Efficacy of an electronic reminder for HIV screening in primary healthcare based on indicator conditions in Catalonia (Spain).

OBJECTIVE: The aim of this study was to assess the efficacy of an electronic reminder in primary healthcare in patients diagnosed with an indicator condition (IC) to improve HIV screening. METHODS: We developed a prospective interventional study in 51 primary healthcare centres in Barcelona randomly assigned into one of two study groups: control and alert. Between June 2018 and May 2019, an electronic reminder appeared in the electronic medical record each time a diagnosis of an IC in patients aged 16-65 years was registered in the alert group. We assessed HIV testing rates within 4 months following the diagnosis of an IC. RESULTS: In all, 13 000 patients were diagnosed with at least one IC. HIV testing was more likely in the alert group than in the control group. The electronic reminder multiplied the odds of being tested in men by 1.26 [95% confidence interval (CI): 1.04-1.52, p = 0.019], by 1.77 (95% CI: 1.33-2.38, p < 0.001) among patients aged < 50 years , and by 1.51 (95% CI: 1.20-1.92, p < 0.001) in diagnoses of IC other than a sexually transmitted infection (STI) or an AIDS-defining illness. Five (0.08%) cases of HIV were detected in the control group and 10 (0.17%) in the alert group. CONCLUSIONS: Implementing an electronic reminder had a positive impact on HIV screening rates in patients diagnosed with an IC. The alert was more effective among older patients, those living in less socioeconomically deprived neighbourhoods, and those with an IC other than an STI or an AIDS-defining illness.

Diagnóstico precoz del VIH en atención primaria en España. Resultados de una prueba piloto de cribado dirigido basado en condiciones indicadoras, criterios conductuales y de origen / Early diagnosis of HIV in Primary Care in Spain. Results of a pilot study based on targeted screening based on indicator conditions, behavioral criteria and region of origin

Objetivos: Estimar la prevalencia de la infección por VIH en pacientes diagnosticados con una condición indicadora (CI) para el VIH y/o que habían tenido una conducta de riesgo para su adquisición y/o que provenían de países con elevada prevalencia. Determinar la aceptabilidad y viabilidad de ofrecer la prueba del VIH basada en CI y criterios conductuales y de origen en atención primaria (AP). Diseño: Estudio transversal en una muestra de conveniencia. Emplazamiento: Seis centros de AP en España. Participantes: Los criterios de inclusión fueron: pacientes entre 16 y 65años que presentaban al menos una de las CI propuestas y/o al menos uno de los criterios conductuales y/o de origen propuestos. Participaron 388 pacientes. Intervención: Se ofreció la serología del VIH a todos los pacientes que cumplían con los criterios de inclusión. Mediciones principales: Descripción de la frecuencia de CI, criterios conductuales y de origen. Prevalencia de infección por VIH. Nivel de aceptabilidad y viabilidad de la oferta de la prueba del VIH basada en criterios conductuales y de origen y CI. Resultados: Un total de 174 pacientes presentaron una CI (44,84%). El criterio conductual más común fue: haber mantenido relaciones sexuales desprotegidas alguna vez en la vida con personas que desconocían su estado serológico para el VIH (298; 76,8%). Se diagnosticaron 4 pacientes VIH+ (1,03%). Todos presentaban una CI y eran hombres que mantenían sexo con hombres. El nivel de aceptabilidad en AP fue elevada. Conclusiones: Ofrecer la prueba del VIH a pacientes con CI y criterios conductuales es viable y efectiva en AP (AU)

Objectives: To estimate the prevalence of HIV infection in patients diagnosed with an indicator condition (IC) for HIV and/or risk behavior for their acquisition and/or coming from high prevalence countries. To determine the acceptability and feasibility of offering HIV testing based on IC and behavioral and origin criteria in Primary Care (PC). Design: Cross-sectional study in a convenience sample.Location: Six PC centers in Spain. Participants: The inclusion criteria were: patients between 16 and 65years old who presented at least one of the proposed ICs and/or at least one of the proposed behavioral and/or origin criteria. A total of 388 patients participated. Intervention: HIV serology was offered to all patients who met the inclusion criteria. Main measurements: Description of IC frequency, behavioral and origin criteria. Prevalence of HIV infection. Level of acceptability and feasibility of the HIV screening based on IC and behavioral and origin criteria. Results: A total of 174 patients had an IC (44.84%). The most common behavioral criterion was: having unprotected sex at some time in life with people who did not know their HIV status (298; 76.8%). Four HIV+ patients (1.03%) were diagnosed. All had an IC and were men who had sex with men. The level of acceptability in PC was high. Conclusions: Offering HIV testing to patients with IC and behavioral criteria is feasible and effective in PC (AU)

[Early diagnosis of HIV in Primary Care in Spain. Results of a pilot study based on targeted screening based on indicator conditions, behavioral criteria and region of origin]. / Diagnóstico precoz del VIH en atención primaria en España. Resultados de una prueba piloto de cribado dirigido basado en condiciones indicadoras, criterios conductuales y de origen.

OBJECTIVES: To estimate the prevalence of HIV infection in patients diagnosed with an indicator condition (IC) for HIV and/or risk behavior for their acquisition and/or coming from high prevalence countries. To determine the acceptability and feasibility of offering HIV testing based on IC and behavioral and origin criteria in Primary Care (PC). DESIGN: Cross-sectional study in a convenience sample. LOCATION: Six PC centers in Spain. PARTICIPANTS: The inclusion criteria were: patients between 16 and 65years old who presented at least one of the proposed ICs and/or at least one of the proposed behavioral and/or origin criteria. A total of 388 patients participated. INTERVENTION: HIV serology was offered to all patients who met the inclusion criteria. MAIN MEASUREMENTS: Description of IC frequency, behavioral and origin criteria. Prevalence of HIV infection. Level of acceptability and feasibility of the HIV screening based on IC and behavioral and origin criteria. RESULTS: A total of 174 patients had an IC (44.84%). The most common behavioral criterion was: having unprotected sex at some time in life with people who did not know their HIV status (298; 76.8%). Four HIV+ patients (1.03%) were diagnosed. All had an IC and were men who had sex with men. The level of acceptability in PC was high. CONCLUSIONS: Offering HIV testing to patients with IC and behavioral criteria is feasible and effective in PC.

Missed opportunities for HIV testing of patients diagnosed with an indicator condition in primary care in Catalonia, Spain.

OBJECTIVE: To estimate the prevalence of HIV testing among patients diagnosed with an indicator condition (IC) for HIV, seen in primary care (PC) in Catalonia, and to estimate the prevalence of HIV infection among those patients. DESIGN: Cross-sectional and population-based study in patients aged between 16 and 65 diagnosed with an IC within PC in Catalonia. METHODS: Data used in this study were extracted from a large population-based public health database in Spain, the Information System for the Development of Research in Primary Care (SIDIAP). All participants registered in SIDIAP from 1 January 2010 to 31 August 2012 and with a diagnosis of an IC were screened to identify those with an HIV test within the following 4 months. RESULTS: 99 426 patients were diagnosed with an IC during the study period. In these patients, there were 102 647 episodes in which at least one IC was diagnosed. An HIV test was performed within 4 months in only 18 515 of the episodes in which an IC was diagnosed (18.5%). The prevalence of HIV infection was 1.46%. Women (OR 1.35, 95% CI 1.30 to 1.39), people aged 50 or over (OR 2.85, 95% CI 2.69 to 3.00) and patients having a single IC (OR 3.59. 95% CI 3.20 to 4.03) had the greatest odds of not having an HIV test. CONCLUSIONS: The study highlights the persistence of missed opportunities for HIV testing within PC in Catalonia. Urgent engagement with PC professionals is required in order to increase HIV testing and prevent late HIV diagnoses.

Barreras para el diagnóstico de las infecciones de transmisión sexual y virus de la inmunodeficiencia humana en Atención Primaria en España / Problems in diagnosing sexually transmitted infections and human immunodeficiency virus in primary health care in Spain

Objetivos Describir la práctica clínica en VIH/infecciones de transmisión sexual (ITS) de los médicos de familia (MF) y las barreras con las que se encuentran para realizar su diagnóstico. Material y métodos Se distribuyó un cuestionario anónimo online a los socios de 2 sociedades españolas de MF. Resultados Participaron 1.308 MF. El 39,3% habían recibido formación sobre VIH/ITS en los últimos 3 años. El 21,2% se sentían incómodos al hablar de sexo con el paciente. Conclusiones Se identificaron carencias importantes en los recursos necesarios para el diagnóstico de VIH/ITS, así como en los circuitos disponibles(AU)

Objectives To describe the clinical practice of the General Practitioner (GP) in HIV and sexually transmitted infections (STIs) and the obstacles they face in diagnosing them. Materials and methods An anonymous questionnaire was distributed online to members of two Spanish GP Societies. Results A total of 1.308 GP took part in the survey, which showed that 39.3% had received training on HIV/STI in the last three years, and 21.2% felt uncomfortable talking about sex with the patient. Conclusions We identified important deficiencies in the resources needed for diagnosis of HIV/STI and in the circuits for referral(AU)

[Problems in diagnosing sexually transmitted infections and human immunodeficiency virus in primary health care in Spain]. / Barreras para el diagnóstico de las infecciones de transmisión sexual y virus de la inmunodeficiencia humana en Atención Primaria en España.

OBJECTIVES: To describe the clinical practice of the General Practitioner (GP) in HIV and sexually transmitted infections (STIs) and the obstacles they face in diagnosing them. MATERIALS AND METHODS: An anonymous questionnaire was distributed online to members of two Spanish GP Societies. RESULTS: A total of 1.308 GP took part in the survey, which showed that 39.3% had received training on HIV/STI in the last three years, and 21.2% felt uncomfortable talking about sex with the patient. CONCLUSIONS: We identified important deficiencies in the resources needed for diagnosis of HIV/STI and in the circuits for referral.

Detección precoz de la infección por el virus de la inmunodeficiencia humana en el contexto de Atención Primaria / Early detection of HIV infection in a Primary Care setting

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EBM in primary care: a qualitative multicenter study in Spain.

BACKGROUND: Evidence based medicine (EBM) has made a substantial impact on primary care in Spain over the last few years. However, little research has been done into family physicians (FPs)' attitudes related to EBM. The present study investigates FPs' perceptions of EBM in the primary care context. METHODS: This study used qualitative methodology. Information was obtained from 8 focus groups composed of 67 FPs from 47 health centers in 4 autonomous regions in Spain. Intentional sampling considered participants' previous education in EBM, and their experience as tutors in family medicine or working groups' members of the Spanish Society of Family Practice. Sociological discourse analysis was used with the support of the MAXqda software. Results were validated by means of triangulation among researchers and contrast with participants. RESULTS: Findings were grouped into three main areas: 1) The tug-of-war between the "science" of EBM and "experience" in the search for good clinical practice in primary care; 2) The development of EBM sensemaking as a reaction to contextual factors and interests; 3) The paradox of doubt and trust in the new EBM experts.The meaning of EBM was dynamically constructed within the primary care context. FPs did not consider good clinical practice was limited to the vision of science that EBM represents. Its use appeared to be conditioned by several factors that transcended the common concept of barriers. Along with concerns about its objectivity, participants showed a tendency to see EBM as the use of simplified guidelines developed by EBM experts. CONCLUSIONS: The identification of science with EBM and its recognition as a useful but insufficient tool for the good clinical practice requires rethinking new meanings of evidence within the primary care reality. Beyond the barriers related to accessing and putting into practice the EBM, its reactive use can determine FPs' questions and EBM development in a direction not always centred on patients' needs. The questioning of experts' authority as a pillar of EBM could be challenged by the emergence of new kinds of EBM texts and experts to believe in.

Guia clinica de enfermedad por reflujo gastroesofagico. Actualizacion 2008 / No disponible

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Perceptions, attitudes and knowledge of evidence-based medicine in primary care in Spain: a study protocol.

BACKGROUND: The philosophy of evidence-based medicine (EBM) was introduced in the early 90s as a new approach to the practice of medicine, using the best available evidence to make decisions about health care. Despite ongoing controversy, EBM has developed enormously and physicians' attitude towards it is generally positive. Nevertheless, in Spain little is known about this topic. We will therefore undertake a study to explore perceptions, attitudes and knowledge about EBM among primary care physicians. METHODS AND DESIGN: A mixed-method study combining qualitative and quantitative designs will target family practitioners in Spain with the objective of evaluating current attitudes and perceptions about evidence-based medicine. The project will consist of two phases: a first phase running focus groups to identify perceptions and attitudes of participants, and a second phase assessing their attitudes and knowledge about EBM by means of a survey. Both phases will explore these issues in three different subgroups: family practitioners, with or without previous formal education in EBM; members of working groups that formulate healthcare recommendations; and physicians in charge of training family practice residents. Additionally, we will undertake a systematic review to identify and synthesize the available evidence on this topic. DISCUSSION: The study will identify and gain insight into the perceived problems and barriers to the practice of evidence-based medicine among general practitioners in Spain. The project will also evaluate the main knowledge gaps and training needs, and explore how evidence-based medicine is being taught to family medicine residents, the medical practitioners of the future. Our results will aid researchers and health care planners in developing strategies to improve the practice of evidence-based medicine in our country.

Guía de práctica clínica sobre el síndrome del intestino irritable / Clinical Practice Guideline for Irritable Bowel Syndrome

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