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    "titulo" => "Opiniones de los gestores de la atención primaria sobre las fuentes de influencia en la práctica médica. Diferencias con la opinión de los médicos asistenciales"
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        "titulo" => "&#40;Opinions of primary care managers on sources of influence on medical practice&#46; Differences with physicians&#39; opinions&#41;"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Objetivos</span></span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los objetivos del estudio son&#58; conocer la opini&#243;n de los gestores de atenci&#243;n primaria acerca de la importancia y legitimidad de distintas fuentes de influencia en la pr&#225;ctica m&#233;dica&#44; y comparar estos resultados con la opini&#243;n de los m&#233;dicos asistenciales de los equipos de atenci&#243;n primaria&#46;</p> <span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Material y m&#233;todos</span></span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dise&#241;o de estudio transversal&#46; Poblaci&#243;n&#58; gestores de atenci&#243;n primaria pertenecientes a la Red del INSALUD &#40;gerentes de &#225;rea&#44; directores m&#233;dicos y de enfermer&#237;a&#41; y al Servicio Andaluz de Salud &#40;directores de distrito&#44; coordinadores de enfermer&#237;a y coordinadores de epidemiolog&#237;a y programas&#41;&#46; La muestra se corresponde con la poblaci&#243;n total y fue de 302&#46; Como variables dependientes se consider&#243; un conjunto de preguntas que recog&#237;an las opiniones de los entrevistados sobre distintas estrategias&#44; instituciones y&#47;o colectivos que ejercen alg&#250;n tipo de influencia en la pr&#225;ctica m&#233;dica&#46; El grado de &#171;importancia&#187; de cada una de ellas se sintetiz&#243; en un conjunto de 9 &#237;tems que se ped&#237;a que se puntuaran desde 1 &#40;el m&#225;s importante&#41; hasta 9 &#40;el menos importante&#41;&#46; Para valorar la &#171;legitimidad&#187; de las mismas se presentaron 16 &#237;tems medidos mediante una escala tipo Likert de 7 puntos &#40;1&#58; nada leg&#237;timo&#59; 7&#58; muy leg&#237;timo&#41;&#46; Se utiliz&#243; un cuestionario autoadministrado enviado por correo&#46; Para el an&#225;lisis estad&#237;stico de los datos se emplearon test no param&#233;tricos &#40;Friedman y Kruskall-Wallis&#41;&#46;</p> <span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Resultados</span></span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La tasa de respuesta fue del 79&#44;8&#37;&#46; El an&#225;lisis de los rangos medios de cada &#237;tem&#44; mediante el test de Friedman para una escala ordinal de 9 puntos&#44; puso de manifiesto que entre las fuentes de influencia m&#225;s importantes para los gestores sanitarios de atenci&#243;n primaria estudiados destacan&#58; la elaboraci&#243;n de protocolos de actuaci&#243;n por los propios m&#233;dicos&#59; la discusi&#243;n con los colegas&#59; recibir retroalimentaci&#243;n de los pacientes atendidos&#44; y la asistencia a cur-sos de formaci&#243;n&#44; lectura de art&#237;culos e informes cient&#237;ficos&#46; Las instituciones o colectivos con mayor legitimidad para influir en la pr&#225;ctica m&#233;dica son&#58; los usuarios o ciudadanos&#44; las auditor&#237;as internas&#44; los compa&#241;eros de trabajo m&#233;dicos&#44; las organizaciones cient&#237;ficas y los propios gestores&#46;</p> <span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Conclusiones</span></span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las fuentes de influencia que se consideran m&#225;s importantes y legitimadas para influir en la pr&#225;ctica m&#233;dica se sit&#250;an en torno al denominado &#171;sistema profesional m&#233;dico&#187;&#46; Respecto a las principales diferencias entre la opini&#243;n de los gestores y la de los m&#233;dicos asistenciales&#44; hay que se&#241;alar que entre los primeros cuentan con una mayor aceptaci&#243;n los mecanismos de gesti&#243;n empresarial y las influencias en la pr&#225;ctica m&#233;dica procedentes de los distintos actores del contexto social&#46; Este hecho podr&#237;a expresar la existencia de diferencias en los sistemas de valores entre los profesionales asistenciales y los gestores de la atenci&#243;n primaria&#46;</p>"
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      "en" => array:2 [
        "titulo" => "Summary"
        "resumen" => "<span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Objectives</span></span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the opinion of primary healthcare managers on the importance and legitimacy of different sources of influence in medical practice&#44; and to compare the results with the opinions of physicians in healthcare teams&#46;</p> <span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Material and methods</span></span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Design&#58; cross-sectional study&#46; Population&#58; primary healthcare managers in the Spanish public health system &#40;area managers&#44; medical and nursing directors&#41; and in the Andalusian health service &#40;district director&#44; nursing coordinators and epidemiology and program coordinators&#41;&#46; The sample comprised the total population of 302&#46; As dependent variables&#44; a series of questions was designed to gather the interviewees&#8217; opinions on different strategies&#44; institutions and&#47;or collectives that exert some kind of influence on medical practice&#46; The degree of &#171;importance&#187; of each factor was summarized into a set of 9 items&#46; The subjects were asked to score each item from 1 &#40;most important&#41; to 9 &#40;least important&#41;&#46; To assess the &#171;legitimacy&#187; of these scores&#44; 16 items were presented measured using a Likert-type 7-point scale &#40;1&#58; not at all legitimate&#59; 7&#58; very legitimate&#41;&#46; A self-administered questionnaire was used&#44; sent by mail&#46; Non-parametric tests &#40;Friedman and Kruskall-Wallis&#41; were used for statistical analysis of the data&#46;</p> <span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Results</span></span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The response rate was 79&#46;8&#37;&#46; Using the Friedman test for an ordinal 9-point scale&#44; analysis of the mean ranges for each item revealed that the most important sources of influence for the primary healthcare managers interviewed were&#58; the devising of management protocols by the doctors themselves&#59; discussion with colleagues&#59; feedback from patients&#44; and attending training courses&#44; and reading articles and scientific journals&#46; The institutions or groups with the greatest legitimacy to influence medical practice were&#58; users or citizens&#59; internal audits&#59; peers&#59; scientific associations&#44; and the managers themselves&#46;</p> <span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Conclusions</span></span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The sources of influence considered to have the greatest importance and legitimacy in influencing medical practice concern the &#171;professional medical system&#187; &#40;selfdefined protocols&#44; discussion with colleagues&#44; etc&#46;&#41;&#46; Managers accept the use of business managerial tools as well as the influence of social actors to a greater extent than do physicians&#46; This finding could indicate differences in the value systems between primary healthcare physicians and managers&#46;</p>"
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Opiniones de los gestores de la atención primaria sobre las fuentes de influencia en la práctica médica. Diferencias con la opinión de los médicos asistenciales
(Opinions of primary care managers on sources of influence on medical practice. Differences with physicians' opinions)
L.A. López
Autor para correspondencia
luisandres@easp.es

Correspondencia: Luis Andrés López Fernández. Escuela Andaluza de Salud Pública. Campus Universitario de Cartuja, s/n. 18080 Granada
, J.M. Jiménez, O. Solas, J.I. Martínez, E. de Manuel
Escuela Andaluza de Salud Pública (EASP). Granada
J.D. de Lunaa
a Facultad de Medicina. Universidad de Granada
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    "titulo" => "Opiniones de los gestores de la atenci&#243;n primaria sobre las fuentes de influencia en la pr&#225;ctica m&#233;dica&#46; Diferencias con la opini&#243;n de los m&#233;dicos asistenciales"
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        "titulo" => "&#40;Opinions of primary care managers on sources of influence on medical practice&#46; Differences with physicians&#39; opinions&#41;"
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Objetivos</span></span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Los objetivos del estudio son&#58; conocer la opini&#243;n de los gestores de atenci&#243;n primaria acerca de la importancia y legitimidad de distintas fuentes de influencia en la pr&#225;ctica m&#233;dica&#44; y comparar estos resultados con la opini&#243;n de los m&#233;dicos asistenciales de los equipos de atenci&#243;n primaria&#46;</p> <span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Material y m&#233;todos</span></span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Dise&#241;o de estudio transversal&#46; Poblaci&#243;n&#58; gestores de atenci&#243;n primaria pertenecientes a la Red del INSALUD &#40;gerentes de &#225;rea&#44; directores m&#233;dicos y de enfermer&#237;a&#41; y al Servicio Andaluz de Salud &#40;directores de distrito&#44; coordinadores de enfermer&#237;a y coordinadores de epidemiolog&#237;a y programas&#41;&#46; La muestra se corresponde con la poblaci&#243;n total y fue de 302&#46; Como variables dependientes se consider&#243; un conjunto de preguntas que recog&#237;an las opiniones de los entrevistados sobre distintas estrategias&#44; instituciones y&#47;o colectivos que ejercen alg&#250;n tipo de influencia en la pr&#225;ctica m&#233;dica&#46; El grado de &#171;importancia&#187; de cada una de ellas se sintetiz&#243; en un conjunto de 9 &#237;tems que se ped&#237;a que se puntuaran desde 1 &#40;el m&#225;s importante&#41; hasta 9 &#40;el menos importante&#41;&#46; Para valorar la &#171;legitimidad&#187; de las mismas se presentaron 16 &#237;tems medidos mediante una escala tipo Likert de 7 puntos &#40;1&#58; nada leg&#237;timo&#59; 7&#58; muy leg&#237;timo&#41;&#46; Se utiliz&#243; un cuestionario autoadministrado enviado por correo&#46; Para el an&#225;lisis estad&#237;stico de los datos se emplearon test no param&#233;tricos &#40;Friedman y Kruskall-Wallis&#41;&#46;</p> <span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Resultados</span></span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La tasa de respuesta fue del 79&#44;8&#37;&#46; El an&#225;lisis de los rangos medios de cada &#237;tem&#44; mediante el test de Friedman para una escala ordinal de 9 puntos&#44; puso de manifiesto que entre las fuentes de influencia m&#225;s importantes para los gestores sanitarios de atenci&#243;n primaria estudiados destacan&#58; la elaboraci&#243;n de protocolos de actuaci&#243;n por los propios m&#233;dicos&#59; la discusi&#243;n con los colegas&#59; recibir retroalimentaci&#243;n de los pacientes atendidos&#44; y la asistencia a cur-sos de formaci&#243;n&#44; lectura de art&#237;culos e informes cient&#237;ficos&#46; Las instituciones o colectivos con mayor legitimidad para influir en la pr&#225;ctica m&#233;dica son&#58; los usuarios o ciudadanos&#44; las auditor&#237;as internas&#44; los compa&#241;eros de trabajo m&#233;dicos&#44; las organizaciones cient&#237;ficas y los propios gestores&#46;</p> <span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Conclusiones</span></span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las fuentes de influencia que se consideran m&#225;s importantes y legitimadas para influir en la pr&#225;ctica m&#233;dica se sit&#250;an en torno al denominado &#171;sistema profesional m&#233;dico&#187;&#46; Respecto a las principales diferencias entre la opini&#243;n de los gestores y la de los m&#233;dicos asistenciales&#44; hay que se&#241;alar que entre los primeros cuentan con una mayor aceptaci&#243;n los mecanismos de gesti&#243;n empresarial y las influencias en la pr&#225;ctica m&#233;dica procedentes de los distintos actores del contexto social&#46; Este hecho podr&#237;a expresar la existencia de diferencias en los sistemas de valores entre los profesionales asistenciales y los gestores de la atenci&#243;n primaria&#46;</p>"
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      "en" => array:2 [
        "titulo" => "Summary"
        "resumen" => "<span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Objectives</span></span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the opinion of primary healthcare managers on the importance and legitimacy of different sources of influence in medical practice&#44; and to compare the results with the opinions of physicians in healthcare teams&#46;</p> <span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Material and methods</span></span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Design&#58; cross-sectional study&#46; Population&#58; primary healthcare managers in the Spanish public health system &#40;area managers&#44; medical and nursing directors&#41; and in the Andalusian health service &#40;district director&#44; nursing coordinators and epidemiology and program coordinators&#41;&#46; The sample comprised the total population of 302&#46; As dependent variables&#44; a series of questions was designed to gather the interviewees&#8217; opinions on different strategies&#44; institutions and&#47;or collectives that exert some kind of influence on medical practice&#46; The degree of &#171;importance&#187; of each factor was summarized into a set of 9 items&#46; The subjects were asked to score each item from 1 &#40;most important&#41; to 9 &#40;least important&#41;&#46; To assess the &#171;legitimacy&#187; of these scores&#44; 16 items were presented measured using a Likert-type 7-point scale &#40;1&#58; not at all legitimate&#59; 7&#58; very legitimate&#41;&#46; A self-administered questionnaire was used&#44; sent by mail&#46; Non-parametric tests &#40;Friedman and Kruskall-Wallis&#41; were used for statistical analysis of the data&#46;</p> <span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Results</span></span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The response rate was 79&#46;8&#37;&#46; Using the Friedman test for an ordinal 9-point scale&#44; analysis of the mean ranges for each item revealed that the most important sources of influence for the primary healthcare managers interviewed were&#58; the devising of management protocols by the doctors themselves&#59; discussion with colleagues&#59; feedback from patients&#44; and attending training courses&#44; and reading articles and scientific journals&#46; The institutions or groups with the greatest legitimacy to influence medical practice were&#58; users or citizens&#59; internal audits&#59; peers&#59; scientific associations&#44; and the managers themselves&#46;</p> <span class="elsevierStyleSectionTitle"><span class="elsevierStyleItalic">Conclusions</span></span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The sources of influence considered to have the greatest importance and legitimacy in influencing medical practice concern the &#171;professional medical system&#187; &#40;selfdefined protocols&#44; discussion with colleagues&#44; etc&#46;&#41;&#46; Managers accept the use of business managerial tools as well as the influence of social actors to a greater extent than do physicians&#46; This finding could indicate differences in the value systems between primary healthcare physicians and managers&#46;</p>"
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Información del artículo
ISSN: 02139111
Idioma original: Español
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2018 Agosto 14 11 25
2018 Julio 19 9 28
2018 Junio 24 10 34
2018 Mayo 32 11 43
2018 Abril 20 7 27
2018 Marzo 18 8 26
2018 Febrero 12 5 17
2018 Enero 15 5 20
2017 Diciembre 17 9 26
2017 Noviembre 22 7 29
2017 Octubre 11 11 22
2017 Septiembre 16 10 26
2017 Agosto 8 5 13
2017 Julio 15 15 30
2017 Junio 28 6 34
2017 Mayo 20 9 29
2017 Abril 30 18 48
2017 Marzo 17 12 29
2017 Febrero 12 5 17
2017 Enero 9 5 14
2016 Diciembre 18 3 21
2016 Noviembre 14 9 23
2016 Octubre 23 11 34
2016 Septiembre 18 5 23
2016 Agosto 23 9 32
2016 Julio 13 5 18
2015 Diciembre 1 0 1
2015 Octubre 1 0 1
2015 Septiembre 1 0 1
2015 Agosto 2 0 2
2015 Julio 1 0 1
2015 Junio 2 0 2
2015 Mayo 1 0 1
2015 Abril 2 0 2
2015 Marzo 1 0 1
2015 Febrero 3 0 3
2015 Enero 3 1 4
2014 Diciembre 2 2 4
2014 Noviembre 2 3 5
2014 Octubre 1 2 3
2014 Septiembre 3 4 7
2014 Agosto 9 1 10
2014 Julio 9 2 11
2014 Junio 6 4 10
2014 Mayo 4 1 5
2014 Abril 5 2 7
2014 Marzo 4 2 6
2014 Febrero 8 0 8
2014 Enero 8 1 9
2013 Diciembre 19 1 20
2013 Noviembre 16 2 18
2013 Octubre 24 4 28
2013 Septiembre 18 5 23
2013 Agosto 25 3 28
2013 Julio 22 2 24
2002 Agosto 1894 0 1894
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