Request for HIV serology in primary care: A survey of medical and nursing professionals. / Solicitud de serologías de VIH en atención primaria: encuesta a profesionales de Medicina y de Enfermería.

INTRODUCTION: In the Community of Madrid there is 42.7% late HIV diagnosis. Primary care is the gateway to the health system and the frequency of serological tests requested by these professionals is unknown. The objectives were to establish the frequency of requests for HIV serology by medical and nursing primary care professionals in the Community of Madrid and the factors associated with these requests. METHOD: An 'on-line' survey was conducted, asking professionals who participated in the evaluation study of strategies to promote early diagnosis of HIV in primary care in the Community of Madrid (ESTVIH) about the number of HIV-serology tests requested in the last 12 months. The association between HIV-serology requesting and the sociodemographic and clinical practice characteristics of the professionals was quantified using adjusted odds ratios (aOR) according to logistic regression. RESULTS: 264 surveys (59.5% physicians). Eighty-two point two percent of medical and 18.7% of nursing professionals reported requesting at least one HIV-serology in the last 12 months (median: 15 and 2 HIV-serology request, respectively). The doctors associated the request with: being male (aOR: 2.95; 95% CI: 0.82-10.56), being trained in pre-post HIV test counselling (aOR: 2.42; 95% CI: 0.84-6.93) and the nurses with: age (<50 years; aOR: 2.75; 95% CI: 0.97-7.75), and number of years working in primary care (>13 years; aOR: 3.02; 95% CI: 1.07-8.52). CONCLUSION: It is necessary to promote HIV testing and training in pre-post HIV test counselling for medical and nursing professionals in primary care centres.

A feasibility study for 3 strategies promoting HIV testing in primary health care in Madrid, Spain (ESTVIH project).

RATIONALE AND OBJECTIVES: Late diagnosis of HIV infection is a public health problem. Framed by the international guidelines for improving HIV testing, in 2014, the Spanish Ministry of Health published a guide of recommendations to promote early diagnosis of HIV in health care settings. In the Community of Madrid, in order to implement these recommendations, we defined 3 new HIV testing strategies in primary health care. The objectives of this study were to know the interest of professionals and the acceptability for patients towards these strategies. METHODS: We performed a quasi-experimental study to assess the feasibility of the implementation of new strategies (indicator condition, risk based, and universal offer) to promote early detection of HIV infection in the framework of the ESTVIH project. The centres participating in this project were randomly chosen among centres located in the health areas with the highest incidence of HIV infection. The feasibility was assessed in 6 centres. We considered outcomes by strategy in relation to the participation of professionals (family physician and nursing) and patients. RESULTS: Overall, 56.9% of eligible professionals agreed to take part in the study; however, the percentage of professionals who recruited patients was 25.9%. This percentage was higher in the indicator condition strategy (47.2%, versus 18.5% in the universal offer and 14.3% in the risk-based strategy, P-value < 0.05). The test uptake percentage was greater than 80%, and there were no statistically significant differences between strategies. CONCLUSION: Different strategies promoting HIV testing in primary care had different acceptability among professionals and similar among patients. At the end of the ESTVIH project, these results will be complemented with others related to the contribution of each strategy to improving the early diagnosis of HIV infection.

[The Madrid autonomous community epidemiological bulletin. A survey on its dissemination and opinion thereof on among primary care physicians for the year 2000]. / Boletín epidemiológico de la Comunidad de Madrid: encuesta sobre su difusión y percepción entre los médicos de atención primaria en el año 2000.

BACKGROUND: The Autonomous Community of Madrid Epidemiological Bulletin is the main communications link between epidemiological monitoring system and health care professionals. The purpose of this study is that of ascertaining the dissemination and opinion of this Autonomous Community of Madrid Epidemiological Bulletin among primary care physicians for the purpose of adapting this publication to its readers' interests. METHOD: A telephone survey among primary care physicians in the Autonomous Community of Madrid, asking how often they read the Bulletin, the interest and usefulness of the information included in it. The sample size was estimated at 346 physicians. A two-stage sampling process was carried out-by cluster sampling in the first stage, randomly selecting 125 health care centers and 2.7 physicians per center, 17% being primary care team coordinators. A comparison is made of the results among physicians and coordinators by means of the Chi-square and Fisher's Exact Test method, with Epi-Info v.6. RESULTS: A total of 305 surveys were conducted (245 physicians and 60 coordinators). There was an awareness of the existence of the Autonomous Community of Madrid Epidemiological Bulletin on the part of 91.5% (CI 95%: 88.1-94.8), and 27.2% (CI 95%: 21.9-32.5) were familiar with more than 50% of the last issues published. A total of 92.4% (CI 95%: 89.4-95.8) considered the Bulletin to be interesting or highly interesting, grading its usefulness an average of 3.5 on a maximum scale of 5. Of the permanent sections, the most highly-valued was Epidemic Outbreaks, those reports related to meningococcal infection, tuberculosis and HIV/AIDS being the most highly-valued. CONCLUSIONS: The Autonomous Community of Madrid Epidemiological Bulletin is a publication which, although not widely-known by the primary care physicians in the Community, is well-valued when it is read, thus being a useful feedback tool within the Epidemiological Monitoring System.

Solicitud de serologías de VIH en atención primaria: encuesta a profesionales de Medicina y de Enfermería / Request for HIV serology in primary care: A survey of medical and nursing professionals

Introducción: En la Comunidad de Madrid existe un 42,7% de retraso diagnóstico de VIH. La atención primaria es la puerta de entrada al sistema sanitario y se desconoce la frecuencia de serologías solicitadas por estos profesionales. Los objetivos fueron conocer la frecuencia y factores asociados a la solicitud de serologías de VIH por profesionales de medicina y de enfermería de atención primaria de la Comunidad de Madrid. Método: Mediante encuesta on-line, se preguntó por la solicitud de serologías para VIH en los últimos 12 meses, a profesionales que participaron en el estudio de evaluación de estrategias de diagnóstico precoz de VIH en consultas de atención primaria de la Comunidad de Madrid (ESTVIH). La asociación entre la solicitud de serologías y las características sociodemográficas y de práctica clínica de los profesionales se cuantificó mediante odds ratio ajustadas (ORa) según regresión logística. Resultados: Se obtuvieron 264 encuestas (59,5% medicina). El 82,2% de profesionales medicina y el 18,7% de enfermería refirieron haber solicitado alguna serología de VIH en los últimos 12 meses (mediana de 15 y 2 serologías solicitadas, respectivamente). En medicina esta petición se asoció con sexo masculino (ORa: 2,95; IC95%: 0,82-10,56) y estar entrenado para dar consejo pre-post prueba de VIH (ORa: 2,42; IC95%: 0,84-6,93); en enfermería se asoció con edad (<50años; ORa: 2,75; IC95%: 0,97-7,75) y tiempo trabajado en atención primaria (>13años; ORa: 3,02; IC95%: 1,07-8,52). Conclusión: Es necesario promover la solicitud de pruebas de VIH y el entrenamiento pre-post prueba de VIH en profesionales de medicina y enfermería de atención primaria

Introduction: In the Community of Madrid there is 42.7% late HIV diagnosis. Primary care is the gateway to the health system and the frequency of serological tests requested by these professionals is unknown. The objectives were to establish the frequency of requests for HIV serology by medical and nursing primary care professionals in the Community of Madrid and the factors associated with these requests. Method: An 'on-line' survey was conducted, asking professionals who participated in the evaluation study of strategies to promote early diagnosis of HIV in primary care in the Community of Madrid (ESTVIH) about the number of HIV-serology tests requested in the last 12 months. The association between HIV-serology requesting and the sociodemographic and clinical practice characteristics of the professionals was quantified using adjusted odds ratios (aOR) according to logistic regression. Results: 264 surveys (59.5% physicians). Eighty-two point two percent of medical and 18.7% of nursing professionals reported requesting at least one HIV-serology in the last 12 months (median: 15 and 2 HIV-serology request, respectively). The doctors associated the request with: being male (aOR: 2.95; 95% CI: 0.82-10.56), being trained in pre-post HIV test counselling (aOR: 2.42; 95% CI: 0.84-6.93) and the nurses with: age (<50 years; aOR: 2.75; 95% CI: 0.97-7.75), and number of years working in primary care (>13 years; aOR: 3.02; 95% CI: 1.07-8.52). Conclusion: It is necessary to promote HIV testing and training in pre-post HIV test counselling for medical and nursing professionals in primary care centres

Accidentes percutáneos con riesgo biológico, producidos por dispositivos de seguridad en la Comunidad de Madrid / Percutaneous injuries with biological risk caused by security devices in Madrid Community

Desde la implantación en 2006, de procedimientos seguros y un Sistema de Vigilancia de Accidentes Biológicos en el ámbito sanitario de la Comunidad de Madrid, se viene observando un aumento de los accidentes percutáneos relacionados con la utilización de Dispositivos de Seguridad. Con la finalidad de estudiar los factores contribuyentes a la producción de accidentes con estos nuevos dispositivos, se realiza un estudio descriptivo longitudinal prospectivo de los accidentes notificados a lo largo de 6 meses (2010-2011). Se incluyen 378 accidentes, el 86% afectó a mujeres, siendo la tasa de incidencia en enfermería de 14,3 y entre facultativos de 3,1 (accidentes por mil). Las agujas subcutáneas fueron las más implicadas (25,7%). En el 6,6% de los accidentes se había inactivado intencionadamente su mecanismo de seguridad y solo un 2,6% podría imputarse a un fallo del dispositivo. Entre los factores externos que han podido contribuir destacan "apremio de tiempo/ritmo de trabajo elevado" (46,5%) y "realizar la maniobra con posturas incómodas" (31,5%). Las intervenciones para prevenir Accidentes Biológicos deben ser específicas para cada categoría profesional y área de trabajo. Se debe seguir apostando por la introducción de Dispositivos de Seguridad, identificar los factores contribuyentes e implementar acciones individualizadas que minimicen los riesgos (AU)

Since the implementation in 2006 of security procedures and a surveillance system of biological accidents in Madrid public health services, an increase of percutaneus accidents related to the use of safety devices has been observed. With the purpose of studying the external factors to the production of accidents with these new devices, there is realized a prospective, longitudinal and descriptive study of the accidents happened throughout six months (2010-2011). 378 accidents are included, 86% happened in women, the incidence rate being 14.3 accidents per thousand in nurses, and 3.1 in doctors. Subcutaneous needles were the most implied (25.7%). In 6.6% of accidents, the safety mechanisms had been intentionally deactivated, and only 2.6% could be attributed to device failure. External contributing factors include "time pressure/ high work rate" (46.5%) and "to realize the process in inconvenient positions" (31.5%). The interventions to prevent Biological Accidents must be specific in each professional category and area of work. It is necessary to continue with the introduction of Safety devices, to identify factors that are related and to implement individualized actions that minimize the risks (AU)

Boletín epidemiológico de la Comunidad de Madrid: encuesta sobre su difusión y percepción entre los médicos de atención primaria en el año 2000 / The autonomous Community of Madrid epidemiological bulletin. A survey regarding its dissemination and opinion thereof on among primary care physicians for the year 2000

Fundamento:. El objetivo es conocer la difusión y percepción del Boletín Epidemiológico de la Comunidad de Madrid (BECAM) entre los médicos de atención primaria, con el fin de adaptar la publicación al interés de sus lectores. Método: Encuesta telefónica entre los médicos de primaria de la Comunidad de Madrid, preguntando por la frecuencia de lectura, interés y utilidad de la información contenida El tamaño muestral se estimó en 346 médicos. Se realizó un muestreo bietápico por conglomerados en la primera etapa, con selección aleatoria de 125 centros de salud y 2,7 médicos por centro, siendo el 17 per cent coordinadores de equipo. Se comparan los resultados entre médicos y coordinadores mediante Chi-cuadrado y test exacto de Fisher, con Epi-Info v.6. Resultados: Se realizó un total de 305 entrevistas: 245 médicos y 60 coordinadores. Sabían de la existencia del BECAM el 91,5 per cent (IC 95 per cent: 88,1-94,8), y el 27,2 per cent (IC 95 per cent: 21,9-32,5) conocía más del 50 per cent de los números editados durante el año. El 92,4 per cent (IC 95 per cent: 89,4-95,8) lo consideraba interesante o muy interesante, puntuando con una media de 3,5 sobre 5 su utilidad. De las secciones fijas, la mejor valorada es Brotes Epidémicos, y de los informes, los relacionados con enfermedad meningocócia, tuberculosis y VIH/Sida. Conclusiones: El BECAM es una publicación que, aunque no es conocida ampliamente entre los médicos de primaria de nuestra Comunidad, cuando se lee es bien valorada; siendo así un instrumento útil de retroalimentación en la Red de Vigilancia Epidemiológico (AU)

Background: The Autonomous Community of Madrid Epidemiological Bulletin is the main communications link between epidemiological monitoring system and health care professionals. The purpose of this study is that of ascertaining the dissemination and opinion of this Autonomous Community of Madrid Epidemiological Bulletin among primary care physicians for the purpose of adapting this publication to its readers’ interests. Method: A telephone survey among primary care physicians in the Autonomous Community of Madrid, asking how often they read the Bulletin, the interest and usefulness of the information included in it. The sample size was estimated at 346 physicians. A two-stage sampling process was carried out - by cluster sampling in the first stage, randomly selecting 125 health care centers and 2.7 physicians per center, 17% being primary care team coordinators. A comparison is made of the results among physicians and coordinators by means of the Chi-square and Fisher’s Exact Test method, with Epi-Info v.6. Results: A total of 305 surveys were conducted (245 physicians and 60 coordinators). There was an awareness of the existence of the Autonomous Community of Madrid Epidemiological Bulletin on the part of 91.5% (CI 95%: 88.1-94.8), and 27.2% (CI 95%: 21.9-32.5) were familiar with more than 50% of the last issues published. A total of 92.4% (CI 95%: 89.4-95.8) considered the Bulletin to be interesting or highly interesting, grading its usefulness an average of 3.5 on a maximum scale of 5. Of the permanent sections, the most highly-valued was Epidemic Outbreaks, those reports related to meningococcal infection, tuberculosis and HIV/AIDS being the most highly-valued. Conclusions: The Autonomous Community of Madrid Epidemiological Bulletin is a publication which, although not widely-known by the primary care physicians in the Community, is well-valued when it is read, thus being a useful feedback tool within the Epidemiological Monitoring System (AU)