RESUMEN
Multimorbidity (MM) is a widespread problem and it poses unsolved issues like the healthcare professionals' training. A training curriculum has been proposed, but it has not been sufficiently explored in a clinical context. The eMULTIPAP course is part of the MULTIPAP complex intervention, applied through a pragmatic controlled, cluster randomized clinical trial to general practitioners (GP) and his/her patients with MM with 12 months follow-up. The eMULTIPAP course is based on problem-based learning, constructivism and Ariadne principles. It has been assessed according to the Kirkpatrick model and has shown knowledge improvement and high applicability of learning with more motivation to consider MM in the clinical practice. It has also improved the Medication Appropriateness Index at 6-months and at 12- months. We conclude that the eMULTIPAP course generates significant changes in GP's learning, enhancing clinical practice in multimorbidity scenarios.
Asunto(s)
Educación Médica Continua/métodos , Multimorbilidad , Médicos de Atención Primaria/educación , Polifarmacología , Atención Primaria de Salud/normas , Aprendizaje Basado en Problemas/métodos , Anciano , Quimioterapia Combinada/métodos , Quimioterapia Combinada/normas , Evaluación Educacional , Femenino , Humanos , Prescripción Inadecuada/prevención & control , Masculino , Polifarmacia , Atención Primaria de Salud/métodos , Mejoramiento de la Calidad , Desarrollo de Personal/métodosRESUMEN
Objectives: To evaluate the impact of a massive online open course (MOOC) design on the appropriate use of antimicrobial agents, to determine specific study areas with better learning outcomes and to identify weak points. Methods: A pre- and post-intervention study in the context of a training course on infectious diseases aimed at health professionals. We designed a questionnaire with 30 questions related to the management of infectious diseases in different clinical situations. Participants had to answer the questions based on their competencies and training for these situations. We analysed the scores obtained before and after the course and the resulting progress. In addition, an open response section was provided to enable a qualitative evaluation. Results: Two thousand one hundred and forty-eight health professionals were enrolled in the course. The questionnaire was completed before and after the course by 606 participants, mainly physicians (81.2%) and pharmacists (15.4%). The mean overall scores for the pre- and post-course questionnaires were 6.2 (SD 1.38) and 7.9 (SD 0.88), respectively (overall score increase = 1.8, SD 1.21, P <â0.001). A significant increase in self-assessment was detected (P <â0.001) for all the questions. Qualitative assessments were provided by 218 participants with 225 comments, most of which were very positive. Conclusions: The course with a MOOC design showed a great teaching capacity in the infectious diseases area for all the clinical situations analysed, notably in the management of severe infections with higher mortality. For future editions of this training activity, the need to include other infectious diseases, especially infections in primary care, was highlighted.
Asunto(s)
Antiinfecciosos/uso terapéutico , Enfermedades Transmisibles/tratamiento farmacológico , Utilización de Medicamentos/normas , Tecnología Educacional/métodos , Preceptoría/métodos , Evaluación de Programas y Proyectos de Salud , Adulto , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Few data exist on the psychosocial factors associated with attrition in longitudinal surveys. This study was undertaken to determine psychosocial and sociodemographic predictors of attrition from a longitudinal study of the onset and persistence of episodes of major depression in primary care. METHODS: A systematic random sample of general practice attendees was recruited in seven Spanish provinces between October 2005 and February 2006. Major depression was diagnosed using the Composite International Diagnostic Interview and a set of 39 individual and environmental risk factors for depression were assessed at baseline and after 6 and 12â months of follow-up. Data were analysed using multilevel logistic regression. RESULTS: 7777 primary care attendees aged 18-75â years were selected, of whom 1251 (16.1%) were excluded. Of the remaining 6526, 1084 (16.6%) refused to participate. Thus, 5442 patients (attending 231 family physicians in 41 health centres) were interviewed at baseline, of whom 3804 (70%) and 3567 (66%) remained at 6 and 12â months of follow-up, respectively. The province and sociodemographic factors were stronger predictors of attrition than psychosocial factors. Depression and anxiety had no effect but other psychosocial factors affected attrition. There were different profiles for the patients lost at 12â months when predictors measured at baseline versus 6â months were included. CONCLUSIONS: These findings suggest that several psychosocial factors might be considered factors of attrition in primary care cohorts and confirm that baseline characteristics are insufficient for analysing non-response in longitudinal studies, indicating that different retention strategies should be applied for patients interviewed at 6 and 12â months.
Asunto(s)
Trastorno Depresivo Mayor/psicología , Conductas Relacionadas con la Salud , Negativa a Participar/psicología , Adolescente , Adulto , Anciano , Trastorno Depresivo Mayor/diagnóstico , Trastorno Depresivo Mayor/epidemiología , Femenino , Estudios de Seguimiento , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Psicometría , Negativa a Participar/estadística & datos numéricos , Factores de Riesgo , Clase Social , España/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: The effects of putative risk factors on the onset and/or persistence of depression remain unclear. We aim to develop comprehensive models to predict the onset and persistence of episodes of depression in primary care. Here we explain the general methodology of the predictD-Spain study and evaluate the reliability of the questionnaires used. METHODS: This is a prospective cohort study. A systematic random sample of general practice attendees aged 18 to 75 has been recruited in seven Spanish provinces. Depression is being measured with the CIDI at baseline, and at 6, 12, 24 and 36 months. A set of individual, environmental, genetic, professional and organizational risk factors are to be assessed at each follow-up point. In a separate reliability study, a proportional random sample of 401 participants completed the test-retest (251 researcher-administered and 150 self-administered) between October 2005 and February 2006. We have also checked 118,398 items for data entry from a random sample of 480 patients stratified by province. RESULTS: All items and questionnaires had good test-retest reliability for both methods of administration, except for the use of recreational drugs over the previous six months. Cronbach's alphas were good and their factorial analyses coherent for the three scales evaluated (social support from family and friends, dissatisfaction with paid work, and dissatisfaction with unpaid work). There were 191 (0.16%) data entry errors. CONCLUSION: The items and questionnaires were reliable and data quality control was excellent. When we eventually obtain our risk index for the onset and persistence of depression, we will be able to determine the individual risk of each patient evaluated in primary health care.