50 results on '"Ariza-Cardiel, Gloria"'
Search Results
2. Impact of hypertension diagnosis on morbidity and mortality: a retrospective cohort study in primary care
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Martín-Fernández, Jesus, Alonso-Safont, Tamara, Polentinos-Castro, Elena, Esteban-Vasallo, Maria Dolores, Ariza-Cardiel, Gloria, González-Anglada, Mª Isabel, Sánchez-Perruca, Luis, Rodríguez-Martínez, Gemma, Rotaeche-del-Campo, Rafael, and Bilbao-González, Amaia
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- 2023
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3. Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study
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García-Martín, Victoria, de Hoyos-Alonso, M. Canto, Ariza-Cardiel, Gloria, Delgado-Puebla, Rosalía, García-Domingo, Paula, Hernández-Melo, Erika, de Haro-de Torres, Javier López, and del Cura-González, Isabel
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- 2022
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4. Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster
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del Cura-González, Isabel, Ariza-Cardiel, Gloria, Polentinos-Castro, Elena, López-Rodríguez, Juan A., Sanz-Cuesta, Teresa, Barrio-Cortes, Jaime, Andreu-Ivorra, Blanca, Rodríguez-Barrientos, Ricardo, Ávila-Tomas, José F., Gallego-Ruiz-de-Elvira, Elisa, Lozano-Hernández, Cristina, and Martín-Fernández, Jesús
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- 2022
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5. Mapping WOMAC Onto the EQ-5D-5L Utility Index in Patients With Hip or Knee Osteoarthritis
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Bilbao, Amaia, Martín-Fernández, Jesús, García-Pérez, Lidia, Arenaza, Juan Carlos, Ariza-Cardiel, Gloria, Ramallo-Fariña, Yolanda, and Ansola, Laura
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- 2020
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6. Psychometric properties of the EQ-5D-5L in patients with hip or knee osteoarthritis: reliability, validity and responsiveness
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Bilbao, Amaia, García-Pérez, Lidia, Arenaza, Juan Carlos, García, Isidoro, Ariza-Cardiel, Gloria, Trujillo-Martín, Elisa, Forjaz, Maria João, and Martín-Fernández, Jesús
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- 2018
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7. Risk aversion, trust in institutions and contingent valuation of healthcare services: trying to explain the WTA-WTP gap in the Dutch population
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Martín-Fernández, Jesús, López-Nicolás, Ángel, Oliva-Moreno, Juan, Medina-Palomino, Héctor, Polentinos-Castro, Elena, and Ariza-Cardiel, Gloria
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- 2021
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8. An analysis of primary nurse consultation in the Community of Madrid
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Rodríguez-Martínez, Gemma, Serrano-Martínez, María, Ibáñez-Gómez, Aránzazu, Perdikidi-Guerra, Adriana, Ariza-Cardiel, Gloria, and Martín-Fernández, Jesús
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- 2019
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9. Explaining differences in perceived health-related quality of life: a study within the Spanish population
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Martín-Fernández, Jesús, Ariza-Cardiel, Gloria, Polentinos-Castro, Elena, Sanz-Cuesta, Teresa, Sarria-Santamera, Antonio, and del Cura-González, Isabel
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- 2018
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10. Burden in caregivers of primary care patients with dementia: Influence of neuropsychiatric symptoms according to disease stage (NeDEM project)
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García-Martín, Victoria, primary, de Hoyos-Alonso, M Canto, additional, Ariza-Cardiel, Gloria, additional, Delgado-Puebla, Rosalía, additional, and Cura-González, Isabel del, additional
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- 2023
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11. Additional file 2 of Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster
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del Cura-González, Isabel, Ariza-Cardiel, Gloria, Polentinos-Castro, Elena, López-Rodríguez, Juan A., Sanz-Cuesta, Teresa, Barrio-Cortes, Jaime, Andreu-Ivorra, Blanca, Rodríguez-Barrientos, Ricardo, Ávila-Tomas, José F., Gallego-Ruiz-de-Elvira, Elisa, Lozano-Hernández, Cristina, and Martín-Fernández, Jesús
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Additional file 2.
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- 2023
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12. Additional file 4 of Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster
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del Cura-González, Isabel, Ariza-Cardiel, Gloria, Polentinos-Castro, Elena, López-Rodríguez, Juan A., Sanz-Cuesta, Teresa, Barrio-Cortes, Jaime, Andreu-Ivorra, Blanca, Rodríguez-Barrientos, Ricardo, Ávila-Tomas, José F., Gallego-Ruiz-de-Elvira, Elisa, Lozano-Hernández, Cristina, and Martín-Fernández, Jesús
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Additional file 4.
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- 2023
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13. Additional file 5 of Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster
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del Cura-González, Isabel, Ariza-Cardiel, Gloria, Polentinos-Castro, Elena, López-Rodríguez, Juan A., Sanz-Cuesta, Teresa, Barrio-Cortes, Jaime, Andreu-Ivorra, Blanca, Rodríguez-Barrientos, Ricardo, Ávila-Tomas, José F., Gallego-Ruiz-de-Elvira, Elisa, Lozano-Hernández, Cristina, and Martín-Fernández, Jesús
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Additional file 5.
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- 2023
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14. Additional file 1 of Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster
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del Cura-González, Isabel, Ariza-Cardiel, Gloria, Polentinos-Castro, Elena, López-Rodríguez, Juan A., Sanz-Cuesta, Teresa, Barrio-Cortes, Jaime, Andreu-Ivorra, Blanca, Rodríguez-Barrientos, Ricardo, Ávila-Tomas, José F., Gallego-Ruiz-de-Elvira, Elisa, Lozano-Hernández, Cristina, and Martín-Fernández, Jesús
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Additional file 1.
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- 2023
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15. Additional file 3 of Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster
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del Cura-González, Isabel, Ariza-Cardiel, Gloria, Polentinos-Castro, Elena, López-Rodríguez, Juan A., Sanz-Cuesta, Teresa, Barrio-Cortes, Jaime, Andreu-Ivorra, Blanca, Rodríguez-Barrientos, Ricardo, Ávila-Tomas, José F., Gallego-Ruiz-de-Elvira, Elisa, Lozano-Hernández, Cristina, and Martín-Fernández, Jesús
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Additional file 3.
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- 2023
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16. Effectiveness of a game-based educational strategy e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster
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Educaguia Group, del Cura-Conzalez, Isabel, Ariza-Cardiel, Gloria, Polentinos-Castro, Elena, Lopez-Rodriguez, Juan A., Sanz-Cuesta, Teresa, Barrio-Cortes, Jaime, Andreu-Ivorra, Blanca, Rodriguez-Barrientos, Ricardo, Avila-Tomas, Jose F., Gallego-Ruiz-de-Elvira, Elisa, Lozano-Hernandez, Cristina, Martin-Fernandez, Jesus, Azcoaga-Lorenzo, Amaya, Hernandez Santiago, Virginia, and University of St Andrews. School of Medicine
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Professional competence ,MCC ,Problem solving ,Motivation ,Evidence-Based Medicine ,NDAS ,General Medicine ,NIS ,Practice guidelines ,Education ,SDG 3 - Good Health and Well-being ,Anti-Infective Agents ,Experimental games ,RA0421 ,Spain ,RA0421 Public health. Hygiene. Preventive Medicine ,Humans ,Female ,Health personnel/education ,Family Practice ,Game-based learning - Abstract
Background Clinical practice guidelines (CPGs) have teaching potential for health professionals in training clinical reasoning and decision-making, although their use is limited. The objective was to evaluate the effectiveness of a game-based educational strategy e-EDUCAGUIA using simulated clinical scenarios to implement an antimicrobial therapy GPC compared to the usual dissemination strategies to improve the knowledge and skills on decision-making of family medicine residents. Additionally, adherence to e-EDUCAGUIA strategy was assessed. Methods A multicentre pragmatic cluster-randomized clinical trial was conducted involving seven Teaching Units (TUs) of family medicine in Spain. TUs were randomly allocated to implement an antimicrobial therapy guideline with e-EDUCAGUIA strategy ( intervention) or passive dissemination of the guideline (control). The primary outcome was the differences in means between groups in the score test evaluated knowledge and skills on decision-making at 1 month post intervention. Analysis was made by intention-to-treat and per-protocol analysis. Secondary outcomes were the differences in mean change intrasubject (from the baseline to the 1-month) in the test score, and educational game adherence and usability. Factors associated were analysed using general linear models. Standard errors were constructed using robust methods. Results Two hundred two family medicine residents participated (104 intervention group vs 98 control group). 100 medicine residents performed the post-test at 1 month (45 intervention group vs 55 control group), The between-group difference for the mean test score at 1 month was 11 ( 8.67 to 13.32) and between change intrasubject was 11,9 ( 95% CI 5,9 to 17,9). The effect sizes were 0.88 and 0.75 respectively. In multivariate analysis, for each additional evidence-based medicine training hour there was an increase of 0.28 points (95% CI 0.15–0.42) in primary outcome and in the change intrasubject each year of increase in age was associated with an improvement of 0.37 points and being a woman was associated with a 6.10-point reduction. 48 of the 104 subjects in the intervention group (46.2%, 95% CI: 36.5–55.8%) used the games during the month of the study. Only a greater number of evidence-based medicine training hours was associated with greater adherence to the educational game ( OR 1.11; CI 95% 1.02–1.21). Conclusions The game-based educational strategy e-EDUCAGUIA shows positive effects on the knowledge and skills on decision making about antimicrobial therapy for clinical decision-making in family medicin residents in the short term, but the dropout was high and results should be interpreted with caution. Adherence to educational games in the absence of specific incentives is moderate. Trial registration ClinicalTrials.gov Identifier: NCT02210442. Registered 6 August 2014.
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- 2022
17. Effectiveness of an educational strategy using educational games e-EDUCAGUIA for implementing antimicrobial clinical practice guidelines in family medicine residents in Spain: a randomized clinical trial by cluster.
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Gonzalez, Isabel Del Cura, primary, Ariza-Cardiel, Gloria, additional, Polentinos-Castro, Elena, additional, López-Rodríguez, Juan A., additional, Sanz-Cuesta, Teresa, additional, Barrio-Cortes, Jaime, additional, Andreu-Ivorra, Blanca, additional, Rodríguez-Barrientos, Ricardo, additional, Ávila-Tomas, José F., additional, Gallego-Ruiz-de-Elvira, Elisa, additional, Lozano-Hernandez, Cristina, additional, Martín-Fernández, Jesús, additional, and Group, EDUCAGUIA, additional
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- 2022
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18. Additional file 4 of Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study
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Garc��a-Mart��n, Victoria, de Hoyos-Alonso, M. Canto, Ariza-Cardiel, Gloria, Delgado-Puebla, Rosal��a, Garc��a-Domingo, Paula, Hern��ndez-Melo, Erika, de Haro-de Torres, Javier L��pez, and del Cura-Gonz��lez, Isabel
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mental disorders ,human activities ,behavioral disciplines and activities - Abstract
Additional file 4. Frequency and intensity of neuropsychiatric symptoms based on the progression of dementia (GDS stage).
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- 2022
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19. Additional file 3 of Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study
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Garc��a-Mart��n, Victoria, de Hoyos-Alonso, M. Canto, Ariza-Cardiel, Gloria, Delgado-Puebla, Rosal��a, Garc��a-Domingo, Paula, Hern��ndez-Melo, Erika, de Haro-de Torres, Javier L��pez, and del Cura-Gonz��lez, Isabel
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mental disorders - Abstract
Additional file 3. Intensity of symptoms and neuropsychiatric subsyndromes in patients with dementia included in the study.
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- 2022
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20. Additional file 2 of Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study
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Garc��a-Mart��n, Victoria, de Hoyos-Alonso, M. Canto, Ariza-Cardiel, Gloria, Delgado-Puebla, Rosal��a, Garc��a-Domingo, Paula, Hern��ndez-Melo, Erika, de Haro-de Torres, Javier L��pez, and del Cura-Gonz��lez, Isabel
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mental disorders - Abstract
Additional file 2. Prevalence of neuropsychiatric symptoms and subsyndromes in patients with dementia included in the study.
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- 2022
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21. Additional file 6 of Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study
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Garc��a-Mart��n, Victoria, de Hoyos-Alonso, M. Canto, Ariza-Cardiel, Gloria, Delgado-Puebla, Rosal��a, Garc��a-Domingo, Paula, Hern��ndez-Melo, Erika, de Haro-de Torres, Javier L��pez, and del Cura-Gonz��lez, Isabel
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mental disorders ,human activities ,behavioral disciplines and activities - Abstract
Additional file 6. Frequency and intensity of neuropsychiatric subsyndromes based on the progression of dementia (GDS stage).
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- 2022
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22. Additional file 5 of Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study
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Garc��a-Mart��n, Victoria, de Hoyos-Alonso, M. Canto, Ariza-Cardiel, Gloria, Delgado-Puebla, Rosal��a, Garc��a-Domingo, Paula, Hern��ndez-Melo, Erika, de Haro-de Torres, Javier L��pez, and del Cura-Gonz��lez, Isabel
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mental disorders ,human activities ,behavioral disciplines and activities ,humanities - Abstract
Additional file 5. Frequency and intensity of significant neuropsychiatric symptoms (NPI ��� 4) based on the progression of dementia (GDS stage).
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- 2022
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23. Neuropsychiatric symptoms and subsyndromes in patients with different stages of dementia in primary care follow-up (NeDEM project): a cross-sectional study.
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García-Martín, Victoria, primary, de Hoyos-Alonso, M Canto, additional, Ariza-Cardiel, Gloria, additional, Delgado-Puebla, Rosalía, additional, García-Domingo, Paula, additional, Hernández-Melo, Erika, additional, Torres, Javier López de Haro-de, additional, and Cura-González, Isabel del, additional
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- 2021
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24. Additional file 1 of Risk aversion, trust in institutions and contingent valuation of healthcare services: trying to explain the WTA-WTP gap in the Dutch population
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Martín-Fernández, Jesús, López-Nicolás, Ángel, Oliva-Moreno, Juan, Medina-Palomino, Héctor, Polentinos-Castro, Elena, and Ariza-Cardiel, Gloria
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Additional file 1. Clinical scenarios and questions to elicit Willingness to pay and Willingness to accept.
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- 2021
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25. Implementación de recomendaciones y guías de práctica clínica por residentes: el papel de las unidades docentes multiprofesionales de atención familiar y comunitaria en España
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Ariza-Cardiel, Gloria, primary, del Cura-González, I. Isabel, additional, Polentinos-Castro, Elena, additional, López-Rodríguez, Juan Antonio, additional, Gil-Moreno, Juan Carlos, additional, and Martín-Fernández, Jesús, additional
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- 2021
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26. Impact of lower limb osteoarthritis on health-related quality of life: A cross-sectional study to estimate the expressed loss of utility in the Spanish population
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Martín-Fernández, Jesús, primary, García -Maroto, Roberto, additional, Bilbao, Amaia, additional, García-Pérez, Lidia, additional, Gutiérrez-Teira, Blanca, additional, Molina-Siguero, Antonio, additional, Arenaza, Juan Carlos, additional, Ramos-García, Vanesa, additional, Rodríguez-Martínez, Gemma, additional, Sánchez-Jiménez, Fco Javier, additional, and Ariza-Cardiel, Gloria, additional
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- 2020
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27. Oral versus intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency: a pragmatic, randomised, multicentre, non-inferiority clinical trial undertaken in the primary healthcare setting (Project OB12)
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Sanz-Cuesta Teresa, González-Escobar Paloma, Riesgo-Fuertes Rosario, Garrido-Elustondo Sofía, del Cura-González Isabel, Martín-Fernández Jesús, Escortell-Mayor Esperanza, Rodríguez-Salvanés Francisco, García-Solano Marta, González-González Rocío, Martín-de la Sierra-San Agustín María, Olmedo-Lucerón Carmen, Palmero María Luisa, Mateo-Ruiz Carmen, Medina-Bustillo Beatriz, Valdivia-Pérez Antonio, Blas-González Francisca, Mariño-Suárez José, Rodríguez-Barrientos Ricardo, Ariza-Cardiel Gloria, Cabello-Ballesteros Luisa, Polentinos-Castro Elena, Rico-Blázquez Milagros, Rodríguez-Monje Ma, Soto-Díaz Sonia, Martín-Iglesias Susana, Rodríguez-González Ramón, Bretón-Lesmes Irene, Vicente-Herrero María, Sánchez-Díaz Jesús, Gómez-Gascón Tomás, Drake-Canela Mercedes, and Barco Ángel
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Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background The oral administration of vitamin B12 offers a potentially simpler and cheaper alternative to parenteral administration, but its effectiveness has not been definitively demonstrated. The following protocol was designed to compare the effectiveness of orally and intramuscularly administered vitamin B12 in the treatment of patients ≥65 years of age with vitamin B12 deficiency. Methods/design The proposed study involves a controlled, randomised, multicentre, parallel, non-inferiority clinical trial lasting one year, involving 23 primary healthcare centres in the Madrid region (Spain), and patients ≥65 years of age. The minimum number of patients required for the study was calculated as 320 (160 in each arm). Bearing in mind an estimated 8-10% prevalence of vitamin B12 deficiency among the population of this age group, an initial sample of 3556 patients will need to be recruited. Eligible patients will be randomly assigned to one of the two treatment arms. In the intramuscular treatment arm, vitamin B12 will be administered as follows: 1 mg on alternate days in weeks 1 and 2, 1 mg/week in weeks 3–8,and 1 mg/month in weeks 9–52. In the oral arm, the vitamin will be administered as: 1 mg/day in weeks 1–8 and 1 mg/week in weeks 9–52. The main outcome variable to be monitored in both treatment arms is the normalisation of the serum vitamin B12 concentration at weeks 8, 26 and 52; the secondary outcome variables include the serum concentration of vitamin B12 (in pg/ml), adherence to treatment, quality of life (EuroQoL-5D questionnaire), patient 3satisfaction and patient preferences. All statistical tests will be performed with intention to treat and per protocol. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in analyses. Discussion The results of this study should help establish, taking quality of life into account, whether the oral administration of vitamin B12 is an effective alternative to its intramuscular administration. If this administration route is effective, it should provide a cheaper means of treating vitamin B12 deficiency while inducing fewer adverse effects. Having such an alternative would also allow patient preferences to be taken into consideration at the time of prescribing treatment. Trial registration This trial has been registered with ClinicalTrials.gov, number NCT 01476007, and under EUDRACT number 2010-024129-20.
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- 2012
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28. Análisis de la consulta enfermera de Atención Primaria en la Comunidad de Madrid (España)
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Rodríguez-Martínez, Gemma, primary, Serrano-Martínez, María, additional, Ibáñez-Gómez, Aránzazu, additional, Perdikidi-Guerra, Adriana, additional, Ariza-Cardiel, Gloria, additional, and Martín-Fernández, Jesús, additional
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- 2019
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29. A study of the user's perception of economic value in nursing visits to primary care by the method of contingent valuation
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Conde-López Juan, Ariza-Cardiel Gloria, Domínguez-Bidagor Julia, Polentinos-Castro Elena, Rodríguez-Martínez Gemma, Tello Bernabé Eugenia, del Cura-González Isabel, Gómez-Gascón Tomás, Pérez-Rivas Francisco, Martín-Fernández Jesús, Beamud-Lagos Milagros, Aguado-Arroyo Óscar, Sanz-Bayona Teresa, and Gil-Lacruz Ana
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Medicine (General) ,R5-920 - Abstract
Abstract Background The identification of the attribution of economic value that users of a health system assign to a health service could be useful in planning these services. The method of contingent valuation can provide information about the user's perception of value in monetary terms, and therefore comparable between services of a very different nature. This study attempts to extract the economic value that the subject, user of primary care nursing services in a public health system, attributes to this service by the method of contingent valuation, based on the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA). Methods/Design This is an economic study with a transversal design. The contingent valuation method will be used to estimate the user's willingness to pay (WTP) for the care received from the primary care nurse and the willingness to accept [compensation] (WTA), were this service eliminated. A survey that meets the requisites of the contingent valuation method will be constructed and pilot-tested. Subsequently, 600 interviews will be performed with subjects chosen by systematic randomized sampling from among those who visit nursing at twenty health centers with different socioeconomic characteristics in the Community of Madrid. The characteristics of the subject and of the care received that can explain the variations in WTP, WTA and in the WTP/WTA ratio expressed will be studied. A theoretical validation of contingent valuation will be performed constructing two explanatory multivariate mixed models in which the dependent variable will be WTP, and the WTP/WTA relationship, respectively. Discussion The identification of the attribution of economic value to a health service that does not have a direct price at the time of use, such as a visit to primary care nursing, and the definition of a profile of "loss aversion" in reference to the service evaluated, can be relevant elements in planning, enabling incorporating patient preferences to health policy decision-making.
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- 2011
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30. Implementación de guías de práctica clínica en el entorno de la formación sanitaria especializada: un estudio de barreras, facilitadores y de la efectividad de una estrategia basada en juegos educativos
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Ariza Cardiel, Gloria, Universidad Rey Juan Carlos. Facultad de Ciencias de la Salud, Departamento de Medicina y Cirugía, Psicología, Medicina Preventiva y Salud Pública Inmunología y Microbiología Médica, Enfermería y Estomatología, Av. de Atenas, s/n, 28922 Alcorcón, Tel. +34914888805, Martín Fernández, Jesús, and Cura González, Isabel del
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estrategia de aprendizaje ,educación sanitaria ,Medicina ,enseñanza profesional ,uso didáctico del ordenador ,juego educativo ,3329.06 Servicios Sanitarios ,médico - Abstract
Tesis Doctoral leída en la Universidad Rey Juan Carlos de Madrid en 2017. Directores de la Tesis: Isabel del Cura González y Jesús Martín Fernández, Las Guías de Práctica Clínica (GPC) son un conjunto de ¿recomendaciones desarrolladas de forma sistemática para ayudar a profesionales y pacientes a tomar decisiones sobre la atención sanitaria más apropiada, y a seleccionar las opciones diagnósticas o terapéuticas más adecuadas a la hora de abordar un problema de salud o una condición clínica específica¿. Tienen la potencialidad de reducir la variabilidad y mejorar la práctica clínica, y pueden ser consideradas como instrumentos clave para la transferencia del conocimiento a la práctica clínica. Diferentes estudios han demostrado que el seguimiento de las recomendaciones de determinadas GPC mejora los resultados en salud de los pacientes, sin embargo, su publicación y difusión no conlleva necesariamente su utilización en la práctica, por lo que es necesario diseñar planes de implementación que faciliten este proceso utilizando estrategias de comunicación efectivas para promover el cambio. Lo que requiere un proceso de planificación donde hay que prestar especial atención al contexto -tanto institucional como social-, y a identificar las barreras y facilitadores que dificultarán o favorecerán el cambio en la práctica. Varios estudios han valorado la percepción y actitud de los médicos españoles hacia las GPC, pero en ninguno de ellos se ha centrado en los médicos residentes durante su formación especializada, momento crucial en el que puedan integrar en su práctica habitual el conocimiento de las GPC. En los últimos años los programas docentes de formación de especialistas están incorporando el uso de las GPC como herramientas para adquirir muchas de las competencias. El programa formativo de la especialidad de Medicina Familiar y Comunitaria (MFyC) en España ha sido pionero en este sentido no obstante existe evidencia del uso limitado que se hace de las GPC tanto por parte de los residentes como de los tutores en otros ámbitos. Se ha estudiado la efectividad de diferentes estrategias para aumentar la adherencia a las recomendaciones de las GPC, concluyendo que la mayoría de ellas mejoraban la adherencia y que la incorporación de programas educativos, casi siempre como componentes de intervenciones más complejas mejoraban estos resultados. Algunas de estas estrategias han sido dirigidas a médicos residentes. En los últimos años estamos asistiendo a la incorporación de los juegos en entornos de aprendizaje virtual como herramienta de apoyo docente en la formación de estudiantes y médicos residentes. Estos juegos permiten que el alumno adquiera nuevos conocimientos y habilidades de una manera interactiva y lúdica y cuentan con una elevada aceptación pero se precisan estudios adecuadamente diseñados ya que sigue siendo controvertida su eficacia didáctica. Varios grupos han evaluado su efectividad como estrategia de implementación de GPC mejorando la adherencia a sus recomendaciones a través de la mejora de sus conocimientos, habilidades y actitudes. Su uso permite desarrollar escenarios virtuales de toma de decisiones vinculados a las recomendaciones de las GPC. La revisión Cochrane que ha evaluado su efectividad concluye que es necesario realizar investigaciones de calidad que exploren el impacto de los juegos educativos en la formación de los profesionales de la salud.
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- 2017
31. Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy: study protocol of a cluster randomized clinical trial (Multi-PAP project)
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Prados Torres, Alexandra, del Cura González, Isabel, Prados Torres, Daniel, López Rodríguez, Juan A., Leiva Fernández, Francisca, Calderón Larrañaga, Amaia, López Verde, Fernando, Gimeno Feliu, Luis A., Escortell Mayor, Esperanza, Pico Soler, Victoria, Sanz Cuesta, Teresa, Bujalance Zafra, M. Josefa, Morey Montalvo, Mariel, Boxó Cifuentes, José Ramón, Poblador Plou, Beatriz, Fernández Arquero, José Manuel, González Rubio, Francisca, Ramiro González, María D., Coscollar Santaliestra, Carlos, Martín Fernández, Jesús, Barnestein Fonseca, M. Pilar, Valderas Martínez, José María, Marengoni, Alessandra, Muth, Christiane, Aza Pascual Salcedo, Mercedes, Poncel Falcó, Antonio, Bandrés Liso, Ana Cristina, Alcaraz Borrajo, Marta, Ruiz San Basilio, José Ma, Mataix San Juan, Ángel, López León, Ana Ma, Mateos Sancho, Carmina, Gimeno Miguel, Antonio, Hernández Santiago, Virginia, García de Blas, Francisca, García Agua, Nuria, Rodríguez Barrientos, Ricardo, Vázquez Alarcón, Rubén, Laguna Berna, Clara, Márquez Chamizo, Maria Isabel, Marta Moreno, Javier, Azcoaga Lorenzo, Amaya, Abad Díez, José María, Sánchez Perruca, Luis, Polentinos Castro, Elena, Clerencia Sierra, Mercedes, Ariza Cardiel, Gloria, González González, Ana Isabel, Rico Blázquez, Milagros, Rogero Blanco, Marisa, Tello Bernabé, Ma Eugenia, álvarez Villalba, Mar, Rumayor Zarzuelo, Mercedes, del Pozo, Carmen Sánchez Celaya, Garrido, José Ignacio Torrente, Aranda, Concepción García, Lafuente, Marina Pinilla, Ma Teresa Delgado Marroquín, Null, Molina, Ma José Gracia, Bernal, Javier Cuartero, Martín, Ma Victoria Asín, Domínguez, Susana García, Gorbea, Carlos Bolea, Negre, Antonio Luis Oto, Royo, Eugenio Galve, Taira, Ma Begoña Abadía, Gutiérrez, José Fernando Tomás, Quintana, José Porta, Miguel, Valentina Martín, de las Heras, Esther Mateo, Algora, Carmen Esteban, de Letosa, Ma Teresa Martín Nasarre, Elena Gascón del Prim, Null, Delgado, Noelia Sorinas, Ma Rosario Sanjuan Cortés, Null, Sánchez, Teodoro Corrales, Lucas, Eustaquio Dendarieta, Mínguez Sorio, Ma del Pilar, Marzal, Adolfo Cajal, García, Eduardo Díaz, Álvarez, Juan Carlos García, De Blas González, Francisca García, Pérez, Cristina Guisado, Franco, Alberto López García, Beneitez, Ma Elisa Viñuela, Ana Ballarín González, Null, Zapata, Ma Isabel Ferrer, Suarez, Esther Gómez, Ortiz, Fernanda Morales, Laguno, Lourdes Carolina Peláez, Gómez, José Luis Quintana, Pascual, Enrique Revilla, López, Francisco Ramón Abellán, Álvaro, Carlos Casado, González, Paulino Cubero, Hamalainen, Santiago Manuel Machín, Fernández, Raquel Mateo, Blanco, Ma Eloisa Rogero, Arce, Cesar Sánchez, Wiesman, Elisa Ceresuela, Galindo, Jorge Olmedo, Marcos, Claudia López, Borda, Soledad Lorenzo, Fernández, Juan Carlos Moreno, Gómez, Belén Muñoz, De Mingo, Enrique Rodríguez, Pascual, Juan Pedro Calvo, Barroso, Margarita Gómez, Serrano, Beatriz López, Peláez, Ma Paloma Morso, González, Fernando Perales, Salvador, Julio Sánchez, Yépez, Jeannet Dolores Sánchez, Alonso, Ana Sosa, Villalba, Ma del Mar Álvarez, Tapia, Purificación Magán, Alcántara, Ma Angelica Fajardo, Alonso, Ma Canto De Hoyos, González, Rosario Iglesias, Antón, Ma Aránzazu Murciano, Pérez, Manuel Antonio Alonso, Lorenzo, Amaya Azcoaga, Medina, Ricardo De Felipe, Laguna, Amaya Nuria López, De Rivera, Eva Martínez Cid, Flores, Iliana Serrano, Rodríguez, Ma Jesús Sousa, Isabel, Ma Soledad Núñez, Sánchez, Jesús Ma Redondo, Llanos, Pedro Sánchez, Campillo, Lourdes Visedo, Izquierdo, Javier Martín, Sainz, Macarena Toro, Jiménez, Ma José Fernández, García, Esperanza Mora, Navarro Jiménez, José Manuel, Gómez, Deborah Gil, Mendoza, Leovigildo Ginel, Luz Pilar de la Mota Ybancos, Null, Genafo, Jaime Sasporte, Rodríguez, Ma José Alcaide, Garach, Elena Barceló, Arteaga, Beatriz Caffarena de, Parrilla, Ma Dolores Gallego, Catalina Sánchez Morales, Null, Chasco, Ma del Mar Loubet, Ríos, Irene Martínez, Delgado, Elena Mateo, Aurioles, Esther Martín, Ruiz, Sylvia Hazañas, Escalante, Nieves Muñoz, Salido, Enrique Leonés, Torres, Ma Antonia Máximo, Rodríguez, Ma Luisa Moya, Gálvez, Encarnación Peláez, Torres, José Manuel Ramírez, Fernández, Cristóbal Trillo, Cañavate, Ma Dolores García Martínez, Mellado, Ma del Mar Gil, Pradilla, Ma Victoria Muñoz, Peña, Ma José Clavijo, Fernández, José Leiva, Romero, Virginia Castillo, Maqueda, Rafael Ángel, Valdés, Gloria Aycart, Santaella, Miguel Domínguez, Vargas, Ana Ma Fernández, García, Irene García, Rodríguez, Antonia González, Mendaño, Ma Carmen Molina, Naranjo, Juana Morales, Torres, Catalina Moreno, Guerra, Francisco Serrano, University of St Andrews. School of Medicine, and Multi-PAP Group
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Male ,law.invention ,Health administration ,Study Protocol ,0302 clinical medicine ,Medication appropriateness index ,Randomized controlled trial ,law ,Patient-Centered Care ,Health care ,Outcome Assessment, Health Care ,Medicine ,030212 general & internal medicine ,Medicine(all) ,Aged, 80 and over ,lcsh:R5-920 ,education.field_of_study ,Massive Online Open Course ,Medicine (all) ,Health Policy ,Health services research ,General Medicine ,T-DAS ,Female ,Public Health ,lcsh:Medicine (General) ,Medication Appropriateness Index ,medicine.medical_specialty ,RM ,Population ,Primary Care Health Centre ,Health Informatics ,Drug Prescriptions ,03 medical and health sciences ,Outcome Assessment (Health Care) ,Quality of life (healthcare) ,SDG 3 - Good Health and Well-being ,Family Physician ,Humans ,ddc:610 ,Medical prescription ,education ,Aged ,Polypharmacy ,Primary care health centre ,Primary Health Care ,business.industry ,Family physician ,Environmental and Occupational Health ,Public Health, Environmental and Occupational Health ,Multimorbidity ,Spanish National Health System ,RM Therapeutics. Pharmacology ,Massive online open course ,Spain ,Family medicine ,Chronic Disease ,business ,030217 neurology & neurosurgery - Abstract
This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe"). Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799 Publisher PDF
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- 2017
32. Health condition and risk attitude in the Dutch population: an exploratory approach
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Martín-Fernández, Jesús, primary, Medina-Palomino, Hector J, additional, Ariza-Cardiel, Gloria, additional, Polentinos-Castro, Elena, additional, and Rutkowski, Anne, additional
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- 2018
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33. “Gaining or losing”: The importance of the perspective in primary care health services valuation
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Martín-Fernández, Jesús, primary, Ariza-Cardiel, Gloria, additional, Peña-Longobardo, Luz Mª, additional, Polentinos-Castro, Elena, additional, Oliva-Moreno, Juan, additional, Gil-Lacruz, Ana Isabel, additional, Medina-Palomino, Héctor, additional, and del Cura-González, Isabel, additional
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- 2017
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34. La valoración de la actitud ante el riesgo en personas que demandan cuidados en salud: una aproximación mediante juegos de loterías utilizando generalized estimating equations
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Jesús Martín-Fernández, Ariza-Cardiel, Gloria, Polentinos-Castro, Elena, Isabel Gil-Lacruz, Ana, Gomez-Gascon, Tomas, Dominguez-Bidagor, Julia, and Del-Cura-Gonzalez, Isabel
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Primary Health Care ,Conducta de elección ,Juegos experimentales ,Consumo de alcohol ,experimental ,Consumo de tabaco ,Inmigrantes ,Tobacco use ,Atención primaria de salud ,Immigrants ,Choice behaviour ,Asunción de riesgos ,Riesgo en Salud ,Alcohol consumption ,Games ,Risk-taking - Abstract
RESUMEN Fundamento: La caracterización de la actitud ante el riesgo puede ser útil en la planificación de las intervenciones sanitarias. El objetivo fue estudiar la actitud ante el riesgo de una población que demanda cuidados de salud y evaluar la capacidad de un juego de loterías para evidenciar dicha actitud. Métodos: Estudio multicéntrico transversal. Se recogieron características demográficas, socioeconómicas, de calidad de vida y conductas de riesgo en salud de 662 personas usuarias de 23 centros de salud seleccionadas mediante muestreo aleatorio. La actitud ante el riesgo se evaluó mediante una escala subjetiva y mediante dos juegos de azar (L1 y L2; L2 incluía la posibilidad de pérdidas económicas). Se realizaron modelos explicativos para valorar la variabilidad de la propensión al riesgo utilizando Generalized Estimating Equations (GEE). Resultados: El 19,1% (IC95%:15,6-22,6%) de los sujetos expresaron una propensión al riesgo alta, el 10,0% (IC95%:7,0-13,0) fueron clasificados como propensos al riesgo con L2. Se encontró asociación entre una mayor propensión al riesgo y tener mejor percepción del estado de salud (0,110; IC95%:0,007-0,212) o mayor renta (0,010; IC95%: 0,017-0,123) o ser fumador (0,059; IC95%: 0,004-0,114). Ser español se relacionaba con menor propensión al riesgo (-0,105; IC95%: -0,205- -0,005), al igual que ser mayor de 65 años (-0,031; IC95%:-0,061--0,001) o ser mujer (-0,038, IC95%:-0,064--0,012). El coeficiente de correlación intraclase para la escala subjetiva fue 0,511 (IC95%:0,372-0,629), 0,571 (IC95%:0,441-0,678) para L1 y 0,349 (IC95%:0,186-0,493) para L2. Conclusiones: Las personas que demandan cuidados de salud presentan con frecuencia propensión al riesgo, la cual se atenúa cuando se caracteriza mediante metodologías que implican pérdidas. La propensión al riesgo parece mayor en personas jóvenes, varones, con mejor estado de salud, con mayor renta y en inmigrantes. ABSTRACT Background: The characterization of the risk-taking attitude of individuals may be useful for planning health care interventions. It has been attempted to study expressions of risk-taking attitude and evaluate characteristics of a standard lottery game in a population that seeks health care to elicit these attitudes. Methods: Multicentric cross-sectional study. Demographic and socioeconomic characteristics, quality of life (EuroQol-5D), and health risk behaviors were collected from 662 users of 23 health centers selected by random sampling. Risk-taking attitude was evaluated by means of a self-evaluation scale and two lotteries games (L1 and L2; L2 included the possibility of economic losses). Generalized estimating equations (GEE) explicative models were used to evaluate the variability of risk-taking attitude. Results: Nineteen percent out of interviewed people (CI95%: 15.6-22.6%) expressed a high risk appetite, but only 10.0% (CI95% 7.0 to 13.0) were classified as risk-seeking by L2. It was found association between increased risk appetite and having a better perception of health status (0.110. CI95%: 0.007-0.212) or a higher income (0.010. CI95%: 0.017-0.123) or smoking status (0.059. CI95%: 0.004-0.114). Being Spanish was associated with lower risk appetite (-0.105. CI95%: -0.005 --0.205), as being over 65 (-0.031. CI95%:- 0.061- -0.001) or a woman (-0.038. CI95%:-0.064- -0.012). The intraclass correlation coefficient for self-evaluation scale was 0.511 (95% CI: 0.372 to 0.629), 0.571 (95% CI: 0.441-0.678) for L1 and 0.349 (95% CI: 0.186-0.493) for L2. Conclusions: People who seek health care express certain inclination to risk, but this feature is attenuated when methodologies involving losses are used. Risk appetite seems greater in young people, males, people with better health, or more income, and in immigrants. Lottery games such as the proposed ones are a simple and useful tool to estimate individuals' inclination to risk.
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- 2016
35. La valoración de la actitud ante el riesgo en personas que demandan cuidados en salud: una aproximación mediante juegos de loterías utilizando generalized estimating equations
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Martín Fernández, Jesús, Ariza Cardiel, Gloria, Polentinos Castro, Elena, Gil Lacruz, Ana Isabel, Domínguez Bidagor, Julia, del Cura González, Isabel, Gómez Gascón, Tomás, Martín Fernández, Jesús, Ariza Cardiel, Gloria, Polentinos Castro, Elena, Gil Lacruz, Ana Isabel, Domínguez Bidagor, Julia, del Cura González, Isabel, and Gómez Gascón, Tomás
- Abstract
Background: The characterization of the risk-taking attitude of individuals may be useful for planning health care interventions. It has been attempted to study expressions of risk-taking attitude and evaluate characteristics of a standard lottery game in a population that seeks health care to elicit these attitudes. Methods: Multicentric cross-sectional study. Demographic and socioeconomic characteristics, quality of life (EuroQol-5D), and health risk behaviors were collected from 662 users of 23 health centers selected by random sampling. Risk-taking attitude was evaluated by means of a self-evaluation scale and two lotteries games (L1 and L2; L2 included the possibility of economic losses). Generalized estimating equations (GEE) explicative models were used to evaluate the variability of risk-taking attitude. Results: Nineteen percent out of interviewed people (CI95%: 15.6-22.6%) expressed a high risk appetite, but only 10.0% (CI95% 7.0 to 13.0) were classified as risk-seeking by L2. It was found association between increased risk appetite and having a better perception of health status (0.110. CI95%: 0.007-0.212) or a higher income (0.010. CI95%: 0.017-0.123) or smoking status (0.059. CI95%: 0.004-0.114). Being Spanish was associated with lower risk appetite (-0.105. CI95%: -0.005 --0.205), as being over 65 (-0.031. CI95%:- 0.061- -0.001) or a woman (-0.038. CI95%:-0.064- -0.012). The intraclass correlation coefficient for self-evaluation scale was 0.511 (95% CI: 0.372 to 0.629), 0.571 (95% CI: 0.441-0.678) for L1 and 0.349 (95% CI: 0.186-0.493) for L2. Conclusions: People who seek health care express certain inclination to risk, but this feature is attenuated when methodologies involving losses are used. Risk appetite seems greater in young people, males, people with better health, or more income, and in immigrants. Lottery games such as the proposed ones are a simple and useful tool to estimate individuals' inclination to risk., RESUMEN Fundamento: La caracterización de la actitud ante el riesgo puede ser útil en la planificación de las intervenciones sanitarias. El objetivo fue estudiar la actitud ante el riesgo de una población que demanda cuidados de salud y evaluar la capacidad de un juego de loterías para evidenciar dicha actitud. Métodos: Estudio multicéntrico transversal. Se recogieron características demográficas, socioeconómicas, de calidad de vida y conductas de riesgo en salud de 662 personas usuarias de 23 centros de salud seleccionadas mediante muestreo aleatorio. La actitud ante el riesgo se evaluó mediante una escala subjetiva y mediante dos juegos de azar (L1 y L2; L2 incluía la posibilidad de pérdidas económicas). Se realizaron modelos explicativos para valorar la variabilidad de la propensión al riesgo utilizando Generalized Estimating Equations (GEE). Resultados: El 19,1% (IC95%:15,6-22,6%) de los sujetos expresaron una propensión al riesgo alta, el 10,0% (IC95%:7,0-13,0) fueron clasificados como propensos al riesgo con L2. Se encontró asociación entre una mayor propensión al riesgo y tener mejor percepción del estado de salud (0,110; IC95%:0,007-0,212) o mayor renta (0,010; IC95%: 0,017-0,123) o ser fumador (0,059; IC95%: 0,004-0,114). Ser español se relacionaba con menor propensión al riesgo (-0,105; IC95%: -0,205- -0,005), al igual que ser mayor de 65 años (-0,031; IC95%:-0,061--0,001) o ser mujer (-0,038, IC95%:-0,064--0,012). El coeficiente de correlación intraclase para la escala subjetiva fue 0,511 (IC95%:0,372-0,629), 0,571 (IC95%:0,441-0,678) para L1 y 0,349 (IC95%:0,186-0,493) para L2. Conclusiones: Las personas que demandan cuidados de salud presentan con frecuencia propensión al riesgo, la cual se atenúa cuando se caracteriza mediante metodologías que implican pérdidas. La propensión al riesgo parece mayor en personas jóvenes, varones, con mejor estado de salud, con mayor renta y en inmigrantes.
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- 2016
36. Estudio sobre la tasa de vacunación para el virus de la hepatitis B en pacientes infectados con el virus de la hepatitis C en un centro de Atención Primaria
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Miranda García, Mario, primary, Gutiérrez Teira, Blanca, additional, and Ariza Cardiel, Gloria, additional
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- 2014
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37. Willingness to pay for a quality-adjusted life year: an evaluation of attitudes towards risk and preferences
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Martín-Fernández, Jesus, primary, Polentinos-Castro, Elena, additional, del Cura-González, Ma Isabel, additional, Ariza-Cardiel, Gloria, additional, Abraira, Victor, additional, Gil-LaCruz, Ana Isabel, additional, and García-Pérez, Sonia, additional
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- 2014
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38. Variables que condicionan la utilización de la consulta de enfermería en centros de salud de la Comunidad de Madrid
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Martín Fernández, Jesús, Rodríguez, Gemma, Ariza Cardiel, Gloria, Vergel Gutierrez, Mª Ángeles, Hidalgo, Ana, Conde López, Juan Francisco, Martín Fernández, Jesús, Rodríguez, Gemma, Ariza Cardiel, Gloria, Vergel Gutierrez, Mª Ángeles, Hidalgo, Ana, and Conde López, Juan Francisco
- Abstract
Background: Different conditions in health services utilization may create situations of inequity. The objective was analyze the differences of nurse consultation utilization in primary care. Methods: Cross-sectional study, in 23 health centres in Madrid. Environmental variables, consultation characteristics, socio-demographic and health need characteristics were collected. The quality of life and satisfaction were also studied. The variables were classified according to the «behavioral model» in predisposing, enabling or need variables. Explanatory multivariate models were constructed (Generalized-Estimating-Equations). Results: The higher income areas and aging, predisposing factors, were associated with increases of 17% (95% CI: 0.4 to 36.9%) and 11.0% per decade (95% CI: 6.2 - 16.2) in nursing consultations per year. Among enabling factors, each additional minute of consultation length was associated with an increase of 2.0% (95% CI :1.2-2, 9%) in number of nurse consultations, each new medical consultation was associated with a increase of 2.7% (95% CI: 2.1-3.2%) and the delay in getting appointment over a day, represented a decrease of 32.8% (95% CI: 19.3 to 44.1%) in the total nursing consultations. Each chronic condition, which expresses the need health, was associated with an increase in the number of visits of 4.8% (95% CI: 1.7 to 8.0%). The improved perception of quality of life was associated with a reduction of 5.4% (95% CI 1.0 to 8.7%) of the consultations. Conclusion: The difference of the use of primary care nurse consultations is based on health need criteria, but is also influenced by accessibility conditions., Fundamentos: Diferentes condiciones de utilización de servicios sanitarios pueden originar situaciones de falta de equidad. El objetivo del trabajo es conocer si existen diferencias en el uso de la consulta de enfermería en atención primaria. Métodos: Estudio multicéntrico transversal en 23 centros de salud de la Comunidad de Madrid. Se incluyó a 662 sujetos. Se recogieron variables relativas al centro de salud, de la consulta de enfermería, características sociodemograficas y de necesidad en salud. Se estudiaron la calidad de vida y la satisfacción de los sujetos. Las variables se clasificaron, según el modelo «conductual», en predisponentes, facilitadoras o de necesidad. Se construyeron modelos multivariantes explicativos. Resultados: Vivir en zonas de renta alta y la edad se asociaron con aumentos del 17% (IC95%: 0,4-36,9%) y del 11,0% por cada década (IC95%: 6,2-16,2) de las consultas/año de enfermería. De los factores facilitadores, cada minuto añadido de duración de la consulta se asoció con un aumento del 2,0% (IC95%: 1,2-2,9%) en las consultas/año, cada nueva consulta médica se asociaba con un aumento del 2,7% (IC95%: 2,1-3,2%) y la demora en conseguir cita superior a un día supuso una disminución del 32,8% (IC95%: 19,3-44,1%) del número de consultas. Cada condición crónica, que expresa necesidad en salud, se asoció con un incremento del número de consultas del 4,8% (IC 95%: 1,7-8,0%). La mejor percepción de la calidad de vida se asoció con una reducción de las consultas de un 5,4% (IC95%: 1,0-8,7%). Conclusión: Las diferencias en el uso de la consulta de enfermería responde a criterios de necesidad, pero también está influenciada por condiciones de accesibilidad.
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- 2013
39. Variables que condicionan la utilización de la consulta de enfermería en centros de salud de la Comunidad de Madrid
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Martín-Fernández, Jesús, primary, Rodríguez-Martínez, Gemma, additional, Ariza-Cardiel, Gloria, additional, Vergel Gutierrez, Mª Ángeles, additional, Hidalgo Escudero, Ana Victoria, additional, and Conde-López, Juan Francisco, additional
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- 2013
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40. Economic Valuation of Health Care Services in Public Health Systems: A Study about Willingness to Pay (WTP) for Nursing Consultations
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Martín-Fernández, Jesús, primary, del Cura-González, Mª Isabel, additional, Rodríguez-Martínez, Gemma, additional, Ariza-Cardiel, Gloria, additional, Zamora, Javier, additional, Gómez-Gascón, Tomás, additional, Polentinos-Castro, Elena, additional, Pérez-Rivas, Francisco Javier, additional, Domínguez-Bidagor, Julia, additional, Beamud-Lagos, Milagros, additional, Tello-Bernabé, Mª Eugenia, additional, Conde-López, Juan Francisco, additional, Aguado-Arroyo, Óscar, additional, Bayona, Mª Teresa Sanz-, additional, and Gil-Lacruz, Ana Isabel, additional
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- 2013
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41. Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project): a clinical trial by clusters.
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del Cura-González, Isabel, López-Rodríguez, Juan A., Sanz-Cuesta, Teresa, Rodríguez-Barrientos, Ricardo, Martín-Fernández, Jesús, Ariza-Cardiel, Gloria, Polentinos-Castro, Elena, Román-Crespo, Begoña, Escortell-Mayor, Esperanza, Rico-Blázquez, Milagros, Hernández-Santiago, Virginia, Azcoaga-Lorenzo, Amaya, Ojeda-Ruiz, Elena, González-González, Ana I., Ávila-Tomas, José F., Barrio-Cortés, Jaime, Molero-García, José M., Ferrer-Peña, Raul, Tello-Bernabé, María Eugenia, and Trujillo-Martín, Mar
- Subjects
PHYSICIAN practice patterns ,EDUCATIONAL games ,EDUCATIONAL planning ,COMMUNITY-based clinical trials ,COMPUTER assisted instruction ,COMPARATIVE studies ,FAMILY medicine ,HEALTH planning ,INTERNSHIP programs ,LONGITUDINAL method ,MATHEMATICS ,RESEARCH methodology ,MEDICAL cooperation ,MEDICAL protocols ,PUBLIC health ,RESEARCH ,STATISTICAL sampling ,EVALUATION research ,RANDOMIZED controlled trials ,EVALUATION of human services programs - Abstract
Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6 months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs.Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6 months post-intervention, using 95 % confidence intervals. A linear multilevel regression will be used to adjust the model.Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance.Trial Registration: ClinicalTrials.gov: NCT02210442 . [ABSTRACT FROM AUTHOR]- Published
- 2016
- Full Text
- View/download PDF
42. A study of the user's perception of economic value in nursing visits to primary care by the method of contingent valuation
- Author
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Martín-Fernández, Jesús, primary, Pérez-Rivas, Francisco Javier, additional, Gómez-Gascón, Tomás, additional, del Cura-González, Isabel, additional, Tello Bernabé, Eugenia, additional, Rodríguez-Martínez, Gemma, additional, Polentinos-Castro, Elena, additional, Domínguez-Bidagor, Julia, additional, Ariza-Cardiel, Gloria, additional, Conde-López, Juan Francisco, additional, Beamud-Lagos, Milagros, additional, Aguado-Arroyo, Óscar, additional, Sanz-Bayona, Teresa, additional, and Gil-Lacruz, Ana Isabel, additional
- Published
- 2011
- Full Text
- View/download PDF
43. Differences in the Nursing Consultation Utilization in Primary Care, Spain
- Author
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Jesús Martín-Fernández, Rodriguez-Martinez, Gemma, Ariza-Cardiel, Gloria, Vergel Gutierrez, Ma Angeles, Hidalgo Escudero, Ana Victoria, and Francisco Conde-Lopez, Juan
- Subjects
Utilization ,Inequality ,Utilización ,Factores socioeconómicos ,Servicios sanitarios Necesidades y demanda ,Enfermería ,Inequidad ,Nursing ,Socioeconomic factors ,Health services needs and demand ,Atención primaria de la salud ,Primary health care - Abstract
Fundamentos: Diferentes condiciones de utilización de servicios sanitarios pueden originar situaciones de falta de equidad. El objetivo del trabajo es conocer si existen diferencias en el uso de la consulta de enfermería en atención primaria. Métodos: Estudio multicéntrico transversal en 23 centros de salud de la Comunidad de Madrid. Se incluyó a 662 sujetos. Se recogieron variables relativas al centro de salud, de la consulta de enfermería, características sociodemograficas y de necesidad en salud. Se estudiaron la calidad de vida y la satisfacción de los sujetos. Las variables se clasificaron, según el modelo «conductual», en predisponentes, facilitadoras o de necesidad. Se construyeron modelos multivariantes explicativos. Resultados: Vivir en zonas de renta alta y la edad se asociaron con aumentos del 17% (IC95%: 0,4-36,9%) y del 11,0% por cada década (IC95%: 6,2-16,2) de las consultas/año de enfermería. De los factores facilitadores, cada minuto añadido de duración de la consulta se asoció con un aumento del 2,0% (IC95%: 1,2-2,9%) en las consultas/año, cada nueva consulta médica se asociaba con un aumento del 2,7% (IC95%: 2,1-3,2%) y la demora en conseguir cita superior a un día supuso una disminución del 32,8% (IC95%: 19,3-44,1%) del número de consultas. Cada condición crónica, que expresa necesidad en salud, se asoció con un incremento del número de consultas del 4,8% (IC 95%: 1,7-8,0%). La mejor percepción de la calidad de vida se asoció con una reducción de las consultas de un 5,4% (IC95%: 1,0-8,7%). Conclusión: Las diferencias en el uso de la consulta de enfermería responde a criterios de necesidad, pero también está influenciada por condiciones de accesibilidad. Background: Different conditions in health services utilization may create situations of inequity. The objective was analyze the differences of nurse consultation utilization in primary care. Methods: Cross-sectional study, in 23 health centres in Madrid. Environmental variables, consultation characteristics, socio-demographic and health need characteristics were collected. The quality of life and satisfaction were also studied. The variables were classified according to the «behavioral model» in predisposing, enabling or need variables. Explanatory multivariate models were constructed (Generalized-Estimating-Equations). Results: The higher income areas and aging, predisposing factors, were associated with increases of 17% (95% CI: 0.4 to 36.9%) and 11.0% per decade (95% CI: 6.2 - 16.2) in nursing consultations per year. Among enabling factors, each additional minute of consultation length was associated with an increase of 2.0% (95% CI :1.2-2, 9%) in number of nurse consultations, each new medical consultation was associated with a increase of 2.7% (95% CI: 2.1-3.2%) and the delay in getting appointment over a day, represented a decrease of 32.8% (95% CI: 19.3 to 44.1%) in the total nursing consultations. Each chronic condition, which expresses the need health, was associated with an increase in the number of visits of 4.8% (95% CI: 1.7 to 8.0%). The improved perception of quality of life was associated with a reduction of 5.4% (95% CI 1.0 to 8.7%) of the consultations. Conclusion: The difference of the use of primary care nurse consultations is based on health need criteria, but is also influenced by accessibility conditions.
44. Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project): a clinical trial by clusters
- Author
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del Cura-González, Isabel, López-Rodríguez, Juan A., Sanz-Cuesta, Teresa, Rodríguez-Barrientos, Ricardo, Martín-Fernández, Jesús, Ariza-Cardiel, Gloria, Polentinos-Castro, Elena, Román-Crespo, Begoña, Escortell-Mayor, Esperanza, Rico-Blázquez, Milagros, Hernández-Santiago, Virginia, Azcoaga-Lorenzo, Amaya, Ojeda-Ruiz, Elena, González-González, Ana I., Ávila-Tomas, José F., Barrio-Cortés, Jaime, Molero-García, José M., Ferrer-Peña, Raul, Tello-Bernabé, María Eugenia, Trujillo-Martín, Mar, Barral, Araceli Garrido, Moreno, Aurora Fernández, Pérez, Paloma Casado, Barba, Emilio Cervera, Rodríguez Monje, María Teresa, Iturbe, Ana Gorroñogoitia, Crespo, Luis Ignacio Mendibil, Mañeru, M. Eulalia Mariñelarena, de Gómez Barragan, Ma Josefa Gil, Elustondo, Sofía Garrido, Fuertes, Rosario Riesgo, Cabello Ballesteros, Luisa María, Nido, Rocío álvarez, Moreno, Cruz Bartolome, Rojas, Guillermo Cairo, Rivas, Jose Luis Lopez, Pikatza, Amaya Zenarutzabeitia, Celaya, Carmen Sánchez, Montalvo, Mariel Morey, Almeida, Lizzy Paola Cisneros, álamo Rodríguez, Manuel Del, García-Franco, Alberto López, Weismann, Elisa Ceresuela, álvarez, Remedios Martín, Bustillo, Beatriz Medina, del Pozo, Marta Sánchez Celaya, Perruca, Luis Sánchez, Salinero Fort, Miguel ángel, de Burgos Luna, Carmen, SanJuan, Angel Mataix, Educaguia Group, and University of St Andrews. School of Medicine
- Subjects
Gerontology ,Program evaluation ,Professional competence ,LB Theory and practice of education ,Clinical Decision-Making ,education ,030232 urology & nephrology ,NDAS ,Health Informatics ,Health informatics ,Health administration ,Study Protocol ,03 medical and health sciences ,Experimental ,0302 clinical medicine ,SDG 3 - Good Health and Well-being ,RA0421 ,Surveys and Questionnaires ,RA0421 Public health. Hygiene. Preventive Medicine ,Health care ,Humans ,Medicine ,Practice guidelines as a topic ,030212 general & internal medicine ,Health policy ,Medicine(all) ,Medical education ,Problem solving ,business.industry ,Health Policy ,Health Plan Implementation ,Health services research ,Public Health, Environmental and Occupational Health ,Internship and Residency ,General Medicine ,Guideline ,Clinical trial ,Games, Experimental ,Community Medicine ,Spain ,Practice Guidelines as Topic ,LB ,Health personnel/education ,Family Practice ,business ,Games ,Follow-Up Studies ,Program Evaluation - Abstract
This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding. Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442. Publisher PDF
- Full Text
- View/download PDF
45. La calidad de vida relacionada con la salud en el trastorno depresivo mayor: factores asociados con su evolución.
- Author
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Martín-Fernández, Jesús, Patricia del Nido-Varo, Laura, Vázquez-de-la-Torre-Escalera, Paloma, Candela-Ramírez, Ruth, Ariza-Cardiel, Gloria, García-Pérez, Lidia, Ramos-García, Vanesa, Retolaza, Ander, and Bilbao, Amaia
- Subjects
- *
MENTAL depression , *QUALITY of life , *COMORBIDITY , *EATING disorders , *HEALTH surveys , *SOCIOECONOMIC status , *OLDER people , *PATIENTS' attitudes , *PROGNOSIS - Abstract
Introduction. Major Depressive Disorder (MDD) is the most prevalent mental disorder. We aimed to analyze which factors were associated to their Health-Related Quality of Life (HRQoL) perception in patients diagnosed of MDD and how they evolved over six months. Methods. We included 432 subjects with MDD (DSM-IVTR) from hospital consultations, mental health centres and primary care centres in Basque Country, Madrid and Canary Islands. Patients were followed for 6 months. Clinical, sociodemographic and therapeutic variables were collected. HRQoL was measured by EQ-5D-5L, expressed as "utilities". Generalized Linear Models were constructed to meet the objectives. Results. Women, older people, disadvantaged social groups and those with higher "physical comorbidity" expressed a worse HRQoL at inclusion. At 6 months, 305 subjects remained in follow-up. The average change in "utilities" was 0.033 (CI95%: 0.008-0.059), and 0.132 (CI95%: 0.093-0.171) in the 109 subjects (35.51%) who expressed improvement in their health status. "Physical comorbidity", the presence of eating disorders, older age, belonging to disadvantaged socioeconomic groups or the need for greater therapeutic effort were negatively associated with HRQoL evolution. Conclusion. MDD is associated with a great impact on HRQoL, which partially reverts when the patients showed good clinical evolution. Older age, comorbidity and disadvantaged socioeconomic group are associated with a worse evolution of HRQOoL. [ABSTRACT FROM AUTHOR]
- Published
- 2022
46. Health Related Quality of Life in Major Depressive Disorder: evolution in time and factors associated.
- Author
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Martín-Fernández J, Del Nido-Varo LP, Vázquez-de-la-Torre-Escalera P, Candela-Ramírez R, Ariza-Cardiel G, García-Pérez L, Ramos-García V, Retolaza A, and Bilbao A
- Subjects
- Humans, Depressive Disorder, Major, Quality of Life
- Abstract
Major Depressive Disorder (MDD) is the most prevalent mental disorder. We aimed to analyze which factors were associated to their Health-Related Quality of Life (HRQoL) perception in patients diagnosed of MDD and how they evolved over six months.
- Published
- 2022
47. [Implementation of Recommendations and Clinical Practice Guidelines by residents: the role of the Multiprofessional Family and Community Care Teaching Units in Spain].
- Author
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Ariza-Cardiel G, Del Cura-González II, Polentinos-Castro E, López-Rodríguez JA, Gil-Moreno JC, and Martín-Fernández J
- Subjects
- Cross-Sectional Studies, Humans, Spain, Surveys and Questionnaires, Health Education
- Abstract
Objective: To analyze the role of Family and Community Care Trainig Units as facilitators of the implementation of Clinical Practice Guidelines (CPG) and the factors associated with a greater effort in this task., Material and Methods: Design: Cross-sectional descriptive study with analytical approach., Participants: Training Units in Spain (N=94)., Main Measurements: Variables were collected through a self-completed survey into five domains: characteristics of Training Units, training activity directed at evidence-based clinical practice (EBPP), importance attributed to this activity, responsibility for EBPP implementation, perception of barriers and facilitators to its use. Descriptive and multivariate analysis with the dependent variable being the perceived effort of the training unit to implement CPG., Results: 45 Training Units responded (47.9%). 42.2%(CI 95%: 27.8-56.6) of their coordinators have directed research projects and 31.1% (CI 95%:17.6-44.6) have participated in elaborating CPG. They organized an average of 51hours (SD 47.2) of training in PCBP. 97.7% (CI95%:93.3-100) considered it fundamental that the residents ow and apply PCBP and 93.3% (CI95%:86.0-100) considered that tutors are responsible for the implementation. The participation of the coordinator in CPG (coef: 0.58; IC 95%: 0.00-1.16), awareness of how important is that residents know about CPG (coef: 0.89; IC 95%: 0.24-1.54) and that CPG appear to be widely applicable. applicable (coef: 0.35; IC 95%: -0.01-0.70) were related to a greater effort by the training units., Conclusions: The training units recognize the importance of CPGs and consider that tutors are responsible for their implementation. Training Units effort to implement CPG was related to unit coordinators previous experience, the perception of applicability and residents needs., (Copyright © 2020 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)
- Published
- 2021
- Full Text
- View/download PDF
48. Risk-Taking Attitudes of Patients who Seek Health Care: An Exploratory Approach through Lottery Games.
- Author
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Martín-Fernández J, Ariza-Cardiel G, Polentinos-Castro E, Gil-Lacruz AI, Gómez-Gascón T, Domínguez-Bidagor J, and Del-Cura-González I
- Subjects
- Adult, Age Factors, Aged, Cross-Sectional Studies, Diagnostic Self Evaluation, Emigrants and Immigrants, Female, Health Status, Humans, Male, Middle Aged, Quality of Life, Risk, Sex Factors, Spain epidemiology, Attitude to Health, Health Behavior, Risk-Taking
- Abstract
Background: The characterization of the risk-taking attitude of individuals may be useful for planning health care interventions. It has been attempted to study expressions of risk-taking attitude and evaluate characteristics of a standard lottery game in a population that seeks health care to elicit these attitudes., Methods: Multicentric cross-sectional study. Demographic and socioeconomic characteristics, quality of life (EuroQol-5D), and health risk behaviors were collected from 662 users of 23 health centers selected by random sampling. Risk-taking attitude was evaluated by means of a self-evaluation scale and two lottery games, (L1 and L2; L2 included the possibility of economic losses). Generalized estimating equations (GEE) explicative models were used to evaluate the variability of risk-taking attitude., Results: Nineteen percent out of interviewed people (CI95%: 15.6-22.6%) expressed a high risk appetite, but only 10.0% (CI95% 7.0 to 13.0) were classified as risk-seeking by L2. It was found association between increased risk appetite and having a better perception of health status (0.110, CI95%: 0,007-0,212) or a higher income (0.010, CI95%: 0.017- 0.123) or smoking status (0.059, CI95%: 0.004- 0.114). Being Spanish was associated with lower risk appetite (-0.105, CI95%: -0.005 --0.205), as being over 65 (-0.031, CI95%:- 0.061- -0.001) or a woman (-0.038, CI95%:-0.064- -0.012). The intraclass correlation coefficient for self-evaluation scale was 0.511 (95% CI: 0.372 to 0.629), 0.571 (95% CI: 0.441 to 0.678) for L1 and 0.349 (95% CI: 0.186-0.493) to L2., Conclusions: People who seek health care express certain inclination to risk, but this feature is attenuated when methodologies involving losses are used. Risk appetite seems greater in young people, males, people with better health, or more income, and in immigrants. Lottery games such as the proposed ones are a simple and useful tool to estimate individuals' inclination to risk.
- Published
- 2016
49. [A study on the hepatitis B virus vaccination rates in hepatitis C-infected patients in a Primary Care centre].
- Author
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Miranda García M, Gutiérrez Teira B, and Ariza Cardiel G
- Subjects
- Female, Health Facilities, Humans, Male, Middle Aged, Primary Health Care, Hepatitis B prevention & control, Hepatitis B Vaccines, Hepatitis C, Chronic, Vaccination statistics & numerical data
- Published
- 2014
- Full Text
- View/download PDF
50. [Differences in the nursing consultation utilization in primary care, Spain].
- Author
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Martín-Fernández J, Rodríguez-Martínez G, Ariza-Cardiel G, Vergel Gutierrez MÁ, Hidalgo Escudero AV, and Conde-López JF
- Subjects
- Aged, Chronic Disease, Cross-Sectional Studies, Female, Health Services Accessibility statistics & numerical data, Humans, Male, Middle Aged, Primary Health Care statistics & numerical data, Quality of Life, Socioeconomic Factors, Spain, Health Services Needs and Demand statistics & numerical data, Practice Patterns, Nurses' statistics & numerical data
- Abstract
Background: Different conditions in health services utilization may create situations of inequity. The objective was analyze the differences of nurse consultation utilization in primary care., Methods: Cross-sectional study, in 23 health centres in Madrid. Environmental variables, consultation characteristics, socio-demographic and health need characteristics were collected. The quality of life and satisfaction were also studied. The variables were classified according to the "behavioral model" in predisposing, enabling or need variables. Explanatory multivariate models were constructed (Generalized-Estimating-Equations)., Results: The higher income areas and aging, predisposing factors, were associated with increases of 17% (95% CI: 0.4 to 36.9%) and 11.0% per decade (95% CI: 6.2 - 16.2) in nursing consultations per year. Among enabling factors, each additional minute of consultation length was associated with an increase of 2.0% (95% CI :1.2-2, 9%) in number of nurse consultations, each new medical consultation was associated with a increase of 2.7% (95% CI: 2.1-3.2%) and the delay in getting appointment over a day, represented a decrease of 32.8% (95% CI: 19.3 to 44.1%) in the total nursing consultations. Each chronic condition, which expresses the need health, was associated with an increase in the number of visits of 4.8% (95% CI: 1.7 to 8.0%). The improved perception of quality of life was associated with a reduction of 5.4% (95% CI 1.0 to 8.7%) of the consultations., Conclusion: The difference of the use of primary care nurse consultations is based on health need criteria, but is also influenced by accessibility conditions.
- Published
- 2013
- Full Text
- View/download PDF
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