Desarrollo informático de los niveles de integración de información entre diferentes unidades de provisión desde una perspectiva de Atención Primaria / Computing development of information integration levels between different provision units from the Primary Health Care perspective

La informatización de la historia clínica es una realidad en Atención Primaria. En la medida en que mayor número de centros y personas disponen de registros informatizados, resulta una necesidad cada vez más acuciante el intercambio de información clínica entre distintos centros, ya sea entre centros de salud, entre éstos y hospitales, consultorios periféricos o unidades de apoyo. Esta necesidad viene determinada básicamente por garantizar la continuidad de la atención y la comunicación entre profesionales, habitualmente entre sistemas informáticos distintos. En este artículo se describen cuatro niveles posibles de intercambio de información y se aportan soluciones técnicamente sencillas y factibles de poner en práctica partiendo de unas mínimas condiciones: la propia existencia de registros informatizados, la existencia de una red de comunicaciones (tipo Intranet o Internet) y un identificador común, el código de identificación personal de la Tarjeta Sanitaria. Ésta se convierte así en un elemento clave y estratégico de primer orden para el Sistema Nacional de Salud (SNS) cuya integridad habría que salvaguardar ante las futuras transferencias del INSALUD a las Comunidades Autónomas y a ser posible avanzar hacia una tarjeta sanitaria para todo el SNS, ya sea única o habilitando mecanismos que hagan compatibles las actuales (AU)

Modelos estratégicos para el diseño de la historia clínica electrónica / Strategic patterns for the design of the electronic medical record

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La informatización de atención primaria (II) / Computerising primary care (II)

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Informatización en la atención primaria (I) / Computerising primary care (I)

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[An analysis of long-term computerized prescriptions for those over and under 65 at a health center]. / Análisis de la prescripción crónica informatizada en mayores y menores de 65 años en un centro de salud.

OBJECTIVES: To analyse the origin, diagnoses and types of medicine used in computerised long-term prescription at our centre, which are classified by age distribution; and to extract, if possible, use parameters for monitoring internal activities. DESIGN: Descriptive study. SETTING: Zumaia Health Centre (Guipúzcoa). PATIENTS: 976 patients divided into those over and those under 65, included in the programme of long-term treatment cards. MEASUREMENTS AND MAIN RESULTS: 54% of patients were over 65 and 46% under. Average medicines per patient were 3.24 and 2.23, respectively. 34% of long-term prescription originated in primary care, although primary care was only the main indicator to a significant degree in group K (CIAP) diagnoses for under-65's. The commonest diagnoses belonged to group K, independently of the origin of the prescription. The most prescribed medicines were those in groups M and C (IMC), significantly higher in the over-65's. CONCLUSIONS: Only one third of the prescriptions originated in PC. A significant reversal of this tendency was observed in young people with chronic group K pathologies. The indication of long-term treatment for psychological problems often escapes the public health system; when the PC doctor indicates this treatment, he/she usually does so on the basis of symptomatic conditions. Monitoring new cases could help us find the efficacy of the corrective measures introduced, both at the level of structural innovations and changes in care procedure.

[Computerization: equipment, attitudes and aptitudes at health centers of the Autonomous Basque Community]. / Dotación material, actitudes y aptitudes hacia la informática en los centros de salud de la Comunidad Autónoma Vasca.

OBJECTIVE: To find the material complement, skills and attitudes towards computers of professionals working in the Primary Care field in the Basque Autonomous Community. DESIGN: A descriptive study based on a personal questionnaire. SETTING: Primary Care Centre of Osakidetza-Basque Health service. MAIN RESULTS: Overall reply rate was 83.5%. The actual hardware complement was only 8% of that required. Hardware needs were calculated as 89 regular and 6 occasional outlets for each 100 professionals. A minimum of 27% of the network's professionals already used a computer. About 2,000 people needed first-contact training. Proficiency training needs oscillated between 25 and 50% of the staff in function of the type of software. CONCLUSIONS: There is a significant equipment deficit. Professionals are highly sensitised to the reality of computerisation, as both the high rate of reply and the desire to acquire computer literacy confirm.

[Who prescribes? Origin and adequacy of long term prescriptions included in a computerized long term treatment programme at a health center]. / Quién prescribe? Origen y adecuación de las prescripciones crónicas incluidas en un programa informatizado de largos tratamientos en un centro de salud.

OBJECTIVE: To quantify medications not prescribed at the primary level and their suitability for patients included in a programme of compliance and computerised control of long treatments at a Health Centre. DESIGN: Descriptive study. SETTING: Zumaia Health Centre (Guipúzcoa). PATIENTS: The study sampled 75 patients out of a total of 397 in treatment. MEASUREMENTS AND MAIN RESULTS: The total number of drugs studied was 230, out of which 23% were prescribed by the General Practitioner and 77% referred from other care levels. Of these last, the bibliographical sources consulted advised against their use in chronic treatments in one out of every 5 cases, which depended on the pathology which was the cause of referral. CONCLUSIONS: Much of the medication included in our long-treatment programme was prescribed at other care levels than our Health Centre. The elaboration of a list of medications excluded from long-treatment programmes should bear in mind the prescription's real origin in order to avoid negative consequences both for the user and the system. The computerisation of prescriptions could be extremely valuable both in the control of our programmes and the analysis of their attributable costs. We propose that the validity of the type of referred medications used for long-treatment patients should be studied as an indicator of a Health Centre's proper functioning.

[The evaluation of a computer program for the filling of repeat prescriptions]. / Evaluación de un programa informático de cumplimentación de prescripciones repetidas.

OBJECTIVE: To study the long-term prescriptions at our health centre, using information supplied by the data base of the long-term treatment programme (LTP). Secondly, to evaluate the programme's efficiency as regards the best use of available time at our Health Centre. DESIGN: Descriptive study. SETTING: Zumaia Health Centre (Guipúzcoa). PATIENTS: The 533 patients at present included in the long-term treatment programme. MEASUREMENTS AND MAIN RESULTS: 7.9% of the adult population were included in the LTP. There was a significant increase, greater than expected, in the 65-74 age group. On average, the patients received 8.2 jars of medicine at each check-up, which on average took place every 54 days. 60% of patients needed three or less different drugs. On average, the programme printed 560 prescriptions per week, thus avoiding a manual filling of prescriptions calculated at 4 hours and 40 minutes. CONCLUSIONS: The transferral to computers of the filling and control of repeat prescriptions is an alternative of sufficient importance to justify its general use. Modification of the present form authorizing repeat prescriptions would greatly increase efficiency. Further studies are required in order to look deeper into the origin and adequacy of prescriptions.