«Consultas sagradas» en atención primaria: ¿qué suponen para el personal médico? / "Sacred encounters" in primary care: What do they mean for family physicians?

OBJETIVO: Conocer las percepciones y actitudes de profesionales médicos de familia (MF) ante consultas con gran componente emocional, denominadas inicialmente «consultas sagradas», e identificar ámbitos de mejora en su atención. DISEÑO: Metodología cualitativa con enfoque sociosubjetivo orientado a los servicios de salud. Estudio descriptivo-interpretativo. Emplazamiento: Centros de salud de Araba y Bizkaia. Participantes y/o contextos: Selección de 23 MF de 23 centros de salud urbanos y rurales. MÉTODO: Muestreo intencional buscando la diversidad discursiva. Datos generados en 2016 mediante 3 grupos de discusión y 3 entrevistas individuales grabadas y transcritas tras consentimiento informado. Presentación al Comité de Ética de Euskadi. Análisis temático con ayuda de mapas conceptuales y programa MaxQDA. Triangulación de los resultados entre investigadores y verificación por los participantes. Resultados y discusión: Los hallazgos se agruparon en áreas temáticas solapadas entre sí y relacionadas con el significado de dichas consultas, actitudes profesionales, contexto sanitario y pacientes. Se subraya la importancia de lo emocional en las consultas de atención primaria y su invisibilización, pero se cuestiona la idoneidad del término «sagradas». Su expresión se construye en la interrelación MF-paciente si el personal médico lo favorece y el paciente lo permite, discutiéndose las principales circunstancias que intervienen en una dimensión considerada clave de la integralidad de la atención. CONCLUSIONES: La atención a la dimensión emocional en la consulta presenta deficiencias que es necesario subsanar. Además de su reconocimiento y evaluación, sería preciso modificar los factores organizativos, formativos y profesionales que condicionan la implicación del personal MF en su buena asistencia

OBJECTIVE: To determine the perceptions and attitudes of the general practitioners (GP) towards consultations with great emotional component, initially called "sacred encounters", and to identify areas of improvement. DESIGN: A qualitative methodology based on a socio-subjective approach and focused on health services research. Descriptive-interpretative study. LOCATION: Health Centres of Alava and Biscay. Participants Selection of 23 GP from 23 urban and rural Health Centres. METHOD: Intentional sampling aimed at looking for discursive diversity. Data generated in 2016 by means of 3 discussion groups and 3 individual interviews recorded and transcribed after informed consent. Presentation to the ethics committee of the Basque Country. Thematic analysis with the aid of conceptual maps and MaxQDA program. Triangulation of the results between researchers and verification by the participants. Results and discusión: The findings were clustered into overlapping thematic areas related to the meaning of these encounters, attitudes of GP, health context, and patients. The importance of the emotions in primary care encounters and their invisibility is underlined, but the adequacy of the term "sacred" is questioned. This expression is built into the GP-patient relationship, if GP favours it and the patient also allows it, discussing the main circumstances that intervene in an essential dimension of integral care. CONCLUSIONS: The attention to the emotional dimension in the encounters has deficiencies that need to be corrected. In addition to its recognition and evaluation, it would be necessary to modify the organisational, training and professional factors that determine the involvement of the GPs in their good health care

[]"Sacred encounters" in primary care: What do they mean for family physicians?] / «Consultas sagradas¼ en atención primaria: ¿qué suponen para el personal médico?

OBJECTIVE: To determine the perceptions and attitudes of the general practitioners (GP) towards consultations with great emotional component, initially called "sacred encounters", and to identify areas of improvement. DESIGN: A qualitative methodology based on a socio-subjective approach and focused on health services research. Descriptive-interpretative study. LOCATION: Health Centres of Alava and Biscay. PARTICIPANTS: Selection of 23 GP from 23 urban and rural Health Centres. METHOD: Intentional sampling aimed at looking for discursive diversity. Data generated in 2016 by means of 3 discussion groups and 3 individual interviews recorded and transcribed after informed consent. Presentation to the ethics committee of the Basque Country. Thematic analysis with the aid of conceptual maps and MaxQDA program. Triangulation of the results between researchers and verification by the participants. RESULTS AND DISCUSSION: The findings were clustered into overlapping thematic areas related to the meaning of these encounters, attitudes of GP, health context, and patients. The importance of the emotions in primary care encounters and their invisibility is underlined, but the adequacy of the term "sacred" is questioned. This expression is built into the GP-patient relationship, if GP favours it and the patient also allows it, discussing the main circumstances that intervene in an essential dimension of integral care. CONCLUSIONS: The attention to the emotional dimension in the encounters has deficiencies that need to be corrected. In addition to its recognition and evaluation, it would be necessary to modify the organisational, training and professional factors that determine the involvement of the GPs in their good health care.

Factors related to the development of health-promoting community activities in Spanish primary healthcare: two case-control studies.

OBJECTIVE: Spanish primary healthcare teams have the responsibility of performing health-promoting community activities (CAs), although such activities are not widespread. Our aim was to identify the factors related to participation in those activities. DESIGN: Two case-control studies. SETTING: Performed in primary care of five Spanish regions. SUBJECTS: In the first study, cases were teams that performed health-promoting CAs and controls were those that did not. In the second study (on case teams from the first study), cases were professionals who developed these activities and controls were those who did not. MAIN OUTCOME MEASURES: Team, professional and community characteristics collected through questionnaires (team managers/professionals) and from secondary sources. RESULTS: The first study examined 203 teams (103 cases, 100 controls). Adjusted factors associated with performing CAs were percentage of nurses (OR 1.07, 95% CI 1.01 to 1.14), community socioeconomic status (higher vs lower OR 2.16, 95% CI 1.18 to 3.95) and performing undergraduate training (OR 0.44, 95% CI 0.21 to 0.93). In the second study, 597 professionals responded (254 cases, 343 controls). Adjusted factors were professional classification (physicians do fewer activities than nurses and social workers do more), training in CAs (OR 1.9, 95% CI 1.2 to 3.1), team support (OR 2.9, 95% CI 1.5 to 5.7), seniority (OR 1.06, 95% CI 1.03 to 1.09), nursing tutor (OR 2.0, 95% CI 1.1 to 3.5), motivation (OR 3.7, 95% CI 1.8 to 7.5), collaboration with non-governmental organisations (OR 1.9, 95% CI 1.2 to 3.1) and participation in neighbourhood activities (OR 3.1, 95% CI 1.9 to 5.1). CONCLUSIONS: Professional personal characteristics, such as social sensitivity, profession, to feel team support or motivation, have influence in performing health-promoting CAs. In contrast to the opinion expressed by many professionals, workload is not related to performance of health-promoting CAs.

Observational study on factors related to health-promoting community activity development in primary care (frAC Project): a study protocol.

INTRODUCTION: According to Spanish health regulations, primary care professionals have the responsibility to carry out health-promoting community activities (CAs). However, in practice, their implementation is not as widespread as it should be. The aims of this study were to identify factors within the team, the community and the professionals that influence the development of these activities and to describe the community interventions in progress. METHODS AND ANALYSIS: This study is an observational analytical retrospective study. The information will be collected from five Spanish regions: Catalonia, Madrid, the Balearic Islands, Navarra and Aragón. The authors will contact primary care teams (PCTs) and identify the CAs from the previous year. The research team will conduct a peer review whether the inclusion criteria are met. In the health centres where CAs are implemented, the authors will select professionals carrying them out and randomly select an identical number of professionals not doing these activities. In the centres where no CA is implemented, three professionals will be randomly selected. The selected professionals will complete the questionnaires for individual-level variables. Information about the registered population and the PCTs will be collected through questionnaires and secondary sources. OUTCOMES: Variables will be collected from the community, the PCTs, the individual professionals and CAs. ANALYSIS: A descriptive analysis of all the variables will be carried out, along with a bivariate and a logistic regression analysis, with CAs being the primary outcome. ETHICS AND DISSEMINATION: This study has been approved by the Research Ethics Committee of the Jordi Gol y Gurina Foundation in Barcelona and area 11 in Madrid. The questionnaire distributed to the professionals will be anonymous.

La medicina familiar y comunitaria y la universidad. Informe SESPAS 2012 / Family and community medicine and the university. SESPAS report 2010

La medicina familiar y comunitaria es una disciplina académica, una especialidad y una profesión sanitaria que contiene un cuerpo asistencial, docente, investigador y de gestión. Su objeto de conocimiento es la persona entendida como un todo. La medicina familiar y comunitaria como disciplina académica, y la atención primaria como ámbito educativo sanitario, deben ser incorporadas en la universidad de manera nuclear. Su ausencia causa sesgos formativos y tiene importantes repercusiones sobre la calidad, la coordinación y la seguridad. El desarrollo de la Ley de Ordenación de las Profesiones Sanitarias (LOPS) y la construcción del Espacio Europeo de Educación Superior (EEES) propician, actualmente, su presencia en la Universidad. Desde los años 1960 se ha consolidado la disciplina académica, con departamentos de medicina familiar y comunitaria en prácticamente todas las universidades europeas, y un importante número de profesores médicos de familia. Se ha establecido el equilibrio entre un sistema basado en el hospital, orientado a la teoría, la enfermedad y el modelo biológico, con un modelo centrado en el paciente, basado en la resolución de problemas, orientado a la comunidad y con un modelo biopsicosocial. La introducción de la medicina familiar y comunitaria como asignatura propia, como materia longitudinal a lo largo de los años y transversal con otras disciplinas, y la atención primaria como ámbito de prácticas, supone una adecuación de la enseñanza a las necesidades de la sociedad y una normalización con respecto a la enseñanza en Europa, y da respuesta a las distintas normas legales que la amparan. Y esta nueva situación precisa una estructura (departamentos) y un profesorado (catedráticos, titulares y profesores asociados) (AU)

Family and community medicine is an academic subject, a medical specialty and a health profession with distinct dimensions: healthcare, teaching, research and management. In this discipline, the object of knowledge is the person, understood as a whole. Family medicine, as an academic subject, and primary care, as a health education setting, should be incorporated into the core graduate and postgraduate curricula. The absence of these elements leads to training bias and has major repercussions on quality, coordination and patient safety. The development of the Health Professions Act and the construction of the European Higher Education Area (EHEA) have created a favorable climate for the presence of this discipline in the university.Since the 1960s, family medicine has been consolidated as an academic subject with its own departments in almost all European universities, and a significant number of family physicians are teachers. A balance has been achieved between the hospital-based system (based on theory, disease, and the biological model) and the patient-centred model (based on problem solving, community-oriented and the bio-psycho-social model). The introduction of family and community medicine as a specific subject, and as a transverse subject and as an option in practicals, represents the adaptation of the educational system to social needs. This adaptation also represents a convergence with other European countries and the various legal requirements protecting this convergence. However, this new situation requires a new structure (departments) and faculty (professors and associate and assistant professors) (AU)

[Family and community medicine and the university. SESPAS report 2010]. / La medicina familiar y comunitaria y la universidad. Informe SESPAS 2012.

Family and community medicine is an academic subject, a medical specialty and a health profession with distinct dimensions: healthcare, teaching, research and management. In this discipline, the object of knowledge is the person, understood as a whole. Family medicine, as an academic subject, and primary care, as a health education setting, should be incorporated into the core graduate and postgraduate curricula. The absence of these elements leads to training bias and has major repercussions on quality, coordination and patient safety. The development of the Health Professions Act and the construction of the European Higher Education Area (EHEA) have created a favorable climate for the presence of this discipline in the university. Since the 1960s, family medicine has been consolidated as an academic subject with its own departments in almost all European universities, and a significant number of family physicians are teachers. A balance has been achieved between the hospital-based system (based on theory, disease, and the biological model) and the patient-centred model (based on problem solving, community-oriented and the bio-psycho-social model). The introduction of family and community medicine as a specific subject, and as a transverse subject and as an option in practicals, represents the adaptation of the educational system to social needs. This adaptation also represents a convergence with other European countries and the various legal requirements protecting this convergence. However, this new situation requires a new structure (departments) and faculty (professors and associate and assistant professors).

La polivalencia rural desde la práctica urbana / Rural medicine aptitudes from the urban practice

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