).Conclusions: The prevalence of DE in our clinics is similar to that reported in other studies, but lower than expected for the patients, with an insignificant CDE. Doctors and patients usually attribute the responsibility of the DE to the other party. Few patients consider their doctor to be a DP(AU)

[Difficult to treat patients in primary care: are they satisfied with the care received in their health centre?]. / Pacientes de trato difícil en atención primaria: 'están satisfechos con la atención recibida en su centro de salud?

OBJECTIVES: To evaluate the satisfaction of difficult to treat patients (DTP) cared for by a primary care team (PCT), as regards the organisational aspects and the care received, and to compare it with that obtained by a sample of the general patient population (GPP). DESIGN. Cross-sectional descriptive study. SETTING: Urban health centre. PARTICIPANTS: One hundred-one DTP participated, after being selected using Ellis and O'Dowd criteria by 8 doctors. METHOD: Between March and May 2004 the DTP were given self-administered anonymous questionnaires, prepared and validated by the Catalonian Health Institute, which was divided into 8 sections for their analysis. The results were compared with those obtained in June 2003 from a representative sample from the GPP. RESULTS: A total of 52 questionnaires were returned (51% participation), of which 62% were from women, with a mean age of 61.5+/-12.3. Average scores (0 to 10) were: organisation 7.2+/-1.8; (95% confidence intervale [CI], 6.6-7.7), care by the doctors 8.4+/-2.1 (95% CI, 7.7-9), by nurses 7.9+/-2.1 (95% CI, 7.3-8.6), by administrators 6.9+/-1.9 (95% CI, 6.3-7.4), care resolved 7.2+/-2 (95% CI, 6.6-7.9), installations 7.6+/-1.7 (95% CI, 7.1-8.1), overall satisfaction 7.5+/-1.8 (95% CI, 7-8), and total satisfaction total 7.2+/-1.6 (95% CI, 6.8-7.7). The 91.7% (95% CI, 80-97.7) would recommend their friends to be treated in the centre. All the scores are higher than those in the GPP sample, with no statistical differences in the care by doctors and nurses sections. CONCLUSIONS: Although the relationships with the DTP are often problematic, the results show a high level of satisfaction within the DTP in all the sections evaluated, even higher than that of the GPP group.

Pacientes de trato difícil en atención primaria: ¿están satisfechos con la atención recibida en su centro de salud? / Difficult to treat patients in primary care: are they satisfied with the care received at their health centre?

Objetivos. Valorar la satisfacción de los pacientes de trato difícil (PD) atendidos por un equipo de atención primaria (EAP) con los aspectos organizativos y la atención recibida. Compararla con la obtenida en una muestra de la población general atendida (PG). Diseño. Estudio descriptivo, transversal. Ámbito. Centro de salud urbano. Participantes. Participaron 101 PD seleccionados por 8 médicos (criterios de Ellis y O'Dowd). Método. Entre marzo y mayo de 2004 se entregó a los PD un cuestionario de satisfacción autoadministrado, anónimo, elaborado y validado por el Institut Català de la Salut, que para su análisis se divide en 8 dimensiones. Se compararon los resultados con los obtenidos en junio 2003 en una muestra representativa de la PG. Resultados. En total se administraron 52 cuestionarios (participación del 51%). El 62% eran mujeres, con una media de edad de 61,5 ± 12,3 años. La puntuación media por dimensiones (0 a 10) fue: organización 7,2 ± 1,8 (intervalo de confianza [IC] del 95%, 6,6-7,7), atención por médicos 8,4 ± 2,1 (IC del 95%, 7,7-9), por enfermería 7,9 ± 2,1 (IC del 95%, 7,3-8,6), por administrativos 6,9 ± 1,9 (IC del 95%, 6,3-7,4), atención-resolución 7,2 ± 2 (IC del 95%, 6,6-7,9), instalaciones 7,6 ± 1,7 (IC del 95%, 7,1-8,1), satisfacción global 7,5 ± 1,8 (IC del 95%, 7-8) y satisfacción total 7,2 ± 1,6 (IC del 95%, 6,8-7,7). El 91,7% (IC del 95%, 80-97,7) recomendaría a sus amigos ser atendidos en el centro. Todas las puntuaciones son superiores a las de la muestra de la PG, sin diferencias estadísticamente significativas en las dimensiones atención por médicos y enfermería. Conclusiones. Aunque a menudo la relación con PD tiene características disfuncionales, éstos muestran un alto nivel de satisfacción con el EAP en todas las dimensiones evaluadas, superior incluso al de la PG

Objectives. To evaluate the satisfaction of difficult to treat patients (DTP) cared for by a primary care team (PCT), as regards the organisational aspects and the care received, and to compare it with that obtained by a sample of the general patient population (GPP). Design. Cross-sectional descriptive study. Setting. Urban health centre. Participants. One hundred-one DTP participated, after being selected using Ellis and O'Dowd criteria by 8 doctors. Method. Between March and May 2004 the DTP were given self-administered anonymous questionnaires, prepared and validated by the Catalonian Health Institute, which was divided into 8 sections for their analysis. The results were compared with those obtained in June 2003 from a representative sample from the GPP. Results. A total of 52 questionnaires were returned (51% participation), of which 62% were from women, with a mean age of 61.5 (12.3). Average scores (0 to 10) were: organisation 7.2 (1.8) (95% confidence intervale [CI], 6.6-7.7), care by the doctors 8.4 (2.1) (95% CI, 7.7-9), by nurses 7.9 (2.1) (95% CI, 7.3-8.6), by administrators 6.9 (1.9) (95% CI, 6.3-7.4), care resolved 7.2 (2) (95% CI, 6.6-7.9), installations 7.6 (1.7) (95% CI, 7.1-8.1), overall satisfaction 7.5 (1.8) (95% CI, 7-8), and total satisfaction total 7.2 (1.6) (95% CI, 6.8-7.7). The 91.7% (95% CI, 80-97.7) would recommend their friends to be treated in the centre. All the scores are higher than those in the GPP sample, with no statistical differences in the care by doctors and nurses sections. Conclusions. Although the relationships with the DTP are often problematic, the results show a high level of satisfaction within the DTP in all the sections evaluated, even higher than that of the GPP group