[Research in primary care?]

[Thematic analysis of Primary Care journals indexed in Journal Citation Reports: 2015-2019]

OBJECTIVE

Analyze the thematic lines of the articles and reviews published between 2015 and 2019 in the journals indexed in the "Primary Health Care" category of the Journal Citation Reports.

METHODS

Observational bibliometric study. The bibliographic records of the Web of Science were identified and the frequencies of appearance of the thematic descriptors and their co-occurrence in the documents included in the study were analyzed. In addition to the global analysis, the reviews, the most cited documents, those published in 2015, and those published in 2019 were analyzed separately. Descriptors were classified by thematic clusters using the Current Canadian Index scale and clinical publications were analyzed using the second edition of the International Classification of Primary Care.

RESULTS

A total of 16,444 descriptors were identified in the 7,453 documents analyzed. The most frequent descriptors focus on: diagnosis, prevalence, management, risks, care practice and the figure of the health professional. In the most cited documents, terms with specific themes were used: depression, intervention, satisfaction, quality, therapy, research-based practice. In 2019, there were a greater number of publications focused on epidemiology, clinic, research and provision of services. From a clinical point of view, studies on psychological and mental health problems, nervous system, social problems, palliative care and cancer increased in 2019.

CONCLUSIONS

The analysis carried out identifies the relevant thematic lines in primary care journals, highlighting the diagnosis and prevalence of diseases, the management of pathologies and their associated risks, as well as clinical practice and the figure of the health professional.

[Bibliometric map of research done in primary care in Spain during the period 2008-2012]

OBJECTIVE

To describe the Spanish scientific production of primary care during 2008-2012.

DESIGN

Observational study bibliometric.

SETTING

Spanish scientific production in primary care.

PARTICIPANTS

The study focused on publications indexed in Medline.

MAIN MEASUREMENTS

In each record was obtained journal, year of publication, first/last author, workplace and autonomous community. Later, articles were classified according to their content or areas of research. The impact factor was obtained from the basis of bibliometric analysis Journal Citation Reports.

RESULTS

Using search criteria, were selected 1,048 documents. The transiency rate was 62.6%. Production increased from 170 papers in 2008 to 291 in 2012. Most (65.7%) came from health centers, but we observed a significant increase (P=.01) of the articles from units or research institutes (5.9% in 2008, 12.0% in 2012). Of the total, 61.6% were classified as «clinical aspects», 22.5% were published in the journal Atención Primaria, 80.5% in journals with impact factor and 33.49% in foreign journals, being higher this proportion (P<.001) in units or research institutes (70.5% vs. 29.8%). In relation to population (articles/100.000 inhab.), the most productive communities were Cataluña (4.1), Castilla-La Mancha (3.6), Aragón (3.4) and Navarra (3.4).

CONCLUSIONS

In primary care publications there is great diversity in both research areas such as in journals where published. Most are from health centers, treat clinical aspects and published in Spanish journals. Differences in the volume of scientific production between regions are observed.

La investigación al alcance de los profesionales de Osakidetza: Programa de Investigación en Atención Primaria de Salud

Objetivo

Describir el proceso y resultados del Programa de Investigación en Atención Primaria de Salud 2010-2011, organizado por la Unidad de Investigación de Atención Primaria de Bizkaia.

Diseño

Estudio descriptivo.

Emplazamiento

Atención primaria del servicio público de salud Osakidetza.

Participantes

Un total de 107 profesionales que solicitaron participar entre los 4.338 médicos/as, enfermeros/as y personal administrativo a los que se difundió el programa.

Mediciones principales

Nivel de participación, clasificación de los temas de investigación, valoración del programa por los participantes, financiación de los proyectos generados y costes del programa.

Resultados

La proporción de profesionales que solicitaron participar en el programa fue de un 2,47%; IC 95% 2,41-2,88%. Se seleccionaron 28 de ellos y lo finalizaron 19. Los temas a investigar están mayoritariamente relacionados con los problemas de salud crónicos más frecuentes (32%) y la prevención y promoción de la salud (18%). Más del 90% de los participantes evaluó como buena o excelente la calidad del programa y la mitad lo consideró difícil o muy difícil. Se generaron 18 proyectos nuevos, de los que 12 obtuvieron financiación, con 16 ayudas, 10 del Departamento de Sanidad del Gobierno Vasco, 4 del Instituto de Salud Carlos III y 2 del Instituto Kronikgune, captando 500.000 € para dichos proyectos. Los costes totales del programa ascendieron a 198.327 €.

Conclusiones

Esta experiencia puede servir para otros interesados en el fomento de la investigación en atención primaria de salud (APS), ya que el programa ha logrado sus objetivos, es útil y productivo.

[The scientific entertainer in primary health care]

The scientific method is capable of being applied in primary care. In this article we defend the role of the "scientific entertainer "as strategic and necessary in achieving this goal. The task has to include playful and light-hearted content. We explore some words in English that may help us to understand the concept of "scientific entertainer" from a semantic point of view (showman, master of ceremonies, entrepreneur, go-between) also in Spanish language (counsellor, mediator, methodologist) and finally in Latin and Greek (tripalium, negotium, chronos, kairos). We define the clinical, manager or research health-worker who is skilled in primary care as a "primarylogist".

[Research and protection of personal data in Primary Care]

Research is one of the fundamental functions that have to be carried out in Primary Care. The clinical information stored in different records arising from medical care is a basic tool for this activity. The use of personal data for the purposes of research is legitimate according to our laws; however, this information must be treated confidentially at all times. Two alternatives are available for this. One is to obtain the informed consent of the patient, and the other is to dissociate the handling of the information. But in some situations, the compliance to legal demands when obtaining data for research is not easy, there being a series of obstacles which in many cases makes it impossible to carry out research. In this article, we will give guidance on how to access the information contained in records while respecting the rights of the patient and the current legislation.

[Concept maps as a tool for the diagnosis of rare diseases]

Rare diseases are a real public health problem for hospitals and also for primary care. We describe some metaphor-based diagnosis procedures, such as: "When you hear hoof beats don't always think horses, sometimes they could be zebras", or that one about the antiquarian who recognised a museum masterpiece while walking in the Rastro (Madrid). The "lightning diagnoses" by Skoda are an important historic record. T. Greenhalgh has tried to cover the gap between evidence based medicine and the intuitive diagnosis. We point out some clinical epidemiology rules in order to improve their early detection by family practitioners and paediatricians. In our opinion, the training in the diagnosis of rare diseases has to be different for primary care level and for hospital doctors. Concept maps are useful for diagnosis in primary care clinics.

[Documental review of community health promotion experiences in primary health care]

OBJECTIVE

Describe the community activities (CA) published or registered in health promotion networks in which Primary Health Care (PHC) has taken part.

DESIGN

Descriptive study, by documental review of experiences.

DATA SOURCE

articles, activities in exchange networks, presentations and funded projects. SELECTED EXPERIENCES: The AC included were those where PHC and the local community were involved in its inception, development and/or evaluation, but not solitary actions with no continuity.

DATA EXTRACTION

The following variables were collected: Source and year of the document; region; municipality; name and number of health centres involved; target population; objectives; involvement of the community, the health and the non-health sectors; theoretical perspective and evaluation methods.

RESULTS

A total of 472 activities were found that met criteria, involving 300 health centres in most of the autonomous regions. Of those, 71.8% were registered in networks, and 19.3% were registered in articles. The most frequent target populations were: the general population (22.2%), youth (18.2%) and parents (10.2%). More than half (58.2%) had one or more of the following objectives: to empower the community to choose healthy behaviours; transmit health information to the population, or encourage self-care. In 33.3% of the activities there were no other sectors involved besides Primary Care. Of the remainder, non-health sectors participated in 53.8%, civic bodies in 26.9%, and government administration in 24.2%.

CONCLUSIONS

Most of the CA are documented in networks and their presence is uneven by region. The involvement of sectors other than PHC in the activities identified is low.

[Promotion of research in primary care]

OBJECTIVE

To identify what can be done to promote research and development (R+D) in primary care. To find the main lines of primary care R+D in the Community of Valencia, Spain.

DESIGN

Qualitative research based on consensus group. Concretely, the Phillips technique, modified for the number attending, was employed.

SETTING

Primary care.

PARTICIPANTS

Twenty-four primary care professionals in the Community of Valencia (75% of 32 invited): physicians, pharmacists, teaching or research unit professionals, medical managers, and researcher-doctors leading primary care R+D projects.

MAIN MEASUREMENTS

Four questions were asked: concerning barriers to research, how to make it easier to take part in competitive R+D contests, how to disseminate results and what topics are of most interest today.

RESULTS

Problems identified were: lack of time, need for technical support, and need for day-schools and prizes to promote investigation. It was suggested that research should be given value in job contests, it should be made a requirement to finish training (MIR), funds for projects in health areas should be created and finance for emerging groups should be provided.

CONCLUSIONS

In summary, it was proposed to create research units in every department/area with professionals given time off to lead projects and with administrative support to gain resources. Doctors should be encouraged to take part by the recognition of research for job contests, in their professional careers and in productivity indicators.

[Organisational issues in implementing clinical trials in primary care]

OBJECTIVE

To identify health professionals concerns on the organisational issues of a randomised clinical trial.

DESIGN

A qualitative cross-sectional, descriptive study.

SETTING

Primary Care Area 11, Madrid, Spain.

PARTICIPANTS

Twenty-four doctors and nurses from 4 primary care teams.

METHOD

Three planning meetings with researchers. Design of an anonymous self-administered questionnaire to collect researchers' perceptions on design, method, and organisation during the implementation of a clinical trial.

RESULTS

The prestige of being involved in a multi-centre nationwide project, the training sessions offered, a primary care research topic, a working team model of doctor and nurse, and the support provided by team from the 11th Area, were the main organisational incentives. Lack of time, increased clinic workload, and methodological difficulties are discouraging issues. 79.2% (19/24) of the researchers returned the questionnaire. 94.7% (18/19) considered themselves highly motivated. 84.2% (16/19) of researchers, the time required to complete recruitment was reasonable. The 57.9% (13/19) spent 20-25 minutes collecting data at the interview. Cooperation between doctors and nurses had been effective for 68.4% (13/19) of researchers. 89.4% (17/18) considered that support from the Area 11 organisers was useful.

CONCLUSIONS

Organisational barriers for implementation are: complexity of data collection at the recruitment interview, design and methodological issues too unrealistic for a primary care setting, and lack of time and extra workload at consultations. The factors that make organisation easier are: having a high level of motivation, sharing workload with other professionals, and support provided by organisers of the trial.

[Research in primary care: 1994-2003]

OBJECTIVES

To analyse the characteristics of the original articles published in the journal Atención Primaria (Primary Care) during the last 10 years.

DESIGN

Literature study.

SETTING

Primary health care.

PARTICIPANTS

Original articles published in Atención Primaria between 1994 and 2003.

MAIN MEASUREMENTS

The professional category of the authors, whether it was a multidisciplinary or multicentred study, the autonomous community of origin, the topic, the type of study, and if it had a grant or financial assistance.

RESULTS

1229 articles have been reviewed. In 40.0% of them a family doctor is included in the authorship. 31.4% can be considered multidisciplinary and 20.5% multicentred. The Communities of Valencia, Madrid, Andalusia, and Catalonia took up 60% of the volume of publications. The most common topic is the provision and organisation of the health services (40.5%). Only 4.3% of the designs are experimental. A grant or financial aid is stated in 16.2% of the articles.

CONCLUSIONS

Although the situation as regards the previous years has not varied too much, some positive findings, such as the emergence of research groups, increasing presence of multicentre and multidisciplinary studies, better access to sources of finance, etc, suggest that we are in a process of improving the quality of research in primary care.

[Primary Care research: attitudes and hindrances perceived by our doctors]

OBJECTIVES

To discover how much research doctors in our area do; to describe their attitudes to research; and to evaluate the hindrances to developing research that they found.

DESIGN

Cross-sectional, descriptive study.

SETTING

Area 7 of Primary Care, Madrid.

PARTICIPANTS

Area 7 doctors.

MAIN MEASUREMENTS

An anonymous self-administered questionnaire was designed in order to gather the following information: age, gender, professional details, training in research methodology, research activity, questions from a previously validated questionnaire for finding attitudes towards research (scores from 0 to 80), and a question for assigning a value to 6 hindrances to research.

RESULTS

174 were returned (49.4% response). 65.9% of the doctors were women, with an average age of 43.23+/-7.33 years; and 55.5% were specialists in Family and Community Medicine. Over the last 5 years, 49.4% had published a scientific paper and 38% had given reports at congresses. The mean score on attitudes to research was 53.49+/-10.59. Hindrances to research were given in the following order, from greatest to least: case-load, lack of time, structural deficiencies, absence of multi-centred research lines, lack of incentives, lack of training, no motivation.

CONCLUSIONS

The research activity of our doctors is similar to that found in other studies. Attitude to research is no better than "acceptable." The main hindrances stated were: case-load and lack of time.