Percepción de los pacientes sobre la atención recibida por el personal no sanitario en los centros de salud / Patients’ perception on attention received from Health Centres non-sanitary staff

Objetivos. Conocer la percepción que tienen los usuarios sobre algunos aspectos interpersonales y técnicos relacionados con la atención que reciben del personal de atención al ciudadano cuando acuden a los centros de atención primaria. Valorar la posible utilidad de dos modos de medición de la satisfacción. Material y métodos. Estudio observacional descriptivo realizado con usuarios que utilizaron los servicios de atención al ciudadano de los centros de salud. Tras consultar con este personal, los usuarios fueron entrevistados personalmente utilizando dos tipos de preguntas que evaluaron sus opiniones y satisfacción con diferentes aspectos comunicacionales y de tipo técnico relacionados con la demanda realizada. Las preguntas abiertas fueron agrupadas en categorías en un proceso que involucró a tres investigadores de manera independiente. Se realizó un análisis descriptivo e inferencial (test de la X2, p<0,05). Resultados. Más de un 90% (360) de los usuarios encuestados declararon estar satisfechos o muy satisfechos con la atención recibida en atención al ciudadano; sin embargo, entre el 18 y el 36% hicieron sugerencias para mejorar esta atención tras su consulta. Independientemente del dominio explorado, destacaron las sugerencias referidas a la relación/comunicación, capacitación del personal para resolver los problemas, calidad y cantidad de las explicaciones y tiempo de espera. Conclusiones. Las encuestas que incorporan preguntas abiertas parecen más útiles para valorar la calidad de la atención recibida de los administrativos de los centros de salud, detectar problemas en esta atención y planificar nuevas intervenciones de mejora. Los aspectos relacionales e informativos representan un área de mejora prioritaria en este ámbito(AU)

Aims. To know patients’ perceptions about relational aspects and technical procedures when they are attended by the administrative staff in Health Centres. To assess the utility of two ways for measuring satisfaction. Material and methods. Cross-sectional study carried out in people attending the administrative sections of Health Centres for diverse reasons. Just after the interaction with the administrative they were interviewed using two different questions for assessing their opinions and satisfaction with communicational and technical aspects related with their demands. Descriptive analysis. Significant differences among mean was explored by X2 test. Open-ended questions were grouped in categories in a process involving three researchers independently. Results. Over than 90% (360) of the attendees declared to be satisfied or very satisfied with the service received from the staff personal. Nevertheless, among 18-36% gave suggestions for improving the service after their consultation. Independently the domain explored, people suggested the communicational, personal capability, quality and quantity of explanations and waiting time as the main aspects to be improved. Conclusions. Surveys with open-ended questions are more useful to assess the quality of the attention the citizens receive from no-sanitary staff in Health Centres. These type of questions are also more useful for detecting problems and planning new interventions. Relational and informative issues seem to be the most prioritary areas to improve in this section of Health Centres(AU)

[Patients' perception on attention received from Health Centres non-sanitary staff]. / Percepción de los pacientes sobre la atención recibida por el personal no sanitario en los centros de salud.

AIMS: To know patients' perceptions about relational aspects and technical procedures when they are attended by the administrative staff in Health Centres. To assess the utility of two ways for measuring satisfaction. MATERIAL AND METHODS: Cross-sectional study carried out in people attending the administrative sections of Health Centres for diverse reasons. Just after the interaction with the administrative they were interviewed using two different questions for assessing their opinions and satisfaction with communicational and technical aspects related with their demands. Descriptive analysis. Significant differences among mean was explored by χ(2) test. Open-ended questions were grouped in categories in a process involving three researchers independently. RESULTS: Over than 90% (360) of the attendees declared to be satisfied or very satisfied with the service received from the staff personal. Nevertheless, among 18-36% gave suggestions for improving the service after their consultation. Independently the domain explored, people suggested the communicational, personal capability, quality and quantity of explanations and waiting time as the main aspects to be improved. CONCLUSIONS: Surveys with open-ended questions are more useful to assess the quality of the attention the citizens receive from no-sanitary staff in Health Centres. These type of questions are also more useful for detecting problems and planning new interventions. Relational and informative issues seem to be the most prioritary areas to improve in this section of Health Centres.

La enseñanza virtual de imágenes clínicas, tutorizadas mediante correo electrónico, es más eficiente que la enseñanza tradicional / On-line learning with e-mail tutoring for clinical images is more efficient than traditional teaching methods

Introducción. La enseñanza de la patología médica a través de imágenes es la clave para conseguir habilidad clínica en el diagnóstico. Objetivos. Comparar la eficacia docente de un método de enseñanza basado en imágenes en un entorno no presencial frente a la enseñanza tradicional en un entorno presencial, y evaluar el grado de satisfacción del alumno sobre este método de innovación docente en la enseñanza de la patología médica. Materiales y métodos. El estudio se realizó durante el curso 2005-2006 entre 62 alumnos de Patología médica, de la Facultad de Medicina de Córdoba. Se compararon los dos métodos de enseñanza: el presencial (en cada seminario se expusieron verbalmente 15 imágenes) y en el no presencial (imágenes clínicas expuestas en la página web de la Facultad de Medicina con tutorización a través del correo electrónico). La evaluación consistió en la valoración clínica de 16 imágenes (ocho imágenes de cada modelo de enseñanza). Se comparó la puntuación del examen teórico con la de las imágenes clínicas. Tras el examen final, el alumno realizó un cuestionario de evaluación. Resultados. La calificación media final de las imágenes (sobre 10 puntos) fue de: 6.8+/-1.5 y la del test (sobre 10 puntos) fue de 7.3+/-0.9. La calificación media de las imágenes expuestas en la web (7.4+/-1.6) fue superior a la del modelo presencial (6.3+/-1.7) p<0.0001. Existía una correlación entre la puntuación total de la imagen y la del test (r:0.584, p<0.0001). Asimismo, se correlacionaba la calificación de la imagen del modelo presencial y la e la imagen expuesta en al web (r:0.697, p<0.0001. Conclusiones. Las calificaciones de los casos expuestos en la web fueron superiores a las de los casos expuestos en los seminarios presenciales. La enseñanza de la patología médica a través de imágenes clínicas fue un método muy bien considerado por los alumnos (AU)

Introduction. The teaching of Internal Medicine through images is the key for the achievement of clinical skills in the diagnosis. Aims. To compare the efficiency of a teaching method based on images in a face-to-face learning situation with the traditional teaching methods, and to evaluate the degree of satisfaction amongst the alumni regarding the new teaching method within the Internal Medicine. Materials and methods. The study was carried out throughout the academic year 2005/06 amongst 62 Internal Medicine students in the School of Medicine in Córdoba. Two teaching methods were compared: (i) face-to-face- 15 images were exposed in workshop, and (ii)distance-clinical images were exposed at the School of Medicine web site through a tutorial system based on e-mail. The evaluation consisted in a clinical evaluation of 16 images-8 images for each teaching method. The results from the multiple choice exam and the clinical images exam were also compared. Finally, students answered an assessment questionnaire. Results. The final average qualification – out of 10- for the images was: 6.8+/-1.5 and fot the multiple choice exam – out of 10- was 7.3+/-0.9. The average qualification was higher for the images exposed at the web site than for the face-to-face model: (7.4+/-1.6) vs (6.3+/-1.7) p<0.0001. There was a correlation between the total punctuation for the images and the examination (r:0.584, p<0.0001). Moreover, there was also a correlation between the qualification obtained for the images in the face-to-face method and the images exposed on-line (r:0.697, p<0.0001). Conclusions: Qulaifications for the cases displayed on the website were higher than those for the cases exposed on the face-to-face workshops. In addition to this, students had a very positive opinion regarding the new teaching method for Internal Medicine based on clinical images (AU)

[Validity and reliability of a tool for assessing clinical communication in consultations: the CICAA questionnaire]. / Validez y fiabilidad de un instrumento para evaluar la comunicación clínica en las consultas: el cuestionario CICAA.

OBJECTIVE: To assess the validity and reliability of a tool for evaluating the clinical communication skills of health professionals. DESIGN: Descriptive study of the validation of a tool. SETTING: Primary and specialist care. PARTICIPANTS: Twenty communication experts, in 31 interviews with patients seen by real and standardised nurses, primary care, and specialist doctors, residents with acute and chronic patients. INTERVENTIONS: The study looked at a 36-item, multidimensional evaluative scale on 3 levels, based on the CICAA theoretical model of an interview and examined: 1) its apparent validity, consensus, and content: the clinical communication experts made 2 assessments, a qualitative one and one to weigh the importance of the remaining items; 2) its internal consistency and intra-observer reliability. An expert evaluated 31 interviews, video-recorded on 2 occasions with a 1-to-2 month interval. RESULTS: A 29-item scale was obtained. Cronbach's alpha was 0.957 (95% CI, 0.932-0.976). The overall Intra-class Correlation Coefficient was 0.967 (95% CI, 0.933-0.984). The Kappa values of the items were <0.4 in 3, 0.4-0.6 in 6, 0.6-0.8 in 14, and >0.8 in 4. CONCLUSIONS: The CICAA is a valid and reliable questionnaire for evaluating the clinical communication between various health professionals and patients.

Acerca de la «Noticia sobre publicación redundante» / Concerning the “information on redundant publication”

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Validez y fiabilidad de un instrumento para evaluar la comunicación clínica en las consultas: el cuestionario CICAA / Validity and Reliability of a Tool for Assessing Clinical Communication in Consultations: the CICAA Questionnaire

Objetivo. Valorar la validez y la fiabilidad de un instrumento para evaluar la comunicación clínica de un profesional sanitario. Diseño. Estudio descriptivo de validación de un instrumento. Emplazamiento. Atención primaria y especializada. Participantes. Participaron 20 profesionales expertos en comunicación y se realizaron 31 entrevistas con pacientes atendidos por enfermeros, médicos de atención primaria y especializada, residentes con pacientes agudos y crónicos, reales y estandarizados. Intervenciones. Partiendo de una escala evaluativa de 3 niveles, multidimensional con 36 ítems basada en un modelo teórico de entrevista (CICAA) se realizó: a) estudio de validez aparente, de consenso y contenido: los expertos en comunicación clínica realizaron dos evaluaciones, una primera de tipo cualitativo y una segunda para ponderar la importancia de los ítems restantes, y b) estudio de la consistencia interna y la fiabilidad intraobservador. Un experto evaluó 31 entrevistas videograbadas en dos ocasiones con un intervalo de 1-2 meses. Resultados. Se obtuvo una escala de 29 ítems. El valor de alfa de Cronbach fue 0,957 (intervalo de confianza [IC] del 95%, 0,932-0,976). El coeficiente de correlación intraclase global fue de 0,967 (IC del 95%, 0,933-0,984). Los valores kappa de los ítems fueron 0,8 en 4. Conclusiones. El CICAA es un cuestionario válido y fiable para evaluar la comunicación clínica de diferentes profesionales sanitarios y pacientes

Objective. To assess the validity and reliability of a tool for evaluating the clinical communication skills of health professionals. Design. Descriptive study of the validation of a tool. Setting. Primary and specialist care. Participants. Twenty communication experts, in 31 interviews with patients seen by real and standardised nurses, primary care, and specialist doctors, residents with acute and chronic patients. Interventions. The study looked at a 36-item, multidimensional evaluative scale on 3 levels, based on the CICAA theoretical model of an interview and examined: 1) its apparent validity, consensus, and content: the clinical communication experts made 2 assessments, a qualitative one and one to weigh the importance of the remaining items; 2) its internal consistency and intra-observer reliability. An expert evaluated 31 interviews, video-recorded on 2 occasions with a 1-to-2 month interval. Results. A 29-item scale was obtained. Cronbach's alpha was 0.957 (95% CI, 0.932-0.976). The overall Intra-class Correlation Coefficient was 0.967 (95% CI, 0.933-0.984). The Kappa values of the items were 0.8 in 4. Conclusions. The CICAA is a valid and reliable questionnaire for evaluating the clinical communication between various health professionals and patients

[Validation of the AUDIT test for identifying risk consumption and alcohol use disorders in women]. / Validación del cuestionario AUDIT para la identificación del consumo de riesgo y de los trastornos por el uso de alcohol en mujeres.

OBJECTIVE: To validate the AUDIT test for identifying women with excess alcohol consumption and/or dependency syndrome (DS). DESIGN: Descriptive study to validate a test. SETTING: Two primary care centres and a county drug-dependency centre. PARTICIPANTS: 414 women from 18 to 75 recruited at the clinic. Interventions. Social and personal details were obtained through personal interview, their alcohol consumption was quantified and the AUDIT and MALT questionnaires were filled in. Then the semi-structured SCAN interview was conducted (gold standard; DSM-IV and CIE-10 criteria), and analyses were requested (GGT, GOT, GPT, VCM). 186 patients were given a follow-up appointment three-four weeks later (retest). MAIN MEASUREMENTS: Intra-observer reliability was evaluated with the Kappa index, internal consistency with Cronbach s alpha, and the validity of criteria with indexes of sensitivity and specificity, predictive values and probability quotients. To evaluate the diagnostic performance of the test and the most effective cut-off point, a ROC analysis was run. RESULTS: 11.4% (95% CI, 8.98-13.81) were diagnosed with alcohol abuse (0.5%) or DS (10.9%). The Kappa coefficients of the AUDIT items ranged between 0.685 and 0.795 (P<.001). Internal reliability, with Cronbach s alpha, was 0.932 (95% CI, 0.921-0.941). Test sensitivity was 89.6% (95% CI,76.11-96.02) and specificity was 95.07% (95% CI, 92.18-96.97). The most effective cut-off point was at 6 points. CONCLUSIONS: The AUDIT is a questionnaire with good psycho-measurement properties. It is reliable and valid for the detection of risk consumption and DS in women.

¿Bienvenido y hasta luego u hola y adiós?: conductas comunicativas de los médicos residentes en los momentos iniciales y finales de las consultas / Welcome and I´ll see you again or hallo and goodbye? Communicative behaviour of medical residents in the first and last moments of a consultation

Objetivos. Describir las conductas empleadas por los residentes en los momentos iniciales (recibimiento, primeros segundos de la obtención de información) y finales de las consultas y valorar en qué medida interrupciones muy precoces de estos a los pacientes afectan a algunos resultados intraconsultas como la duración de los cierres o la aparición de nuevas demandas en esta fase. Diseño. Estudio observacional, descriptivo. Emplazamiento. Consultas de atención primaria. Participantes. Treinta y siete residentes de medicina de familia de tercer año y 307 pacientes con problemas incidentes. Material y método. Todas las consultas fueron videograbadas y analizadas por dos observadores entrenados que usaron protocolos establecidos ad hoc previamente validados. Resultados. Los residentes realizaron recibimientos y cierres de consulta muy breves y comunicativamente muy pobres ya que emplearon muy pocas habilidades relacionales. La mitad de los médicos redirigen muy precozmente el discurso inicial del paciente (en 16 s) y esto se asoció significativamente (p = 0,03) a nuevas demandas del paciente en el momento del cierre y con despedidas más prolongadas (p = 0,001). Conclusiones. La conducta de los residentes en los instantes estudiados seguramente limita su capacidad para establecer y mantener la relación clínica, obtener información y aclarar la que dan a los pacientes. Los cierres disfuncionales son más probables cuando el médico tiene conductas dominantes muy precozmente; estas conductas no acortan las entrevistas

Objectives. To describe the communicative behaviour by residents at the beginning (reception and first seconds after obtaining information) and closing of the consultation and to evaluate in what way very early interruptions in the patient monologue affect within-consultation results, such as the duration of their closing and the appearance of new concerns in this phase. Design. Descriptive observational study. Location. Primary care clinics. Participants. Thirty seven third year residents of family medicine and 307 patients with incidental problems. Material and method. All the consultations were videotaped and analysed by 2 trained observers who used previously validated established ad hoc procedures. Results. The reception and closing of the consultations by the residents were very short and very poorly communicated since they used very few relational abilities. Half of the doctors redirected the initial discourse of the patient very early on (in 16 sec) and this was significantly associated (P=.03) with new concerns by the patient at the time of closing and with longer goodbyes (P=.001). Conclusions. The conduct of the residents in the moments studied surely limits their ability to establish and maintain a clinical relationship, to obtain information and explain what they are giving to the patients. The dysfunctional closures are most probable when the doctor assumes a dominant role very early: this behaviour does not shorten the consultations

Validación del cuestionario AUDIT para la identificación del consumo de riesgo y de los trastornos por el uso de alcohol en mujeres / Validation of the audit test for identifying risk consumption and alcohol use disorders in women

Objetivo. Validar el cuestionario AUDIT para identificar a las mujeres con un consumo excesivo de alcohol y/o síndrome de dependencia (SDA). Diseño. Estudio descriptivo de validación de un test. Emplazamiento. Dos centros de atención primaria y un centro comarcal de drogodependencias. Participantes. Participaron 414 mujeres de 18 a 75 años captadas en la consulta. Intervenciones. Mediante entrevista personal se obtuvieron datos sociodemográficos, se cuantificó el consumo de alcohol y se aplicaron los cuestionarios AUDIT y MALT. Posteriormente se les realizó la entrevista semiestructurada SCAN (patrón de referencia, criterios DSM-IV y CIE-10) y se solicitaron determinaciones analíticas (GGT, GOT, GPT, VCM). Se volvió a citar a 186 pacientes a las 3-4 semanas (retest). Mediciones principales. La fiabilidad intraobservador se evaluó con el índice kappa, la consistencia interna con el alfa de Cronbach, la validez criterial con los índices de sensibilidad, especificidad, valores predictivos y cocientes de probabilidades, y para evaluar el rendimiento diagnóstico del test y el punto de corte más eficaz se hizo un análisis ROC. Resultados. El 11,4% (intervalo de confianza [IC] del 95%, 8,98-13,81) fue diagnosticado de abuso del alcohol (0,5%) o SDA (10,9%). Los coeficientes kappa de los ítems del AUDIT oscilaron entre 0,685 y 0,795 (p < 0,001). La fiabilidad interna, con el alfa de Cronbach, fue 0,932 (IC del 95%, 0,921-0,941). La sensibilidad del test fue del 89,6% (IC del 95%, 76,11-96,02) y la especificidad del 95,07% (IC del 95%, 92,18-96,97). El punto de corte más eficaz fue el de 6 puntos. Conclusiones. El AUDIT es un cuestionario con unas buenas propiedades psicométricas y es fiable y válido para la detección del consumo de riesgo y SDA en mujeres

Objective. To validate the AUDIT test for identifying women with excess alcohol consumption and/or dependency syndrome (DS). Design. Descriptive study to validate a test. Setting. Two primary care centres and a county drug-dependency centre. Participants. 414 women from 18 to 75 recruited at the clinic. Interventions. Social and personal details were obtained through personal interview, their alcohol consumption was quantified and the AUDIT and MALT questionnaires were filled in. Then the semi-structured SCAN interview was conducted (gold standard; DSM-IV and CIE-10 criteria), and analyses were requested (GGT, GOT, GPT, VCM). 186 patients were given a follow-up appointment three-four weeks later (retest). Main measurements. Intra-observer reliability was evaluated with the Kappa index, internal consistency with Cronbach´s alpha, and the validity of criteria with indexes of sensitivity and specificity, predictive values and probability quotients. To evaluate the diagnostic performance of the test and the most effective cut-off point, a ROC analysis was run. Results. 11.4% (95% CI, 8.98-13.81) were diagnosed with alcohol abuse (0.5%) or DS (10.9%). The Kappa coefficients of the AUDIT items ranged between 0.685 and 0.795 (P<.001). Internal reliability, with Cronbach´s alpha, was 0.932 (95% CI, 0.921-0.941). Test sensitivity was 89.6% (95% CI,76.11-96.02) and specificity was 95.07% (95% CI, 92.18-96.97). The most effective cut-off point was at 6 points. Conclusions. The AUDIT is a questionnaire with good psycho-measurement properties. It is reliable and valid for the detection of risk consumption and DS in women

La relación clínica, hoy / The clinical relationship today

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[Welcome and I'll see you again, or hello and goodbye?: Communication behaviour of medical residents at the beginning and the end of consultations]. / Bienvenido y hasta luego u hola y adiós?: Conductas comunicativas de los médicos residentes en los momentos iniciales y finales de las consultas.

OBJECTIVES: To describe the communicative behaviour by residents at the beginning (reception and first seconds after obtaining information) and closing of the consultation and to evaluate in what way very early interruptions in the patient monologue affect within-consultation results, such as the duration of their closing and the appearance of new concerns in this phase. DESIGN: Descriptive observational study. SETTING: Primary care clinics. PARTICIPANTS: Thirty seven third year residents of family medicine and 307 patients with incidental problems. Material and method. All the consultations were videotaped and analysed by 2 trained observers who used previously validated established ad hoc procedures. RESULTS: The reception and closing of the consultations by the residents were very short and very poorly communicated since they used very few relational abilities. Half of the doctors redirected the initial discourse of the patient very early on (in 16 sec) and this was significantly associated (P=.03) with new concerns by the patient at the time of closing and with longer goodbyes (P=.001). CONCLUSIONS: The conduct of the residents in the moments studied surely limits their ability to establish and maintain a clinical relationship, to obtain information and explain what they are giving to the patients. The dysfunctional closures are most probable when the doctor assumes a dominant role very early: this behaviour does not shorten the consultations.

El reto de la información a los pacientes / The challenge of information for patients

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La voz de los pacientes:mejorando el entendimiento entre médicos y pacientes / Patients´s voice: improving understanding between doctors and patients

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¿Qué estilo de consulta debería emplear con mis pacientes?: reflexiones prácticas sobre la relación médico-paciente / What style of consultation with my patients should I adopt? PRactical reflections on the doctor-patient relationship

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[Effectiveness of medical counseling for alcoholic patients and patients with excessive alcohol consumption seen in primary care]. / Efectividad del consejo médico a pacientes alcohólicos y bebedores excesivos atendidos en consultas de atención primaria.

AIM: To determine the effectiveness of medical counseling for alcohol abuse, when it is provided in primary care centers. DESIGN: Quasi-experimental, open, multicenter before-after study.Setting. 14 primary care physician's practices (7 rural, 7 urban) in the province of Córdoba (Spain). PARTICIPANTS: 306 patients of both sexes, recruited with a case-finding strategy, who consumed >=35 (men) or >=21 (women) IU per week, or who had alcohol dependence syndrome (ADS) (MALTS score O>=11). Interventions. All patients were offered brief counseling to reduce drinking, and all were followed to evaluate their status 3 months, 1 year and 2 years later. MAIN MEASURES: The response variable was self-reported alcohol consumption together with normal GGT values or confirmation of alcohol consumption by a relative. The results were subjected to intention-to-treat analysis. RESULTS: Of the 306 patients included in the study, 95.1% were men and 78.4% had ADS. After 2 years 38.89% (95% CI, 32.2%-44.3%) had attained their treatment goal: 23.85% were in complete abstinence, and 15.0% consumed moderate amounts of alcohol below the limit considered to indicate risk. Starting excessive consumption at less than 16 years of age (odds ratio [OR], 3.0885), living in a slum (OR, 3.2103), smoking (OR, 1.7187), and a positive CAGE test (OR, 1.9949) were associated with failure of the intervention (P<.05). CONCLUSIONS: Counseling provided by the family doctor was highly effective under the usual conditions of general practice, both for patients with excessive alcohol consumption and for patients with con ADS.