Diseño y validación del cuestionario ACPAPS para valorar la atención centrada en la persona por el médico de familia / Design and validation of the ACPAPS questionnaire to assess person-centred care by the family doctor

Objetivos: Diseño, construcción y validación de un test autocumplimentable que permita al médico de familia (MF) valorar en qué medida integra en su práctica clínica la atención centrada en la persona (ACP).Diseño: Cualitativo. Diseño de cuestionarios. Emplazamiento: Atención primaria. Participantes: 214 MF y residentes de medicina familiar y comunitaria de 62 de los 80 centros de salud de la comunidad autónoma de Murcia. Métodos: Construcción de un cuestionario a partir de un banco de 873 ítems provenientes de una revisión sistemática y un estudio Delphi. Revisión por panel de 8 expertos ACP. Realización de pretest cognitivo con 10 MF. Se invita a participar a los médicos de 62 centros de salud. Con las respuestas medimos la fiabilidad, la validez y la factibilidad. Resultados: El cuestionario final contiene 37 ítems. Medimos la fiabilidad a través de la consistencia interna con un alfa de Cronbach de 0,915. Para la validez de constructo, el test de esfericidad de Bartlett adecuado y la medida de Kaiser-Mayer-Olkin de 0,889 nos permitió realizar un análisis factorial con la extracción de nueve factores (regla de Kaiser), siendo 5 los principales (Scree Test), cuyos ítems coinciden con las dimensiones propuestas por los expertos. Para valorar su factibilidad consideramos la tasa de respuesta del 31,15%, el tiempo de respuesta de 17 minutos 23 segundos, y solo el 0,9% de encuestados consideraban el cuestionario largo o complejo. Conclusiones: El cuestionario ACPAPS es una herramienta fiable, válida y factible para valorar la ACP en el MF, lo cual tiene múltiples y trascendentes aplicaciones.(AU)

Objectives: Design, construction and validation of a self-completion test that allows the Family Physician (FP) to assess the extent to which he/she integrates person-centred care (PCC) in his/her clinical practice. Design: Qualitative. Questionnaire design. Location: Primary care. Participants: Two hundred and fourteen family and community medicine physicians and residents, from 62 of the 80 health centres in the autonomous community of Murcia (Spain). Methods: Construction of a questionnaire from a bank of 873 items from a systematic review and a Delphi study. Review by PCC panel of experts (8). Cognitive pretest with 10 FP. Doctors from 62 health centres were invited to participate. With the responses we measured reliability, validity and feasibility. Results: The final questionnaire contains 37 items. We measured reliability through internal consistency with a Cronbach's alpha of .915. For construct validity, the appropriate Bartlett's test of sphericity and the Kaiser-Mayer-Olkin measure of .889 allowed us to carry out a factor analysis with the extraction of nine factors (Kaiser's rule) with five main factors (Scree test) whose items coincide with the dimensions proposed by the experts. To assess its feasibility we considered the response rate of 31.15%, the response time of 17minutes 23seconds and only .9% of respondents considered the questionnaire long or complex. Conclusions: The ACPAPS questionnaire is a reliable, valid and feasible tool to assess PCC in FM, which has multiple and far-reaching applications.(AU)

[Design and validation of the ACPAPS questionnaire to assess person-centred care by the family doctor]. / Diseño y validación del cuestionario ACPAPS para valorar la atención centrada en la persona por el médico de familia.

OBJECTIVES: Design, construction and validation of a self-completion test that allows the Family Physician (FP) to assess the extent to which he/she integrates person-centred care (PCC) in his/her clinical practice. DESIGN: Qualitative. Questionnaire design. LOCATION: Primary care. PARTICIPANTS: Two hundred and fourteen family and community medicine physicians and residents, from 62 of the 80 health centres in the autonomous community of Murcia (Spain). METHODS: Construction of a questionnaire from a bank of 873 items from a systematic review and a Delphi study. Review by PCC panel of experts (8). Cognitive pretest with 10 FP. Doctors from 62 health centres were invited to participate. With the responses we measured reliability, validity and feasibility. RESULTS: The final questionnaire contains 37 items. We measured reliability through internal consistency with a Cronbach's alpha of .915. For construct validity, the appropriate Bartlett's test of sphericity and the Kaiser-Mayer-Olkin measure of .889 allowed us to carry out a factor analysis with the extraction of nine factors (Kaiser's rule) with five main factors (Scree test) whose items coincide with the dimensions proposed by the experts. To assess its feasibility we considered the response rate of 31.15%, the response time of 17minutes 23seconds and only .9% of respondents considered the questionnaire long or complex. CONCLUSIONS: The ACPAPS questionnaire is a reliable, valid and feasible tool to assess PCC in FM, which has multiple and far-reaching applications.

¿Cómo valorar la atención centrada en la persona según los profesionales? Un estudio Delphi / How to assess Person-Centered Care according to professionals? A Delphi study

Objetivos: Conocer la perspectiva de profesionales sobre aspectos y dimensiones que deberían formar parte indispensable de la Atención Centrada en la Persona (ACP).DiseñoTécnica Delphi.EmplazamientoAtención Primaria.ParticipantesSetenta y cuatro expertos médicos especialistas en medicina familiar y comunitaria (MF), tutores docentes, psicólogos y sociólogos distribuidos por todo el territorio nacional (enero-junio 2015).MétodosRespondieron a tres cuestionarios: primero sobre aspectos que debería tener en cuenta un MF para realizar ACP en todas sus dimensiones. En el segundo se preguntó sobre el grado de acuerdo con cada ítem y dimensión en que lo clasificaba. Las respuestas se priorizaron en un tercer cuestionario (escala Likert, rango de puntuación 1-10).ResultadosLa tasa de respuesta (TR) al primer cuestionario fue de 54,05%, obteniéndose 84 ítems, los más frecuentes Respeto y Atención Integral. El 2.° cuestionario con TR=48,6%, obtuvo 52 ítems con acuerdo superior al 75%. La TR del tercer cuestionario fue de 52,7%, obteniendo 21 ítems con puntuación >9. Los valores más altos correspondieron a aspectos esenciales de la ACP: respeto, atención integral, enfoque biopsicosocial, autonomía del paciente y participación en la toma de decisiones.ConclusionesSe identificaron nuevas dimensiones: Prevención y promoción de la salud, Gestión de Recursos y Competencia Clínica; añadidas a las previamente descritas: Perspectiva biopsicosocial, Médico como persona, Paciente como persona, Relación médico-paciente y Poder y Responsabilidad compartidas.El respeto, la atención integral, el enfoque biopsicosocial, la autonomía del paciente y su participación en la toma de decisiones, son los aspectos más valorados entre los seleccionados por los profesionales participantes.

Objectives: To know the perspective of professionals on aspects and dimensions that should be an indispensable part of Person-Centered Care (PCA).DesignDelphi Technique.LocationPrimary Care.Participants74 medical experts specializing in family and community medicine (FM), teaching tutors, psychologists and sociologists distributed throughout the national territory (January-June 2015).MethodsThey responded to three questionnaires: first, on aspects that a FP should take into account to carry out PCA in all its dimensions. In the second, they asked about the degree of agreement with each item and dimension in which it was classified. The responses were prioritized in a third questionnaire (Likert scale, score range 1-10).ResultsThe response rate (RR) to the 1st questionnaire was 54.05%, obtaining 84 items, the most frequent Respect and Comprehensive Attention. The 2nd questionnaire with RR = 48.6%, obtained 52 items with a degree of agreement greater than 75%. The RR of the 3rd questionnaire was 52.7%, obtaining 21 items with a score> 9. The highest values corresponded to essential aspects of PCA: respect, comprehensive care, biopsychosocial approach, patient autonomy, and participation in decision-making.

[How to assess Person-Centered Care according to professionals? A Delphi study]. / ¿Cómo valorar la atención centrada en la persona según los profesionales? Un estudio Delphi.

OBJECTIVES: To know the perspective of professionals on aspects and dimensions that should be an indispensable part of Person-Centered Care (PCA). DESIGN: Delphi Technique. LOCATION: Primary Care. PARTICIPANTS: 74 medical experts specializing in family and community medicine (FM), teaching tutors, psychologists and sociologists distributed throughout the national territory (January-June 2015). METHODS: They responded to three questionnaires: first, on aspects that a FP should take into account to carry out PCA in all its dimensions. In the second, they asked about the degree of agreement with each item and dimension in which it was classified. The responses were prioritized in a third questionnaire (Likert scale, score range 1-10). RESULTS: The response rate (RR) to the 1st questionnaire was 54.05%, obtaining 84 items, the most frequent Respect and Comprehensive Attention. The 2nd questionnaire with RR = 48.6%, obtained 52 items with a degree of agreement greater than 75%. The RR of the 3rd questionnaire was 52.7%, obtaining 21 items with a score> 9. The highest values corresponded to essential aspects of PCA: respect, comprehensive care, biopsychosocial approach, patient autonomy, and participation in decision-making. CONCLUSIONS: New dimensions were identified: Prevention and health promotion, Resource Management and Clinical Competence, added to those previously described: Biopsychosocial perspective, Doctor as a person, Patient as a person, Doctor-patient relationship and Shared Power and Responsibility. Respect, comprehensive care, the biopsychosocial approach, the patient's autonomy and their participation in decision-making, are the most valued aspects among those selected by the participating professionals.

Información sanitaria en la red. Necesidades, expectativas y valoración de la calidad desde la perspectiva de los pacientes. Investigación cualitativa con grupos focales / Online health information. Needs, expectations and quality assessment from the patients’ perspective. A qualitative study using focus group

Objetivo: explorar y comprender necesidades, expectativas y valoración de la calidad desde el punto de vista de los pacientes cuando buscan información sobre salud en internet. Diseño: Investigación cualitativa con grupos focales. Emplazamiento: Centro de Salud Profesor Jesús Marín, Molina de Segura. Región de Murcia. Participantes: Tres grupos focales. Número = 17 participantes, 11 mujeres y 6 hombres, de entre 24 y 55 años, que habían usado recientemente internet para buscar información sobre salud. Método: muestreo de conveniencia con cuotas por edad y sexo. Grabación y transcripción de las discusiones grupales. Análisis de texto mediante segmentación, categorización e interpretación de los discursos. Triangulación por varios investigadores. Resultados: cuando los pacientes usan internet como fuente de información, valoran la accesibilidad, inmediatez y exhaustividad, así como la autonomía y el poder que les proporciona en su relación con el sistema sanitario. Los procesos de búsqueda son sencillos, breves, muy específicos y habitualmente se limitan a los resultados de la primera pantalla. Entre los criterios para seleccionar unas páginas web frente a otras, destacan su comprensibilidad, diseño y ausencia de publicidad. Para valorar la fiabilidad de la información, los pacientes utilizan como estrategias el contraste entre diversas fuentes y la intuición. Conclusiones: internet satisface necesidades no solo de información, sino de apoyo emocional y sitúa a los pacientes en un plano de igualdad con los profesionales. Para valorar la calidad y fiabilidad de la información encontrada, se utilizan criterios y estrategias que no coinciden con los que definen los profesionales. Globalmente, la experiencia de buscar en internet información sanitaria se percibe como muy positiva.(AU)

Objective: to explore and understand patients’ needs, expectations and quality evaluation when searching for health information on the internet. Design: qualitative research with focus groups. Location: Professor Jesús Marín Primary Care Centre, Molina de Segura. Region of Murcia. Participants: three focus groups. N = 17 participants, 11 women and 6 men, aged between 24 and 55, who had recently used the internet to search for health information. Method: non-probabilistic convenience sampling of patients from a Primary Care Centre. Recording and subsequent transcription of group discussions. Text analysis by means of segmentation, categorization and speech interpretation. Researchers’ triangulation analysis. Results: when patients use the internet as a source of health-related information, accessibility, immediacy and thoroughness are highly valued, as well as the autonomy and the power it provides them in their interactions with the health system. Online searches are simple, short, very specific and, most often, limited to the results displayed on the first screen. Amongst the criteria used when selecting some web pages over the others, there their comprehensibility, design and absence of advertising are notable. In order to assess the reliability of the information, patients’ strategies rely on both contrasting different sources and their intuition. Conclusions: the internet not only fulfils the need for information, but also for emotional support, placing patients on an equal footing with professionals. The criteria and strategies used to evaluate the quality and reliability of the information found do not coincide with those defined by professionals. Overall, the experience of online searching for health information is perceived as very positive.(AU)

Cuestionarios de atención centrada en la persona en atención primaria. Una revisión sistemática / Questionnaires of person centered care in primary care. A systematic review

OBJETIVO: Pese a la importancia de la «atención centrada en la persona» (ACP), hay evidentes limitaciones para valorarla y medirla, debidas probablemente a la dificultad para definirla. El objetivo del estudio fue identificar herramientas validadas que midiesen la ACP o algunos de sus aspectos en el ámbito de la atención primaria. DISEÑO: Revisión sistemática. Fuentes de datos: MEDLINE, Embase, Cochrane, PSYCinfo, IME-Biomedicina, LILACS y TESEO hasta del 31 de mayo de 2018. SELECCIÓN DE ESTUDIOS: Los criterios de inclusión fueron: a) estudios de validación de cuestionarios, revisiones sistemáticas sobre estudios de validación u otros estudios descriptivos, b) realizados todos ellos en el ámbito de la atención primaria y c) que midieran aspectos de la ACP en profesionales y/o pacientes. Dos investigadores revisaron de forma independiente los artículos y sus discrepancias fueron resueltas por un tercer investigador. Extracción de datos: Se recogieron datos sobre los aspectos de la ACP medidos, población a la que se dirige, tipo de cuestionario, y datos sobre validez y fiabilidad. RESULTADOS: Se localizaron 1.415 artículos a los que se añadieron 54 referencias adicionales identificadas a través de referencias de los artículos de la revisión sistemática. Tras una depuración finalmente fueron 75 los artículos que cumplieron todos los criterios y 39 las herramientas identificadas y clasificadas según las dimensiones analizadas. CONCLUSIONES: Debido a la dificultad de medir la ACP en su conjunto, la mayor parte de los artículos hacen referencia solo a alguno de sus aspectos o dimensiones, predominando la perspectiva del paciente frente a la del profesional. Estas herramientas son, no obstante, un importante punto de partida para futuros cuestionarios que intenten valorar de forma integral la ACP

OBJECTIVE: Despite the acknowledged importance of 'Person Centered Care' (PCC), there are obvious limitations for its determination and measurement due to the difficulty of its exact definition. The objective of our review is to identify valid tools that measure the PCC or some of its aspects in the field of Primary Health Care. DESIGN: Systematic review Data sources: MEDLINE, Embase, Cochrane, PSYCinfo, IME-Biomedicine, LILACS and TESEO until May 31, 2018. Selection of studies: The inclusion criteria were: validation studies of questionnaires, systematic reviews of validation or other descriptive studies, all of which were carried out in the context of the Primary Health Care and that measured aspects of the PCC in professionals and/or patients. Two investigators independently reviewed the articles and their discrepancies were resolved by a third investigator. Data extraction: Data were collected on the measured ACP aspects, target population, type of questionnaire, and data on validity and reliability. RESULTS: 1,415 articles were located, to which 54 additional references were subsequently added via cross references. Finally, there were 75 articles that fulfilled all the criteria and there were 39 which had the tools identified and classified according to the dimensions analyzed. CONCLUSIONS: Due to the difficulty of measuring PCC as a whole, most of the articles refer only to one of its aspects or dimensions, with the patient's perspective prevailing over that of the professional. All these tools are, nevertheless, an important starting point for future questionnaires that attempt an integral approach to the PCC

[Questionnaires of person centered care in primary care. A systematic review]. / Cuestionarios de atención centrada en la persona en atención primaria. Una revisión sistemática.

OBJECTIVE: Despite the acknowledged importance of 'Person Centered Care' (PCC), there are obvious limitations for its determination and measurement due to the difficulty of its exact definition. The objective of our review is to identify valid tools that measure the PCC or some of its aspects in the field of Primary Health Care. DESIGN: Systematic review DATA SOURCES: MEDLINE, Embase, Cochrane, PSYCinfo, IME-Biomedicine, LILACS and TESEO until May 31, 2018. SELECTION OF STUDIES: The inclusion criteria were: validation studies of questionnaires, systematic reviews of validation or other descriptive studies, all of which were carried out in the context of the Primary Health Care and that measured aspects of the PCC in professionals and/or patients. Two investigators independently reviewed the articles and their discrepancies were resolved by a third investigator. DATA EXTRACTION: Data were collected on the measured ACP aspects, target population, type of questionnaire, and data on validity and reliability. RESULTS: 1,415 articles were located, to which 54 additional references were subsequently added via cross references. Finally, there were 75 articles that fulfilled all the criteria and there were 39 which had the tools identified and classified according to the dimensions analyzed. CONCLUSIONS: Due to the difficulty of measuring PCC as a whole, most of the articles refer only to one of its aspects or dimensions, with the patient's perspective prevailing over that of the professional. All these tools are, nevertheless, an important starting point for future questionnaires that attempt an integral approach to the PCC.

Sobrediagnóstico y sobretratamiento en el ámbito cardiovascular: factores de riesgo, no enfermedades / No disponible

Los factores de riesgo cardiovascular y en concreto la hipertensión arterial, hiperlipidemia y diabetes, representan una parte muy importante en relación con el emergente problema del sobrediagnóstico y sobretratamiento en atención primaria de salud. Las razones que apoyan esta amenaza son diversas. A su elevada prevalencia y a que la intervención sobre ellos no se va a ver reflejada de forma directa en el estado de salud, se suma que los criterios diagnósticos e indicaciones de tratamiento farmacológico no se basan en evidencias sólidas. Estas recomendaciones se han visto además modificadas en los últimos años en virtud de consensos profesionales, con grandes posibilidades de sobretratamiento y riesgo de efectos indeseables para la salud. Por ello es imprescindible evaluar adecuadamente los criterios diagnósticos, informar de las dudas existentes e insistir en la importancia de las modificaciones de los hábitos saludables como la dieta y el ejercicio físico, así como reflexionar activamente sobre las ventajas e inconvenientes del tratamiento farmacológico

Cardiovascular risk factors, specifically arterial hypertension, hyperlipidemia and diabetes, represent a very important part in relation to the emerging problem of overdiagnosis and overtreatment in primary health care. The reasons that support this threat are diverse. Given its high prevalence and the fact that the intervention on them is not going to be reflected directly in the state of health, it is added that the diagnostic criteria and indications for pharmacological treatment are not based on solid evidence. These recommendations have also been modified in recent years by virtue of professional consensus, with great potential for overtreatment and risk of undesirable effects on health. Therefore, it is essential to adequately evaluate the diagnostic criteria, inform of existing doubts and insist on the importance of changes in healthy habits such as diet and physical exercise, as well as actively reflect on the advantages and disadvantages of pharmacological treatment

Sobrediagnóstico y sobretratamiento en el ámbito cardiovascular: factores de riesgo, no enfermedades.

Cardiovascular risk factors, specifically arterial hypertension, hyperlipidemia and diabetes, represent a very important part in relation to the emerging problem of overdiagnosis and overtreatment in primary health care. The reasons that support this threat are diverse. Given its high prevalence and the fact that the intervention on them is not going to be reflected directly in the state of health, it is added that the diagnostic criteria and indications for pharmacological treatment are not based on solid evidence. These recommendations have also been modified in recent years by virtue of professional consensus, with great potential for overtreatment and risk of undesirable effects on health. Therefore, it is essential to adequately evaluate the diagnostic criteria, inform of existing doubts and insist on the importance of changes in healthy habits such as diet and physical exercise, as well as actively reflect on the advantages and disadvantages of pharmacological treatment.

En relación con "Recursos bibliográficos para atención primaria en las bibliotecas virtuales de salud de las comunidades autónomas" / Statement by SemFYC on the access to scientific information by general practioners

No disponible

¿Qué pensamos los médicos de familia sobre la medicina basada en la evidencia? Un estudio con grupos focales / What do general practioners think about evidenced-based medicine? A study with focus groups

ObjetivoExplorar las actitudes de una muestra de médicos de familia (MF) hacia la medicina basada en la evidencia (MBE), su utilización y las barreras para su tratamiento en atención primaria (AP).DiseñoEstudio cualitativo mediante grupos focales.EmplazamientoComunidad Autónoma de Murcia, de enero-junio de 2007. Atención primaria.ParticipantesMédicos de familia con práctica clínica en AP del Servicio Murciano de Salud.MétodoDos grupos focales (con/sin formación previa en MBE). Mediante muestreo intencional se seleccionaron 19 MF entre los profesionales de AP. Las discusiones se registraron en vídeo y se transcribieron literalmente. Posteriormente se procedió a segmentar, a categorizar y a interpretar los discursos.ResultadosActitudes: la MBE es útil, permite reducir la variabilidad de la práctica clínica y disminuye la incertidumbre. Se concede gran importancia a la experiencia clínica y se muestra recelo ante el papel que las farmacéuticas y la administración sanitaria puedan tener en su difusión. Utilización: su empleo es aún escaso. Consultar a compañeros sigue siendo la principal fuente de información.ResultadosBarreras: las mayores dificultades identificadas son el escaso tiempo de que disponen, la falta de conocimientos y el idioma.ConclusionesAunque los MF muestran una actitud positiva hacia la MBE todavía son pocos los que reconocen utilizarla en consulta. El principal limitante identificado es la falta de tiempo en consulta derivada de una excesiva presión asistencial. Proponen, para aumentar su uso, mayor actividad formativa, incentivación de una adecuada praxis y reorganización de la labor asistencial(AU)

ObjectiveTo examine the attitudes of a sample of General Practitioners (GPs) towards Evidenced-Based Medicine (EBM) and its use and the obstacles to put into practice in Primary Care (PC).DesignQualitative study using Focus Groups (FG).SettingPrimary Care in the Autonomous Community of Murcia, Spain, January–June 2007.ParticipantsGPs with a clinical practice in PC in the Murcian Health Service.MethodTwo FG (with/without previous training in EBM). Using intentional sampling, 19 GPs were selected from PC professionals. The discussions were recorded on video and transcribed literally. The discussions were then, segmented, categorised and interpreted.ResultsAttitudes: EBM is useful, it helps to reduce variation in clinical practice and decreases uncertainty. Great importance is given to clinical experience and the role of the Pharmaceutical Industry and the Health Administration may have in its promotion is viewed with suspicion. Use: Its use is still limited. To consult with colleagues continues to be the main source of information. Obstacles: The major difficulties identified were the limited time it has been available, lack of experience and the language.ConclusionsAlthough GPs show a positive attitude towards EBM, there are still a few who recognise the use of consultation. The main limitation identified was lack of time in the clinic due to excessive pressure of care work. To increase its use, they proposed, more training activities, motivation by an appropriate process and reorganisation of their care work(AU)

[What do general practitioners think about evidenced-based medicine? A study with focus groups]. / ¿Qué pensamos los médicos de familia sobre la medicina basada en la evidencia? Un estudio con grupos focales.

OBJECTIVE: To examine the attitudes of a sample of General Practitioners (GPs) towards Evidenced-Based Medicine (EBM) and its use and the obstacles to put into practice in Primary Care (PC). DESIGN: Qualitative study using Focus Groups (FG). SETTING: Primary Care in the Autonomous Community of Murcia, Spain, January-June 2007. PARTICIPANTS: GPs with a clinical practice in PC in the Murcian Health Service. METHOD: Two FG (with/without previous training in EBM). Using intentional sampling, 19 GPs were selected from PC professionals. The discussions were recorded on video and transcribed literally. The discussions were then, segmented, categorised and interpreted. RESULTS: Attitudes: EBM is useful, it helps to reduce variation in clinical practice and decreases uncertainty. Great importance is given to clinical experience and the role of the Pharmaceutical Industry and the Health Administration may have in its promotion is viewed with suspicion. Use: Its use is still limited. To consult with colleagues continues to be the main source of information. Obstacles: The major difficulties identified were the limited time it has been available, lack of experience and the language. CONCLUSIONS: Although GPs show a positive attitude towards EBM, there are still a few who recognise the use of consultation. The main limitation identified was lack of time in the clinic due to excessive pressure of care work. To increase its use, they proposed, more training activities, motivation by an appropriate process and reorganisation of their care work.

Análisis de las alternativas terapéuticas del trastorno de pánico en atención primaria mediante un árbol de decisión / Tree decision analysis of the therapeutic alternatives for panic disorders in primary care

ObjetivoAnalizar las diferentes estrategias terapéuticas para el trastorno de pánico, de forma que se facilite la toma de decisiones conjunta entre el profesional sanitario de atención primaria y el paciente.DiseñoAnálisis cuantitativo por árbol de decisión.Fuentes de datosRevisión del período de 1990 a 2008 en Medline, Embase, librería Cochrane Plus y Tripdatabase. Términos utilizados: “panic disorder”, “psychotherapy” y “drug therapy”.Selección de estudiosSumarios de pruebas, revisiones sistemáticas, metaanálisis y guías de práctica clínica.Extracción de datosa) Elaboración de un árbol de decisión con una única opción terapéutica; b) idéntico procedimiento con 2 opciones terapéuticas secuenciales, y c) análisis de sensibilidad para valorar la consistencia del modelo.ResultadosLa terapia cognitivo-conductual (TCC) obtiene la utilidad media esperada (UME) más elevada (UME = 0,58), seguida de los antidepresivos, inhibidores selectivos de la recaptación de serotonina (ISRS) (UME = 0,53) y de los antidepresivos tricíclicos (UME = 0,44). La secuencia TCC seguida de ISRS es la que obtiene una UME más alta (0,62). EL análisis de sensibilidad indica que el modelo no es suficientemente consistente..(AU)

AimsTo analyse the different therapeutic alternatives for Panic Disorders to make it easier to make collaborative treatment decisions between patients and doctors in a Primary Care setting.DesignQuantitative analysis by a decision tree.Data SourcesTime period reviewed; 1990–2008 in Med-line, Embase, Cochrane-plus Library and Tripdatabase. Terms used “panic disorder”, “psychotherapy” and “drug therapy”.MethodsI) A decision tree was prepared with only one therapeutic option in each arm; II) The same procedure with two sequential therapeutic options; III) Sensitivity analysis to test the robustness of the model.Study selectionEvidence summary, systematic reviews, meta-analysis and clinical guidelines.ResultsCognitive-Behavioural Therapy (CBT) obtains the highest usefulness (UME=0.58), followed by the Selective serotonin reuptake inhibitors (SSRI) (UME=0.53) and by the tricyclic antidepressants (UME=0.44). CBT followed by SSRI is the therapeutic sequence with the highest usefulness (0.62). The sensitivity analysis suggests the model is not robust enough.ConclusionsThe CBT in monotherapy or followed by SSRI in a sequential strategy would be the options with the highest usefulness. The results are not robust enough because they can clearly vary with changes in the most important variables in a reasonable range(AU9

[Tree decision analysis of the therapeutic alternatives for Panic Disorders in Primary Care]. / Análisis de las alternativas terapéuticas del trastorno de pánico en atención primaria mediante un árbol de decisión.

AIMS: To analyse the different therapeutic alternatives for Panic Disorders to make it easier to make collaborative treatment decisions between patients and doctors in a Primary Care setting. DESIGN: Quantitative analysis by a decision tree. DATA SOURCES: Time period reviewed; 1990-2008 in Med-line, Embase, Cochrane-plus Library and Tripdatabase. Terms used "panic disorder", "psychotherapy" and "drug therapy". METHODS: I) A decision tree was prepared with only one therapeutic option in each arm; II) The same procedure with two sequential therapeutic options; III) Sensitivity analysis to test the robustness of the model. STUDY SELECTION: Evidence summary, systematic reviews, meta-analysis and clinical guidelines. RESULTS: Cognitive-Behavioural Therapy (CBT) obtains the highest usefulness (UME=0.58), followed by the Selective serotonin reuptake inhibitors (SSRI) (UME=0.53) and by the tricyclic antidepressants (UME=0.44). CBT followed by SSRI is the therapeutic sequence with the highest usefulness (0.62). The sensitivity analysis suggests the model is not robust enough. CONCLUSIONS: The CBT in monotherapy or followed by SSRI in a sequential strategy would be the options with the highest usefulness. The results are not robust enough because they can clearly vary with changes in the most important variables in a reasonable range.