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Purposes: To study the resolution improvement of endocrine diseases in primary care using communication and information technology (IT). Reduce number of inappropriate appointments to specialist care visits. Direct line establishment of communication between primary care and specialist care and provide quick and useful advices to GPs., Materials and Methods: The GP establishes appointments for patients who need a visit with the specialist of endocrinology without physical presence. The queries are recorded in the medical share history of each patient. If a person requires a visit, the specialist care makes an appointment himself. A descriptive analysis was made based on virtual visits during 2008-2010, using the electronic medical history of patients from 6 GP centers. Adequacy of first visits (according to agreed protocols) between 2007 and 2009 was compared., Results: Total number of online queries: 1705. Pathology: thyroid 35%, diabetes 50%, obesity 4% and others 11%. The most common virtual queries were the thyroid dysfunctions in 2008 and diabetes in 2010. Diabetes increased from 25.5% to 66%. In 2007 there were 25% of inappropriate first visit which were reduced to 10% in 2009. 88% of queries were resolved virtually., Conclusions: There was an increase in the capacity of case resolution in primary care with decrease of inappropriate first visits from primary care to specialist care. Teamwork between hospital and primary care was encouraged. The access of training in endocrine pathology among GP was improved., (Copyright © 2011 SEEN. Published by Elsevier Espana. All rights reserved.)

Background: The diversity of definitions of frequent attendance in the literature hampers comparison of their precision, validity, and associated factors., Aim: To examine different definitions of frequent attendance in order to identify the sociodemographic and clinical factors associated with frequent attendance in primary care, according to each definition., Design of Study: One-phase cross-sectional study., Setting: Seventy-seven primary care centres in Catalonia, Spain., Method: A total of 3815 primary care patients were interviewed between October 2005 and March 2006. Three definitions of frequent attendance were tested: (1) frequent attenders as the top 25% and the top 10% consulting patients; (2) frequent attenders as the top 25% and the top 10% consulting patients stratified by age and sex; and (3) frequent attenders as the top 25% and the top 10% consulting patients stratified by the presence of physical/mental conditions (patients with only mental disorders, with only chronic physical conditions, with comorbid conditions, and with no condition). Multilevel logistic regressions were used., Results: The following factors were systematically related to frequent attender status: being on sick leave, being born outside of Spain, reporting mental health problems as the main reason for consulting, and having arthritis/rheumatism, or bronchitis. Major depression was related to frequent attendance in two of the three definitions. The factor 'GP' was related to frequent attendance when the top decile cut-off point was used. The models with a 10% cut-off point were more discriminative than those with a 25% cut-off point: the area under the receiver operating characteristic curve for models with a 25% cut-off and a 10% cut-off ranged between 0.71 (95% confidence interval [CI] = 0.70 to 0.73) and 0.75 (95% CI = 0.74 to 0.77) and between 0.79 (95% CI = 0.78 to 0.81) and 0.85 (95% CI = 0.83 to 0.86), respectively., Conclusion: The way frequent attendance is defined is of crucial importance. It is recommended that a more discriminative definition of frequent attendance is used (the top 10%).