RESUMEN

Type 2 diabetes mellitus represents 30-50% of the cases of end stage renal disease worldwide. Thus, a correct evaluation of renal function in patients with diabetes is crucial to prevent or ameliorate diabetes-associated kidney disease. The reliability of formulas to estimate renal function is still unclear, in particular, those new equations based on cystatin-C or the combination of creatinine and cystatin-C. We aimed to assess the error of the available formulas to estimate glomerular filtration rate in diabetic patients. We evaluated the error of creatinine and/or cystatin-C based formulas in reflecting real renal function over a wide range of glomerular filtration rate (from advanced chronic kidney disease to hyperfiltration). The error of estimated glomerular filtration rate by any equation was common and wide averaging 30% of real renal function, and larger in patients with measured glomerular filtration rate below 60 mL/min. This led to chronic kidney disease stages misclassification in about 30% of the individuals and failed to detect 25% of the cases with hyperfiltration. Cystatin-C based formulas did not outperform creatinine based equations, and the reliability of more modern algorithms proved to be as poor as older equations. Formulas failed in reflecting renal function in type 2 diabetes mellitus. Caution is needed with the use of these formulas in patients with diabetes, a population at high risk for kidney disease. Whenever possible, the use of a gold standard method to measure renal function is recommended.

RESUMEN

Objetivo: Examinar desde la perspectiva del médico de atención primaria (AP) las ventajas e inconvenientes de 2 formas diferentes de organización del sistema sanitario. Diseño: Estudio cualitativo basado en análisis de documentos elaborados para el estudio a modo de diarios. Emplazamiento: Atención Primaria de Canarias (España) y Alberta (Canadá). Participantes y/o contextos: Muestreo intencionado con el fin de identificar diferentes perfiles de médicos. Método: A los participantes se solicitó que escribieran un documento en el que hicieran una descripción de su actividad laboral, incluyendo un análisis del impacto en su vida personal como de la organización del sistema. Se solicitó a 2 representantes del sistema sanitario que hicieran una descripción detallada de cómo se organiza la atención primaria en su país. Se obtuvieron 9 diarios de médicos (5 de Canarias y 4 de Alberta). Se utilizó el marco de Ritchie y Spencer para el análisis. Resultados: En Alberta los médicos tienen acceso a más pruebas complementarias; pueden ofrecer asistencia en el hospital; tienen que ocuparse de la gestión; pueden establecerse donde consideren; y pueden especializarse por áreas. En Canarias los médicos disponen de vacaciones y no depende de ellos la responsabilidad de la administración de los servicios; los pacientes tienen un médico asignado; y tienen más apoyo institucional. Conclusiones: Los resultados de este estudio permiten hacer una crítica constructiva sobre el papel del médico en atención primaria, valorar las ventajas y replantearnos los inconvenientes relacionados con nuestra forma de trabajar con el fin de aprender de otros sistemas organizativos(AU)

Objective: To examine the advantages and disadvantages of two different Health Care Systems from the perspective of Primary Care (PC) physicians. Design: Qualitative research based on the analysis of documents written as diaries for the study. Setting: Primary Care in the Canary Islands (Spain) and Alberta (Canada). Context and participants: Intentional sample to identify different profiles of physicians. Method: Participants were asked to write a document describing their work activities, including the impact of the organisational system and on their personal life. Two representatives of the health care system were asked to write a detailed description about how PC is organised in their country. Nine diaries were collected (5 from the Canary Islands and 4 from Alberta). Ritchie & Spencer framework was used for the analysis. Results. In Alberta, physicians have access to more complementary tests; they can offer hospital care; they have to sort out administrative work; they can choose were to work; and can specialise in different types of health care services. In the Canary Islands physicians can have paid holidays and the administrative issues do not depend on them, patients have a physician assigned and seem to have more institutional support. Conclusions: The results of this study allow us to constructively analyse the role of PC physicians, assess the advantages and re-think the disadvantages related to how we work in order to learn from other health care systems(AU)

Asunto(s)

RESUMEN

OBJECTIVE: To examine the advantages and disadvantages of two different Health Care Systems from the perspective of Primary Care (PC) physicians. DESIGN: Qualitative research based on the analysis of documents written as diaries for the study. SETTING: Primary Care in the Canary Islands (Spain) and Alberta (Canada) CONTEXT AND PARTICIPANTS: Intentional sample to identify different profiles of physicians. METHOD: Participants were asked to write a document describing their work activities, including the impact of the organisational system and on their personal life. Two representatives of the health care system were asked to write a detailed description about how PC is organised in their country. Nine diaries were collected (5 from the Canary Islands and 4 from Alberta). Ritchie & Spencer framework was used for the analysis. RESULTS: In Alberta, physicians have access to more complementary tests; they can offer hospital care; they have to sort out administrative work; they can choose were to work; and can specialise in different types of health care services. In the Canary Islands physicians can have paid holidays and the administrative issues do not depend on them, patients have a physician assigned and seem to have more institutional support. CONCLUSIONS: The results of this study allow us to constructively analyse the role of PC physicians, assess the advantages and re-think the disadvantages related to how we work in order to learn from other health care systems.

Asunto(s)