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Pérez Hernández FJ, Goya Arteaga L, González Siverio JL, Llada Marrero RP. [Diagnostic agreement of primary care and minor surgery in a basic health area]. Semergen 2020; 47:144-150. [PMID: 33268265 DOI: 10.1016/j.semerg.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/17/2020] [Accepted: 09/13/2020] [Indexed: 11/25/2022]
Abstract
AIM Minor Surgery (MS) is an ever-increasing programmed activity in Primary Health Care Centres (PHC). The aim of this study is to establish the clinical and histopathology diagnostic agreement between PHC and MS and evaluating the efficacy of this activity. METHODS AND MATERIALS A retrospective, observational, and reliability study was performed. A total of 234 patient specimens were sent to Histopathology between January 2014 and December 2018 in basic health area of San Benito-La Laguna, Santa Cruz de Tenerife. Of these, 203 specimens met criteria, with 31 being excluded due to death or absence of diagnosis. Sociodemographic and diagnostic variables were analysed, and 10 possible diagnoses were grouped into 3 categories according to their nature. Cohen kappa coefficient was used as the main evaluation measure. RESULTS The majority of specimens were obtained from women (51.2%), and the mean age was 52.82±17.82 years. The most frequently referred lesion was the epidermoid cyst (20.2-21.67%). A clinical-pathological agreement of 60% was obtained in Minor Surgery, with a specificity of 98.3% and a sensitivity of 61.9%. In Primary Care agreement was 36.1%, with a specificity of 98.4% and a sensitivity of 42.8%. Infectious lesions represented the largest concordance difference obtained, with 27% less in Primary Care compared to Minor Surgery. CONCLUSIONS Minor Surgery is an effective support in the initial diagnosis of lesions referred for evaluation at Primary Care. However, it is necessary to implement improvements in diagnostic efficacy of Primary Care.
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Affiliation(s)
- F J Pérez Hernández
- Unidad de Atención Familiar y Comunitaria «Tenerife-Norte», Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, España; Medicina Familiar y Comunitaria, CAP La Esperanza, El Rosario, Gerencia de Atención Primaria de Tenerife, Santa Cruz de Tenerife, España.
| | - L Goya Arteaga
- Unidad de Atención Familiar y Comunitaria «Tenerife-Norte», Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, España; Medicina Familiar y Comunitaria, CAP La Esperanza, El Rosario, Gerencia de Atención Primaria de Tenerife, Santa Cruz de Tenerife, España
| | - J L González Siverio
- Unidad de Atención Familiar y Comunitaria «Tenerife-Norte», Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, España; Enfermería Familiar y Comunitaria, CAP San Benito-La Laguna, San Cristóbal de La Laguna, Gerencia de Atención Primaria de Tenerife, Santa Cruz de Tenerife, España
| | - R P Llada Marrero
- Unidad de Atención Familiar y Comunitaria «Tenerife-Norte», Hospital Universitario de Canarias, San Cristóbal de la Laguna, Santa Cruz de Tenerife, España; Medicina Familiar y Comunitaria, CAP La Esperanza, El Rosario, Gerencia de Atención Primaria de Tenerife, Santa Cruz de Tenerife, España
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Romero-Rodríguez E, Pérula de Torres LÁ, Ruiz Moral R, Fernández García JÁ, Parras Rejano JM, Roldán Villalobos A, Camarelles Guillem F. Training health providers to address unhealthy alcohol use in primary care: a cross-sectional, multicenter study. BMC Health Serv Res 2020; 20:877. [PMID: 32938457 PMCID: PMC7493933 DOI: 10.1186/s12913-020-05730-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 09/10/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Health professionals' training is a key element to address unhealthy alcohol use in Primary Care (PC). Education about alcohol use can be effective in improving PC provider's knowledge and skills addressing alcohol-related problems. The aim of the study was to evaluate the training of health professionals to address unhealthy alcohol use in PC. METHODS An observational, descriptive, cross-sectional, multicenter study was performed. LOCATION PC centres of the Spanish National Health System (SNHS). PARTICIPANTS Family physicians, residents and nurses completed an online questionnaire that inquired about their training (none, basic, medium or advanced), knowledge and preventive practices aimed at reducing unhealthy alcohol use. The study population was recruited via random sampling, stratified by the regions of the SNHS's PC centre, and by email invitation to members of two Spanish scientific societies of Family Medicine. RESULTS A total of 1760 professionals participated in the study. Sixty-seven percent (95% CI: 67.5-71.8) reported not having received specific training to address unhealthy alcohol use, 30% (95% CI: 27.4-31.7) reported having received basic training, and 3% (95% CI: 2.3-4.0) medium/advanced training. The training received was greater in younger providers (p < 0.001) who participated in the PAPPS (Preventive Activities and Health Promotion Programme) (p < 0.001). Higher percentages of providers with intermediate or advanced training reported performing screening for unhealthy alcohol use (p < 0.001), clinical assessment of alcohol consumption (p < 0.001), counselling of patients to reduce their alcohol intake (p < 0.001) or to abstain, in the cases of pregnant women and drivers (p < 0.001). CONCLUSION Our study reveals a low level of training among Spanish PC providers to address unhealthy alcohol use. A higher percentage of screening, clinical assessment and counselling interventions aimed at reducing unhealthy alcohol use was reported by health professionals with an intermediate or advanced level of training.
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Affiliation(s)
- Esperanza Romero-Rodríguez
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - Luis Ángel Pérula de Torres
- Teaching Unit of Family and Community Medicine of Cordoba, Program of Preventive Activities and Health Promotion -PAPPS- (semFYC), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Roger Ruiz Moral
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
| | - José Ángel Fernández García
- Villarrubia Health Center, Andalusian Health Service, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Juan Manuel Parras Rejano
- Villanueva del Rey Health Center, Andalusian Health Service, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Ana Roldán Villalobos
- Teaching Unit of Family and Community Medicine of Cordoba, Carlos Castilla Del Pino Health Center, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | | | - Collaborative Group Alco-AP
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Córdoba, Spain
- Teaching Unit of Family and Community Medicine of Cordoba, Program of Preventive Activities and Health Promotion -PAPPS- (semFYC), Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Villarrubia Health Center, Andalusian Health Service, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Villanueva del Rey Health Center, Andalusian Health Service, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Teaching Unit of Family and Community Medicine of Cordoba, Carlos Castilla Del Pino Health Center, Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
- Infanta Mercedes Health Center, Madrid Health Service, PAPPS Health Education Group (semFYC), Madrid, Spain
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Vich Pérez P, Vicente Mata B, Prieto Checa I, Brusint Olivares B, Sevilla Machuca I, Sánchez López O. [Detecting doubts and training needs of family doctors of a health centre]. Semergen 2018; 45:434-440. [PMID: 30594501 DOI: 10.1016/j.semerg.2018.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 11/14/2018] [Accepted: 11/22/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To detect doubts and training needs in an urban health and family doctor training centre during the usual practice. MATERIAL AND METHODS A cross-sectional descriptive study was conducted for one month in an urban health centre in Madrid. Family doctors were interviewed after their daily clinics about the doubts they had identified, choosing two of them. Unresolved questions were grouped by subject and according to the current taxonomies. A teaching program was then developed to tackle them. RESULTS Out of a total 21 physicians of the centre, 19 attended 10,678 patients during the period. The doubt detection rate was 0.44 doubts for every 10 patients attended. Of the 384 questions chosen, 83.34% were clinical and 16.66% were non-clinical. Just over half (51.2%) of these were still unresolved 15days later the consultation event. The main methods for their resolution were using the scientific bases on the internet (mainly PubMed, UpToDate and Clinical Practice Guidelines; 38%), followed by consultation with other colleagues (34.9%). CONCLUSIONS Most of the doubts generated during clinics were clinical, although there is a significant burden of bureaucratic questions. More than half of the doubts are not resolved during the consultation or within the following 15days. The scientific databases on the internet are the main sources of information, although consulting other colleagues was often used as well. Additional time for dealing with patients and enhanced access to solve complex questions should be available to improve the success rate.
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Affiliation(s)
- P Vich Pérez
- Medicina de Familia y Medicina Interna, CS Los Alpes, Madrid, España.
| | | | | | | | | | - O Sánchez López
- Medicina de Familia y Medicina del Deporte, CS Los Alpes, Madrid, España
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Jiang AJ, Eide MJ, Alexander GL, Altschuler A, Asgari MM, Geller AC, Fletcher SW, Halpern AC, Weinstock MA. Providers' Experiences with a Melanoma Web-Based Course: a Discussion on Barriers and Intentions. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:272-279. [PMID: 26391994 PMCID: PMC4803637 DOI: 10.1007/s13187-015-0910-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Primary care visits provide an opportunity for skin examinations with the potential to reduce melanoma mortality. The INFORMED (INternet curriculum FOR Melanoma Early Detection) Group developed a Web-based curriculum to improve primary care providers' (PCPs') skin cancer detection skills. This study details feedback obtained from participant focus groups, including the feasibility of implementing in other PCP practices. Practicing PCPs at Henry Ford Health System and Kaiser Permanente Northern California completed the curriculum. Feedback sessions were conducted with standardized questions focusing on four domains: (1) overall impressions of the curriculum, (2) recommendations for improvement, (3) current skin examination practices, and (4) suggestions for increasing skin screening by PCPs. Discussions at each site were audio recorded, transcribed verbatim, and de-identified. Providers (N = 54) had a positive impression of the Web-based curriculum, with suggestions to provide offline teaching aids and request assistance. Despite having improved confidence in diagnosing malignant lesions, many providers felt a lack of confidence in performing the screening and time constraints affected their current practices, as did institutional constraints. Providers intended to increase discussion with patients about skin cancer. The accessibility, effectiveness, and popularity of the curriculum indicate potential for implementation in the primary care setting. Participating providers noted that institutional barriers remain which must be addressed for successful dissemination and implementation.
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Affiliation(s)
- Angela J Jiang
- Stritch School of Medicine, Loyola University Chicago, 2160 1st Avenue, Maywood, IL, 60153, USA
| | - Melody J Eide
- Department of Dermatology, Henry Ford Hospital, 3031 W Grand Boulevard, Suite 800, Detroit, MI, 48202, USA.
- Department of Public Health Sciences, Henry Ford Hospital, One Ford Place, Detroit, MI, 48202, USA.
| | - Gwen L Alexander
- Department of Public Health Sciences, Henry Ford Hospital, One Ford Place, Detroit, MI, 48202, USA
| | - Andrea Altschuler
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Maryam M Asgari
- Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, USA
| | - Alan C Geller
- Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Ave, Kresge Building, Boston, MA, 02115, USA
| | - Suzanne W Fletcher
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
- , 208 Boulder Bluff, Chapel Hill, NC, 27516, USA
| | - Allan C Halpern
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, 16 East 60th Street, New York, NY, 10022, USA
| | - Martin A Weinstock
- Dermatoepidemiology Unit, Veterans Affairs Medical Center, 830 Chalkstone Avenue, Providence, RI, 02908, USA
- Department of Dermatology, Rhode Island Hospital, 593 Eddy Street, Providence, RI, 02903, USA
- Departments of Dermatology and Community Health, Brown University, Providence, RI, 02912, USA
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[Use of ineffective practices in Primary Health Care: professional opinions]. ACTA ACUST UNITED AC 2014; 29:220-8. [PMID: 24928717 DOI: 10.1016/j.cali.2014.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 04/10/2014] [Accepted: 04/11/2014] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To estimate the frequency of ineffective practices in Primary Health Care (PHC) based on the opinions of clinical professionals from the sector, and to assess the significance, implications and factors that may be contributing to their continuance. MATERIAL AND METHODS An on line survey of opinion from a convenience sample of 575 professionals who had published articles over the last years in Atención Primaria and Semergen medical journals. RESULTS A total of 212 professionals replied (37%). For 70.6% (95% confidence interval [CI] 64.5 to 73.3) the problem of ineffective practices is frequent or very frequent in PHC, and rate their importance with an average score of 7.3 (standard deviation [SD]=1.8) out of 10. The main consequences would be endangering the sustainability of the system (48.1%; 95% CI, 41.2 to 54.9) and harming patients (32.1%; 95% CI, 25.7 to 38.5). These ineffective practices are the result of the behaviour of the patients themselves (28%; 95% CI, 22.6 to 35.0) workload (26.4%; 95% CI, 20.3 to 32.5), and the lack of the continuous education (19.3%; 95% CI, 13.9 to 24.7). Clinical procedures of greatest misuse are the prescribing of antibiotics for certain infections, the frequency of cervical cancer screening, rigorous pharmacological monitoring of type 2 diabetes in patients over 65 years, the use of psychotropic drugs in the elderly, or the use of analgesics in patients with hypertension or renal failure. CONCLUSIONS The use of ineffective procedures in PHC is considered a very important issue that negatively affects many patients and their treatment, and possibly endangering the sustainability of the system and causing harm to patients.
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Goulart JM, Quigley EA, Dusza S, Jewell ST, Alexander G, Asgari MM, Eide MJ, Fletcher SW, Geller AC, Marghoob AA, Weinstock MA, Halpern AC. Skin cancer education for primary care physicians: a systematic review of published evaluated interventions. J Gen Intern Med 2011; 26:1027-35. [PMID: 21472502 PMCID: PMC3157536 DOI: 10.1007/s11606-011-1692-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Revised: 02/14/2011] [Accepted: 03/02/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Early detection of melanoma may provide an opportunity to positively impact melanoma mortality. Numerous skin cancer educational interventions have been developed for primary care physicians (PCPs) to improve diagnostic accuracy. Standardized training is also a prerequisite for formal testing of melanoma screening in the primary care setting. OBJECTIVE We conducted a systematic review to determine the extent of evaluated interventions designed to educate PCPs about skin cancer, including melanoma. DESIGN Relevant studies in the English language were identified through systemic searches performed in MEDLINE, EMBASE, BIOSIS, and Cochrane through December 2010. Supplementary information was obtained from corresponding authors of the included studies when necessary. APPROACH Studies eligible for inclusion formally evaluated skin cancer education interventions and were designed primarily for PCPs. Excluded studies lacked a specified training intervention, used decision-making software, focused solely on risk factor identification, or did not directly educate or assess participants. Twenty studies met the selection criteria. Data were extracted according to intervention content and delivery format, and study outcomes. KEY RESULTS All interventions included instructions about skin cancer diagnosis, but otherwise varied in content. Curricula utilized six distinct educational techniques, usually incorporating more than one. Intervention duration varied from 12 min to over 6 h. Eight of the 20 studies were randomized trials. Most studies (18/20, 90%) found a significant improvement in at least one of the following five outcome categories: knowledge, competence, confidence, diagnostic performance, or systems outcomes. Competence was most commonly measured; no study evaluated all categories. Variability in study design, interventions, and outcome measures prevented correlation of outcomes with intervention characteristics. CONCLUSIONS Despite the development of many isolated educational interventions, few have been tested rigorously or evaluated under sufficient standardized conditions to allow for quantitative comparison. Improved and rigorously tested skin cancer educational interventions for PCPs with outcome measures focusing on changes in performance are needed.
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Affiliation(s)
- Jacqueline M Goulart
- Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, NY 07920, USA
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Tello Bernabé M, Izquierdo-Palomares J, Aguado Arroyo O, Ferrer Arnedo C. El quién, cómo y dónde de la formación continuada de un área de salud. Semergen 2011. [DOI: 10.1016/j.semerg.2011.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sesiones docentes en Atención Primaria. Experiencia en los centros de un Área de Madrid. Aten Primaria 2011; 43:263-8. [DOI: 10.1016/j.aprim.2010.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Revised: 04/25/2010] [Accepted: 04/26/2010] [Indexed: 11/23/2022] Open
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