Eficiencia de la actividad de enfermería en consultorios del médico y la enfermera de la familia / Efficiency of Nursing Activity in Family Doctor and Nurse's Offices

RESUMEN Introducción: En Cuba, la enfermera de la familia se distingue por tener múltiples áreas de trabajo y para cada una son necesarios diferentes recursos. Se desconoce si es mucho o poco el recurso consumido de cara a las actividades realizadas. Objetivo: Caracterizar la eficiencia de la actividad de enfermería en consultorios del médico y enfermera de la familia. Métodos: Estudio descriptivo transversal con la totalidad de consultorios de tres policlínicos del municipio 10 de Octubre. Se resolvió un modelo de análisis envolvente de datos de maximización de resultados y rendimientos constantes a escala con seis indicadores de resultados y cuatro de recursos. Resultados: La media de la eficiencia estuvo entre 86,66 por ciento y 95,63 por ciento. Para mejorar la eficiencia se deben alcanzar los siguientes valores promedios de cumplimiento del seguimiento: atención materno infantil, entre 85,32 por ciento y 88,58 por ciento; para cada paciente con enfermedades crónicas, entre 8,99 por ciento y 41,67 por ciento; para pacientes con enfermedades transmisibles, entre 34,87 por ciento y 54,55 por ciento; para el adulto mayor, entre 65,70 por ciento y 90,23 por ciento; y para las citologías vaginales, entre 91,97 por ciento y 162,72 por ciento. Además, reducir en promedio el gasto en material gastable, entre 11,25 por ciento y 47,28 por ciento; en medicamentos, entre 15,31 por ciento y 107,22 por ciento; y en recursos humanos entre 15,01 por ciento y 32,72 por ciento. Conclusiones: Se determinaron niveles altos de eficiencia técnica pura para la actividad de enfermería en los consultorios, aunque se verificó la presencia de unidades ineficientes. Existen unidades con ineficiencia estructuralmente determinada, y para solucionarla es necesario un análisis del consumo de recursos(AU)

ABSTRACT Introduction: In Cuba, the family nurse is distinguished by having multiple work areas, and for each one different resources are necessary. It is not known if the resource consumed is too much or too little for the activities carried out. Objective: To characterize the efficiency of the nursing activity in family doctor and nurse's offices. Methods: Cross-sectional, descriptive study carried out with all the family medical offices of three outpatient polyclinics in Diez de Octubre Municipality. An analysis model was solved that involved maximization of results and constant returns to scale data with six results indicators and four resource indicators. Results: The average efficiency was between 86.66 percent and 95.63 percent. In order to improve efficiency, the following average values of monitoring compliance must be achieved: mother and child care, between 85.32 percent and 88.58 percent; for each patient with chronic diseases, between 8.99 percent and 41.67 percent; for patients with communicable diseases, between 34.87 percent and 54.55 percent; for the elderlies, between 65.70 percent and 90.23 percent; and for vaginal Pap smear tests, between 91.97 percent and 162.72 percent. In addition, there was an average reduction on consumption of materials that can be used, between 11.25 percent and 47.28 percent; in medicines, between 15.31 percent and 107.22 percent; and in human resources, between 15.01 percent and 32.72 percent. Conclusions: High levels of pure technical efficiency were determined for the nursing activity in the outpatient polyclinics, although the presence of inefficient units was verified. There are units with structurally determined inefficiency, and to solve it, an analysis of the consumption of resources is necessary(AU)

Embodied disruption: "Sorting out" gender and nonconformity in the doctor's office.

Among LGBTQ people, those who are gender nonconforming (GNC) may be at heightened risk of both discrimination and underutilization of healthcare-yet little is known about what happens during healthcare encounters to compel GNC individuals to continue or avoid seeking future care. This study qualitatively examines the healthcare experiences of a racially diverse sample of 34 adult LGBTQ cis women, transgender men, and nonbinary individuals in a metropolitan area of the United States who do not conform to dominant biomedical schemas of sex and gender. GNC individuals experience embodied disruption in medical settings when patients are mis/recognized; providers respond to disruption in ways that further distress patients. Broadly, participants report similar experiences across racial and gender identities, but patients manage disruption somewhat differently depending on their embodied positions to gender norms. This study contributes to literature of stress, stigma, and sex, gender, and sexuality within medicine by illuminating how stigmatizing healthcare interactions deter LGBTQ individuals from seeking healthcare. Findings point to the importance of considering both structural factors and embodied visibility in future research addressing how stigma and discrimination manifest within health settings to disadvantage LGBTQ groups.

The Impact of Vaccine Refusal on Physician Office Visits During the Subsequent 12 Months.

We hypothesized that families who are nonadherent to the routine vaccination schedule (RVS) present less frequently for physician visits. We conducted a retrospective chart review to compare the number of visits made over the subsequent 12-month period by families that refused the RVS versus those who were adherent. Subjects were aged 0 to 4 years, enrolled to Keller Army Hospital, and had a diagnosis indicating the RVS was refused. Age-matched controls, who were adherent to the RVS, were randomly chosen for each case. Subjects made significantly more total visits than CASES: 7 (interquartile range [IQR] = 1-20) versus 6 (IQR = 2-17), p = 0.0049. When each visit type was compared independently, there was no significant difference in the number of acute (p = 0.494) or emergency department (p = 0.077) visits between groups. However, subjects who refused to follow the RVS made significantly fewer routine care visits during the 1-year follow-up period compared to those that adhered to the RVS (p < 0.001).

Hábitos de consumo en la sala de espera / Waiting room intake habits

Introducción: el consumo de alimentos en la sala de espera es un hábito que podría estar relacionado con el incremento en la incidencia de obesidad infantil. Objetivo: analizar el consumo de alimentos y su uso como premio en niños que asisten a un consultorio pediátrico explorando y su relación con el estado nutricional. Población, material y método: se realizó un estudio cuantitativo, descriptivo y transversal en 94 niños entre 1 y 15 años, que asisten a un consultorio pediátrico de la Ciudad Autónoma de Buenos Aires (CABA), República Argentina. Se evaluó el tipo de alimentos/bebidas llevado a la sala de espera, su utilización como premio y la intención de compra luego de la consulta. Se valoró el estado nutricional (IMC/Edad) con Anthro Plus, 2009. El análisis estadístico incluyó t de Student y prueba de Wilcoxon. Resultados: el 46,8% de los padres trajo alimentos a la sala de espera. Alfajores/chocolates (n=10), seguidos de galletitas saladas (n=8) y, entre las bebidas, las gaseosas y jugos (n=6) ocuparon el segundo lugar. El 56,4% de los cuidadores tenía pensado comprar algo de comer al salir de la consulta. Se encontró asociación significativa entre los puntajes z de IMC/Edad y quienes trajeron algún alimento a la sala de espera (p:0,02). El 46,8% de los niños presentó sobrepeso u obesidad. Conclusión: una elevada cantidad de padres utilizó el consumo de alimentos en la consulta, la mayoría de tipo chatarra. Este hábito se asoció significativamente con la presencia de sobrepeso y obesidad en los niños afectados por lo que podría indagarse sistemáticamente en la consulta. (AU)

Introduction: food and drink intake and its use as a reward are common habits in medical waiting rooms in the context of an increase in overweight and obesity prevalence worldwide. Objective: to analyze the habit of food intake, its type and use as a reward and the relation with the nutritional status in children who attend a pediatric outpatient clinic. Population and method: descriptive study, in a sample of 94 children ages 1 to 15 who attended a pediatric outpatient clinic in Buenos Aires, Argentina. We assessed the type of food/ beverage taken to the waiting room and the intention of buying one after the visit. The nutritional status was measured (BMI/AGE) using Anthro Plus software, 2009. Student´s t Test and Wilcoxon test were used for statistical analysis. Results: 46,8% of parents had brought something to eat or drink to the waiting room. Sweets were most frequent, followed by salty snacks and among beverages we found soft drinks and commercial juices. 56,4% of caretakers had the intention of buying something to eat or drink as a reward after the visit. There was a significant correlation between z scores of BMI/AGE and food intake in the waiting room (p= 0,02). 46.8% of the sample was either overweight or obese. Conclusion: many parents use food as a reward, mainly junk food. This habit had a significant correlation with overweight and obesity in affected children and could be assessed systematically in pediatric visits. (AU)

Out-of-hospital births in the United States 2009-2014.

OBJECTIVE: To evaluate recent trends of out-of-hospital births in the US from 2009 to 2014. METHODS: We accessed data for all live births occurring in the US from the National Vital Statistics System, Natality Data Files for 2009-2014 through the interactive data tool, VitalStats. RESULTS: Out-of-hospital (OOH) births in the US increased from 2009 to 2014 by 80.2% from 32,596 to 58,743 (0.79%-1.47% of all live births). Home births (HB) increased by 77.3% and births in freestanding birthing centers (FBC) increased by 79.6%. In 2014, 63.8% of OOH births were HB, 30.7% were in FBC, and 5.5% were in other places, physicians offices, or clinics. The majority of women who had an OOH birth in 2014 were non-Hispanic White (82.3%). About in one in 47 non-Hispanic White women had an OOH in 2014, up from 1 in 87 in 2009. Women with a HB were older compared to hospital births (age ≥35: 21.5% vs. 15.4%), had a higher live birth order(≥5: 18.9% vs. 4.9%), 3.48% had infants <2500 g and 4.66% delivered <37 weeks' gestation. 4.34% of HB were patients with prior cesarean deliveries, 1.6% were breech, and 0.81% were twins. CONCLUSIONS: Since 2004 the number of women delivered out of the hospital, at home and in freestanding birthing centers has significantly increased in the US making it the country with the most out of hospital births among all developed countries. The root cause of the increase in planned OOH births should be identified and addressed by the medical community.

Economic impact of converting an interventional pain medicine physician office-based practice into a provider-based ambulatory pain practice.

BACKGROUND: One consequence of the shifting economic health care landscape is the growing trend of physician employment and practice acquisition by hospitals. These acquired practices are often converted into hospital- or provider-based clinics. This designation brings the increased services of the hospital, the accreditation of the hospital, and a new billing structure verses the private clinic (the combination of the facility and professional fee billing). One potential concern with moving to a provider-based designation is that this new structure might make the practice less competitive in a marketplace that may still be dominated by private physician office-based practices. The aim of the current study was to evaluate the impact of the provider-based/hospital fee structure on clinical volume. OBJECTIVE: Determine the effect of transition to a hospital- or provider-based practice setting (with concomitant cost implications) on patient volume in the current practice milieu. SETTING:   Community hospital-based academic interventional pain medicine practice. STUDY DESIGN: Economic analysis of effect of change in price structure on clinical volumes. METHODS: The current study evaluates the effect of a change in designation with price implications on the demand for clinical services that accompany the transition to a hospital-based practice setting from a physician office setting in an academic community hospital. RESULTS: Clinical volumes of both procedures and clinic volumes increased in a mature practice setting following transition to a provider-based designation and the accompanying facility and professional fee structure. Following transition to a provider-based designation clinic visits were increased 24% while procedural volume demand did not change. LIMITATIONS: Single practice entity and single geographic location in southeastern United States. CONCLUSIONS: The conversion to a hospital- or provider-based setting does not negatively impact clinical volume and referrals to community-based pain medicine practice. These results imply that factors other than price are a driver of patient choice.  

Difference of antihypertensive prescribing between office- and hospital-based clinics in Taiwan.

BACKGROUND: The geographical location and medical facility may affect the pattern of antihypertensive prescriptions. Information regarding the correlation between the prescription and health care faculties in different geographical locations was lacking. OBJECTIVE: The aim of this study was to compare differences in the prescribing of antihypertensives between hospital-based clinics (hospital arm) and office-based clinics (office arm) in different geographical locations in Taiwan. METHOD: We collected data from the National Health Insurance database of Taiwan to carry out a population-based, retrospective cohort analysis of 3,218,794 patients newly diagnosed with hypertension in the period January 1, 1997 to December 31, 2004. Eligible participants were classified into either of two groups based on the level of health care faculty: hospital arm and office arm. The covariates composed of age, gender, antihypertensive regimens, urbanization status, comorbidity, and Charlson comorbidity index. RESULTS: There were 2,028,784 cases (63.0 %) for the hospital arm and 1,190,010 (37 %) for the office arm. In the hospital-based arm, there were 168,933 (8.3 %) patients diagnosed with diabetes mellitus, 166,110 (8.2 %) patients diagnosed with coronary artery disease, 147,465 (7.3 %) patients diagnosed with cerebrovascular accident, 86,866 (4.3 %) patients diagnosed with chronic kidney disease, 74,525 (3.7 %) patients diagnosed with benign prostatic hyperplasia, 55,517 (2.7 %) patients diagnosed with congestive heart failure. The all comorbidities in the hospital arm had significantly higher proportions than those in the office arm (p < 0.001). The Charlson comorbidity index in the hospital arm was higher than that in the office arm (p < 0.001). Physicians who practiced in the office arm prescribed polytherapy less often than those in the hospital arm (OR = 0.68, 95 % CI: 0.67-0.68). For overall urbanization status, the adjusted OR of polytherapy prescriptions in the aging city (OR = 1.08, 95 % CI: 1.05-1.12) was higher than other type cities. The highest urbanization-specific OR of polytherapy prescriptions was observed for highly urbanized city in the hospital arm (OR = 1.20, 95 % CI: 1.18-1.23) and aging city in the office arm (OR = 1.42, 95 % CI: 1.21-1.67). In the both arm, patients with lower CCI showed decreased risk of polytherapy prescription. CONCLUSION: The antihypertensive prescriptions in the clinical practices were different between the hospital arm and the office arm in the different health care, comorbidity, and urbanization status. During the study period, the proportion of antihypertensive polytherapy had declined.

Factores que influyen en el estado de salud de la población del consultorio médico 33, Policlínico I Manzanillo-Granma, Enero-Diciembre 2009 / Factors that influence in the population´s health stage in the medical practice # 33: Manzanillo-Granma: January- December 2009

Teniendo en cuenta que el estado de salud de la población está determinado por muchos factores con tendencias crecientes, se realizó un estudio descriptivo. Con el objetivo de determinar los factores que influyen en el estado de salud de la población del consultorio número 33 del Policlínico I de Manzanillo, Consejo Popular 13, en el período comprendido de enero-diciembre del 2009, para lo cual se utilizaron las historias clínicas individual, familiar, análisis de la situación de salud y encuesta a la población, lo cual nos permitió identificar los factores del ambiente físico, psicosocial y biológicos que incidieron en el estado de salud de la población, obteniéndose como resultado por cientos elevados de familias con consumo de agua no hervida y con manipulación inadecuada de la misma, así como alta incidencia de mosquitos afectando a toda la población, predominio de un funcionamiento familiar moderado y disfuncional, la cultura sanitaria se comportó con tendencia a ser regular, así como las características psicosociales y la satisfacción de las necesidades básicas. Los grupos etéreos de 35-39 años alcanzaron un mayor valor en la población, con comportamiento similar en ambos sexos. La hipertensión arterial y el asma bronquial tuvieron valores significativos en las enfermedades crónicas no trasmisibles. El grupo I y III presentaron un mayor número de casos. El sedentarismo y el tabaquismo alcanzaron un alto valor entre los factores de riesgo individual. El adulto mayor vulnerable predominó sobre el frágil en la clasificación geriátrica(AU)

Taking into account that the population's health stage is determined by several factors with increased tendency it was performed a descriptive research with the objective to determine the factors that influenced in the population's heath stage in medical practice # 33 from the Policlinic #1 Manzanillo, 13 popular council in the period from January of December 2008. For that purpose the individual familiar medical records as well as the analysis of health situation populational surveys what allowed us to identify the physical environmental, psychological and biological factors that influenced in the population's health stage. Obtaining as results high percents of families drinking no boiled water and inadequate manifestation of it. As well as the high incidence of mosquitoes affecting the whole population. Prevailing of a moderated familiar and non functional performance. The health culture behaved with a tendency to be regular as well as the psychosocial characteristics and the satisfaction of the basic needs. The etharian groups of 35 to 39 years reached a higher value in the population with a similar behavior for both sexes. Hypertension and bronchial asthma had similar values in the non transmitted chronic diseases. Group I AND II presented a high amount of cases. The sedentarism and tobacco pollution reached a high value among the factors of individual risk. The vulnerable elder prevailed over the fragile in geriatric classification(EU)

Office-based treatment in opioid dependence: a critical survey of prescription practices for opioid maintenance medications and concomitant benzodiazepines in Vienna, Austria.

BACKGROUND: The success of maintenance treatment for opioid dependence in office-based settings is influenced by the extent of treatment coverage, the availability of effective medications and the capacity of general practitioners to prescribe opioids in adequate doses with a minimum of concomitant benzodiazepine prescriptions. METHODS: This study compares prescriptions for opioid maintenance and concomitant benzodiazepine from Viennese physicians in 2002 and 2005 using health insurance prescription records (n = 30,309). RESULTS: Between 2002 and 2005, the number of patients prescribed opioids more than doubled (ratio 1:2.3), slow-release oral morphine replaced methadone as the most frequently prescribed medication (57.1 vs. 23.4%; buprenorphine 19.5%), and the ratio of benzodiazepine to opioid prescriptions significantly declined (0.76:1 vs. 0.42:1). Many patients were prescribed concomitant benzodiazepines (27%), in some cases from a secondary physician. CONCLUSION: Increased utilization of opioid medications in office-based settings will facilitate better treatment coverage. However, safeguards are necessary to ensure that general practitioners have sufficient training and support to safely and appropriately provide treatment, including the reduction in concomitant benzodiazepine use.

Voces y cuerpos: el consultorio médico radial como espacio discursivo en el Perú / Voices and bodies: radio consulting as an arena for discourse in Peru

O consultório radiofônico apresenta-se como un espaço virtual de encontro entre médico e paciente. Assim sendo, o que é desvelado nele, o corpo, converte-se em um território reconstruído pelos distintos discursos enunciados a partir do lugar que se ocupa neste espaço virtual: o lugar do médico e do paciente. Neste trabalho descrevemos as diferentes estratégias discursivas utilizadas na construçäo do corpo no tempo e no espaço e a construçäo de múltiplos corpos no espaço radiofônico. Säo abordados dois aspectos importantes: o processo de publicizaçäo dos espaços íntimos como uma característica da sociedade atual e o consultório como espaço onde discursos sobre o corpo, provenientes de lugares distintos, se encontram e se fundem, se misturam ou se opöem e se mostram divergentes.