ObjectivesTo investigate the association between sick leave prescription and physician burnout and empathy in a primary care health district in Lleida, Spain.MethodsThis descriptive study included 108 primary care doctors from 22 primary care centers in Lleida in 2014 (183,600 patients). Burnout was measured with the Maslach Burnout Inventory and empathy with the Jefferson Scale of Physician Empathy. The reliability of the instruments was measured by calculating Cronbach’s alpha and normal distribution was analyzed using the Kolmogorov-Smirnov-Lilliefors and χ2 tests. Burnout and empathy scores were analyzed by age, sex, and place of work (urban vs rural). Sick leave data were obtained from the Catalan Health Institute.ResultsHigh empathy was significantly associated with low burnout. Neither empathy nor burnout were significantly associated with sick leave prescription.ConclusionSick leave prescription by physicians is not associated with physicians' empathy or burnout and may mostly depend on prescribing guidelines.

BackgroundThe prevalence of ischemic heart disease is high. Few recent studies have investigated the periods of sick leave of these patients. Our aim is to determine the length of sick leave after an acute coronary syndrome, its costs, associated factors and to assess the use of antidepressants and/or anxiolytics.MethodsAn observational study of a retrospective cohort of patients on sick leave due to ischemic heart disease in a health region between 2008–2011, with follow-up until the first return to work, death, or end of the study (31/12/2012). Measurements: length of sick leave, sociodemographic variables and medical prescriptions.ResultsFour hundred and ninety-seven patients (mean age 53 years, 90.7% male), diagnosed with acute myocardial infarction (60%), angina pectoris (20.7%) or chronic form of ischemic heart disease (19.1%). Thirty-seven per cent of patients took anxiolytics the year after diagnosis and 15% took antidepressants. The average duration of sick leave was 177 days (95% CI: 163–191 days). Patients diagnosed with acute myocardial infarction returned to work after a mean of 192 days, compared to 128 days in cases with angina pectoris. Patients who took antidepressants during the year after diagnosis returned to work after a mean of 240 days. The mean work productivity loss was estimated to be 9,673 euros/person.ConclusionsThe mean duration of sick leave due to ischemic heart disease was almost six months. Consumption of psychotropic medication doubled after the event. Older age, suffering an acute myocardial infarction and taking antidepressants were associated with a longer sick leave period.

To describe the characteristics of patients visiting a Hospital Emergency Department (HED) due to chronic obstructive pulmonary disease (COPD) exacerbation (AECOPD) and to evaluate their management.A cross-sectional study of the first 219 patients with AECOPD visiting the HED of the University Hospital Arnau de Vilanova, Lleida, Spain, was performed from January to May 2016. The data collected included the following: main patient characteristics, diagnostic tests, applied treatments, response times, discharge destination, need for hospital admission, and re-admissions and deaths at 90 days. Comparisons were made according to sex and need for hospitalization.The patients consisted of 84% men, with a mean age (standard deviation [SD]) of 75.9 (11) years and a FEV1/FVC of 56 (13)%; 63% were ex-smokers. The median time (P25–P75) in the HED was 6 (4–10) hours, with shorter waiting times for severe patients. Additionally, 74% of patients required hospital admission. The percentages of re-admissions and mortality at 90 days were 25% and 14%, respectively. Among female patients, 63% never consumed tobacco, and the most frequent clinical phenotype was asthma combined with COPD; female patients visited the family doctor sooner after AECOPD than men (4 vs 7 days). Overall, the following areas of improvement were identified: use of sputum culture (performed in 3% of patients); documentation of variables; patient care times; and reduction in the time until first medical check-up.The overall quality of care provided to AECOPD patients was satisfactory and consistent with current clinical guidelines. Nevertheless, improving the quality of care at the HED requires establishing protocols that ensure that the necessary diagnostic tests are performed, optimize response times and guarantee that all relevant information is collected.

Non traumatic chest pain is the second most common cause of attention at the Emergency Departments (ED). The objective is to compare the effectiveness of HEART risk score and the risk of having a Major Adverse Cardiovascular Event (MACE) during the following 6 weeks in ‘Acute Non-traumatic Chest Pain’ (ANTCP) patients of an ED in Lleida (Spain). The ANTCP patient cohort was defined using medical data from January 2015 to January 2016. A retrospective study was performed among 300 ANTCP patients. Diagnostic accuracy to predict MACE, HEART risk score effectiveness and patient risk stratification were analysed on the ANTCP Cohort. HEART risk score was conducted on ANTCP Cohort data and patients were stratified as low-risk (n = 116, 38.7%), moderate-risk (n = 164, 54.7%) and high-risk (n = 20, 6.7%); differently from the assessment performed by 'Current Emergency Department Guidelines’ (CEDG) on the same patients: low risk and discharge (n = 56, 18.7%), medium risk and need of complementary tests (n = 137, 45.7%) and high risk and hospital admission (n = 107, 35.7%).The incidence of MACE was 2.5%, 20.7% and 100% in low, moderate and high-risk, respectively. Discrimination and accuracy indexes were moderate (AUC = 0.73, 95% confidence interval: 0.67–0.80). Clustering moderate-high risk groups by MACE incidence showed an 89.5% of sensitivity. Data obtained from this study suggests that HEART risk score stratified better ‘acute non-traumatic chest pain’ (ANTCP) patients in an Emergency Department (ED) compared with ‘Current Emergency Department Guidelines’ (CEDG) at the Hospital Universitari Arnau de Vilanova (HUAV). HEART score would reduce the number of subsequent consultations, unnecessary admissions and complementary tests.Trial registration: Retrospectively registered.