Search

Objectives: 1. To find the scientific output on communication and health both in Spain and internationally. 2. To compare the two outputs according to the type of articles published and the design of the research., Design: Descriptive and bibliometric study., Material: The data bases MEDLINE (1995-2000) and IME (1990-2000) and the books summarising papers from semFYC Congresses (1995-2000) were used., Measurements: The number of articles on MEDLINE published and indexed with the description <>, plus a series of subject describers that could be included under the heading <>, were counted. On the IME and in the semFYC congress summaries the describers <> were used. The articles indexed on MEDLINE-IME were compared for their classification as original articles, clinical practice guidelines, review, editorial or letter to the editor. Original articles were classified in randomised and non-randomised trials, meta-analysis and observation studies., Main Results: 6766 articles were found on MEDLINE, 42 on the IME (0.046% of the total indexed) and 34 summaries from semFYC congresses (1.47% of the total). Among the most commonly studied questions were found patients' information and education, professional stress and psychological interviews; among the least studied were difficult and aggressive patients, negotiation and people accompanying patients. The original articles on MEDLINE and IME were 70% and 37%; and review articles, 11% and 44%. 1.4% of MEDLINE articles were randomised trials; and 0.08%, meta-analysis., Conclusions: Communication and health research is a young field that still requires descriptive studies. There is little scientific output in this area in Spain, with few original papers and too many reviews.

Objective: To 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., Design: Observation study, to validate a measurement instrument., Setting: Primary care. Family and community medicine teaching units., Study Population: For the validity analysis: 25 family and community medicine residents. For the reliability analysis: 48 doctors in the same speciality., Measurements and Interventions: The questionnaire was constructed on the basis of a version (GATHA-BASE) 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., Results: We obtained a version of the GATHA-RES with 27 items. The factorial analysis revealed that there were 9 factors (<>, <>, <>, <>, <>, <>, <> and <>) 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 > or = 0.90., Conclusions: The GATHA-RES questionnaire is a valid and reliable instrument that can be used for evaluating the communication skills of general practitioners in training.

Objective: To find out the influence of gender and age on various types of utilization of primary care services., Method: A random sample group containing 2662 patients over 14 years of age was observed over a continuous period of a year. Having already excluded the losses subjects, health service utilization was measured using patients whose clinical records had previously been validated., Results: A small number of patients (15%) use a disproportionate amount of the total number of visits. A numerical breakdown shows: 43% of global visits (GV), 45% of acute clinical visits (ACV), 68% administrative visits (AV) and 94% programmed visits (PV). The ACV, PV and GV were significantly higher in woman (p = 0.000), though in the AV was not the case. These remained a significant difference when age was controlling factor. The coefficients of correlation between age and the logarithm of the ACV, AV, PV and GV were respectively 0.27, 0.23, 0.40 and 0.41. Gender is not a consideration with regard to use of health services below 35 and above 75 years of age. In multiple lineal regression equations age stands out as the most predictive variable, followed by gender, excluding the AV where the doctor comes before gender., Conclusion: A small group of highusers use a desproportionate amount of the total number of visits, particularly the AV and PV. The positive correlation between age and utilization is more clear by the PV and GV. The female is more user than the male, specially among 35 and 75 years old; although the gender is not determinant by the AV. There is not much explained variability with the age and gender, but the age is more important than the gender on utilization.