RESUMEN
Abstract: The information system on chronic diseases is an electronic system that was recently established in Mexico to monitor new cases and cumulative chronic diseases that are increasing. The aim of this study was to evaluate the qualitative and quantitative consistency of the electronic record of diseases such as diabetes, obesity, hypertension and dyslipidemia, in contrast to what was found in the medical records through a validation system exprofeso data. It followed up on 3,293 diseases recorded and compared with the pathologies registered in the files, these were higher than the records (n = 4,188). It was found that there is an electronic sub-register of diseases recorded in medical units with a differential in the quality standards of care. Our results reveal that to increase the effectiveness of electronic health information it is required a mechanism of annual or biennial review by a systematic validation and based on clinical records. This system also enables validation mechanisms and promotes greater adherence to treatment in the management of chronic diseases, contributing to quality improvement and cost containment in health.
Resumen: El sistema de información en enfermedades crónicas, es un sistema electrónico que se estableció en México recientemente para el monitoreo de los casos nuevos y acumulados de enfermedades crónicas que van en aumento. El objetivo de este estudio fue evaluar la consistencia cualitativa y cuantitativa del registro electrónico de enfermedades como la diabetes, obesidad, hipertensión arterial y dislipidemias, en contraste con lo encontrado en el expediente clínico a través de un sistema de validación de datos exprofeso. Se dio seguimiento a 3,293 patologías registradas y se compararon con las patologías registradas en los expedientes las cuales fueron mayores a los registros en los expedientes (n = 4,188). Se encontró que existe un sub-registro electrónico de las enfermedades registradas en las unidades médicas con un diferencial en los estándares de calidad de la atención. Nuestros resultados dejan ver que para incrementar la efectividad de un sistema de información electrónica en salud se requiere de un mecanismo de revisión anual o bianual a través de una validación sistematizada y basada en los expedientes clínicos. Este sistema de validación también permite y promueve mecanismos de mayor adherencia al tratamiento en el manejo de las enfermedades crónicas contribuyendo a mejoras en la calidad y en la contención de costos en salud.
RESUMEN
AIM: To describe the physical activity (PA) prescribing behaviour of Mexican primary care physicians and determine if the theory of planned behaviour (TPB) explains this behaviour. METHODS: 633 physicians (56% male, mean age 38 years) from 305 primary care clinics in Jalisco, Mexico self-reported PA prescription behaviour, PA involvement, attitude, subjective norm, perceived behavioural control (PBC) and intention related to PA prescription behaviour. Structural equation modelling (SEM) was employed. RESULTS: 48% of physicians reported they always ask patients about their PA, 33% provide verbal prescriptions, 6% provide written prescriptions, 8% refer patients to PA resources and 4% assess patient fitness. SEM analysis showed that the fit of the TPB model was satisfactory (RMSEA = 0.05, CFI = 0.98, SRMR = 0.05). The model explained 79% of the variance on intention (r(2) = 0.79, p < 0.05), and 14% of the variance on prescription behaviour (r(2) = 0.14, p < 0.05). Subjective norm (ß = 0.73, p < 0.05) and attitude (ß = 0.16, p < 0.05) explained behavioural intention, while PBC (ß = 0.38, p < 0.05) and physician PA (ß = 0.15, p < 0.05) explained prescription behaviour. DISCUSSION: The TPB provided useful insight into physician prescription behaviour, although not all the theory tenets were supported. More research testing the TPB and other theories is needed to better understand psychosocial predictors of this behaviour. CONCLUSION: Strategies aimed at improving physicians' perceived ability to prescribe PA and their own PA involvement seem worthwhile.