[The scientific information that the pharmaceutical industry provides to family doctors]. / La información científica que la industria farmacéutica proporciona a los médicos de familia.

OBJECTIVE: To check whether the information in the written publicity that the pharmaceutical industry gives to family doctors really is based on the scientific studies that support it. DESIGN: Cross-sectional study. SETTING: Health centre on the outskirts of a big city. PARTICIPANTS: Over a year, all the scientific studies that laboratory reps gave family doctors along with the advertising for medicines were collected. A total of 63 paired studies and advertising pieces were obtained. MAIN MEASUREMENTS: 1-3 advertising messages with each supporting study were selected and reviewed in a structured fashion. Then whether or not the messages selected were based on the study was appraised. RESULTS: 44.5% of the advertising messages were not based on the accompanying study; 29.9% clearly were based on the study; and in the rest there was a half-and-half relationship. There was a significant relationship between the evaluation of the advertising messages and the kind of study, masking and the kind of result variable. CONCLUSIONS: A high proportion of advertising messages are not based on the study that is reputed to support them. A critique of these studies has to be undertaken before the advertising messages can be looked at.

La información científica que la industria farmacéutica proporciona a los médicos de familia / The scientific information that the pharmaceutical industry provides to family doctors

Objetivo. Verificar si la información contenida en los soportes escritos que la industria farmacéutica entrega a los médicos de familia se deriva de los estudios científicos que la avalan. Diseño. Estudio transversal. Emplazamiento. Centro de salud de la periferia de una gran ciudad. Participantes. Durante un año se recogieron todos los estudios científicos que los representantes de laboratorios entregaron a los médicos de familia, junto con la publicidad de medicamentos adjunta. Se obtuvo un total de 63 parejas de estudios y soportes publicitarios. Mediciones principales. Se seleccionaron 1-3 mensajes publicitarios por cada soporte publicitario y se realizó una revisión estructurada por pares de los estudios correspondientes y sus características, para después valorar si los mensajes seleccionados se consideraban o no derivados del estudio. Resultados. El 44,5% de los mensajes publicitarios no se deriva del estudio que lo acompaña, el 29,9% se deriva claramente del estudio y en el resto aparece una relación intermedia. Se observa una relación significativa de la valoración de los mensajes publicitarios con el tipo de estudio, el enmascaramiento y el tipo de variable de resultado. Conclusiones. Gran proporción de mensajes publicitarios no se deriva del estudio que supuestamente los avala. Es necesario hacer una crítica de estos estudios antes de considerar los mensajes publicitarios

Objective. To check whether the information in the written publicity that the pharmaceutical industry gives to family doctors really is based on the scientific studies that support it. Design. Cross-sectional study. Setting. Health centre on the outskirts of a big city. Participants. Over a year, all the scientific studies that laboratory reps gave family doctors along with the advertising for medicines were collected. A total of 63 paired studies and advertising pieces were obtained. Main measurements. 1-3 advertising messages with each supporting study were selected and reviewed in a structured fashion. Then whether or not the messages selected were based on the study was appraised. Results. 44.5% of the advertising messages were not based on the accompanying study; 29.9% clearly were based on the study; and in the rest there was a half-and-half relationship. There was a significant relationship between the evaluation of the advertising messages and the kind of study, masking and the kind of result variable. Conclusions. A high proportion of advertising messages are not based on the study that is reputed to support them. A critique of these studies has to be undertaken before the advertising messages can be looked at

[Characteristics of diagnoses of malignant neoplasms in primary care]. / Características del diagnóstico de las neoplasias malignas en atención primaria.

OBJECTIVE: To describe the diagnostic process of malignant neoplasms according to the level of care, initial symptoms and diagnostic procedures.Design. Retrospective descriptive study. SETTING: Health centre on the periphery of a big city. PARTICIPANTS: Cases of malignant neoplasms recorded between 1990 and 2000 through the mortality register and specific recording in 2000. MAIN MEASUREMENTS: We reviewed the records, obtaining age and gender, location, initial symptoms, date of first consultation and at what care level, diagnostic tests requested in primary care (PC) and the time elapsed until they became available, until the patients referral and until the definitive diagnosis. 274 cases were included, with information lacking for 12. RESULTS: 42.4% were women, with average age 67.6. The most frequent types of cancer were digestive, respiratory and masculine genital-urinary. 75.2% consulted initially in PC. The most common symptoms were pain and haemorrhage. Of those attended in PC, diagnostic tests were requested for 46.7%, the most common of these being basic analysis (53.2%) and simple x-ray (24.8%). Mean time before results were available was 15.4 days. 67.2% of all cases were referred. Mean time from consultation to referral was 7.3 days; and to definitive diagnosis, 68.0 days. However, for those initially attended in PC, the mean wait was 81.0 days; and at other levels, 30 days (P<.0001). CONCLUSIONS: Most patients consult on their initial symptoms in PC. The time taken for the diagnostic process at this level is adequate, although the total length of the process is greater for those who first consulted in PC.

Características del diagnóstico de las neoplasias malignas en atención primaria / Characteristics of diagnoses of malignant neoplasms in primary care

Objetivo. Describir el proceso diagnóstico de las neoplasias malignas según el nivel asistencial, síntomas iniciales y procedimientos diagnósticos. Diseño. Estudio descriptivo, retrospectivo. Emplazamiento. Centro de salud de la periferia de una gran ciudad. Participantes. Casos de neoplasias malignas registrados desde 1990 hasta 2000 mediante fichero de mortalidad y registro específico durante el año 2000.Mediciones principales. Revisamos las historias, obteniendo edad y género, localización, síntomas iniciales, fecha de primera consulta y nivel asistencial de ésta, pruebas diagnósticas solicitadas en atención primaria (AP) y tiempo hasta que están disponibles, hasta la derivación del paciente y hasta el diagnóstico definitivo. Se incluyeron 274 casos, careciéndose de información en 12.Resultados. Un 42,4 por ciento eran mujeres; su edad media fue 67,6 años. Las localizaciones más frecuentes fueron en aparato digestivo, respiratorio y genitourinario masculino. El 75,2 por ciento consultó inicialmente en AP. Los síntomas más frecuentes fueron dolor y hemorragia. De los atendidos en AP, se solicitaron pruebas diagnósticas en un 46,7 por ciento, y las más utilizadas fueron la analítica básica (53,2 por ciento) y la radiografía simple (24,8 por ciento); la mediana de tiempo que se tardó en disponer de resultados fue de 15,4 días. Se derivó un 67,2 por ciento de todos los casos. La mediana de tiempo desde consulta hasta derivación fue de 7,3 días y hasta el diagnóstico definitivo de 68,0 días, aunque para los atendidos inicialmente en AP la mediana fue de 81,0 días y de 30,0 si consultaron en otros niveles (p < 0,0001).Conclusiones. Los pacientes consultan los síntomas iniciales mayoritariamente en AP, y la duración del proceso diagnóstico en este nivel es adecuada, aunque la duración total del proceso es mayor en quienes consultan en AP (AU)

[Characteristics of patients who do not use primary care services]. / Características de los pacientes que no utilizan las consultas de atención primaria.

OBJECTIVE: To determine the proportion of patients who do not consult their doctor for one year time and to investigate their characteristics, to determine of they are different from patients that do consult. METHODS: This is a prospective study, with a follow-up of one year in the city of Valencia, Spain. The patients included were all registered in a general practitioner's list, 1473 subjects. We took every day all the patients that consulted: home visits were excluded, and so were visits from patients that did not belong to our territory, patients of another general practitioner's list and all patients under 14 years. We included patients attended without citation. We counted the number of visits for each subject, and their age and gender, presence of hypertension, diabetes, hyperlipidemia, chronic respiratory disease, HIV/Aids and health problems that limit their autonomy. RESULTS: 46.3% of patients did not consult, 48.7% made between 1 and 14 visits, and 4.9% 15 visits or more (high utilization is defined as the average plus 2 standard deviations). Among the subjects that did not consult, there were significantly less women, they were younger and had less chronic problems than the patients that consulted and these ones less than high users. CONCLUSIONS: The percent of subjects that did not use primary care medical consultations is 46.3% in one year; they were more frequently men, young people and persons without chronic health problems.

Características de los pacientes que no utilizan las consultas de atención primaria / Characteristics of patients who do not use primary care services

Objetivo: Determinar la proporción de pacientes que no consultaron con su médico a lo largo de un año y determinar sus características, averiguando si éstas son diferentes en los pacientes que sí consultaron. Métodos: Se trata de un estudio prospectivo, con un año de seguimiento. Los pacientes incluidos son todos los asignados a un cupo médico de la ciudad de Valencia, que fueron 1.473, recogiendo día a día las consultas que se realizaban; se excluyeron las consultas domiciliarias, a pacientes desplazados, pertenecientes a otros cupos y menores de 14 años; se incluyeron los atendidos sin cita. Se contabilizó el número de consultas para cada paciente, así como su edad, género y existencia de hipertensión, diabetes, dislipemia, enfermedad respiratoria crónica, VIH/sida y problemas de salud que limitan la autonomía. Resultados: El 46,3 por ciento de los pacientes no realizó ninguna consulta, el 48,7 por ciento realizó entre 1 y 14 consultas, y el 4,9 por ciento realizó 15 consultas o más (hiperutilizador definido como media más 2 desviaciones estándar). Entre los que no consultaron había significativamente menos mujeres, eran más jóvenes y presentaban menos problemas crónicos que los que consultaron, y éstos, a su vez, menos que los hiperutilizadores. Conclusiones: La cantidad de pacientes que no utilizan las consultas médicas de atención primaria es del 46,3 por ciento en un año; predominan los hombres, jóvenes y sin problemas crónicos de salud (AU)

[Primary care as a determinant of the utilization of hospital emergency services]. / La atención primaria como determinante de la utilización del servicio de urgencias hospitalario.

OBJECTIVE: To study the characteristics of emergency care within Primary Care (ECPC), which determine the use of hospital emergency services (HES). DESIGN: Retrospective study. The unit of analysis was the patient attended at the HES. SETTING: Xàtiva Hospital records and data from Primary Care Management, regarding the type of ECPC and the distance from the patient's town of residence to the hospital. PATIENTS AND OTHER PARTICIPANTS: The data of all the patients, a total of 15,290 cases, attended at the HES during the first six months of 1992 were analysed. MEASUREMENTS AND MAIN RESULTS: We constructed a logistic regression model whose explicative variables were the type of ECPC and the distance to the hospital. The variable reply was the probability for each town of causing a high use of HES. We obtained a model whose predictive capacity was 82.98%, in which, independently of distance, the probability of causing a high use of HES was ordered from low to high, as follows: 1) Towns where the Primary Care Team (PCT) physically provided ongoing care in the town itself. 2) Towns attended by a normal Emergency Service (in the town itself). 3) Towns where the PCT provided ongoing care of a localised nature. 4) Towns where the PCT physically provided ongoing care in another town. The relation of distance to the use of HES was inverse. CONCLUSIONS: Distance and the different types of ECPC affect the use of HES.

[The validation and usefulness of a questionnaire for evaluating the infrastructure of health centers]. / Validación y utilidad de una encuesta para la evaluación de la infraestructura de los centros de salud.

A questionnaire was distributed in all the health centers of the Comunidad Valenciana to establish its validity and usefulness for the evaluation of the physical structure of the health centers. Subsequently, the results were validated by direct verification in 30% of centers. The results of the first part of the questionnaire, related to the type of premises that should be available, and of the second, about the characteristics of such premises, were significantly related with the satisfaction degree (r = -0.724, p less than 0.01), as well as with the criterion of previous planning (p less than 0.001) and the inclusion in structures of a traditional model (p less than 0.001). The 75th percentile of the results of the first and second part of the questionnaire are proposed to select those centers with an unacceptable structure, and, as a quick method, it is recommended to test the parameters of satisfaction degree, previous planning, and inclusion within traditional model structures.