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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir la aplicaci&#243;n de t&#233;cnicas m&#233;dicas &#40;ATM&#41; en tres comunidades aut&#243;nomas espa&#241;olas &#40;Andaluc&#237;a&#44; Catalu&#241;a y Pa&#237;s Vasco&#41; y analizar sus relaciones con diversas caracter&#237;sticas relacionadas con los m&#233;dicos de atenci&#243;n primaria y el centro de salud&#46;</p> <span class="elsevierStyleSectionTitle">&#33;Dise&#241;o</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio multic&#233;ntrico&#44; transversal&#46;</p> <span class="elsevierStyleSectionTitle">Emplazamiento</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Un total de 319 m&#233;dicos generales que trabajaban en los centros de atenci&#243;n primaria del sector p&#250;blico reformado en las comunidades de Andaluc&#237;a&#44; Pa&#237;s Vasco y Catalu&#241;a&#46;</p> <span class="elsevierStyleSectionTitle">Mediciones principales</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Cuestionario estructurado y validado de 100 preguntas en cuatro apartados&#58; caracter&#237;sticas generales del profesional y centro de trabajo&#44; perfil de actividad y satisfacci&#243;n laboral&#46; &#201;ste fue enviado por correo al centro de trabajo &#40;Andaluc&#237;a y Euskadi&#41; o domicilio particular &#40;Catalu&#241;a&#41;&#46; Para el an&#225;lisis se cre&#243; una variable &#237;ndice a partir de las respuestas de las preguntas de ATM&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La variable &#237;ndice de ATM obtuvo un valor medio &#40;desviaci&#243;n est&#225;ndar &#91;DE&#93;&#41; de 10&#44;02 &#40;4&#44;55&#41; y Andaluc&#237;a el valor m&#225;s alto &#40;media &#91;DE&#93;&#58; 11&#44;11 &#91;4&#44;33&#93;&#41; de las tres comunidades del estudio &#40;p &#61; 0&#44;012&#41;&#46; La variable &#237;ndice ATM adquiere valores significativamente m&#225;s altos en relaci&#243;n con&#58; el sexo masculino &#40;muestra de tres comunidades aut&#243;nomas&#59; p &#61; 0&#44;046&#41;&#44; el &#225;mbito rural&#44; el trabajo en equipo&#44; la disponibilidad de equipamiento b&#225;sico&#44; el n&#250;mero de pacientes m&#225;s reducido y menor carga asistencial&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los &#237;ndices de ATM en Espa&#241;a son significativamente distintos en las tres comunidades espa&#241;olas estudiadas&#46; La calidad de la asistencia sanitaria evaluada desde la dimensi&#243;n de la ATM parece estar muy relacionada con caracter&#237;sticas demogr&#225;ficas&#44; la disponibilidad en las consultas del material cient&#237;fico-t&#233;cnico y el tiempo adecuado de las visitas m&#233;dicas&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To describe the application of medical techniques &#40;ATM&#41; in Spain and to analyze the relationship with diverse characteristics related to general practitioners and the center of primary health&#46;</p> <span class="elsevierStyleSectionTitle">Design</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Multicenter cross-sectional study&#46;</p> <span class="elsevierStyleSectionTitle">Setting</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Three hundred nineteen general practitioners working in primary care centers in the restructured public sector of the Autonomous Communities of Andalusia&#44; Basque Country and Catalonia in Spain&#46;</p> <span class="elsevierStyleSectionTitle">Main measurements</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Structured and validated questionnaire comprising 100 items in four sections&#58; general characteristics of the physician and health center&#44; task profile&#44; and job satisfaction&#46; The questionnaire was sent by mail to the health center &#40;Andalusia and Basque Country&#41; or to the home &#40;Catalonia&#41;&#46; For the analysis an index variable was created from the answers to the questions on AMT&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">The index variable of AMT obtained a mean value of 10&#46;02 &#40;SD &#61; 4&#46;55&#41;&#46; Andalusia obtained the highest value &#40;median&#58; 11&#46;11&#59; SD&#58; 4&#46;33&#41; of the three Autonomous Communities in the study &#40;p &#61; &#46;012&#41;&#46; AMT acquired significantly higher values when associated with&#58; masculine sex &#40;sample from the three autonomous communities&#59; p &#61; &#46;046&#41;&#44; rural environment&#44; teamwork&#44; availability of basic equipment&#44; fewer patients&#44; and reduced work load&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Index of ATM in Spain is significantly different in the three Spanish communities under study&#46; The quality of the sanitary services evaluated from the dimension of the ATM seems to be much related with demographic characteristics&#44; the readiness in the consultations of scientific-technical stuff and the appropriate time for medical consultations&#46;</p>"
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                    0 => array:1 [
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                        "paginaFinal" => "1225"
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                      "titulo" => "On the need for outcomes research and the prospects for the evaluative clinical sciences"
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                          "autores" => array:1 [
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                    0 => array:1 [
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                        "titulo" => "The challenges of medical practice variations"
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                      ]
                    ]
                  ]
                ]
              ]
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                      "titulo" => "Unwanted variations in the rules of practice"
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                          "autores" => array:1 [
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                        "paginaInicial" => "1306"
                        "paginaFinal" => "1307"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1995981"
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                        "tituloSerie" => "Br Med J"
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                            0 => "W&#46;G&#46;W&#46; Boerma"
                            1 => "J&#46; Van der Zee"
                            2 => "D&#46;M&#46; Fleming"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Gen Pract"
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                        "volumen" => "47"
                        "paginaInicial" => "481"
                        "paginaFinal" => "486"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9302786"
                            "web" => "Medline"
                          ]
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                ]
              ]
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                      "titulo" => "The interface study&#46; &#91;Occasional Paper 48&#93;"
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                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;L&#46; Crombie"
                            1 => "J&#46; Van der Zee"
                            2 => "P&#46; Backer"
                          ]
                        ]
                      ]
                    ]
                  ]
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                    0 => array:1 [
                      "LibroEditado" => array:1 [
                        "serieFecha" => "1990"
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              "etiqueta" => "10&#46;"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Dutch national survey of general practice&#58; a summary of the survey design"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Foets"
                            1 => "J&#46; Van der Velden"
                            2 => "J&#46; De Bakker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:1 [
                        "serieFecha" => "1992"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gender-related differences in the organization and provision of services among general practitioners in Europe"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;G&#46;W&#46; Boerma"
                            1 => "A&#46; Van den Brink-Muinen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Care"
                        "fecha" => "2000"
                        "volumen" => "38"
                        "paginaInicial" => "993"
                        "paginaFinal" => "1002"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11021672"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perfil de actividad de los m&#233;dicos de atenci&#243;n primaria y sus relaciones con el sistema reformado y no reformado en Catalu&#241;a"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "B&#46; Bolibar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Fundaci&#243; Jordi Gol i Gurina"
                        "fecha" => "1997"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Perfil de los m&#233;dicos de atenci&#243;n primaria en un &#225;rea de salud&#58; un an&#225;lisis de cl&#250;sters"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "V&#46;R&#46; Cabedo"
                            1 => "J&#46;L&#46; Poveda"
                            2 => "M&#46;J&#46; Tejedo"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "Aten Primaria"
                        "fecha" => "1996"
                        "volumen" => "18"
                        "paginaInicial" => "221"
                        "paginaFinal" => "224"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8963009"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0091674900747488"
                          "estado" => "S300"
                          "issn" => "00916749"
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                  ]
                ]
              ]
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            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Boerma WGW&#46; Task profiles of district doctors in Estonia and general practitioners in Finland"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Lember"
                            1 => "E&#46; Kosunen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Scand J Prim Health Care"
                        "fecha" => "1998"
                        "volumen" => "16"
                        "paginaInicial" => "56"
                        "paginaFinal" => "62"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9612881"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The general practitioner as the first contacted health professional by patients with psychosocial problems&#58; a European study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;G&#46;W&#46; Boerma"
                            1 => "P&#46; Verhaak"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Psychol Med"
                        "fecha" => "1999"
                        "volumen" => "29"
                        "paginaInicial" => "689"
                        "paginaFinal" => "696"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10405090"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "General practice in urban and rural Europe&#58; the range of curative services"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "W&#46;G&#46;W&#46; Boerma"
                            1 => "P&#46;P&#46; Groenewegen"
                            2 => "J&#46; Van der Zee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Soc Sci Med"
                        "fecha" => "1998"
                        "volumen" => "47"
                        "paginaInicial" => "445"
                        "paginaFinal" => "453"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9680228"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "GP Home visiting in 18 European countries&#46; Adding the role of health system features"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;G&#46;W&#46; Boerma"
                            1 => "P&#46;P&#46; Groenewegen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Gen Pract"
                        "fecha" => "2001"
                        "volumen" => "7"
                        "paginaInicial" => "132"
                        "paginaFinal" => "137"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gender differences in practice style&#58; a Dutch estudy of general practitoners"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;M&#46; Bensing"
                            1 => "A&#46; Van den Brink-Muinen"
                            2 => "D&#46;H&#46; De Bakker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Care"
                        "fecha" => "1993"
                        "volumen" => "31"
                        "paginaInicial" => "219"
                        "paginaFinal" => "229"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8450680"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Gender differences in general practitioners at work"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Chambers"
                            1 => "I&#46; Campbell"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Gen Pract"
                        "fecha" => "1996"
                        "volumen" => "46"
                        "paginaInicial" => "291"
                        "paginaFinal" => "293"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8762745"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The sex of the general practitioner&#58; a comparison of characteristics&#44; patients&#44; and our conditions managed"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46; Britt"
                            1 => "A&#46; Bhasale"
                            2 => "D&#46;A&#46; Miles"
                            3 => "D&#46;A&#46; Meza"
                            4 => "G&#46;P&#46; Sayer"
                            5 => "M&#46; Angelis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Med Care"
                        "fecha" => "1996"
                        "volumen" => "34"
                        "paginaInicial" => "403"
                        "paginaFinal" => "415"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8614163"
                            "web" => "Medline"
                          ]
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                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21&#46;"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "El papel del g&#233;nero en la relaci&#243;n m&#233;dico-paciente"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Delgado"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "FMC"
                        "fecha" => "1999"
                        "volumen" => "6"
                        "paginaInicial" => "509"
                        "paginaFinal" => "516"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Sex of physician&#58; patients&#39; preferences and sterotypes"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "K&#46; Fennema"
                            1 => "Dl Meyer"
                            2 => "N&#46; Owen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Fam Pract"
                        "fecha" => "1990"
                        "volumen" => "30"
                        "paginaInicial" => "441"
                        "paginaFinal" => "446"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2324696"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
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            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Patient choice in a practice with men and women general practitioners"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "J&#46; Graffy"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Gen Pract"
                        "fecha" => "1990"
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                        "paginaInicial" => "13"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2107832"
                            "web" => "Medline"
                          ]
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                    ]
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                ]
              ]
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Identifying predictors of high quality care in English general practice&#58; observational study"
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                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;M&#46; Campbell"
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                            2 => "J&#46; Hacker"
                            3 => "C&#46; Burns"
                            4 => "D&#46; Oliver"
                            5 => "A&#46; Thapas"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "BMJ"
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                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11440920"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "referencia" => array:1 [
                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Diez minutos por consulta&#46; Estableciendo l&#237;mites a la carga de trabajo del m&#233;dico de familia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
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                            0 => "J&#46; Saura"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Jano"
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                        "paginaInicial" => "23"
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              "etiqueta" => "26&#46;"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Diez minutos y Confucio"
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                            0 => "A&#46; Segura"
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                        "tituloSerie" => "El Pa&#237;s"
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                ]
              ]
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            26 => array:3 [
              "identificador" => "bib27"
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                      "titulo" => "Diez minutos&#44; &#161;qu&#233; menos&#33; &#91;editorial&#93;"
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                          "etal" => false
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Aten Primaria"
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                        "paginaInicial" => "297"
                        "paginaFinal" => "298"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11333547"
                            "web" => "Medline"
                          ]
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                ]
              ]
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              "identificador" => "bib28"
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              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Variations Research&#58; the physician perspective"
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                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46;P&#46; Steinberg"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Med Care"
                        "fecha" => "1993"
                        "volumen" => "31Y"
                        "paginaInicial" => "S86"
                        "paginaFinal" => "S88"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Are hospital services rationed in New Haven or overutilized in Boston&#63;"
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                        0 => array:2 [
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                          "autores" => array:3 [
                            0 => "J&#46;E&#46; Wennberg"
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                            2 => "W&#46;J&#46; Culp"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1987"
                        "volumen" => "1"
                        "paginaInicial" => "1185"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/2566746"
                            "web" => "Medline"
                          ]
                        ]
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                          "pii" => "S0091674901372172"
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Vol. 16. Núm. 6.
Páginas 497-504 (noviembre - diciembre 2002)
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Vol. 16. Núm. 6.
Páginas 497-504 (noviembre - diciembre 2002)
Open Access
Variaciones en la aplicación de técnicas médicas en atención primaria
(Variations in the application of medical techniques in primary health care)
Visitas
5242
J. Sobrequésa,
Autor para correspondencia
29744jss@comb.es

Correspondencia: Dr. J. Sobrequés Soriano. Breda, 14. 08029 Barcelona
, B. Bolíbarb, L. Unzuetac, J.D. Pradosd, F. Leivad, W. Boermae
a Consultor
b Fundació Jordi Gol i Gurina
c Médico de Familia, Centro de Salud Deusto. Bilbao. Osakidetza
d Unidad Docente de Medicina de Familia y Comunitaria de Málaga. Servicio Andaluz de Salud.
e Instituto NIVEL. Utrecht. Países Bajos
Este artículo ha recibido

Under a Creative Commons license
Información del artículo
Resumen
Objetivo

Describir la aplicación de técnicas médicas (ATM) en tres comunidades autónomas españolas (Andalucía, Cataluña y País Vasco) y analizar sus relaciones con diversas características relacionadas con los médicos de atención primaria y el centro de salud.

!Diseño

Estudio multicéntrico, transversal.

Emplazamiento

Un total de 319 médicos generales que trabajaban en los centros de atención primaria del sector público reformado en las comunidades de Andalucía, País Vasco y Cataluña.

Mediciones principales

Cuestionario estructurado y validado de 100 preguntas en cuatro apartados: características generales del profesional y centro de trabajo, perfil de actividad y satisfacción laboral. Éste fue enviado por correo al centro de trabajo (Andalucía y Euskadi) o domicilio particular (Cataluña). Para el análisis se creó una variable índice a partir de las respuestas de las preguntas de ATM.

Resultados

La variable índice de ATM obtuvo un valor medio (desviación estándar [DE]) de 10,02 (4,55) y Andalucía el valor más alto (media [DE]: 11,11 [4,33]) de las tres comunidades del estudio (p = 0,012). La variable índice ATM adquiere valores significativamente más altos en relación con: el sexo masculino (muestra de tres comunidades autónomas; p = 0,046), el ámbito rural, el trabajo en equipo, la disponibilidad de equipamiento básico, el número de pacientes más reducido y menor carga asistencial.

Conclusiones

Los índices de ATM en España son significativamente distintos en las tres comunidades españolas estudiadas. La calidad de la asistencia sanitaria evaluada desde la dimensión de la ATM parece estar muy relacionada con características demográficas, la disponibilidad en las consultas del material científico-técnico y el tiempo adecuado de las visitas médicas.

Palabras clave:
Atención primaria
Perfil de actividad
Variaciones práctica médica
Calidad asistencial
Summary
Objectives

To describe the application of medical techniques (ATM) in Spain and to analyze the relationship with diverse characteristics related to general practitioners and the center of primary health.

Design

Multicenter cross-sectional study.

Setting

Three hundred nineteen general practitioners working in primary care centers in the restructured public sector of the Autonomous Communities of Andalusia, Basque Country and Catalonia in Spain.

Main measurements

Structured and validated questionnaire comprising 100 items in four sections: general characteristics of the physician and health center, task profile, and job satisfaction. The questionnaire was sent by mail to the health center (Andalusia and Basque Country) or to the home (Catalonia). For the analysis an index variable was created from the answers to the questions on AMT.

Results

The index variable of AMT obtained a mean value of 10.02 (SD = 4.55). Andalusia obtained the highest value (median: 11.11; SD: 4.33) of the three Autonomous Communities in the study (p = .012). AMT acquired significantly higher values when associated with: masculine sex (sample from the three autonomous communities; p = .046), rural environment, teamwork, availability of basic equipment, fewer patients, and reduced work load.

Conclusions

Index of ATM in Spain is significantly different in the three Spanish communities under study. The quality of the sanitary services evaluated from the dimension of the ATM seems to be much related with demographic characteristics, the readiness in the consultations of scientific-technical stuff and the appropriate time for medical consultations.

Key words:
Primary health care
Task profile
Variation in medical practice
Health care quality assurance
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Biblografía
[1.]
J. Marión, S. Peiro, S. Márquez, R. Meneu.
Variaciones en la Práctica Médica: importancia, causas e implicaciones.
Med Clin (Barc), 110 (1998), pp. 382-390
[2.]
P.J. Saturno, O. Quintana, J. Varo.
¿Qué es calidad? Tratado de Calidad Asistencial en Atención Primaria.
[3.]
D.M. Berwick.
Controlling variation in health care: a consultation from Walter Shewhart.
Med Care, 29 (1991), pp. 1212-1225
[4.]
J.E. Wennberg.
On the need for outcomes research and the prospects for the evaluative clinical sciences.
The challenges of medical practice variations, pp. 158-173
[5.]
J.E. Wennberg.
Unwanted variations in the rules of practice.
JAMA, 265 (1991), pp. 1306-1307
[6.]
J.E. Wennberg, A. Gittelsohn.
Small area variations in health care deli-very. A population-based health information system can guide planning and regulatory decision-making.
Science, 18 (1973), pp. 1102-1108
[7.]
J.P. Bunker.
Variations in hospital admissions and the appropriateness of care: American preoccupations?.
Br Med J, 301 (1990), pp. 531-532
[8.]
W.G.W. Boerma, J. Van der Zee, D.M. Fleming.
Service profiles of general practitioners in Europe.
Br J Gen Pract, 47 (1997), pp. 481-486
[9.]
D.L. Crombie, J. Van der Zee, P. Backer.
The interface study. [Occasional Paper 48].
[10.]
M. Foets, J. Van der Velden, J. De Bakker.
Dutch national survey of general practice: a summary of the survey design.
[11.]
W.G.W. Boerma, A. Van den Brink-Muinen.
Gender-related differences in the organization and provision of services among general practitioners in Europe.
Med Care, 38 (2000), pp. 993-1002
[12.]
B. Bolibar.
Perfil de actividad de los médicos de atención primaria y sus relaciones con el sistema reformado y no reformado en Cataluña.
Fundació Jordi Gol i Gurina, (1997),
[13.]
V.R. Cabedo, J.L. Poveda, M.J. Tejedo.
Perfil de los médicos de atención primaria en un área de salud: un análisis de clústers.
Aten Primaria, 18 (1996), pp. 221-224
[14.]
M. Lember, E. Kosunen.
Boerma WGW. Task profiles of district doctors in Estonia and general practitioners in Finland.
Scand J Prim Health Care, 16 (1998), pp. 56-62
[15.]
W.G.W. Boerma, P. Verhaak.
The general practitioner as the first contacted health professional by patients with psychosocial problems: a European study.
Psychol Med, 29 (1999), pp. 689-696
[16.]
W.G.W. Boerma, P.P. Groenewegen, J. Van der Zee.
General practice in urban and rural Europe: the range of curative services.
Soc Sci Med, 47 (1998), pp. 445-453
[17.]
W.G.W. Boerma, P.P. Groenewegen.
GP Home visiting in 18 European countries. Adding the role of health system features.
Eur J Gen Pract, 7 (2001), pp. 132-137
[18.]
J.M. Bensing, A. Van den Brink-Muinen, D.H. De Bakker.
Gender differences in practice style: a Dutch estudy of general practitoners.
Med Care, 31 (1993), pp. 219-229
[19.]
R. Chambers, I. Campbell.
Gender differences in general practitioners at work.
Br J Gen Pract, 46 (1996), pp. 291-293
[20.]
H. Britt, A. Bhasale, D.A. Miles, D.A. Meza, G.P. Sayer, M. Angelis.
The sex of the general practitioner: a comparison of characteristics, patients, and our conditions managed.
Med Care, 34 (1996), pp. 403-415
[21.]
A. Delgado.
El papel del género en la relación médico-paciente.
FMC, 6 (1999), pp. 509-516
[22.]
K. Fennema, Dl Meyer, N. Owen.
Sex of physician: patients' preferences and sterotypes.
J Fam Pract, 30 (1990), pp. 441-446
[23.]
J. Graffy.
Patient choice in a practice with men and women general practitioners.
Br J Gen Pract, 40 (1990), pp. 13-15
[24.]
S.M. Campbell, M. Hann, J. Hacker, C. Burns, D. Oliver, A. Thapas, et al.
Identifying predictors of high quality care in English general practice: observational study.
BMJ, 323 (2001), pp. 1-6
[25.]
J. Saura.
Diez minutos por consulta. Estableciendo límites a la carga de trabajo del médico de familia.
Jano, 61 (2001), pp. 23
[26.]
A. Segura.
Diez minutos y Confucio.
El País, (12 de junio de 2001),
[27.]
J. Casajuana.
Diez minutos, ¡qué menos! [editorial].
Aten Primaria, 27 (2001), pp. 297-298
[28.]
E.P. Steinberg.
Variations Research: the physician perspective.
Med Care, 31Y (1993), pp. S86-S88
[29.]
J.E. Wennberg, J.L. Freeman, W.J. Culp.
Are hospital services rationed in New Haven or overutilized in Boston?.
Lancet, 1 (1987), pp. 1185
[30.]
R. Delgado.
La variabilidad en la práctica de la atención sanitaria.
En: libro de Ponencias del XII Congreso Nacional de la Sociedad Española de Calidad Asistencial, (1995, septiembre, 23),
[31.]
P.J. Saturno, J.J. Gascón, Y. Fonseca.
¿Es adecuada la atención médica en los caos de resfriado común? Resultado de una evaluación en ocho centros de salud.
Med Clin (Barc), 104 (1995), pp. 521-525
[32.]
V. Ortún Rubio, F. Rodríguez Artalejo.
De la efectividad clínica a la eficiencia social.
Med Clin (Barc), 95 (1990), pp. 385-388
Copyright © 2002. Sociedad Española de Salud Pública y Administración Sanitaria
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