Perfil comunicacional y enfoque centrado en el paciente de los tutores y residentes de medicina familiar y comunitaria en consultas de atención primaria

[ES] Objetivo:conocer el perfil comunicacional y el enfoque centrado en el paciente (ECP) de los tutores y residentes médicos de familia. Diseño:descriptivo multicéntrico. Emplazamiento:Unidades Docentes de Almería, Granada, Jaén y Huelva. Participantes:119 médicos de familia videograbados en consulta. Mediciones:Análisis de la comunicación médico-paciente mediante la escala CICAA. Se realizó un análisis descriptivo, bivariable y regresión múltiple. Resultados:La mayoría se muestran amables y facilitan el discurso del paciente. En cambio, pocos resumen la información, exploran el ánimo y entorno del paciente o emplean preguntas abiertas. La frecuencia del ECP es del 47%, asociada a ser tutor (OR:1,56), mayor tiempo de consulta (OR:1,25) y visita sucesiva (OR:1,83). Una mejor comunicación se relaciona con ser tutor (B:2,98), mayor tiempo de[EN]Aim:To understand the communicative profiles and patient-centred approach (PCA) of preceptors and 4thyear residents family physicians. Design:descriptive multicentre study. Location:Teaching Units in Almeria, Granada, Jaen and Huelva. Participants:119 family physicians video-recorded. Measurements:Analysis of the doctor-patient communication using a CICAA scale. A descriptive, bivariable, multiple regression analysis were carried out. Results:Most of physicians were friendly and facilitating a dialogue with the patient. However, few physicians summarize the information gathered, explore the patient's state of mind, family situation or ask open-ended questions. The frequency of PCA was 47%. Being a preceptor (OR:1,56), longer consultations (OR:1,25) and follow up consultations (OR:1,83)Tesis Univ. Jaén. Departamento de Ciencias de la Salud. Leída el 18 de enero de 201

Oferta de actividades preventivas propuestas por médicos residentes de Medicina Familiar en Atención Primaria y su relación con las habilidades comunicacionales.

To determine the offer of preventive activities by resident physicians of family medicine in the Primary Care consultations and the relation with their communication habilities. A descriptive multicentre study assessing medical consultations video recording. Eight Primary Healthcare centres in Jaen (Andalucia). Seventy-three resident physicians (4th year) filmed and observed with patients. Offer of preventive activities (according to the Spanish Program of Preventive Activities and Health Promotion -PAPPS-). Doctor, patient and consultation characteristics. Peer-review of the communication between physicians and patients, using a CICAA scale. A descriptive, bivariate, logistic regression analysis was performed. Two hundred and sixty interviews were evaluated (duration 8.5±4.0min) of 73 residents (50.7% women, mean age 32.9±7.7 years, 79% urban environment). The patient is more frequently a woman (60%) who comes alone (72%) due to acute processes (80%) and with 2.1±1.0 demands. Preventive activities are offered in 47% (duration less than one minute) of primary (70%) and secondary (59%) prevention, offered through advice (72%) or screening (52%) and focused on the cardiovascular area (52%) and lifestyles (53%). Eighty percent related to the patient's reason for consultation. Communication skills 41% improvable, 26% adequate, 23% excellent. The offer of preventive activities is related to the duration of the consultation (OR=1.1, 95% CI 1.01; 1.16) and communication skills (OR=1.03, 95% CI 1.01; 1.10). Preventive activities are carried out in almost half of the consultations, although focused on advice and screening and linked to the patient's demand. Consultation time and communication skills favor a greater preventive offer

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

Prevalencia y factores asociados a la práctica del consejo clínico contra el consumo de drogas entre los especialistas internos residentes de Andalucía (España)

Objetivos: Conocer la frecuencia de la oferta de consejo clínico contra el consumo de alcohol, tabaco y drogas ilegales por los especialistas internos residentes (EIR) y los factores relacionados con dicho consejo. Diseño: Estudio multicéntrico transversal mediante encuesta autoadministrada. Emplazamiento y participantes: EIR de Andalucía (España), mediante correo electrónico. Mediciones principales: Consejo declarado contra alcohol, tabaco y drogas ilegales, mediante escala Likert categorizada como «frecuente»/«no frecuente». Variables independientes: edad/sexo, especialidad, país de origen y características del consumo de drogas. Análisis mediante regresión logística. Resultados: Cuatro mil doscientos cuarenta y cinco participantes con el 66% de respuestas, 29% no respondedores y 5% mala cumplimentación; edad media 29,1 ± DE 5,1 años, 69% mujeres, 89% nacionalidad española, 84% con formación en medicina (hospitalaria 73%, medicina familiar 27%). El consejo frecuente contra tabaco (85%) y alcohol (82%) es superior al de drogas ilegales (56%; p < 0,001 test de Chi cuadrado). El consejo frecuente contra el alcohol se relaciona con la especialidad (medicina familiar: OR = 2,8, IC 95% [1,4-4,6]; enfermería: OR = 2,5 [1,7-4,4]) y la edad del primer consumo alcohólico (OR = 1,07; [1,03-1,1]). Para el tabaco hay relación con la especialidad (medicina familiar: OR = 12,9 [7,6-21,9]; enfermería: OR = 8,4, [4,3-16,5]), el tabaquismo (OR = 1,5 [1,2-2,0]) y edad del primer consumo alcohólico (OR = 1,06 [1,01-1,1]), más importante para el vino (OR = 1,1 [1,04-1,3]). Aconsejar contra drogas ilegales se relaciona con la edad del primer consumo alcohólico (OR = 1,09 [1,05-1,1]) y el tabaquismo (OR = 0,58 [0,4-0,7]). Conclusión: Hay una alta oferta de consejo contra el consumo por los EIR, aunque llamativamente menor para drogas ilegales. Los factores que influyen son tanto elementos formativos de su propia especialidad como el consumo personal de alcohol y tabaco, que deben ser tenidos en cuenta para una mejora de esta actividad preventiva

Grado de conocimiento y actitudes de los profesionales ante el Documento de Voluntades Anticipadas: diferencias entre distintos profesionales y provincias de una misma autonomía

Objetivos: Principal: determinar las diferencias por categoría profesional y provincias en los conocimientos y actitudes de los profesionales sanitarios sobre el Documento de Voluntades Anticipadas (DVA) en 4 provincias andaluzas: Córdoba, Jaén, Cádiz y Granada. Secundarios: conocer el número de documentos realizados en esas zonas y el número consultado en situaciones terminales. Material y métodos: Estudio observacional descriptivo multicéntrico en 17 zonas básicas de salud de 4 provincias de Andalucía. Población diana: médicos, enfermeros y trabajadores sociales de las zonas estudiadas (n = 340). Intervenciones: Cuestionario validado autoadministrado sobre conocimientos y actitudes de voluntades anticipadas. Se realizó análisis descriptivo y bivariante (×2) de los datos. Resultados: Edad media de 46 ± 8,8 anos, ˜ 53,2% mujeres. Médicos 56,1%, enfermeros 41,1%, trabajadores sociales 2,6%. La puntuación media (de 0-10) de sus conocimientos fue 5,42 ± 2,41. El 78,4% creía que las voluntades anticipadas estaban reguladas en Andalucía (diferencias por provincias; p = 0,001). Había leído dicho documento un 36,7% (diferencias por profesiones; p = 0,001). La puntuación media sobre la conveniencia de que los ciudadanos realizaran un DVA fue 8,27 ± 2,16 (diferencias por provincias; p = 0,02). La puntuación media sobre si el profesional respetaría los deseos expresados por un paciente en un DVA fue de 9,14 ± 1,64 (diferencias por provincias; p = 0,03), y la puntuación de la pregunta que expresaba los deseos del profesional acerca de realizar su DVA en el próximo ano˜ fue 4,85 ± 3,74 (p = 0,02). Conclusiones: Existen diferencias entre profesiones en la realización de la lectura del DVA. Existen diferencias entre provincias en los siguientes aspectos: saber si están reguladas, conveniencia de realizar el DVA y respeto a lo previsto en el DVA.Objectives: Primary: To determine the differences, by occupational category and province, in the knowledge and attitudes of health professionals on the Living Wills Document (LWD) in 4 Andalusian provinces: Cordoba, Jaen, Cadiz, and Granada. Secondary: To determine the number of documents prepared in these areas and the number consulted in terminal situations. Material and methods: Descriptive observational multicenter study, with 17 health areas in 4 Andalusian provinces. Target population: Family doctors, nurses and social workers of the areas studied (n = 340). Interventions Validated self-administered questionnaire about advance directives. Descrip tive and bivariate (×2) analysis of data was performed. Results: Mean age 46 ± 8.8 years, 53.2% women. Physicians 56.1%, nurses 41.1%, social workers 2.6%. The mean score (0-10) of their knowledge was 5.42 ± 2.41, with 78.4% believing that LWD are regulated in Andalusia (provinces differences, P = .001). More than one-third (36.7%) had read the document (differences by occupation, P = .001). The mean score on the advantage of preparing a LWD for the patient was 8.27 ± 2.16 (significant differences between provinces P = .02). Mean score about the practitioner would respect the wishes of a patient in a LWD was 9.14 ± 1.64 (significant difference between provinces P = .03). The mean score of the question about expressing the desires of the professional on preparing their LWD in the following year was 4.85 ± 3.74 (P = .02). Conclusions: There are different behaviors between professions on reading the LWD. There are differences between provinces in the following aspects: whether the documents are regula ted, whether the professionals prepare the LWD, and whether the professionals respects the provisions of the LWD

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

Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol

Abstract Background Health personnel are susceptible to high levels of work stress and burnout due to the psychological and emotional demands of their work, as well as to other aspects related to the organisation of that work. This paper describes the rationale and design of the MINDUUDD study, the aim of which is to evaluate the effectiveness of a mindfulness and self-compassion 4-session programme versus the standard 8-session programme to reduce work stress and burnout in Family and Community Medicine and Nursing tutors and residents. Methods The MINDUDD study is a multicentre cluster randomised controlled trial with three parallel arms. Six Teaching Units will be randomised to one of the three study groups: 1) Experimental Group-8 (EG8); 2) Experimental Group-4 (EG4) Control group (CG). At least 132 subjects will participate (66 tutors/66 residents), 44 in the EG8, 44 in the EG4, and 44 in the CG. Interventions will be based on the Mindfulness-Based Stress Reduction (MBSR) program, including some self-compassion practices of the Mindful Self-Compassion (MSC) programme. The EG8 intervention will be implemented during 8 weekly face-to-face sessions of 2.5 h each, while the EG4 intervention will consist of 4 sessions of 2.5 h each. The participants will have to practice at home for 30 min/day in the EG8 and 15 min/day in the EG4. The Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS), Perceived Stress Questionnaire (PSQ), Maslach Burnout Inventory (MBI), Jefferson Scale of Physician Empathy (JSPE), and Goldberg Anxiety-Depression Scale (GADS) will be administered. Measurements will be taken at baseline, at the end of the programs, and at three months after completion. The effect of the interventions will be evaluated by bivariate and multivariate analyses (Multiple Linear Regression). Discussion If the abbreviated mindfulness programme is at least as effective as the standard program, its incorporation into the curriculum and training plans will be easier and more appropriate. It will also be more easily applied and accepted by primary care professionals because of the reduced resources and means required for its implementation, and it may also extend beyond care settings to academic and teaching environments as well. Trial registration The study has been registered at ClinicalTrials.gov (NCT03629457; date of registration: 13.08.2018)