Atencion Primaria Practica最新文献

Objective

To determine the frequency of classification error and its associated factors during telephone triage in a home care service.

Design

Cross-sectional observational study.

Site

Regulatory center of a home care service. Medellin Colombia.

Participants

Health care staff of the regulatory center.

Interventions

The records of the telephone calls answered by the assistance personnel during January to June of the year 2020 were evaluated.

Main measurements

Frequency of classification error and characteristics of the telephone call and of the assistance personnel. The factors associated with the classification error were analyzed using a model of generalized estimating equations (GEE).

Results

260 telephone records were analyzed, of which 15.4% (n = 40) presented a classification error, 53.7% of them against the patient (undertriage). Regarding the care staff (n = 58), the median age was 26.5 years (IQR 23-31) and 69% (n = 40) were women. A higher percentage of classification error was found in services requested by people other than the patient (75%; n = 30) and in calls made during the night (42.5%; n = 17). In the multivariate analysis, an association was observed between the patient's complaint and classification error (OR: 2.42, CI95% 1.06-5.53).

Conclusions

Undertriage can generate delays and increase the risk of complications in primary care. It is important to implement training strategies for 4 healthcare personnel to avoid errors during telephone triage and generate a positive impact on patients and the quality of care.

Objective

To determine if poor oral health and frailty are risk factors for community-acquired pneumonia in adults.

Design

Case-control study in a population ≥ 18 years.

Place

The cases of pneumonia admitted to the Hospital of Mataró were matched with controls of the same sex and age (± 5 years) who had not had pneumonia in the last 12 months and who were visiting admitted relatives.

Participants

During two years (June 1, 2018 to May 31, 2020) 102 cases of patients admitted with CAP and 102 controls were identified and recruited.

Interventions

All participants gave their signed consent to participate in the study, sociodemographic, anthropometric variables, comorbidities, functional capacity, toxic habits, vaccinations and swallowing disorders were collected.

Main Measurements

Oral health was assessed with the General Oral Health Assessment Index, frailty with the FRAIL test, and quality of life with the EUROQ-5D test.

Results

Bivariate analysis: pneumonia is associated with an oral health index ≤ 57 (OR 4.63), being frail (OR 18.5), dental visit in the last 3 months (OR 0.42), daily tooth brushing (OR 0.26) and having some personal care problem (OR 3.29). The multivariate analysis shows an independent association between the appearance of pneumonia and poor oral health (OR 6.16), being a former smoker (OR 5.65) and being frail (OR 49.7).

Conclusions

Being frail and having poor oral health are independent risk factors for CAP.

We present the case of glioma in both optic nerves in a patient with a medical history of neurofibromatosis type 1. The patient presented constant bilateral retro-ocular pain refractory to analgesic treatment and blurred vision. On examination, Lisch nodules were seen on the surface of the iris and pale optic nerves in the fundus. Nuclear magnetic resonance revealed a large suprasellar mass separate from the pituitary glands.

Objective

To describe the adoption, scope, and effectiveness of the Telehealth Service launched by health insurance in the context of the COVID-19 pandemic in Argentina.

Design

Descriptive cross-sectional study.

Setting

Outpatient teleconsultation for adults, pediatrics and dentistry following a primary care approach.

Participants

18,300 patients (5.7% of insured population) were attended during the first year of the health emergency by COVID 19.

Main measurements

number of teleconsultations, patients’ characteristics, geographical distribution, waiting and attention times, completed and canceled appointments, reasons for consultation, and resources.

Results

A total of 132,142 teleconsultations were analyzed. In the first quarter of 2021, the interannual variation was 515% compared to 2020. The population served consisted of adults of average age of 32 years, (59% female). In pediatrics, the average age was 5.3 years (44% female). The geographical scope was national, most teleconsultations were in Buenos Aires (50%), Federal Capital (18%), and Córdoba (10%). The most common health problems were related to COVID-19, prescription refills, rhinopharyngitis, and gastroenteritis. Average attention times ranged from 6-7 minutes and waiting room time was 3 to 6 minutes. There were 86% of successful consultations and 7-11% of canceled consultations due to connection issues. On average, patients ranked the satisfaction with the service with 4.5 points on a scale out of 5. The team consisted of 97 doctors with a generalist training profile.

Conclusions

The teleconsultations facilitated accessibility to primary healthcare and prompt resolution of queries with comprehensive national coverage. More research is needed to strengthen telemedicine access and safety policies.