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The aim of this study was to estimate the level of empathy among primary care (PC) health professionals and its relationship with their approach to patients at risk due to alcohol consumption. This is an observational, descriptive, and multicenter study that included 80 PHC professionals. The professionals completed a questionnaire comprising socio-occupational questions and inquiries regarding their actions when dealing with patients suspected of risky alcohol consumption. The Jefferson Scale of Empathy was used to measure their level of empathy and was completed by 80 professionals, of whom 57.5% were family physicians, 10% were nurses, and 32.5% were family- and community-medicine residents. The mean age was 39.5 ± 13.1 (SD) (range of 24-65 years) and 71.3% were females. The mean empathy level score was 112.9 ± 11.1 (95% CI: 110.4-115.4; range: 81-132 points). Actions that stood out for their frequency were providing health advice in the general population, offering advice to pregnant women, and recommending abstinence to users of hazardous machinery or motor vehicles. The level of empathy was associated with age ( p = 0.029), the health center's scope ( p = 0.044), systematic alcohol exploration ( p = 0.034), and follow-ups for patients diagnosed with risky consumption ( p = 0.037). The mean score obtained indicated a high level of empathy among professionals. Professionals with greater empathy more frequently conducted systematic screening for risky alcohol consumption.

Background: Motivational interviewing (MI) could be a method for minimizing alcohol-related harm. The study aims to assess the effectiveness of a brief intervention, based on a MI, in patients with risky alcohol use attended in Primary Care (PC)., Materials and Methods: A cluster-randomized, two-arm parallel, multicenter, open-label, controlled clinical trial. Fifty PC healthcare professionals from the province of Córdoba (Spain) will be randomized to one of the two study groups: (1) Experimental Group (EG): MI-based approach; (2) Control Group (CG): Usual care based on health advice. EG intervention: Professionals will receive a training program focused on MI, consisting of a training workshop and the use of pre- and post-workshop questionnaires to measure knowledge and skills acquired, as well as the degree of empathy, with a videotape of the health professionals with standardized patients, before and after the workshop, and subsequent training feedback. CG intervention: Workshop on the management of risky alcohol use based on health advice; participants will also complete the pre-and post-workshop questionnaires and be videotaped. Study population: Patients ≥ 14 years old with risky alcohol consumption (28 Standard Drink Units-SDU-/week in men and 17 SDU/week in women) or excessive alcohol use (≥ 6 SDU in men or ≥ 4 SDU in women, in less than 2 h). It would be necessary to include 110 subjects/group to find a difference of 20% between the percentage of patients in abstinence between EG (37%) and CG (20%), alpha error of 5%, and statistical power of 80%. Assuming a loss rate of 5% and the cluster design effect, the number of subjects to be recruited is estimated at 197/group. The follow-up period will be 12 months. The primary outcome variables will be the self-reported alcohol use level and the Alcohol Use Disorders Identification Test (AUDIT) questionnaire score., Discussion: The study aims to demonstrate the effectiveness of the motivational approach in the comprehensive treatment of the patient with risky alcohol use, improving the empathy of the healthcare professionals and strengthening the healthcare professional-patient relationship to achieve the behavioral change of the patients with this problem in primary care consultations., Clinical Trial Registration: ClinicalTrials.gov., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Romero-Rodríguez, Pérula-Jiménez, Fernández-López, Cabello-Gracia, Fernández-García, Pérula-de Torres, Roldán-Villalobos, Leiva-Cepas, Fernández-Márquez, Parras-Rejano and ALCO-AP-20 Collaborative Study Group.)

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 alcohol-related 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.

Objective: The identification of atrial fibrillation in older patients who come to Primary Care consultations is a topic of interest that has been scarcely studied. The objective of this work was to estimate the frequency of new cases of atrial fibrillation and to analyze the clinical-epidemiological characteristics of patients 65 years of age or older, detected in Primary Care in Spain., Methods: An observational, descriptive, national, multicenter study was carried out in 48 health centers, in which 218 doctors and 101 Primary Care nurses recruited 7,068 patients, who underwent an arterial pulse and an electrocardiogram. in case of being abnormal or doubtful, determining the presence of atrial fibrillation and other rhythm disorders, symptoms and signs compatible with atrial fibrillation and comorbidity and cardiovascular risk factors. A univariate, bivariate and multivariate analysis (multiple logistic regression) was performed., Results: The patients had a mean age of 74.41±6.78 (DT) years. 2.3% presented atrial fibrilation (95% CI: 2.0-2.7), being its frequency higher in men (2.9%; p<0.001), and as age increased (p<0.001). The most frequent symptoms present among patients with atrial fibrillation were palpitations (Odds Ratio -OR-=3.50; 95% CI: 2.28-5.37), dyspnea (OR=2.71; 95% CI: 1.87-3.90), general discomfort (OR=2.32, 95% CI: 1.15-4.63), and dizziness (OR=1.80, 95% CI: 1.20-3.51). The 21.8% were asymptomatic., Conclusions: The frequency of new cases of atrial fibrillation in the Spanish population of 65 years or older is high, being higher in men and increasing with age. Two out of ten patients are asymptomatic. Palpitations and dyspnea are the predominant symptoms in patients with atrial fibrillation.

Objective: To evaluate the effectiveness of training activities directed at Primary Health Care personnel on the management of patients with alcohol consumption problems., Design: A systematic review of randomised controlled trials., Data Sources: Trip Database, Cochrane Central Register of Controlled Trials (CENTRAL), Medline, EMBASE, CINAHL, Web of Science, Scopus, Alcohol and Alcohol Problems Science Database - ETOH and FAMILY RESOURCES DATABASE. The search was performed in June 2017., Study Selection: The final sample was n=3 studies. Randomised controlled trials, indexed until 30 May 2017, with the objective of assessing the effectiveness of training programs directed at Primary Care providers in the management of patients with alcohol abuse disorder were included., Data Extraction: The main variables were expressed in terms of effectiveness of the training program: level of global implementation, screening of alcohol consumption, intervention in patients with a consumption risk, and level of support required., Results: Three Randomised controlled trials, published from 1999 to 2004, were included. Both screening and short intervention techniques showed an increase of its application in the three studies after the development of the three training programs. Statistical significance in terms of effectiveness was achieved in 2 of the 3 selected trials: both in detection of risk consumers, and in short intervention., Conclusion: The development of training programs in the management of patients with alcohol abuse disorder is an effective strategy for Primary Care providers, allowing the implementation of population screening, as well as the application of intervention techniques., (Copyright © 2018 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To assess the impact of a training program targeted to Primary Care (PC) professionalson 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., (Copyright © 2019 Elsevier B.V. All rights reserved.)

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 setting.

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., Competing Interests: The authors have declared that no competing interests exist.

Aim: To estimate the prevalence of alcohol consumption and analyse the drinking patterns among primary healthcare (PHC) providers., Design: Observational, cross-sectional, descriptive study., Setting: PHC centres in the Spanish National Health System (SNHS)., Participants: 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., Primary and Secondary Outcome Measures: Frequency of alcohol consumption, number of alcohol drinks on a typical day, frequency of more than six standard drinks (SDs) intake., Results: 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<0.001), in contrast to a higher number of drinks consumed on a typical day by younger providers (p<0.001). Intake was higher among males (p<0.001), primary care physicians (p<0.001) and resident trainers (p<0.001)., Conclusions: 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., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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 years were recruited for the EG, and 1,525 patients with a mean age of 74.07 years 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<.001). A total of 164 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 fibrillation in patients aged≥65 years with symptoms or signs suggestive of atrial fibrillation is a more effective strategy than opportunistic screening through pulse palpation in asymptomatic patients., Trial Registration: The trial is registered in ClinicalTrials.gov (NCT01291953; February 8, 2011)., (Copyright © 2016 Elsevier España, S.L.U. All rights reserved.)

Background: Clinical Practice Guidelines recommend using peripheral blood pulse measuring as a screening test for Atrial Fibrillation. However, there is no adequate evidence supporting the efficacy of such procedure in primary care clinical practice. This paper describes a study protocol designed to verify whether early opportunistic screening for Atrial Fibrillation by measuring blood pulse is more effective than regular practice in subjects aged 65 years attending primary care centers., Methods/design: An cluster-randomized controlled trial conducted in Primary Care Centers of the Spanish National Health Service. A total of 269 physicians and nurses will be allocated to one of the two arms of the trial by stratified randomization with a 3:2 ratio (three practitioners will be assigned to the Control Group for every two practitioners assigned to the Experimental Group). As many as 12 870 patients aged 65 years or older and meeting eligibility criteria will be recruited (8 580 will be allocated to the Experimental Group and 4 290 to the Control Group). Randomization and allocation to trial groups will be carried out by a central computer system. The Experimental Group practitioners will conduct an opportunistic case finding for patients with Atrial Fibrillation, while the Control Group practitioners will follow the regular guidelines. The first step will be finding new Atrial Fibrillation cases. A descriptive inferential analysis will be performed (bivariate and multivariate by multilevel logistic regression analysis)., Discussion: If our hypothesis is confirmed, we expect Primary Care professionals to take a more proactive approach and adopt a new protocol when a patient meeting the established screening criteria is identified. Finally, we expect this measure to be incorporated into Clinical Practice Guidelines., Trial Registration: The study is registered as NCT01291953 (ClinicalTrials.gob).