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OBJECTIVES: To know the needs and lack of information on health issues of Maghrebi women. SUBJECTS, MATERIAL AND METHOD: Design: Qualitative study technique nominal group (TGN). SUBJECTS: 14 North African women from Association for Solidarity and Rapprochement of Cultures (ASAC) from the rural clinic of La Aljorra who knew and understood Spanish, older age, and lived in the town for more than 3 years. Material and method TGN asks: «What daily health issues for you and your family worry you the most and do you need answers?¼ Individual reflection and list that were discussed among them, joining the group consensus. Subsequently, they were prioritized individually and a definitive list of their prioritized health needs was made. RESULTS: Thirty-six percent of the ASAC associates attended. At first, 17 topics were written on health needs for which they wanted a response. The final topics chosen and grouped by them were 6: 1) Contraceptive methods; 2) Relationship problems; 3) Thyroid; 4) How to cure the sciatic nerve?; 5) Anemia and 6) Stress. 70% related to the area of sexuality. CONCLUSIONS: 1) Qualitative research is an adequate consensus method to obtain information on little-known topics and directly from the person involved; 2) The Moroccan migrant woman considers information about sexuality and couple relationships very important; 3) Another pathology unknown to them and emerging in the area is thyroid; 4) Stress and its repercussions; 5) Sciatica and its consequences are also important when being agricultural workers.

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OBJETIVOS. 1.o Cuantificar el número de fumadores entre los profesionales sanitarios (PS) de Atención Primaria(AP). 2.o Conocer el nivel de formación en el abordaje del fumador. 3.o Analizar los factores que pueden influir en dicho abordaje. DISEÑO. Estudio descriptivo-transversal. EMPLAZAMIENTO. Atención Primaria. PARTICIPANTES. Población diana (N): 1.250 profesionales. Población muestral (n): 297 (intervalo de confianza [IC]95%, e = 5%, p = 40%).MEDICIONES PRINCIPALES. Encuesta anónima (29ítems) y auto-cumplimentada. Variables: sociodemográficas, patrón-consumo, actitud ante su abandono, abordaje de la deshabituación. Análisis estadístico: descriptivo, t-Test, ANOVA, ji-cuadrado, regresión logística. RESULTADOS. El 56,8% son médicos (IC 95% 51,2-62%).Edad: 41,71 (IC 95% 41,1-42,3 años). El 28,7% son fumadores (17% fuma > 20 cigarrillos/día). Los fumadores (p =0,003), enfermeros/as (p = 0,007) y PS mujeres (p = 0,021)piensan que debe crearse un lugar en el centro de salud (CS) para fumadores (p = 0,003). El 17,2% no quiere abandonarlo. El 41,2% ha recibido formación en tabaco, estando más formado el médico (p = 0,0001) y el exfumador (31,8%; p =019), que es el que más recomienda el abandono a sus pacientes (24,3%; p = 0,017). La edad superior y el género masculino son los factores diferenciadores (y = -8,35+1,63 x género+ 0,69 x edad) (p = 0,0001). El 23% de los PS consideran fumar un hábito. El tabaquismo es poco valorado como factor de riesgo cardiovascular (p = 0,002). CONCLUSIONES. 1. Alto número de fumadores con consumo elevado. 2. El fumador valora la necesidad de tener un lugar para fumar. 3. El exfumador está más formado, aconseja y presenta mayor capacidad para abordar el tabaquismo. 4. Edad y género son los factores más determinantes en el abordaje del fumador

OBJECTIVES. 1. Measure number of smokers among primary health care professionals (PHCP). 2. Know the training level in the approach to the smoker. 3. Analyze the factors that may influence such approach. DESIGN. Descriptive-cross-sectional study. SITE. Primary Health Care. PARTICIPANTS. Target population (N): 1250 professionals. Sample population (N): 297 (95% CI, e = 5%, p = 40%).PRIMARY MEASUREMENTS. Anonymous survey (29items) and self-applied. Variables: sociodemographic, pattern-consumption; attitude to abandonment; de habituation approach. Statistical analysis: descriptive, T-test, ANOVA, chi-squared, logistic regression. RESULTS. 59.8% doctors (95% C 51.2%-62%). Age: 41.71(95% CI 41.1 - 42.3 years). 28.7% smokers (17% smoke > 20cig/day). Smokers (p = 0.003), ill subjects (p = 0.007) and female PHCP (p = 0.021) think that a site should be created for smokers (p = 0.003) in the health care sites (HCS). A total of 17.2% subjects do not want to quit and 41.2% have received education about smoking, it being the male doctor (p =0.0001) and ex-smoker (31.8%; p = 019), who most recommends their patient to quit smoking (24.3%; p = 0.017). Older age and male gender are the differentiating factors (y = -8.35+1.63 x gender + 0.69 x age) (p = 0.0001). A total of 23% PHCP consider that smoking is a habit. Smoking is not very evaluated as a cardiovascular risk factor (p = 0,002). CONCLUSIONS. 1. A high number of smokers with elevated consumption. 2. The smoker evaluates the need to have a place to smoke. 3. The ex-smoker is more trained, and recommends and has greater capacity to approach the smoking habit. 4. Age and gender are the most determining factors in the approach to the smoker

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OBJECTIVE: To analyse the factors that affect patients´ wait at a health centre before they enter the doctor´s consulting room (CD). DESIGN: Prospective full evaluative cycle of quality. SETTING: A teaching health centre in the Cartagena Health Area (Murcia). PARTICIPANTS: All those patients seen by the doctor during the weeks of the study (1st stage: 3823; 2nd stage: 4247). MAIN MEASUREMENTS: The dimensions evaluated were accessibility and patient satisfaction, through four criteria. Data were collected from the register of scheduled appointments and by telephone questionnaire. The intervention measures were: a) to create empty spaces without any appointments in the day´s diary in order to avoid delays; b) to create spaces at the end of the day for emergency patients, and c) to avoid interruptions during the consultation. RESULTS: 1st stage: on 48.3% of days there were patients with a delay greater than 20 minutes on entering the CD, with a mean waiting-time of 21.3 minutes per patient. 63.1% of the consulting rooms had over 5% «unavoidable¼ appointments per day, of which 61.3% were «emergencies¼. 72.6% of the consulting rooms had 5 or more interruptions per day. 46.7% of patients thought that the time they waited before going into the consulting room was «a lot or enough¼. 2nd stage: after putting the improvement criteria into practice, the number of consultations with waiting time over 20 minutes dropped (37.1%) (P<.05). The number of unavoidable consultations over 5% of the total fell by 35.7% (P=.001), as did the number of consultations with over 5 interruptions per day (by 58.6%) (P=.001). Fewer patients were dissatisfied with the time they had to wait before going into the CD (40.8%) (P<.05). CONCLUSIONS: Patients' waiting time at the clinic dropped. The number of «unavoidable¼ appointments and interruptions was reduced. Patients´ satisfaction improved with the time they had to wait at the clinic improved. The corrective measures introduced are the right ones for correcting the situation.

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OBJECTIVES: To elaborate and validate a scale which can be used as an instrument to find the attitudes towards primary health care of doctors at the first care level. DESIGN: Validation study and questionnaire on attitudes. SETTING: The first care level in the Murcia region. Subjects were 155 doctors (27 family and 128 general doctors) in fixed and provisional posts working in the out-clinics and health centres. MEASUREMENTS AND RESULTS: A Likert-type attitudes scale was designed with five reply options. After the pilot-study on the initial scale and the full item-item correlation, the definitive 46-item survey was elaborated. Selection of subjects was through two-stage stratified randomised sampling, by specialty (general/family medicine) and health district. Reliability was high. Contents validity was reached through various consensus methods. To test validity of construction, a factorial analysis of the main components was performed, with 7 factors isolated: overall patient care, team-work, guidance on health problems, doctor's interest in in-work training, professional role, concern for the psychosocial aspects of the illness and inclusion of second level professionals. CONCLUSIONS: The scale designed is a valid instrument, both a reliable way of identifying PHC doctors' attitudes and the attitudes, which could be improved.

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OBJECTIVE: To determine the on-going training (OT) needs expressed by Primary Care professionals in the Murcia region. DESCRIPTION: A descriptive, crossover study using a postal questionnaire, filled in anonymously by the subjects themselves. SETTING: Primary Care. PARTICIPANTS: All the PC health professionals (doctors, nurses, paediatricians) in the Murcia region (n = 1052). MEASUREMENTS AND MAIN RESULTS: 37.93% of the questionnaires were returned (n = 399): 39.14% of doctors, 35.02% of nurses and 43.5% of paediatricians. 94.7% of respondents thought that OT was necessary; and 80.5% thought it should be compulsory. The main learning source was journals, although courses were considered more useful. Limitations on OT were: incompatibility with working hours, lack of financing (for cover) and lack of time to attend courses. Doctors, nurses and paediatricians agreed that the priority OT areas were: "organising the PC team," "recording procedures and programming" and "guaranteed quality". CONCLUSIONS: The PC professional who replied to our questionnaire considers that he/she needs on-going training, that this should be compulsory, that courses set up by the administration are useful and that time and financing are the limitations on OT.

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OBJECTIVE: To determine the professional profile of health staff (doctors, paediatricians and nurses) in primary care (PC). DESIGN: Three simultaneous Delphi techniques (consensus method). SETTING: Primary care. PARTICIPANTS: 55 doctors, 45 nurses and 23 paediatricians from the whole of Spain and different fields of activity. INTERVENTION: The filling in of three questionnaires, using the Delphi methodology. RESULTS: The overall percentage of replies was 69.1% (first questionnaire), 70.7% (2nd) and 60.16% (3th). The PC doctor should guide in a suitable way his/her community's health problems, using the relevant diagnostic and therapeutic methods, caring for patients' all-round health, controlling the doctor-patient interview, all in collaboration with other professionals, with a planning, programming and evaluation of his/her activity and a basically community-oriented approach. The nursing professional should provide all-round care for patients, using nursing diagnostic and therapeutic methods, within a multidisciplinary team and carrying out planning, programming and evaluation of the community's health problems. The PC paediatrician should be concerned with the prevention and treatment of the most common pathologies. He/she has a vital role to play in childrens' health education, should have the training to resolve the most common paediatric emergencies and organise his/her work within a multidisciplinary team. CONCLUSIONS: The Delphi method is a useful technique for determining professional profiles. Paediatricians have a more sharply defined profile than doctors and nursing staff.

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