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

Effectiveness of motivational interviewing to improve therapeutic adherence in patients over 65 years old with chronic diseases: A cluster randomized clinical trial in primary care.

Objective: To evaluate the effectiveness of motivational interviewing (MI) in improving medication adherence in older patients being treated by polypharmacy. Methods: Cluster randomized clinical trial in 16 primary care centers with 27 health care providers and 154 patients. Thirty-two health care providers were assigned to an experimental (EG) or control group (CG). Interventions: MI training program and review of patient treatments. Providers in the EG carried out MI, whereas those in the CG used an “advice approach”. Three follow-up visits were completed, at 15 days and at 3 and 6[0] months. Medication adherence in both groups was compared (p<0.05). Results: Patients recruited: 70/84 (EG/CG). Mean age: 76 years; female: 68.8%. The proportion of subjects changing to adherence was 7.6% higher in the EG (p<0.001). Therapeutic adherence was higher for patients in the EG (OR=2.84), women (OR=0.24) and those with high educational levels (OR=3.93). Conclusion: A face-to-face motivational approach in primary care helps elderly patients with chronic diseases who are being treated by polypharmacy to achieve an improved level of treatment adherence than traditional strategies of providing information and advice. Practice Implications: MI is a patient-centered approach that can be used to improve medication adherence in primary care.pre-print152 K

Training health providers to address unhealthy alcohol use in primary care: a cross-sectional, multicenter study.

Background: Health professionals’ training is a key element to address unhealthy alcohol use in Primary Care (PC). Education about alcohol use can be effective in improving PC provider’s knowledge and skills addressing alcoholrelated problems. The aim of the study was to evaluate the training of health professionals to address unhealthy alcohol use in PC. Methods: An observational, descriptive, cross-sectional, multicenter study was performed. Location: PC centres of the Spanish National Health System (SNHS). Participants: Family physicians, residents and nurses completed an online questionnaire that inquired about their training (none, basic, medium or advanced), knowledge and preventive practices aimed at reducing unhealthy alcohol use. The study population was recruited via random sampling, stratified by the regions of the SNHS’s PC centre, and by email invitation to members of two Spanish scientific societies of Family Medicine. Results: A total of 1760 professionals participated in the study. Sixty-seven percent (95% CI: 67.5–71.8) reported not having received specific training to address unhealthy alcohol use, 30% (95% CI: 27.4–31.7) reported having received basic training, and 3% (95% CI: 2.3–4.0) medium/advanced training. The training received was greater in younger providers (p < 0.001) who participated in the PAPPS (Preventive Activities and Health Promotion Programme) (p < 0.001). Higher percentages of providers with intermediate or advanced training reported performing screening for unhealthy alcohol use (p < 0.001), clinical assessment of alcohol consumption (p < 0.001), counselling of patients to reduce their alcohol intake (p < 0.001) or to abstain, in the cases of pregnant women and drivers (p < 0.001). Conclusion: Our study reveals a low level of training among Spanish PC providers to address unhealthy alcohol use. A higher percentage of screening, clinical assessment and counselling interventions aimed at reducing unhealthy alcohol use was reported by health professionals with an intermediate or advanced level of training.post-print565 K

Prevalence of hazardous alcohol use among Spanish primary care providers

Background: Alcohol 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. Methods: A 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. Results: One 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 56 years 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). Conclusion: Our 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 settingThe study has been financed by the Spanish Society of Family and Community Medicine (semFYC, Sociedad Española de Medicina Familiar y Comunitaria) through the Francesc Borrell Scholarship in the year 2018 and has been awarded with the 1st Prize for the best Research Project in Primary Care by the Spanish Society of Primary Care Physicians (SEMERGEN, Sociedad Española de Médicos de Atención Primaria) in the year 2018. Also, this publication has been financed by one of the PhD scholarships, SEMERGEN, 2018

Opportunistic screening for atrial fibrillation versus detecting symptomatic patients aged 65 years and older: a cluster-controlled clinical trial.

Objective: The goal of this study was to assess the effectiveness of opportunistic screening through pulse palpation in the early detection of atrial fibrillation in subjects aged ≥ 65 years versus detection through an active search for patients with symptoms and/or complications and sequelae associated. -Material and methods: This was a cluster randomized controlled trial performed in 48 primary care centers of the Spanish National Healthcare System. A total of 368 physicians and nurses were randomized. The researchers in the Experimental Group (EG) performed opportunistic screening for auricular fibrillation, whereas the researchers in the Control Group (CG) actively searched for symptomatic patients. An ECG was performed on patients found to have an irregular heartbeat to confirm the diagnosis of auricular fibrillation. -Results: A total of 5,465 patients with a mean age of 75.61 were recruited for the EG, and 1,525 patients with a mean age of 74.07 were recruited for the CG. Of these, 58.6% were female, without significant differences between groups. Pulse was irregular in 4.3% and 15.0% of the patients in the EG and the CG, respectively (p<0.001). A total of 165 new cases of atrial fibrillation were detected (2.3%), 1.1% in the EG and 6.7% in the CG (adjusted OR: 0.29; 95%CI: 0.18-0.45). -Conclusions: Case finding for atrial fibrilation in patients aged ≥ 65 years with symptoms or signs suggestive of atrial fibrilation is a more effective strategy than opportunistic screening through pulse palpation in asymptomatic patients.pre-print325 K

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

Knowledge, attitudes and preventive practices of primary health care professionals towards alcohol use: A national, cross-sectional study.

Introduction Primary care (PC) professionals' knowledge about alcohol use has been identified as one of the barriers PC providers face in their clinic. Both PC professionals’ level of training and attitude are crucial in the clinical practice regarding alcohol use. Objective To evaluate the knowledge, attitude, and preventive practices of Spanish PC physicians and nurses towards alcohol use. Design An observational, descriptive, cross-sectional, multi-center study. Methodology Location: PC centers of the Spanish National Health System (NHS). Participants: PC physicians and nurses selected randomly from health care centers, and by sending an e-mail to semFYC and SEMERGEN members. Healthcare providers completed an online survey on knowledge, attitude, and follow-up recommendations for reducing alcohol intake. A descriptive, bivariate, and multivariate statistical analysis was conducted (p<0.05). Results Participants: 1,760 healthcare providers completed the survey (75.6% [95% CI 73.5–77.6] family physicians; 11.4% [95% CI 9.9–12.9] medical residents; and 12.5% [95% CI 10.9–14.1] nurses), with a mean age of 44.7 (SD 11.24, range: 26–64, 95% CI: 47.2–48.2). Knowledge was higher in family physicians (p<0.001), older professionals (Spearman's r = 0.11, p<0.001), and resident trainers (p<0.001). The PC professional most likely to provide advice for reducing alcohol use was: a nurse (p <0.001), female (p = 0.010), between 46 and 55 years old (p <0.001). Conclusions PC providers’ knowledge and preventive practices regarding alcohol use are scarce, hence specific training strategies to increase their knowledge and improve their attitude and skills with regard to this health problem should be considered a healthcare policy priority.post-print507 K

Effectiveness of a training program for the management of risky alcohol use in primary care professionals based on motivational interviewing

Objective: To assess the effectiveness of a training program for Primary Care (PC) professionals developed to increase knowledge, attitudes, and skills for managing patients with risky alcohol use and in the motivational interview. Design: Multicenter, two-arm parallel, randomized, open-label controlled clinical trial. Setting: PC of the Andalusian Health Service. Participants: The study was completed by 80 healthcare professionals from 31 PC centers. Interventions: In both experimental and control groups, a workshop on managing patients with risky alcohol consumption and the resolution of two videotaped clinical cases with standardized patients were conducted. The experimental group attended a workshop on motivational interviewing. Main measurements: Knowledge about managing risky alcohol use, clinical performance in patients with this health problem, and assessment of the motivational interview. Results: Mean age was 39.50 ± 13.06 – SD – (95% CI: 36.59–42.41); 71.3% (95% CI: 61.1–80.9%) were women. The average score of both groups in the knowledge questionnaire before the training program was 15.10 ± 4.66, becoming 21.99 ± 3.93 points after the training (95% CI: 5.70–7.92; p < 0.001). The experimental group showed an average score of 18.53 ± 13.23 before the intervention with the motivational interview and 28.33 ± 11.86 after this intervention (p = 0.002). In contrast, no significant variation was found in the score of the control group. Conclusions: A training program aimed at PC professionals designed to increase knowledge on how to manage risky alcohol use and acquire communication skills in motivational interviewing is effective. Resumen: Objetivo: Evaluar la efectividad de un programa de formación para profesionales de Atención Primaria (AP) para incrementar conocimientos, actitudes y habilidades en el manejo de pacientes con consumo de riesgo de alcohol y en la entrevista motivacional. Diseño: Ensayo clínico controlado, abierto, aleatorizado, multicéntrico, paralelo de dos brazos. Emplazamiento: Centros de AP del Servicio Andaluz de Salud. Participantes: Fue completado por 80 profesionales sanitarios de 31 centros. Intervenciones: En el grupo experimental y en el control se realizó un taller de manejo de pacientes con consumo de riesgo de alcohol y la resolución de dos casos clínicos videograbados con pacientes estandarizados. El grupo experimental asistió a un taller sobre entrevista motivacional. Mediciones principales: Conocimiento sobre el manejo del consumo de riesgo de alcohol, desempeño clínico en pacientes con este problema de salud y valoración de la entrevista motivacional. Resultados: La edad media fue 39.50 ± 13,06 -DE- (IC 95%: 36,59-42,41); El 71,3% (IC 95%: 61,1%-80,9%) eran mujeres. La puntuación media en el cuestionario de conocimientos antes del programa de formación fue de 15,10 ± 4,66, siendo 21,99 ± 3,93 puntos después del entrenamiento (IC 95%:5,70-7,92; p < 0,001). La puntuación promedio del grupo experimental antes de la intervención con la entrevista motivacional era de 18,53 ± 13,23 y después de 28,33 ± 11,86 (p = 0,002). No se encontró variación significativa en la puntuación del grupo control. Conclusiones: Un programa de formación para profesionales de AP, para incrementar el conocimiento sobre cómo gestionar el consumo de riesgo de alcohol y adquirir habilidades comunicativas en la entrevista motivacional es efectivo

Efectividad de un curso de pregrado sobre medicina de familia: Validez y fiabilidad de un test de concordancia script

Introducción: La medicina de familia tiene una presencia cada vez más amplia en el pregrado, siendo necesario la exploración de las estrategias metodológicas, evaluativas y de aplicación práctica eficaces y aceptables. Objetivos: comprobar la efectividad de un curso de pregrado sobre los principales problemas clínicos de la medicina familiar. Conocer la validez y fiabilidad de un test para valorar la aplicación de los conocimientos a situaciones prácticas. Material y Métodos: estudio quasi-experimental"antes-después". Población de estudio: 20 estudiantes. Programa educativo: curso de 60 horas con objetivos en el área de conocimientos, razonamiento clínico, toma de decisiones y comunicación; metodología basada en problemas. Mediciones: preguntas de elección múltiple (PEM), simulaciones escritas (test "concordancia scripts" (CS) y pacientes estandarizados ("CC"). Diseñaron los tests de CS 10 médicos de familia (validez de consenso y aparente). Se valoró la comunicación clínica con un caso clínico común videograbado, de bajo nivel de dificultad representado por un paciente estandarizado utilizando el cuestionario GATHA. La satisfacción de los estudiantes con el curso fue medida con un cuestionario diseñado al efecto. Se midió la consistencia interna y la fiabilidad del test de CS. Resultados: Las diferencias entre las situaciones antes y después (Wilcoxon) fueron: PEM: 14,45±2,7 - 17,2±2,4 (p=0,003); CS: 15,97±1,56 -17,93±2,16 (p<0,0001) y CC: 14,45±3,8- 18,55±3,3 (p=0,001). El test de CS tenía un alfa de Cronbach de 0,96 y un Coeficiente de Correlación Intraclase de 0,7876. Alto grado de satisfacción con los contenidos teórico-prácticos, metodología y profesorado. Conclusiones: Curso factible y muy bien aceptado, los estudiantes mejoran significativamente no solo en conocimiento sino en la aplicación del mismo a situaciones prácticas y en habilidades de razonamiento clínico, toma de decisiones y comunicación después del curso. El test de CS es un test válido y fiable

Alcohol consumption in Spanish primary health care providers: a national, cross-sectional study.

To estimate the prevalence of alcohol consumption and analyse the drinking patterns among primary healthcare (PHC) providers. Observational, cross-sectional, descriptive study. PHC centres in the Spanish National Health System (SNHS). Doctors and nurses who completed an online questionnaire which explored their alcohol intake, using the Alcohol Use Disorders Identification Test (AUDIT-C) alcohol assessment tool. The study population was recruited by random sampling stratified by regions of the SNHS PHC centres. Frequency of alcohol consumption, number of alcohol drinks on a typical day, frequency of more than six standard drinks (SDs) intake. A total of 1760 PHC providers completed the questionnaire. The frequency of alcohol consumption was: abstention (12%, 95% CI 10.4% to 13.5%); one or less SDs/month (26%, 95% CI 23.8% to 27.9%); 2-4 SDs/month (32.2%, 95% CI 29.7% to 34.1%); 2-3 SDs/week (17.9%, 95% CI 16.0% to 19.6%); four or more SDs/week (11.9%, 95% CI 10.3% to 13.3%). The number of drinks on a typical day was: none (45.6%, 95% CI 42.9% to 47.6%); 1-2 drinks (47.3%, 95% CI 23.8% to 27.9%); 3-4 drinks (6.5%, 95% CI 5.3% to 7.6%). The percentage of hazardous drinking, according to AUDIT-C criteria, was 32% (95% CI 26.7 to 37.3), with a greater frequency of intake in older professionals (p Our study discloses the most up-to-date portrait of current alcohol consumption among Spanish PHC providers, showing a higher prevalence of alcohol intake, compared with the general population. Preventive strategies should be implemented to improve the awareness and training of PHC professionals towards alcohol consumption