Gestión de la demanda de urgencias: Quiero que el médico me vea ahora. ¿Cómo lo hacemos? / Demand management of emergencies, I want the doctor to see me now. What do we do?

Objectivo. Descripción de la experiencia organizativa de gestión de la demanda en nuestro centro de salud. Valoración de la utilidad, grado de satisfacción y percepción de mejora por parte de los profesionales del centro mediante una encuesta de valoración. Material y métodos. DISEÑO: Estudio descriptivo de la experiencia y de una encuesta de valoración. EMPLAZAMIENTO: Área urbana con 29.674 pacientes asignados. PARTICIPANTES: Todo el equipo de profesionales sanitarios y no sanitarios del centro de salud. INTERVENCIONES: Disminución de la cita previa en las agendas de los facultativos con aumento de las visitas del día y creación de un circuito nuevo de atención a los pacientes con una enfermera de triaje y un médico de guardia. Aplicación de una encuesta de valoración a todos los «profesionales del centro». MEDICIONES PRINCIPALES: Análisis de las visitas de la enfermera de triaje así como del porcentaje de resolución y análisis de los resultados de la encuesta por estamentos. Resultados. La media de visitas por parte de la enfermera de triaje es de 30 con un 41% de resolución por parte de la misma. Encuesta cumplimentada por el 93,8% de los profesionales del centro. Conclusiones. Valoración elevada por parte de todo el personal de la consulta de triaje. Las mejoras y la disminución de carga de trabajo lo refieren principalmente administrativos y médicos (AU)

Objectives. Description of the experience of organizational management of demand in our health centre. Assessment of the usefulness, level of satisfaction and perception of improvement on the part of the professionals of the centre using an evaluation survey. Material and methods. DESIGN: Descriptive Study of the experience and an evaluation survey. SETTING: Urban Area with 29,674 patients assigned. PARTICIPANTS: The team of health and non-health professionals of the health centre. INTERVENTIONS: Decrease in previous appointments in the lists of the physicians, with an increase in the visits on the day and creation of a new circuit of patient care using a triage nurse and an emergency physician. Implementation of an evaluation survey of all “professionals of the centre”. MAIN MEASUREMENTS: Analysis of triage nurse visits, as well as the percentage of resolution and analysis of the results of the survey by profession. Results. The average of visits to the nurse triage was 30, with 41% of them being resolved there. The survey was completed by 93.8% of professionals of the centre. Conclusions. There were high appraisals for the triage clinic by all the staff. The improvements and the decrease in workload were mainly administrative and medical (AU)

[Prevalence of Helicobacter pylori infection in primary health care]. / Prevalencia de la infección por Helicobacter pylori en atención primaria de salud.

OBJECTIVES: To find the prevalence of Helicobacter pylori (Hp) infection in the population as a whole. To assess its relationship with the associated factors described in other studies. DESIGN: Transversal study of an urban population of 20,000. PARTICIPANTS: Between 14 and 80 years old. Randomised sampling of the computerised records (640 clinical histories). Necessary sample n = 384 (alpha = 0.05, prior prevalence = 50%, precision 0.05). MEASUREMENTS: Breath test with urea marked (13C), age, sex, alcohol and tobacco consumption, social class and dyspepsia and/or gastro-duodenal pathology. RESULTS: 123 exclusions. 122 losses (23%). 397 people screened, 43.6% male. Average age: 42.6. 41.6% consumed alcohol. 30.5% smoked. Prevalence of dyspepsia, gastritis, gastric ulcer and duodenal ulcer, 14%, 2.8%, 2.8% and 2.0%, respectively. Hp prevalence: 56.1% (95% CI, 51.2-60.1). There were no significant differences between prevalence of Hp+ and sex, dyspepsia, peptic ulcer history, gastritis, alcohol consumption and tobacco consumption. Greatest prevalence of Hp+ in over-70s (73%). Significant linear tendency between presence of Hp+ and age (p < 0.05) and low social class (p < 0.05). The logistic regression analysis found a statistically significant relationship only between the presence of H. pylori and age and social class. CONCLUSIONS: Prevalence was similar to that in other studies. The relationship between low social class and age and greater Hp prevalence was confirmed. Dyspepsia is not a justification for empirical treatment of Hp. Patients with and without the infection must be followed to evaluate morbidity longitudinally.

Prevalencia de la infección por Helicobacter pylori en atención primaria de salud / Prevalence of helicobacter pylori infection in primary health care

Objetivos. Conocer la prevalencia de infección por Helicobacter pylori (Hp) en población general. Valorar la relación con los factores asociados descritos en otros ámbitos. Diseño y ámbito. Estudio transversal. Población urbana: 20.000 personas. Sujetos. Edad de 14-80 años. Muestreo aleatorio del registro informatizado (640 historias clínicas). Muestra necesaria, 384 (alfa, 0,05; prevalencia previa, 50 por ciento; precisión, 0,05). Mediciones. Prueba del aliento con urea marcada (13C), edad, sexo, consumo de alcohol y tabaco, clase social y dispepsia y/o patología gastroduodenal. Resultados. Exclusiones, 123; pérdidas, 122 (23 por ciento); cribados, 397; varones, 43,6 por ciento; edad media, 42,6 años; consumía alcohol, 41,6 por ciento; fumaba, 30,5 por ciento. Prevalencia de dispepsia, gastritis, ulcus gástrico y duodenal, respectivamente, 14, 2,8, 2,8 y 2,0 por ciento. Prevalencia Hp, 56,1 por ciento (IC del 95 por ciento, 51,2-60,1). No hay diferencias significativas entre prevalencia de Hp+ y sexo, dispepsia, antecedentes de ulcus péptico, gastritis, consumo de alcohol y consumo de tabaco. Máxima prevalencia de Hp+ en mayores de 70 años (73 por ciento). Tendencia lineal significativa entre presencia de Hp+ y edad (p < 0,05) y clase social baja (p < 0,05). El análisis de regresión logística sólo encuentra relación estadísticamente significativa entre presencia de Hp y edad y clase social. Conclusiones. La prevalencia es similar a la de otros estudios. Se confirma la relación entre clase social baja y edad y mayor prevalencia de Hp. La dispepsia no justificaría el tratamiento empírico de Hp. Es necesario el seguimiento de los pacientes con y sin infección para evaluar la morbilidad longitudinalmente (AU)

[Overattendance at primary care: a study of psychosocial factors]. / Hiperfrecuentación en atención primaria: estudio de los factores psicosociales.

OBJECTIVE: To determine the effect of various psychological and social factors--family function, social support, psychological malaise and social class--on frequency of attendance. DESIGN: Study with cases and controls. SETTING: Health Districts Girona-3 and La Bisbal. PARTICIPANTS: Criteria for inclusion: being older than 14, being on a list as a user, and having been seen at least once during the study period. The person over-attending is defined as someone attending 7 or more times in a year. The normal attender attends less than 7 times. The sample was 441 patients (209 cases and 232 controls). MEASUREMENTS AND MAIN RESULTS: The Smilkestein family Apgar and the DUKE-UNC social support questionnaires, and the Goldberg anxiety and depression scale, were administered. Social class was defined according to the job of the head of the family. Statistical analysis was undertaken in two steps: firstly, bivariate analysis; and second, multivariate. The social support and age variables were related to frequency of attendance: they explained 8.1% of it (through multiple regression). Depression increased by between 1.21 and 2.58 the risk of over-attending and explained 10.53% of the variability of over-attendance, in line with the logistical regression analysis. CONCLUSIONS: The psychological and social variables studied fail to explain most of the variability. We should demystify the importance of psychological and social factors in the use of health resources.