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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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