[Expanding the portfolio of laboratory services in primary care does not increase the cost]. / Ampliar la cartera de servicio de laboratorio en Atención Primaria no incrementa el gasto.

INTRODUCTION: Our health care system gives crucial importance to Primary Care, since it is the first step in medical care. The family doctor becomes the filter of the diseases that they attend to and direct the patients to the different services according to their needs. Therefore, a very important role is granted that conflicts with the limitation in access to diagnostic tests. However, in reality it appears that the Primary Care professionals have limitations in order to access complementary tests. MATERIAL AND METHOD: After the publication of a list of accessible laboratory tests for Primary Care, the use of these tests was evaluated without any type of limitation, except for the adequacy of the tests to the diagnosis, as happens in the hospital during 6months, measuring the number of determinations and the relative units of value used. A comparison was made with a previous period and with the activity developed. RESULTS: After 6months of follow-up and with equal care activity, the use of laboratory diagnostic tests decreased by 24%, and the relative value units decreased by 10%. CONCLUSIONS: Access to the portfolio of laboratory services for Primary Care does not translate into an increase in spending, while sending a positive message about the role that primary health care should play in our health system.

Ampliar la cartera de servicio de laboratorio en Atención Primaria no incrementa el gasto / Expanding the portfolio of laboratory services in primary care does not increase the cost

INTRODUCCIÓN: Nuestro sistema sanitario le da a la Atención Primaria una importancia crucial al situarla como primer escalón en la asistencia sanitaria. El médico de familia se convierte en el filtro de la patología que atiende y dirige a los pacientes a los diferentes servicios según las necesidades de los mismos. Por tanto, se otorga un papel muy importante que choca con la limitación en el acceso a las pruebas diagnósticas. Sin embargo, en la realidad nos encontramos con limitaciones de los profesionales de Atención Primaria para el acceso a pruebas complementarias. MATERIAL Y MÉTODO: A raíz de la publicación de un catálogo de pruebas de laboratorio accesibles para atención primaria se evaluó el consumo de estas pruebas sin ningún tipo de limitación salvo las de una adecuación de las pruebas al diagnóstico, al igual que ocurre en el hospital durante 6meses, midiendo en número de determinaciones y las unidades relativas de valor consumidas. Se comparó con un período previo y con la actividad desarrollada. RESULTADOS: Tras 6 meses de seguimiento y con una actividad asistencial igual, el consumo de pruebas diagnósticas de laboratorio disminuyó un 24% y las unidades relativas de valor bajaron un 10%. CONCLUSIONES: El acceso a la cartera de servicios de laboratorio por parte de atención primaria no se traduce en un incremento del gasto, a la vez que manda un mensaje positivo sobre el papel que la atención primaria debe desempeñar en nuestro sistema de salud

INTRODUCTION: Our health care system gives crucial importance to Primary Care, since it is the first step in medical care. The family doctor becomes the filter of the diseases that they attend to and direct the patients to the different services according to their needs. Therefore, a very important role is granted that conflicts with the limitation in access to diagnostic tests. However, in reality it appears that the Primary Care professionals have limitations in order to access complementary tests. MATERIAL AND METHOD: After the publication of a list of accessible laboratory tests for Primary Care, the use of these tests was evaluated without any type of limitation, except for the adequacy of the tests to the diagnosis, as happens in the hospital during 6 months, measuring the number of determinations and the relative units of value used. A comparison was made with a previous period and with the activity developed. RESULTS: After 6months of follow-up and with equal care activity, the use of laboratory diagnostic tests decreased by 24%, and the relative value units decreased by 10%. CONCLUSIONS: Access to the portfolio of laboratory services for Primary Care does not translate into an increase in spending, while sending a positive message about the role that primary health care should play in our health system

[Influence of an observer in the haemolysis produced during the extraction of blood samples in primary care]. / Influencia de un observador en la hemólisis producida durante las extracciones de muestras sanguíneas en atención primaria.

OBJECTIVE: To check whether an intervention based on direct observation and complementary information to nurses helps reduce haemolysis when drawing blood specimens. MATERIAL AND METHODS: Random sampling study in primary care centres in the serrania de Málaga health management area, using a cross-sectional, longitudinal pre- and post-intervention design. The study period was from August 2012 to January 2015. The level of free haemoglobin was measured by direct spectrophotometry in the specimens extracted. It was then checked whether the intervention influenced the level of haemolysis, and if this was maintained over time. RESULTS: The mean haemolysis measured pre-intervention was 17%, and after intervention it was 6.1%. A year later and under the same conditions, the frequency of haemolysis was measured again the samples analysed, and the percentage was 9% These results are low when compared to the level obtained pre-intervention, but are higher when compared to the levels obtained immediately after the intervention. The transport and analysis conditions were the same. CONCLUSIONS: An intervention based on a direct and informative observation in the process of collecting blood samples contributes significantly to reduce the level of haemolysis. This effect is maintained in time. This intervention needs to be repeated to maintain its effectiveness. Audits and continuing education programs are useful for quality assurance procedures, and maintain the level of care needed for a good quality of care.

Influencia de un observador en la hemólisis producida durante las extracciones de muestras sanguíneas en atención primaria / Influence of an observer in the haemolysis produced during the extraction of blood samples in primary care

Objetivo. Comprobar si una intervención basada en una observación directa, acompañada de información al personal de enfermería encargado de la extracción de sangre, contribuye a disminuir la hemólisis. Material y métodos. Muestreo aleatorio ponderado en centros de atención primaria del área de gestión sanitaria de la serranía de Málaga y diseño de estudio longitudinal transversal pre y postintervención. Período de estudio: desde agosto de 2012 a enero de 2015. Se determinó el nivel de hemoglobina libre en las muestras extraídas por espectrofotometría directa, y si la intervención realizada influía en el nivel de hemólisis y si esta se mantenía en el tiempo. Resultados. Partiendo de un porcentaje de muestras hemolizadas del 17% preintervención, tras la misma se obtuvo una reducción hasta de 6,1%. Un año más tarde, y en las mismas condiciones, se volvió a medir el porcentaje de hemólisis en las muestras analizadas y el porcentaje se situó en el 9%. Este resultado es superior al obtenido tras la intervención, pero inferior al obtenido antes de la misma. Las condiciones del transporte y del análisis fueron las mismas. Conclusiones. Una intervención basada en la observación directa e informativa en el proceso de extracción de muestras sanguíneas contribuye de manera significativa a reducir el nivel de hemólisis. Este efecto se mantiene en el tiempo, aunque es necesario repetirlo para mantener la efectividad del mismo. Las auditorías y los programas de formación continuada son útiles para asegurar la calidad de los procedimientos y mantener el nivel de atención necesario para un buena calidad asistencial (AU)

Objective. To check whether an intervention based on direct observation and complementary information to nurses helps reduce haemolysis when drawing blood specimens. Material and methods. Random sampling study in primary care centres in the serrania de Málaga health management area, using a cross-sectional, longitudinal pre- and post-intervention design. The study period was from August 2012 to January 2015. The level of free haemoglobin was measured by direct spectrophotometry in the specimens extracted. It was then checked whether the intervention influenced the level of haemolysis, and if this was maintained over time. Results. The mean haemolysis measured pre-intervention was 17%, and after intervention it was 6.1%. A year later and under the same conditions, the frequency of haemolysis was measured again the samples analysed, and the percentage was 9% These results are low when compared to the level obtained pre-intervention, but are higher when compared to the levels obtained immediately after the intervention. The transport and analysis conditions were the same. Conclusions. An intervention based on a direct and informative observation in the process of collecting blood samples contributes significantly to reduce the level of haemolysis. This effect is maintained in time. This intervention needs to be repeated to maintain its effectiveness. Audits and continuing education programs are useful for quality assurance procedures, and maintain the level of care needed for a good quality of care (AU)