title: [Management of time used to treat the chronic patient: a new approach to improve quality of health care].
abstract: OBJECTIVE
  Chronic disease is the main epidemic of the 21st century. It takes up a large part of the social-health budgets that are dedicated to its care. The aim of this study is to analyze if the welfare quality in the management of the chronic patients improves by implementing non-contact care time.
  
  
  METHODS
  Intervention study conducted in the health care center of Orcasitas (January 2012 - September 2013) in patients with hypertension (357), diabetes (180) and/or ischemic heart disease (60). Health care quality was analyzed through the effectiveness in the program, Tracking Objectives in Primary Care. The intervention group had four physical 10minute consultations/year and three non-physical 10minute consultations/year. The patients in the control group were seen as usual. The data were compared using the McNemar test, chi-square and Cochran's Q test.
  
  
  RESULTS
  In the intervention group, the effectiveness increased in the analyzed period by 46%, 54% and 55.9%, respectively, for processes of hypertension, diabetes and dyslipidemia control in ischemic heart disease, whereas in the control group (community of Madrid) it was 2.54%, 1.78%, and 5.44%, respectively, for these processes (statistically significant differences [χ(2)=24.78; χ(2)=39.9 y χ(2)=67.3, P<.0001]).
  
  
  CONCLUSIONS
  Thirty minutes/year of non-presential care represents a significant change in the level of control of chronic patients. These results should be considered in the approach strategies to chronic diseases.
authors.affiliation: Centro de Salud de Orcasitas, Madrid, España. Electronic address: Olga.MartinG@salud.madrid.org.
authors.forename: O
authors.initials: O
authors.lastname: Martín Gordo
authors.affiliation: Centro de Salud de Orcasitas, Madrid, España.
authors.forename: V
authors.initials: V
authors.lastname: Martín Moreno
authors.affiliation: Centro de Salud de Orcasitas, Madrid, España.
authors.forename: D
authors.initials: D
authors.lastname: Agüero Orgaz
authors.affiliation: Centro de Salud de Orcasitas, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Martín Fernández
authors.affiliation: Centro de Salud de Orcasitas, Madrid, España.
authors.forename: E R
authors.initials: ER
authors.lastname: Coaquira Condori
authors.affiliation: Centro de Salud de Orcasitas, Madrid, España.
authors.forename: S
authors.initials: S
authors.lastname: Duce Tello
mesh_terms: D002908:Chronic Disease / Q000628:therapy*; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D017202:Myocardial Ischemia / Q000517:prevention & control / Q000628:therapy; D009819:Office Visits; D011204:Poverty Areas; D011320:Primary Health Care / Q000458:organization & administration*; D011369:Professional-Patient Relations; D058996:Quality Improvement; D011787:Quality of Health Care; D012017:Referral and Consultation; D055502:Secondary Prevention; D012959:Socioeconomic Factors; D017748:Time Management / Q000379:methods* / Q000458:organization & administration; D014505:Urban Population
keywords: Atención primaria; Calidad asistencial; Chronic disease; Condiciones sociales; Diabetes mellitus; Enfermedades crónicas; Factores socioeconómicos; Primary health care; Quality of health care; Social conditions; Socioeconomic factors