Evolución del perfil comunicacional de los médicos residentes de medicina de familia

ObjetivoConocer cómo evolucionan en los residentes de medicina de familia las habilidades de relación con los pacientes, al comienzo y al final de su tercer año de residencia, cuando atienden a problemas de salud comunes en su especialidad.DiseñoEstudio cuasi-experimental (antesdespués), multicéntrico, de ámbito nacional. Un total de 193 médicos residentes de tercer año de medicina familiar de 8 unidades docentes, que realizaron su residencia entre 1996–1999. Durante este período los residentes realizaron las actividades formativas y asistenciales habituales que marca el Programa Nacional de la Especialidad. Se valoraron 6 escenarios clínicos videograbados con pacientes estandarizados (3 al inicio del tercer año y 3 al finalizar) mediante el cuestionario GATHA-RES. Análisis estadístico descriptivo, bivariado y multivariante.ResultadosSe evaluó un total de 1.024 entrevistas. El tiempo empleado con cada paciente disminuye significativamente al finalizar la residencia; se observa una relación directamente proporcional entre el tiempo de consulta y las puntuaciones obtenidas (p < 0,05). Se detectan mejorías en los aspectos formales y organizativos de la consulta. Por el contrario, las habilidades relacionadas con la exploración de los aspectos personales y contextuales de la dolencia, así como las habilidades negociadoras, empeoran al finalizar el estudio. Las variables que mejor predicen el perfil comunicacional de los residentes fueron: edad (inversamente), duración de la entrevista, formación del tutor en entrevista clínica y unidad docente.ConclusionesLos residentes aprenden a acortar el tiempo de consulta en detrimento de habilidades de comunicación básicas para la realización de una correcta asistencia a los problemas de salud de sus pacientes. Estos resultados sugieren la necesidad de cambios sustanciales en la formación de los médicos residentes de medicina de familia en España.AimsTo study the development of patient relation skills, as used during interviews with patients for health problems that are common within their specialty, in family medicine residents during the third year of their residency program.MethodsQuasi-experimental (before-after), national-level, multicenter study. The participants were 193 third-year residents in family medicine at 8 training units who were trained between 1996 and 1999. During this period all residents participated in the usual training and clinical activities included in the National Plan for this specialty. The GATHA-RES questionnaire was used to evaluated six clinical scenarios in video recordings of encounters with standardized patients (3 at the start of the third year and 3 at the end of the third year). Descriptive, bivariate and multivariate statistical analyses were used.ResultsA total of 1,024 interviews were analyzed. The time spent with each patient decreased significantly at the end of the residency program; the duration of the visit was directly proportional to the score on the GATHA-RES questionnaire (p < 0.05). Improvements were seen in formal and organizational aspects of the interview. In contrast, skills related with the exploration of personal and contextual aspects of the problem, and negotiating skills, were worse at the end of the study. The variables that best predicted residents’ communicational profile were age (inverse relation), duration of the interview, training of the tutor in clinical interviewing, and teaching unit.ConclusionsResidents learn to shorten the duration of the visit to the detriment of communication skills that are basic to appropriate care for their patients’ health problems. These results suggest the need for substantial changes in the training of family medicine residents in Spain

Prevalence of tobacco consumption among young physicians at a regional university hospital in southern Spain: a cross-sectional study.

Introduction The aim of the study is to analyse the prevalence of smoking among resident physicians at a regional university hospital. In addition, we examined the trends in the smoking behaviour of physicians in relation to results obtained in other studies carried out previously at this hospital, as well as those published nationally and internationally Method A cross-sectional observational study evaluating tobacco consumption in young physicians was carried out at the level of secondary healthcare in a regional university hospital in Cordoba, Spain. All the study subjects were resident physicians who underwent a mandatory preliminary occupational health examination between 2012 and 2016. There was no sampling selection as anyone who took this examination was considered to be within the target population. We calculated the proportions of smokers, former smokers and non-smokers, with 95% CIs. Univariate and multivariate analyses (binary logistic regression) were used to analyse the results (P<0.05). Results The response rate was 99.4%, with a sample size of 324 out of a possible 326 physicians. The average age was 28.6±3.7—DT—(95% CI 28.2 to 29.0), and 62.3% (202/324; 95% CI 57.3 to 67.2) were women. Smoking prevalence was 6.5% (21/324; 95% CI 3.5 to 9.3) with a further 5.2% (17/324; 95% CI 2.7 to 7.8) being ex-smokers. There were no significant differences in the prevalence of tobacco consumption according to age (P=0.266), sex (9.0% for men and 5.0% for women; P=0.128), medical specialty (P=0.651) or year of residency (P=0.975). A 52.7% decline in the number of young physician smokers was noted between 1986 and 2016 (95% CI −44.0 to −63.5), together with a 64.4% increase in non-smokers (95% CI 55.2 to 77.3). Conclusions We observed a significantly low prevalence of tobacco use among trainee physicians in the cohort, an effect of new antismoking laws, with positive role model implications for new physicians and medical students.post-print285 K

Validez y fiabilidad de un instrumento para la valoración de la entrevista clínica en médicos residentes de medicina de familia: el cuestionario GATHA-RES

ObjetivoComprobar la validez de contenido, la consistencia interna y la fiabilidad intraobservador de un cuestionario para la evaluación de la comunicación médico-paciente de los residentes de medicina de familia.DiseñoEstudio observacional, de validación de un instrumento de medida.EmplazamientoNivel de atención primaria. Unidades docentes de medicina de familia y comunitaria.Población de estudioPara el análisis de validez, 25 médicos residentes de medicina familiar y comunitaria. Para el análisis de fiabilidad, 48 médicos de la misma especialidad.Mediciones e intervencionesPara la construcción del cuestionario, se partió de una versión (GATHA-BASE), compuesta por 42 ítems seleccionados por un panel compuesto por 60 médicos de familia. Para la validez de contenido, se utilizaron 68 encuentros clínicos con pacientes simulados, que fueron videograbados y evaluados. La validez de contenido del cuestionario se estudió mediante un análisis factorial, y para medir su consistencia interna se calcularon los coeficientes alfa de Cronbach. La fiabilidad intraobservador de la versión GATHA-RES fue evaluada mediante los índices kappa y los coeficientes de correlación intraclase.ResultadosObtuvimos una versión del GATHA-RES con 27 ítems. El análisis factorial reveló la existencia de 9 factores: «empatía», «anamnesis», «bidireccionalidad», «negociación», «información», «miscelánea 1», «miscelánea 2» y «centrado en el paciente», que mostraron una buena correlación con los contenidos teóricos y formales del cuestionario original (inicialmente agrupados en 3 secciones: actitudes, tareas comunicacionales y habilidades). Todos los coeficientes de correlación intraclase presentaron cifras ≥ 0,90.ConclusionesEl cuestionario GATHA-RES es un instrumento válido y fiable que puede ser usado para la evaluación de las habilidades comunicacionales de los médicos de familia en formación.ObjectiveTo check the validity of content, the internal consistency and the intra-observer reliability of a questionnaire to evaluate the doctor-patient communication of family medicine residents.DesignObservation study, to validate a measurement instrument.SettingPrimary care. Family and community medicine teaching units.Study populationFor the validity analysis: 25 family and community medicine residents. For the reliability analysis: 48 doctors in the same speciality.Measurements and interventionsThe questionnaire was constructed on the basis of a version (GATHABASE) composed of 42 items selected by a panel of 60 general practitioners. For content validity, 68 clinical encounters with simulated patients, video-recorded and evaluated, were used. The questionnaire's validity content was studied through a factorial analysis. To measure its internal consistency, Cronbach's alpha coefficients were calculated. Intra-observer reliability of the GATHA-RES version was evaluated through the kappa indexes and the intra-class correlation coefficients.ResultsWe obtained a version of the GATHA-RES with 27 items. The factorial analysis revealed that there were 9 factors («empathy», «anamnesis», «two-way communication», «negotiation», «information», «miscellaneous 1», «miscellaneous 2» and «patient-focused») which showed close correlation with the theoretical and formal contents of the original questionnaire (originally grouped in three sections: attitudes, communication tasks and skills). All the intraclass correlation coefficients had figures ≥ 0.90.ConclusionsThe GATHA-RES questionnaire is a valid and reliable instrument that can be used for evaluating the communication skills of general practitioners in training

Teaching medical students to express empathy by exploring patient emotions and experiences in standardized medical encounters.

OBJECTIVES: To increase medical students’ ability to detect contextual and emotional cues and to respond empathetically to patients. METHODS: a training course in communication skills and patient-centered care with different teaching activities (didactic, reflective and interactive: workshops and encounters with simulated patients) was delivered to third-year medical students just before their clerckships. The program was evaluated by an external observer (OE) and simulated patients (SP) in 2 or 3 videotaped encounters. RESULTS: Students improved significantly from baseline to 3rd interview in all communicative skills and domains explored both in OE (32.4%) and SP (38.3%) measurement. At the end of the course students detected significantly more clues and made more empathetic expressions. CONCLUSIONS: The course seems to improve the ability of students to explore the illness experience, showing more empathy in a more genuine way. This was carried out in consultations lasting 10 minutes. PRACTICAL IMPLICATIONS: The program is effective and feasible to be applied as a regular formative activity. Further research is needed to assess whether this training program is applicable to students in more advanced educational levels and if it has any additional outcomes.pre-print432 K

Opinions and beliefs held by Spanish teenagers regarding tobacco and alcohol consumption: A descriptive study

Background: Preventive strategies are the most effective approach for dealing with issues of substance abuse, particularly in teenagers. Such strategies adapt well to this target population. Our objective was to reveal the opinions and beliefs held by teenagers about tobacco and alcohol as types of drugs, and their effects on health. Methods: In this cross-sectional study, participants completed a self-administered questionnaire based on the World Health Organization “Health Behaviour of School-aged Children” study. Our sample included 1,005 schoolchildren aged between 11 and 13 years, resident in the province of Co´rdoba in Spain. Descriptive and univariate analyses were performed using a chi-squared test. Results: Of respondents, 25% (95% confidence interval [CI]: 22.2–27.6%) and 61% (95% CI: 58.0–64.1%), respectively, did not consider tobacco or alcohol to be drugs. No relationship was found between tobacco and alcohol use, and the belief that these are drugs (p = 0.477 and p = 0.217, respectively). A total 98.2% of adolescents surveyed (95% CI: 97.3–99.1%) believed that tobacco causes physical damage, mainly to the lungs, heart, and to the developing fetus. Additionally, 92.4% (95% CI: 90.6–94.0%) believed that alcohol is detrimental to health and identified the liver as the organ most frequently damaged by alcohol consumption. The media was identified as the main source of information about these substances by 78.0% of respondents (95% CI: 75.4–80.6%). Conclusions: Teenagers possess an acceptable level of knowledge and information about the negative effects of tobacco and alcohol on health; however, many of them do not consider these substances to be drug

Efectividad del consejo médico a pacientes alcohólicos y bebedores excesivos atendidos en consultas de atención primaria

ObjetivoComprobar la efectividad del consejo médico antialcohólico que se da en las consultas de atención primaria.DiseñoEstudio cuasi-experimental de tipo «antes-después», abierto, multicéntrico.EmplazamientoCatorce consultas médicas de atención primaria (7 rurales y 7 urbanas) de la provincia de Córdoba (España).ParticipantesUn total de 306 pacientes de ambos sexos, captados mediante búsqueda de casos, que presentaban un consumo de alcohol ≥ 35 (varones) y 21 (mujeres) U a la semana, y/o síndrome de dependencia alcohólica (SDA) (MALTS-O ≥ 11).IntervencionesA todos se les ofreció consejo médico breve antialcohólico y se les hizo un seguimiento para valoración de su estado a los 3 meses, 1 y 2 años.Mediciones principalesLa variable de respuesta fue la suma del consumo autorreferido, más valores normales de GGT, y la confirmación del familiar. El análisis del estudio fue por «intención de tratar».ResultadosDe los 306 pacientes incluidos, en un 95,1% de los casos se trataba de varones y un 78,4% presentaba SDA. Al cabo de 2 años, el 38,89% (IC del 95%, 32,2-44,3%) había alcanzado el objetivo terapéutico: un 23,85% se encontraba en abstinencia total y el 15,0% presentaba un consumo moderado de alcohol, por debajo del límite de riesgo. El comienzo del consumo excesivo antes de los 16 años (odds ratio [OR], 3,0885), vivir en un barrio marginal (OR, 3,2103), consumir tabaco (OR, 1,7187) y un test de CAGE positivo (OR, 1,9949) se asociaron al fracaso de la intervención (p < 0,05).ConclusionesSe demuestra la alta efectividad del consejo antialcohólico impartido por el médico de familia en condiciones habituales de consulta, tanto en bebedores excesivos como en aquellos con SDA.AimTo determine the effectiveness of medical counseling for alcohol abuse, when it is provided in primary care centers.DesignQuasi-experimental, open, multicenter before-after study.Setting14 primary care physician's practices (7 rural, 7 urban) in the province of Córdoba (Spain).Participants306 patients of both sexes, recruited with a case-finding strategy, who consumed ≥35 (men) or ≥21 (women) IU per week, or who had alcohol dependence syndrome (ADS) (MALTS score O≥11).InterventionsAll patients were offered brief counseling to reduce drinking, and all were followed to evaluate their status 3 months, 1 year and 2 years later.Main measuresThe response variable was selfreported alcohol consumption together with normal GGT values or confirmation of alcohol consumption by a relative. The results were subjected to intention-to-treat analysis.ResultsOf the 306 patients included in the study, 95.1% were men and 78.4% had ADS. After 2 years 38.89% (95% CI, 32.2%-44.3%) had attained their treatment goal: 23.85% were in complete abstinence, and 15.0% consumed moderate amounts of alcohol below the limit considered to indicate risk. Starting excessive consumption at less than 16 years of age (odds ratio [OR], 3.0885), living in a slum (OR, 3.2103), smoking (OR, 1.7187), and a positive CAGE test (OR, 1.9949) were associated with failure of the intervention (P<.05).ConclusionsCounseling provided by the family doctor was highly effective under the usual conditions of general practice, both for patients with excessive alcohol consumption and for patients with con ADS

Prevalence of hazardous alcohol use among Spanish primary care providers

BackgroundAlcohol use by health care professionals is one of the potential factors that may affect the prevention of hazardous drinking in Primary Care (PC). The objective of the study was to estimate the prevalence of hazardous alcohol use by PC professionals and assess the existing relationship between socio-demographic and occupational variables of PC professionals and their alcohol use.MethodsA descriptive, cross-sectional, observational, multicenter study was performed. Location: PC sites of the Spanish National Health Care System (NHS). Participants: Physicians and nurses, who completed an online questionnaire intended to identify the pattern of hazardous alcohol use through the AUDIT-C test. The study population was recruited through random sampling stratified by regions of the PC sites in the NHS. The primary measurements: Frequency of alcohol use, number of drinks containing alcohol on a typical day, frequency of six or more drinks on one occasion.ResultsOne thousand seven hundred sixty professionals completed the questionnaire. Hazardous alcohol use was detected in 27.80% (95% CI: 25.5-29.7) of PC providers. The prevalence of hazardous alcohol use was higher in males (34.2%) [95% CI: 30.4-37.6] and professionals aged 56years or over (34.2%) [95% CI: 28.2-40.2]. The multiple logistic regression analysis revealed a higher hazardous use in males (OR=1.52; 95% CI: 1.22-1.90), PC physicians (OR=1.42; 95% CI: 1.01-2.02) and professionals with more time worked (OR=1.03; 95% CI: 1.01-1.05).ConclusionOur study shows the current prevalence of hazardous alcohol use among Spanish PC providers, revealing a higher percentage of hazardous alcohol use in healthcare professionals compared to the Spanish general population. Further interventions are required to increase the awareness of negative consequences derived from alcohol use among PC professionals and its impact on the clinical setting

Validación del Münchner Alkoholismus Test Subjektiv para el diagnóstico de alcoholismo en población adulta

ResumenObjetivoValidar la parte subjetiva del cuestionario MALT (Münchner Alkoholismus Test) para el diagnóstico de alcoholismo en población adulta.DiseñoEstudio descriptivo de validación de un instrumento diagnóstico.EmplazamientoDos centros de atención primaria, un centro de drogodependencias y un centro de atención a alcohólicos, ubicados en la provincia de Córdoba, España.ParticipantesSeiscientos catorce pacientes con edades de entre 18 y 80 años.Mediciones principalesMediante entrevista personal se realizaron los cuestionarios MALT, AUDIT (Alcohol Use Disorders Identification Test) y el SCAN (Schedules for clinical assessment in Neuropsychiatry). Se analizó la fiabilidad interna, la reproducibilidad, la validez criterial (patrón de referencia: criterios del Manual Diagnóstico y Estadístico de los Trastornos Mentales IV [DSM-IV]) y la validez convergente.ResultadosLa edad media de la población fue de 43 años (desviación estándar de 1,43). El 17,4% presentó síndrome de dependencia alcohólica. Los coeficientes kappa de los ítems del test oscilaban entre 0,568 y 0,969. El alfa de Cronbach del MALT completo fue de 0,919; el alfa de Cronbach del MALT subjetivo fue de 0,939, y el alfa de Cronbach del MALT objetivo fue de 0,737. El área bajo la curva de eficacia diagnóstica para el MALT-S fue de 0,946 y para el MALT completo fue de 0,953. Para un punto de corte de 4, la sensibilidad del MALT-S fue del 92,6% y la especificidad fue del 90,8%. El coeficiente de correlación del MALT-S y del AUDIT fue de 0,86 (p<0,001).ConclusionesEl MALT subjetivo es un cuestionario tan válido y fiable como el MALT completo, por lo que puede ser utilizado aisladamente para la detección y el diagnóstico de alcoholismo.AbstractObjectiveTo validate the subjective part of the MALT questionnaire (MALT-S) for the detection of alcoholism among the adult population.DesignA descriptive study on the validation of a diagnostic tool.SettingTwo primary health care centres, a centre for drug addicts and a centre for alcoholics in Cordoba (Spain).Participants614 patients, between 18 and 80 years.MeasurementsThrough personal interviews the MALT, AUDIT and SCAN questionnaires were given. The internal reliability, stability and both the criterion and convergent validity were analysed.ResultsThe mean age of the population’ was 43±1.43 (SD) years and 17.4% of them showed Alcohol Dependence Syndrome. The Kappa coefficients of the test items ranged from 0.568 to 0.969. The Cronbach alpha of the complete MALT was 0.919, of the MALT-S, 0.939 and of the MALT-O, 0.737. The area under the ROC curve of the MALT-S was 0.946 and that of the complete MALT was 0.953. For a cut-off point of four, the sensitivity of the MALT-S is 92.7% while its specificity was 90.9%. The correlation coefficient of the MALT-S and AUDIT was 0.86 (P<0.001).ConclusionsThe MALT-S questionnaire is as valid and reliable as the complete MALT; therefore, it can be used on its own for the diagnosis of alcoholism

Impact of a primary care training program on the prevention and management of unhealthy alcohol use: A quasi-experimental study.

Objective: To assess the impact of a training program targeted to Primary Care (PC) professionals on the acquisition of communication skills, attitudes, and knowledge about the prevention and management of unhealthy alcohol use. Methods: A quasi-experimental, pre- and post-intervention study was performed in PC centers of Cordoba (Spain). Family doctors, residents and nurses participated in the study. The intervention was based on a motivational interviewing training program, which consisted in a workshop on learning skills, attitudes and knowledge about the alcohol management. PC providers were videotaped with a standardized patient in order to check the clinical and communication competencies acquired. A descriptive, bivariate and multivariate analysis was carried out (p<0.05). Results: PC providers’ communication skills and attitudes showed significant improvements in the variables studied (p<0.001), as well as in the clinical interview evaluation parameters. Conclusion: The present study reveals the impact of a training program targeted to PC professionals on communication skills, attitudes, and knowledge about the prevention and management of patients with unhealthy alcohol use. Practice implications: Training activities targeted to PC providers represent a valuable strategy to improve communication skills, attitudes and knowledge of these professionals in their clinical practice.pre-print200 K

Conditions for Feasibility of a Multicomponent Intervention to Reduce Social Isolation and Loneliness in Noninstitutionalized Older Adults

Aims: To identify the factors conditioning the feasibility of an intervention to reduce social isolation and loneliness in noninstitutionalized older adults from the perspective of the intervention agents. Design: A Dimensional Grounded Theory study conducted from December 2019 to January 2020. Methods: Twelve participants were recruited from an experimental study developed in a health district of a southern Spanish city. Data were collected through focus group meetings, individual interviews, biograms, anecdote notebooks, and the field diaries of two participants not included in the other techniques. Transcripts were analyzed using thematic analysis. Findings: Findings were divided into three themes: (a) the elderly between the walls of loneliness, economic difficulties, losses, and the past; (b) intervention agents/volunteers between the walls of inexperience in the management of psychological/emotional processes, lack of moral authority, and difficulty in planning results adapted to the (elderly) person; and (c) intervention between the walls of (interest in) company and assistance at home, lack of involvement (“waiting for you to save them”), and withdrawal/“abandonment”. Conclusion: A profile of the specialized intervention agent, professionalized (or at least a mentored agent), with both technical and relational competencies; a clear understanding of the purposes of the intervention (empowerment, as opposed to having company or being helped with household chores) and the commitment to active participation by the elder; or adequate management of the completion of the intervention (flexibility, attachment management) are some of the main factors contributing to the feasibility of these approaches. Impact: The findings have potential implications in the field of primary healthcare because primary and community healthcare services can implement corrections to the proposed intervention and ensure its effectiveness under feasible conditions. The nurse is shown as the most appropriate profile to conduct this intervention, although more research is needed to analyze the feasibility of this type of intervention in the daily practice of community nurses