[Research and teaching units supporting primary care management]

[Validity of clinical records and information systems in studies of health-care delivery in primary care]

OBJECTIVES

To examine how well the clinical process was recorded in the clinical history (CH), and care delivery on the activity sheet (AS). To assemble a series of recommendations on the validity of these documents for recording health care delivery.

DESIGN

Multi-centred, observational, and cross-sectonal study.

SETTING

Four medical clinics at 12 health centres in the Community of Valencia, Spain.

PARTICIPANTS

There were 2051 attendances, with 284 CH and 407 AS involved. Main measurements and results. The information recorded by doctors in the CH and on the AS was validated by external observers who collected directly at the consultation the working day's entire care activity. The following was analysed: 1) in the CH, filling out of the "SOAP" form (basic info.); 2) on the AS, mean per professional per day of scheduled and on-demand patients, home visits and length of consultations; 3) information in the documents validated on the organisation of consultations; 4) analysis of care delivery according to how predictable it is and its clinical content; 5) clinical practice guidelines with validity and clinical usefulness indicators and reliability index (kappa).

CONCLUSIONS

The documents validated do not properly reflect the reality of health care demand. There was an under-recording bias and validity problems that may limit their usefulness as sources of information for health care planning and management.

[Research in primary care: 1994-2003]

OBJECTIVES

To analyse the characteristics of the original articles published in the journal Atención Primaria (Primary Care) during the last 10 years.

DESIGN

Literature study.

SETTING

Primary health care.

PARTICIPANTS

Original articles published in Atención Primaria between 1994 and 2003.

MAIN MEASUREMENTS

The professional category of the authors, whether it was a multidisciplinary or multicentred study, the autonomous community of origin, the topic, the type of study, and if it had a grant or financial assistance.

RESULTS

1229 articles have been reviewed. In 40.0% of them a family doctor is included in the authorship. 31.4% can be considered multidisciplinary and 20.5% multicentred. The Communities of Valencia, Madrid, Andalusia, and Catalonia took up 60% of the volume of publications. The most common topic is the provision and organisation of the health services (40.5%). Only 4.3% of the designs are experimental. A grant or financial aid is stated in 16.2% of the articles.

CONCLUSIONS

Although the situation as regards the previous years has not varied too much, some positive findings, such as the emergence of research groups, increasing presence of multicentre and multidisciplinary studies, better access to sources of finance, etc, suggest that we are in a process of improving the quality of research in primary care.