Atencion Primaria最新文献

Population health management (PHM) is a people-centred, data-driven and proactive approach to improving the health and well-being of a defined population, considering the differences within that population and their social determinants of health. By using quantitative and qualitative data insights, PHM helps primary care providers identify population cohorts with similar needs or 'at risk' of a given negative outcome/s. This enables primary care providers to address their needs in a targeted, tailored, proactive and holistic way through coordination with other care levels and sectors. PHM can be summarized conceptually in a cycle of five steps: defining and identifying the population; health assessment and segmentation; risk stratification and impactibility; tailored service delivery; and evaluation and improvement. The relationship between primary health care (PHC) and PHM is that of a virtuous circle. PHM helps make PHC more effective and many elements of a strong PHC-oriented model of care are essential for effective PHM.

Objective: To characterise patients with heart failure (HF) in Primary Health Care (PHC) and describe their socio-demographic and clinical characteristics and pharmacological treatment.

Design: Descriptive cohort study. SITE: Information System for the Development of Research in Primary Care (SIDIAP), which captures information from the electronic health records of PHC of the Catalan Institute of Health (approximately 80% of the Catalan population).

Participants: Adults with an active diagnosis of HF between 2018 and 2022.

Main measurements: Sociodemographic and anthropometric variables, left ventricular ejection fraction (LVEF), New York Heart Association (NYHA), laboratory data, comorbidities, exposure to drugs for HF and other pathologies.

Results: 75,769 individuals were included; 22.7% with HF with reduced LVEF (HFrEF), 26.2% with preserved LVEF (HfpEF) and 51.2% with non-specific HF. The HfrEF group consisted mostly of men (59.5%), with a mean age of 74.8 years, and the others of women (58.8% and 54.6%, aged 78.7 and 80.6 years, respectively). LVEF was recorded in 20.3% and NYHA in 43.9% of patients. In terms of treatment, 75.3% of people with HfrEF were receiving renin-angiotensin system (RAS) drugs, 75.9% beta-blockers, 42.1% mineralocorticoid receptor antagonists, 33.6% sodium-glucose cotransporter type 2 inhibitors and 62.8% diuretics. 63% with HfpEF were receiving RAS and 68% diuretics. 61.8% with unspecified HF were receiving RAS and 67.5% diuretics.

Conclusions: We analysed the population with HF in PHC in Catalonia. We highlight a low registry of cardiac function, LVEF and NYHA. The frequency of drug use for HF was different between populations and differed from the recommendations.

Objectives: To assess the influence of burnout in family physicians on their score on the EQA index.

Design: Observational study. SITE: Study conducted in the primary care centers of the Terrassa Health Consortium, in Vallès Occidental, Catalonia.

Participants: Primary care physicians with a basic care unit were included. Of the 107 family doctors working in the 8 primary care centers of the Terrassa Health Consortium, 73 professionals participated.

Interventions: A self-administered survey was carried out with demographic and occupational elements such as age, gender, length of service at the work center, the MBI and the last self-reported EQA value belonging to the year 2023.

Main measures: Sociodemographic variables were analysed; years of experience and clinical variables such as the EQA, the Maslach test and its dimensions emotional exhaustion, depersonalisation and personal fulfilment. The Maslach Burnout Inventory test was administered. The level of statistical significance considered was 5%.

Results: Seventy-threefamily doctors took the Maslach test, 54 (74%) had burnout, of which 21.9% (16) were severe. A statistically significant relationship was found between burnout and EQA (P=.023) and between emotional exhaustion and EQA (P=.013) in the mild and severe categories (P=.003).

Conclusions: Family physicians with burnout have a lower EQA value, which is not associated with age, sex or years of experience, but with the emotional exhaustion suffered.

The small intestine bacterial overgrowth (SIBO) is a clinical disorder resulting from colonization of the small intestine by an excessive number of microorganisms or by unusual microorganisms. When they are methane producers it is called intestinal methanogen overgroth (IMO). Known risk factors are congenital or acquired anatomical alterations, motility alterations, some systemic and autoimmune diseases, those that cause alterations in biliopancreatic secretions, hypochlorhydria and some drugs. It causes abdominal pain and distension, bloating, diarrhea, nausea, and weight loss, which can occur in different diseases or with intestinal malabsorption. In IMO there may be constipation. Suggestive analytical data may be iron deficiency, anemia, deficiency of fat-soluble vitamins or B₁₂. The breath test with detection of exhaled H₂ is the most accessible technique, but requires rigorous performance and interpretation. The central treatment is oral antibiotics, rifaximin of choice, but they are empirical and should only be prescribed in the event of high clinical suspicion.

Objective: Studies evaluating urine culture requests in our country have highlighted a high rate of requests that fall outside the indications specified in clinical guidelines. We evaluated the current degree of inadequacy in the request of urine cultures and how this influences the therapeutic decisions of general practitioners.

Design: Cross-sectional descriptive study.

Setting: Three primary care centres in Tarragona area.

Participants: Urine culture requests from the adult population≥18 years old, received at the Microbiology Service of the reference hospital in 2022. All requests were made in primary care settings.

Main measures: The collected variables included sociodemographic data, urinary tract infection (UTI) symptoms at the time of the urine culture request, comorbidities, reason for the request (including diagnosis), type of urine culture, therapeutic approach before and after receiving the result, and the urine culture result.

Results: A total of 461 urine cultures were reviewed: 152 men (mean age 64.1 years) and 309 women (mean age 57 years). Of the urine cultures analyzed, 17.4% were for cystitis (22% in women), 2.4% for pyelonephritis, 1.3% for complicated UTIs, and 1.5% for asymptomatic bacteriuria. In 10.6%, they were for recurrent UTIs; in 9.6%, post-treatment. In 55.5% of cases, general practitioners continued without antibiotic treatment, regardless of urine culture results. The reason to request was unknown in 18.9%. Antibiotic changes occurred in 5.6%.

Conclusions: There is still a high rate of urine culture over-requesting in primary care, with 20% of cultures being ordered for otherwise uncomplicated UTIs. While the methodology of the project does not allow for causal analysis, it provides a detailed description of clinical practices in primary care.

Objective: To analyze the categories of risk and vulnerability based on the experience of health professionals who attended SARS-CoV-2.

Design: Exploratory research. It was developed in different phases during 2020-2021, using concurrent mixed methods and pursuing multiple objectives. This article reports findings from a qualitative section, derived from the analysis of a subsample of participants.

Setting: First-level medical units in rural areas of five states in Mexico.

Participants: Thirty-two health care professionals were included: doctors, nurses and health promoters.

Methods: Three emergent categories were inferentially analyzed based on some constructivist grounded theory assumptions: a) harm reduction strategies used, b) perception of own vulnerability to SARS-CoV-2 and c) impact on personal life.

Results: Perceptions of risk and vulnerability are two interdependent domains constructed from lived experience of health care professionals, meanings were developed as negative attributes were socially assigned: the cause of the infection was unknown, but it was a dangerous virus that caused the deaths of colleagues. A new risk culture for COVID-19 was constructed.

Conclusions: Subjective perceptions of risk perception and vulnerability correspond with objective perceptions and opportunities to implement coping strategies and risk reduction, including at the family level. To support health professionals in the face of future health emergencies, it is necessary to guarantee them job security.