Atención a la demanda indemorable en atención primaria. Descripción y detección de posibles áreas de mejora / Undelayable visits in primary care. Description and identification of possible areas for improvement

Objetivo. Identificar las principales áreas de mejora en el proceso de Atención a la Demanda Indemorable en Atención Primaria en el Centro de Salud de Miralbueno. Diseño. Estudio transversal. Emplazamiento. Centro de Salud urbano con un anexo rural. Participantes. Del total de consultas atendidas durante 2009 por Demanda Indemorable (6.884 consultas), se seleccionó una muestra representativa de 236 usuarios. El índice de respuesta fue del 35%, realizando finalmente 83 encuestas. Mediciones principales. Encuesta telefónica, basada en el cuestionario validado SERVQUAL. Las respuestas de los usuarios fueron valoradas por los profesionales mediante fichas de mejora. Resultados. La encuesta a los usuarios ha detectado valores medios de satisfacción por encima de 3,50 sobre 5. Los ítems mejor valorados fueron: el trato recibido por el personal médico, la información recibida y el grado de resolución de problemas. Las propuestas de mejora aportadas por los profesionales estaban relacionadas con el acceso telefónico, horarios de pediatría y funcionamiento del circuito de Atención a la Demanda Indemorable. Conclusiones. La encuesta a los usuarios ha detectado un nivel alto de satisfacción global. Los aspectos peor valorados han sido: la dificultad de acceso telefónico, la falta de pediatra en horario de atención continuada y el tiempo de espera hasta ser atendidos. Por parte de los profesionales del Centro de Salud, han surgido posibles propuestas de mejora para los aspectos peor valorados por los usuarios(AU)

Objective. To identify the main areas of improvements in the care process of undelayable consultations in Primary Care Health Centre of Miralbueno (Zaragoza). Design. Cross-sectional study using a telephone questionnaire. Location/setting. Urban Health Centre with a rural annexe. Participants. A representative sample of 238 users was selected from the total undelayable consultations made (6884 visits) during 2009. The response rate was 35%, with 83 surveys finally being made. Measurements. Telephone surveys based on a valid questionnaire called SERVQUAL. The user responses were assessed by professional using improvement cards. Results. The user's survey gave mean satisfaction scores above 3.50 out of 5. The best rated items were: the treatment by medical staff, information received and the degree of problem solving. Improvement proposals made by professionals were related to telephone access, and the paediatric opening hours for continuous treatment and the waiting time to be seen. Conclusions. The user survey detected a high level of overall satisfaction. But valued aspects were: the difficulty in telephone access, the lack of paediatric visits availability and the waiting times. The Health Centre professionals offered suggestions to improve the areas rated worst by users(AU)

[Undelayable visits in primary care. Description and identification of possible areas for improvement]. / Atención a la demanda indemorable en atención primaria. Descripción y detección de posibles áreas de mejora.

OBJECTIVE: To identify the main areas of improvements in the care process of undelayable consultations in Primary Care Health Centre of Miralbueno (Zaragoza). DESIGN: Cross-sectional study using a telephone questionnaire. LOCATION/SETTING: Urban Health Centre with a rural annexe. PARTICIPANTS: A representative sample of 238 users was selected from the total undelayable consultations made (6884 visits) during 2009. The response rate was 35%, with 83 surveys finally being made. MEASUREMENTS: Telephone surveys based on a valid questionnaire called SERVQUAL. The user responses were assessed by professional using improvement cards. RESULTS: The user's survey gave mean satisfaction scores above 3.50 out of 5. The best rated items were: the treatment by medical staff, information received and the degree of problem solving. Improvement proposals made by professionals were related to telephone access, and the paediatric opening hours for continuous treatment and the waiting time to be seen. CONCLUSIONS: The user survey detected a high level of overall satisfaction. But valued aspects were: the difficulty in telephone access, the lack of paediatric visits availability and the waiting times. The Health Centre professionals offered suggestions to improve the areas rated worst by users.

[Molecular forms of PSA and differentiating between benign hypertrophy,carcinoma, and disseminated prostatic carcinoma. Correlation between two determination technics]. / Formas moleculares de PSA en la discriminación entre hipertrofia benigna, carcinoma y carcinoma diseminado de próstata. Correlación entre dos diferentes técnicas de determinación.

OBJECTIVE: To determine the correlation between two methods of measurement of total PSA (PSA-T) and free PSA (PSA-F) and the utility of the PSA-F/PSA-T ratio in patients with PSA-T between 4 and 10 ng/ml suspected as having prostate cancer. METHODS: Determinations of both PSA-T and PSA-F were performed using two different techniques in 91 patients suspected as having prostate cancer. Diagnosis was made on the findings of biopsy and the complementary tests. RESULTS: The following correlation was found for the two techniques: R = 0.99 and p < 0.05 for PSA-T, and R = 0.85 and p < 0.05 for PSA-F. For PSA-T values of 4-10 ng/ml and PSA-F greater than 25%, we found two patients with prostate cancer. For a PSA-F/PSA-T ratio less than 9%, all cases had prostate cancer. Three cases with bone metastasis had PSA-T values less than 10 ng/ml. CONCLUSIONS: A PSA-F/PSA-T ratio greater than 25% does not exclude malignancy in patients with a total PSA of 4-10 ng/ml; values less than 9% correspond to prostate cancer. Bone metastasis was found with both methods in patients with total PSA values less than 10 ng/ml.

[Human immunodeficiency virus (HIV) infection. The effectiveness of different diagnostic sequences in suspected pulmonary infection]. / Infección por el virus de la inmunodeficiencia humana (VIH). Rentabilidad de diferentes secuencias diagnósticas ante sospecha de infección pulmonar.

BACKGROUND: Assessment of different diagnostic sequences, in patients VIH(+) with a suspected pulmonary infection. METHODS: A cross-sectional descriptive study of 76 HIV(+) patients with suspected respiratory infection. It has been determined the validity and the pretest and post-test probability of the radiology (Rx) of thorax, 67Ga pulmonary scintigraphy and seric LDH levels, in order to design four different diagnostic algorithms. RESULTS: The diagnostic sequence Rx-LDH-scintigraphy with normal results involved an infection probability of 58.0%. Pathological Rx with successively normal LDH and scintigraphy, implied a likelihood of 97.0%. The LDH elevation in sequence with scintigraphy and Rx rose to 96.1% if both were abnormal and diminished to 8.3% if normal. CONCLUSIONS: The LDH elevation associated with the sequence of normal Rx and scintigraphy suggests a low infection likelihood. On the contrary, associated with pathological Rx and scintigraphy in sequence, practically assures the pulmonary infection.

Infección por el virus de la inmunodeficiencia humana (VlH). Rentabilidad de diferentes secuencias diagnósticas ante sospecha de infección pulmonar / VIH (+) patients: assessment of different diagnostic sequences with a suspected pulmonary infection

Fundamento: Valoración de diferentes secuencias diagnósticas, en pacientes con infección por virus de la inmunodeficiencia humana (VlH), y sospecha de infección pulmonar. Métodos: Estudio descriptivo transversal, de un total de 76 pacientes VIH (+) con sospecha de infección pulmonar. Se determina la validez y razones de probabilidad de infección pulmonar pre y postprueba de la radiografía de tórax (Rx), gammagrafía pulmonar con 67Ga y valores séricos de LDH, con objeto de diseñar cuatro algoritmos diagnósticos diferentes. Resultados: La secuencia diagnóstica Rx-LDH-gammagrafía con resultados normales supuso una probabilidad de infección de 58,0 porciento. Rx alterada con LDH y gammagrafía sucesivamente normales, dio una probabilidad de 97,0 porciento. Una elevación de LDH seguida de gammagrafía y Rx alteradas determinó una probabilidad de infección del 96,1 %. Cuando tras LDH elevada, se obtenía gammagrafía y Rx normales, este porcentaje descendió a 8,3 %. Conclusiones: La elevación de LDH asociada a Rx y gammagrafía secuencialmente normales sugiere una baja probabilidad de infección. Por el contrario, junto a Rx y gammagrafía sucesivamente patológicas, prácticamente aseguran la infección pulmonar (AU)

[Quality control of a computer system for repeat prescriptions]. / Control de calidad de un sistema informatizado de prescripción repetida.

The results of a quality control of a computer system of repeated prescription (RPS) and its basic features are reported. The selected quality criteria were the following: reduction of the bureaucratic index in the visit, correct fulfillment of the treatment order, health attention circuits of the RPS, and compliance of the patient with the treatment. The record of activities and a random sample of treatment orders (TO) were used as sources of data. Quality indexes near the optimal standard (OS) were achieved: bureaucratic index 12.8% (OS = 15%), fulfillment of the TO 94% (OS = 100%), specified dosages 86% (OS = 100%), prescriptions in out-of-date orders 7% (OS = 0%), use higher than calculated 1% (OS = 0%), and use lower than calculated 36% (OS = 25%). Finally, the corrective measures for the detected quality problems are proposed, and the advantages of the computer RPS are discussed.

[Vaccination coverage in a pediatric population attended by a primary health care center]. / Estudio sobre la cobertura vacunal en la población pediátrica atendida en un centro de salud.

It is hereby presented a quality control study of a systematic vaccination program developed in an urban primary care center. Target population were children between 0 and 8 years attended in the center. They were considered as having a correct vaccination coverage those cases in which it was possible to verify documented accomplishment of the local vaccination schedule. Out of the 538 children included in our study, 168 (31%) were founded not to have appropriate vaccination coverage evidenced in their clinical records, and their families were requested for an interview: 126 (75%) attended de appointment. In 93 of them it was founded a recording mistake, and 33 cases were verified as no correctly covered. Vaccination coverage rate was 86%, being inverse relationship between age and coverage rate. They are discussed corrective actions derived from the quality control.