Communication with patients and the duration of family medicine consultations

Objective: To determine the distribution of consultation times, the factors that determine their length, and their relationship with a more participative, patient-centred consulting style. Design: Cross-sectional multicentre study. Location: Primary Healthcare Centres in Andalusia, Spain. Participants: A total of 119 tutors and family medicine physician residents. Principal measurements: Consultation length and communication with the patient were analysed using the CICCAA scale (Connect, Identify, Understand, Consent, Help) during 436 interviews in Primary Care. Results: The mean duration of consultations was 8.8 min (sd: 3.6). The consultation tended to be longer when the physician had a patient-centred approach (10.37 ± 4.19 min vs 7.54 ± 2.98 min; p = 0.001), and when there was joint decision-making (9.79 ± 3.96 min vs 7.73 ± 3.42 min: p = 0.001). In the multivariable model, longer consultations were associated with obtaining higher scores on the CICAA scale, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and a smaller number of daily visits (r2 = 0.32). There was no correlation between physician or patient gender, or problem type. Conclusion: A more patient centred medical profile, increased shared decision-making, a wider range of reasons for consultation, whether they came accompanied, in urban centres, and less professional pressure all seem to be associated with a longer consultation. Resumen: Objetivo: Conocer la distribución del tiempo de consulta, los factores que determinan su duración y su relación con un estilo de consulta participativo y más centrado en el paciente. Diseño: Estudio descriptivo multicéntrico. Emplazamiento: Centros de salud de Atención Primaria en Andalucía (España). Participantes: En total, 119 tutores y residentes de medicina de familia. Mediciones principales: Se analizó el tiempo de consulta y la comunicación con el paciente mediante la escala Conectar, Identificar y Comprender, Acordar y Ayudar (CICAA) en 436 entrevistas en Atención Primaria. Resultados: La duración media de las consultas fue de 8,8 min (DE: 3,86). La consulta fue más larga cuando el profesional tenía un perfil centrado en el paciente (10,37 ± 4,19 vs. 7,54 ± 2,98 min; p = 0,001) y existía toma de decisiones compartida (9,79 ± 3,96 vs. 7,73 ± 3,42 min; p = 0,001). En el modelo multivariable, una mayor duración de la consulta se relacionó con obtener mejores puntuaciones en la escala CICAA, un mayor número de motivos de consulta, presencia de acompañante, centros urbanos y un menor número de visitas diarias (r2 = 0,32). No hubo relación con el sexo del profesional, del paciente ni con el tipo de problema consultado. Conclusiones: Un perfil médico más centrado en el paciente, mayor toma de decisiones compartida, un mayor número de motivos de consulta, la presencia de acompañante, el ser centros de salud urbanos y una menor presión asistencial se muestran asociados a un mayor tiempo de consulta. Keywords: Time, Communication, Physician–patient relations, Primary health care, Patient-centred care, Palabras clave: Tiempo, Comunicación, Relaciones médico-paciente, Atención primaria de salud, Atención dirigida al pacient

Detection of violence against women in the family doctor clinic

Objectives. To find out the magnitude of violence against female partners among patients who visit their family doctor. To study frequency and acceptance of its investigation by the family doctor and to assess the effectiveness of a screening question on abuse. Design. Descriptive, cross-sectional study. Setting. Primary care, 4 samples from 2 urban health centres in Jaén, Spain. Participants. Who participated 170 women randomly selected from the female consulting population. Measurements. Interviews by means of the Bradley modified test and the anxiety and depression Goldberg scales. Perceived health, frequency of detection of domestic violence, by the family doctor, and female opinions were also studied. Results. During the last year, abuse against women was detected in 22.9% of the female population consulting their family doctor (95% confidence interval [95% CI], 16.6-29.2). Abused women had a worse perception of health (odds ratio [OR] =4.2; 95% CI, 1.02-17.5) and a higher probability of depression (OR=4.7; 95% CI, 1.8-12.5) independently from the rest of variables. The question "How are the things going with your partner?" as a screening of abuse does obtain a positive probability quotient of 6.23 (95% CI, 3.6-10.9), a specificity of 89% and a negative predictive value of 90%. Of those interviewed, 96.5% would not mind if their family doctor approached the couple's relationships, a situation that occurs in 24.7% of cases. Conclusions. Some degree of abuse was detected in almost a quarter of women who consult their family doctor. Family doctors do not usually ask about family and partner relationships and environment, although for almost all women it is well appreciated and the item has an increased likelihood ratio and high negative predictive value in detecting abuse.YesObjetivos. Conocer la magnitud de la violencia contra la mujer en la pareja entre las pacientes que acuden al médico de familia, estudiar la frecuencia y aceptación de su investigación por parte del médico de familia y evaluar la efectividad de una pregunta de cribado de maltrato. Diseño. Se trata de un estudio descriptivo y transversal. Ámbito. El estudio se realiza en atención primaria, en 4 cupos de 2 centros de salud urbanos de Jaén. Sujetos. Se seleccionaron aleatoriamente entre las consultantes 170 mujeres. Método. Se realizó entrevista mediante el test de Bradley modificado y las escalas de ansiedad y depresión de Goldberg. También se estudiaron la salud percibida, la frecuencia de detección del maltrato por el médico de familia y la opinión de las mujeres. Resultados. Durante el último año se detectó maltrato en el 22,9% de las consultantes (intervalo de confianza [IC] del 95%, 16,6-29,2). Las mujeres maltratadas presentan una peor salud percibida (odds ratio [OR] = 4,2; IC del 95%, 1,02-17,5) y una mayor probabilidad de depresión (OR = 4,7; IC del 95%, 1,8-12,5), de forma independiente respecto al resto de variables. La pregunta «¿Cómo van las cosas con su pareja?» como cribado de maltrato obtiene un cociente de probabilidades positivo de 6,23 (IC del 95%, 3,6-10,9), una especificidad del 89% y un valor predictivo negativo del 90%. Al 96,5% de las encuestadas no le disgustaría que su médico de familia abordara las relaciones de pareja, situación que se produce en el 24,7% de los casos. Conclusiones. En casi una cuarta parte de las mujeres consultantes se detecta algún tipo de maltrato. El médico de familia no suele investigar el entorno familiar y de pareja, a pesar de ser bien valorado por las mujeres, y del elevado cociente de probabilidades positivo y del elevado valor predictivo negativo para la detección de maltrato

Communication skills of tutors and family medicine physician residents in Primary Care clinics

Aim: To determine the communicative profiles of family physicians and the characteristics associated with an improved level of communication with the patient. Design: A descriptive multicentre study. Location: Primary Healthcare Centres in Almeria, Granada, Jaen and Huelva. Participants: 119 family physicians (tutors and 4th year resident physicians) filmed and observed with patients. Principal measurements: Demographic and professional characteristics. Analysis of the communication between physicians and patients, using a CICAA (Connect, Identify, Understand, Agree and Assist, in English) scale. A descriptive, bivariate, multiple linear regression analysis was performed. Results: There were 436 valid interviews. Almost 100% of physicians were polite and friendly, facilitating a dialogue with the patient and allowing them to express their doubts. However, few physicians attempted to explore the state of mind of the patient, or enquire about their family situation or any important stressful events, nor did they ask open questions. Furthermore, few physicians summarised the information gathered. The mean score was 21.43 ± 5.91 points (maximum 58). There were no differences in the total score between gender, city, or type of centre. The linear regression verified that the highest scores were obtained from tutors (B: 2.98), from the duration of the consultations (B: 0.63), and from the age of the professionals (B: −0.1). Conclusion: Physicians excel in terms of creating a friendly environment, possessing good listening skills, and providing the patient with information. However the ability to empathise, exploring the psychosocial sphere, carrying out shared decision-making, and asking open questions must be improved. Being a tutor, devoting more time to consultations, and being younger, results in a significant improvement in communication with the patient

Estudio comparativo de la ingesta alimentaria y el estado nutricional en ancianas con y sin fractura de cadera

ResumenObjetivoAnalizar comparativamente el estado nutricional y la ingesta alimentaria de mujeres mayores ingresadas por fractura de cadera (FC) frente a un grupo control sin fractura y sin alteraciones conocidas de la densidad mineral ósea.DiseñoObservacional descriptivo.EmplazamientoHospital Neurotraumatológico de Jaén y 3 Centros de Salud de Jaén capital (CS San Felipe, CS Virgen de la Capilla y CS El Valle).ParticipantesCuarenta y cuatro mujeres con FC, considerada de origen osteoporótico y grupo control compuesto por 42 mujeres del mismo rango de edad, seleccionadas al azar entre las que acuden a consulta médica del Centro de Salud de su área geográfica.Mediciones principalesSe recogieron datos sociodemográficos. Se valoró la ingesta dietética previa a la fractura, así como variables antropométricas en las primeras 72 horas tras su ingreso.ResultadosLas pacientes con FC presentan menor peso (67,2±10,1kg frente a 72,0±10,1kg, p<0,05), IMC (27,6±3,7kg/m2 frente a 31,3±4,6kg/m2, p<0,001), y circunferencias del brazo y de la pierna que las controles. Destaca una ingesta significativamente mayor en cuanto a los macronutrientes y consumo energético en el grupo control e ingesta de calcio y vitamina D inferiores a las adecuadas en ambos grupos, pero más acusada en las pacientes con FC. La regresión logística comprueba que la FC se asocia a un menor IMC, así como a menores consumos de proteínas, carbohidratos y calcio.ConclusionesUn correcto estado nutricional y una adecuada ingesta de macro y micronutrientes parecen fundamentales para prevenir la aparición de FC de origen osteoporótico.AbstractAimTo compare the nutritional status and dietary intake of elderly women admitted with hip fracture (HF) versus a control group without fracture and without known abnormalities of bone mineral density. Design: Descriptive and observational study. Location: Hospital Neurotraumatológico in Jaen (Spain) and three urban Primary Health Care centers in Jaen city (San Felipe, Virgen de la Capilla and El Valle).ParticipantsA total of 44 women with HF, which was considered osteoporotic, and a control group composed of 42 women with a similar age range, selected randomly from the medical outpatients who visit their Primary Health Care centers.MeasurementsWe record sociodemographic data. Dietary intake before the fracture and anthropometric variables in the first 72hours after admission were assessed.ResultsPatients with HF had lower weight (67.2±10.1kg versus 72.0±10.1kg, P<.05), BMI (27.6±3.7kg/m2 versus 31.3±4.6kg/m2, P<.001), as well as lower arm and leg circumferences than the control patients. A significantly higher intake, in terms of macronutrients and energy consumption, was detected in the control group, as well as lower than recommended intake of calcium and vitamin D in both groups, which was more marked in patients with HF. Logistic regression found that the HF was associated with a lower BMI as well as lower intakes of protein, carbohydrates and calcium.ConclusionsAdequate nutritional status and adequate intake of essential macro- and micronutrients seem to prevent osteoporotic HF