Y la Atención Primaria durante la pandemia? Martinez, Carme Batalla; Badia, Joan Gené; Roca, Juanjo Mascort
Atención primaria,
November 2020, 2020-11-00, 2020-11-01, Letnik:
52, Številka:
9
Journal Article
What about primary care during the pandemic? Martinez, Carme Batalla; Badia, Joan Gené; Roca, Juanjo Mascort
Atención primaria,
11/2020, Letnik:
52, Številka:
9
Journal Article
Identificar las oportunidades perdidas en el diagnóstico del cáncer de ovario (CO) en el sistema sanitario público de Catalunya mediante el análisis de la visión de los profesionales sobre el relato ...de las experiencias de las pacientes con CO.
Estudio cualitativo exploratorio-descriptivo, con dos grupos focales.
Atención primaria, noviembre de 2017.
Treinta y cuatro profesionales en base a un muestreo teórico: 21médicos de familia, 8profesionales de centros de salud sexual y reproductiva y 5ginecólogos de hospital.
Los participantes debatieron sobre diferentes itinerarios de procesos diagnósticos de mujeres con CO mediante la exposición de tres flujogramas elaborados a partir de los relatos obtenidos en entrevistas a pacientes. Se realizó un análisis de contenido temático.
Se identificaron tres temas con diversos subtemas: a)falta de sospecha diagnóstica (desconocimiento de los síntomas, obviar la anamnesis y la exploración física, fragmentación de la atención y sesgos y prejuicios); b)dificultades para activar el proceso diagnóstico (acceso limitado a pruebas, accesibilidad desigual a ginecología y falta de seguimiento), y c)ausencia de circuitos rápidos preestablecidos.
Los resultados ofrecen una visión de las dificultades del diagnóstico precoz del CO en nuestro ámbito. Creemos que su identificación permitirá la elaboración de estrategias para mejorar la precisión diagnóstica y la calidad de la atención en las mujeres con CO en nuestro medio.
To identify missed opportunities in the diagnosis of ovarian cancer (OC) in the public health system of Catalonia, through the analysis of the perceptions of health professionals on the stories's experiences of OC patients.
Qualitative exploratory-descriptive study, with two focus groups.
Primary Care, November 2017.
Thirty-four professionals based on theoretical sampling: 21 family doctors, 8 professionals from sexual and reproductive health centres and 5 hospital gynaecologists.
Participants discussed the different diagnostic pathways for women with OC through the presentation of flowcharts which were developed with three storie's and experiences of OC patients.
Three themes with various sub-themes were identified as follow: a)lack of cancer diagnostic suspicion (lack of knowledge of symptoms of OC, anamnesis and physical examination overlooked, fragmentation of patient's care and bias and prejudice); b)difficulties in activating the diagnostic process (limited access to tests, unequal accessibility to gynaecology and lack of follow-up); and c)absence of fast-track referral system.
The results offer insight into the difficulties of early diagnosis of OC in our setting. We believe that their identification will allow the development of strategies to improve diagnostic accuracy and quality of care for women with OC in our setting.
Y la Atención Primaria durante la pandemia? Martinez, Carme Batalla; Badia, Joan Gené; Roca, Juanjo Mascort
Atención primaria,
11/2020, Letnik:
52, Številka:
9
Journal Article
Objective
The aim of this study was to assess the efficacy of an electronic reminder in primary healthcare in patients diagnosed with an indicator condition (IC) to improve HIV screening.
Methods
We ...developed a prospective interventional study in 51 primary healthcare centres in Barcelona randomly assigned into one of two study groups: control and alert. Between June 2018 and May 2019, an electronic reminder appeared in the electronic medical record each time a diagnosis of an IC in patients aged 16–65 years was registered in the alert group. We assessed HIV testing rates within 4 months following the diagnosis of an IC.
Results
In all, 13 000 patients were diagnosed with at least one IC. HIV testing was more likely in the alert group than in the control group. The electronic reminder multiplied the odds of being tested in men by 1.26 95% confidence interval (CI): 1.04–1.52, p = 0.019, by 1.77 (95% CI: 1.33–2.38, p < 0.001) among patients aged < 50 years , and by 1.51 (95% CI: 1.20–1.92, p < 0.001) in diagnoses of IC other than a sexually transmitted infection (STI) or an AIDS‐defining illness. Five (0.08%) cases of HIV were detected in the control group and 10 (0.17%) in the alert group.
Conclusions
Implementing an electronic reminder had a positive impact on HIV screening rates in patients diagnosed with an IC. The alert was more effective among older patients, those living in less socioeconomically deprived neighbourhoods, and those with an IC other than an STI or an AIDS‐defining illness.
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