Vich Pérez P, Vicente Mata B, Prieto Checa I, Brusint Olivares B, Sevilla Machuca I, Sánchez López O
Medicina de Familia y Medicina Interna, CS Los Alpes, Madrid, España.
Medicina de Familia, CS Los Alpes, Madrid, España.
Semergen. 2019 Oct;45(7):434-440. doi: 10.1016/j.semerg.2018.11.006. Epub 2018 Dec 26.
To detect doubts and training needs in an urban health and family doctor training centre during the usual practice.
A cross-sectional descriptive study was conducted for one month in an urban health centre in Madrid. Family doctors were interviewed after their daily clinics about the doubts they had identified, choosing two of them. Unresolved questions were grouped by subject and according to the current taxonomies. A teaching program was then developed to tackle them.
Out of a total 21 physicians of the centre, 19 attended 10,678 patients during the period. The doubt detection rate was 0.44 doubts for every 10 patients attended. Of the 384 questions chosen, 83.34% were clinical and 16.66% were non-clinical. Just over half (51.2%) of these were still unresolved 15days later the consultation event. The main methods for their resolution were using the scientific bases on the internet (mainly PubMed, UpToDate and Clinical Practice Guidelines; 38%), followed by consultation with other colleagues (34.9%).
Most of the doubts generated during clinics were clinical, although there is a significant burden of bureaucratic questions. More than half of the doubts are not resolved during the consultation or within the following 15days. The scientific databases on the internet are the main sources of information, although consulting other colleagues was often used as well. Additional time for dealing with patients and enhanced access to solve complex questions should be available to improve the success rate.
在日常实践中，检测城市健康与家庭医生培训中心存在的疑问和培训需求。
在马德里的一个城市健康中心进行了为期一个月的横断面描述性研究。家庭医生在每日门诊结束后接受访谈，询问他们所发现的疑问，并从中挑选两个。未解决的问题按主题并根据当前分类法进行分组。然后制定了一个教学计划来解决这些问题。
该中心共有21名医生，在此期间有19名医生诊治了10678名患者。每诊治10名患者的疑问检出率为0.44个疑问。在所选的384个问题中，83.34%是临床问题，16.66%是非临床问题。在会诊事件发生15天后，其中略多于一半（51.2%）的问题仍未解决。解决这些问题的主要方法是利用互联网上的科学依据（主要是PubMed、UpToDate和临床实践指南；38%），其次是与其他同事协商（占34.9%）。
门诊期间产生的大多数疑问是临床问题，尽管存在大量官僚问题。超过一半的疑问在会诊期间或之后的15天内未得到解决。互联网上的科学数据库是主要信息来源，不过也经常会向其他同事咨询。应该提供更多时间来诊治患者，并加强解决复杂问题的途径，以提高成功率。
