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Psychosocial aspects associated with excessive attendance in primary care paediatric clinics
Aspectos psicosociales relacionados con la hiperfrecuentación en las consultas pediátricas de atención primaria
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Fundación para la Investigación, Estudio y Desarrollo de la Salud Pública, Madrid, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Centro de Salud Cea Bermudez, Madrid, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aspectos psicosociales relacionados con la hiperfrecuentación en las consultas pediátricas de atención primaria" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1704 "Ancho" => 1598 "Tamanyo" => 80752 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">ROC curve of the logistic regression model of number of visits ≥6 in relation to anxiety and age.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">In Spain, universal coverage for paediatric health care is guaranteed by law. The Public Health System has the duty to deliver quality care regardless of the administrative situation of a child.<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">1–5</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The Public Health System is funded through taxation, and it is the citizens, through their tax contributions, that maintain the system. Receiving care on demand as often as the patient wants by presenting the health care card obtained after registering in the census has an economic cost that health care users are often unaware of.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The quality of paediatric health care<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">6</span></a> improves significantly by enhancing primary care (PC) services, increasing the number of paediatricians, expanding service hours from 8 am to 9 pm and including patients through age 14 years. These measures clearly improve accessibility and have been very well received by the population, as when it comes to children, there is generally a rushed, heedless and indulgent attitude towards the use of health care services.<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">7</span></a> On the other hand, health care providers have described the emergence of a phenomenon known as high-frequency utilisation,<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">8</span></a> a concept that is difficult to define because there is no clearly established threshold based on the number of visits a patient would have to make in a given time period.<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">9</span></a> Providers that deliver PC, hospital emergency care and after-hours outpatient urgent care frequently experience stress because the frequent visits of some patients do not seem to be warranted by the clinical situation; furthermore, and considering that this excess entails the unnecessary use of resources, it stands to reason that all the involved agents should act and share the responsibility of regulating the disorganised flows of patients.<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of our study was to analyse the frequency of utilisation of paediatric PC services and the factors that could be associated with specific psychosocial aspects in the families included in the caseloads of participating clinics.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients and methods</span><p id="par0025" class="elsevierStylePara elsevierViewall">We conducted an observational descriptive study by analysing the data collected through the administration of a questionnaire to the parents of 346 children aged 6 months to 14 years that visited 2 paediatric clinics in 2 urban PC centres in the Community of Madrid. We had previously validated the questionnaire in a pilot study (reliability assessed by Cronbach <span class="elsevierStyleItalic">α</span> [0.768; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001] and validity by confirmatory factor analysis and the item-test correlation coefficient). The total number of children in this age group with health care cards assigned to the caseloads of these two clinics was approximately 2800, and we requested the participation in the survey between March and August of 2017 of a randomly selected sample of the children in this group that visited the clinic with or without having previously scheduled an appointment.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We collected data for the following variables: age and sex of the patients, age and country of origin of parents, family structure (whether parents lived together or apart), parental educational attainment, household income, patient enrolment in child care facility or school, number of visits to the primary care centre, hospital emergency departments or after-hours urgent care clinics in the past 6 months; the parents were also assessed with the Goldberg Anxiety and Depression Scale (GADS), a tool used for screening anxiety and depression. The overall scale has a sensitivity of 83% and a specificity of 82%, it is administered by an interviewer, and the cut-off points are 4 points or higher for the anxiety subscale and 2 points or higher for the depression subscale. The scale was designed to detect probable cases rather than for diagnosis.<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">11</span></a> We found the data regarding the number of visits by reviewing the patients’ electronic health records.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We established 3 categories for assessment of household income: (1) monthly income of less than 1000 euro; (2) monthly income between 1000 and 2000 euro, and (3) monthly income greater than 2000 euro. We also established 3 categories for assessment of parental educational attainment: (1) no education or elementary education (primary education); (2) secondary education (middle school, high school, vocational education), and (3) higher education (short- or long-course university degree).</p><p id="par0040" class="elsevierStylePara elsevierViewall">The endpoints in our study were the number of visits made to the 2 primary care centres, hospital emergency departments and after-hours urgent clinics as well as the overall number of visits.</p><p id="par0045" class="elsevierStylePara elsevierViewall">We performed the statistical analysis of the data with the SPSS<span class="elsevierStyleSup">®</span> software version 15.0. We have summarised quantitative data as mean and standard deviation (SD) and the qualitative data as absolute frequencies and percentages, and calculated 95% confidence intervals (CIs). We used the Mann–Whitney <span class="elsevierStyleItalic">U</span> test to compare quantitative variables after verifying that they did not follow a normal distribution (Kolmogorov–Smirnov test). We compared qualitative variables by means of the chi square test. Statistical significance was defined as a <span class="elsevierStyleItalic">P</span>-value of less than 0.05. We performed logistic regression analysis starting with a model that included all candidate variables and removing them one by one until only those that were statistically significant remained.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall">We collected data for 346 children with a mean age of 3.61 years (range, 6 months to 13 years; SD, 2.69), of who 174 (50.2%) were male. The mean maternal age was 34.82 years (SD, 5.88) and the mean paternal age 37.95 years (SD, 6.75). The mean number of children in the household was 1.66 (SD, 0.76), and in 217 cases (62.7%) the patient was the first child. In 37 cases (10.7%), the patient lived in a single-parent household, and in 187 families (54.04%) at least one of the parents had immigrant status. Of all respondents, 127 reported having support from their families (36.7%). When it came to income, 65 households (18.8%) were in the low-income group, 131 (37.9%) in the middle-income group and 150 (43.4%) in the high-income group.</p><p id="par0055" class="elsevierStylePara elsevierViewall">As for educational attainment, 21 respondents (6.1%) had an elementary education, 108 (31.2%) a secondary education and 217 (62.7%) a higher education.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Children of immigrant parents were younger at the time of visiting the health care centre compared to children of Spanish nationals, with a mean age of 3.17 years (SD, 2.21) versus 3.98 years (SD, 2.99) (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.032). We did not find any other significant differences between these two groups in any of the other outcomes.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The mean GADS scores were 1.43 in the anxiety subscale (SD, 2.72) and 0.55 in the depression subscale (SD, 1.75). There were 57 respondents (16.47%) with a score of 4 or higher in the anxiety subscale, and 29 respondents (8.38%) with a score of 2 or more in the depression subscale.</p><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> presents the epidemiologic data for the sample under study.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">The mean number of visits made in the past 6 months for the total sample was 3.06 (SD, 2.56), with a maximum of 20 visits.</p><p id="par0080" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> presents the Spearman correlation coefficients for the association of the number of visits to the PC centre, emergency/urgent care services and overall visits with the anxiety and depression subscale scores in the total sample under study. We did not find an association between the anxiety score and age (<span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.013; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.803).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">We defined high-frequency utilisers as patients whose number of visits exceeded the 90th percentile of the sample (P90), either to the PC centre (P90<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5.7) or overall (PC centre<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>emergency/urgent care, P90<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5.95). Analysing children aged less than 3 years separately, the P90 was 6 for visits to the PC centre and 6.03 for overall visits, so we ultimately defined high-frequency utilisers as those who made 6 or more visits in the period under study. We found a total of 33 high-frequency utilisers if we restricted the definition to PC services (9.53%), and 55 (15.89%) if we included visits to emergency or urgent care services.</p><p id="par0090" class="elsevierStylePara elsevierViewall">The respondents that made 6 or more visits to the PC centre and 6 or more overall visits had a score of 4 or more in the GADS subscale in 20.58% of cases, while they amounted to 6.57% of respondents with a score of less than 4 in the GADS (<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001).</p><p id="par0095" class="elsevierStylePara elsevierViewall">We performed a multivariate analysis (binary logistic regression; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>) to identify variables associated with making 6 or more health care visits in 6 months, and in the final model, the variables that remained significant were age, as a protective factor, and a score of 4 or higher in the GADS, as a risk factor. We plotted a receiver operating characteristic (ROC) curve with the results of the model (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), and found an area under the curve (AUC) of 0.761 (95% CI, 0.678–0.945; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001).</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0100" class="elsevierStylePara elsevierViewall">Researching health care overuse is challenging. This is a multifactorial problem<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">12</span></a> that involves, on the one hand, institutional aspects of health care organisation, on the other, aspects related to health care providers<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">13</span></a> (who in some cases, depending on whether they work at the PC or emergency care level, may contribute to the increased demand for their services), and, last of all, aspects concerning the patients themselves.<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">14</span></a> In the paediatric population, the demand for care originates from the parents or caregivers of the child, and their perception of the child's health and the health education they have received determine whether they repeatedly seek services at the emergency care level. There is no consensus as to what constitutes a high-frequency utiliser, and we found different definitions in the literature. Thus, one could define high-frequency utilisers as patients that exceed the mean number of visits for their age group by at least 2 SDs, or whose number of visits is above the 90th percentile or at least twice the mean, or who arbitrarily seek care in PC clinics or emergency departments at least 10 times a year.<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">15–17</span></a></p><p id="par0105" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Health at a Glance</span> 2017 report<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">18</span></a> presents the most recent data on the health status of populations with the indicators of the Organisation for Economic Co-operation and Development (OECD), and shows that the number of visits per capita in Spain is above the mean of the rest of the countries.</p><p id="par0110" class="elsevierStylePara elsevierViewall">Paediatricians have long been expressing concern about working conditions that jeopardise the quality of the care they provide to children, which is the priority objective of their daily activity, with quality of care referring to providing accessible services of the highest professional quality and with thoughtful use of available resources to achieve user satisfaction and loyalty.</p><p id="par0115" class="elsevierStylePara elsevierViewall">There are few studies on the frequency of primary care utilisation,<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">19</span></a> and their conclusions are controversial and have spurred debate regarding different levels of care, especially on the subject of urgent care delivery.<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">20–22</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The most important aspect in the profile of high-frequency utilisers of paediatric services is age less than 2 years.<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">23</span></a> In this regard, our findings are consistent with the study of Oterino de la Fuente and Peiró Moreno<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">24</span></a>: children aged less than 2 years made the most visits to the paediatrician, which can be explained by the higher incidence of infection in this age group and the well-known risk factor that is attendance to child care centres.<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">25</span></a> Furthermore, parents in this age group are often inexperienced – indeed, in our study 62.7% of the children were the first-born – and therefore more likely to worry significantly about illness in the child. In our study, the data confirmed the correlation between greater age and lower frequency of utilisation.</p><p id="par0125" class="elsevierStylePara elsevierViewall">The family is considered a system that promotes health and improves quality of life, but this is actually contingent on certain aspects of family structure,<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">26</span></a> so that anxiety, depression and/or the personality of parents are other factors that numerous publications have associated with healthcare overuse.<a class="elsevierStyleCrossRefs" href="#bib0325"><span class="elsevierStyleSup">27–32</span></a> Our study found an association between high-frequency utilisation and parental anxiety level, although we did not find an association with depression.</p><p id="par0130" class="elsevierStylePara elsevierViewall">A novelty in our study was the use of the GADS, which is easy to use in PC and in a few minutes can offer a general idea of the level of anxiety and/or depression experienced by the parent or caregiver of the child, which allows intervention by health professionals to try to keep the emotional state of parents from distorting their perception of the child's health. Combining the anxiety score and the age of the child, we obtained a ROC curve with an AUC of 0.761 for prediction of 6 or more visits to the primary care centre in the period under study.</p><p id="par0135" class="elsevierStylePara elsevierViewall">Other social factors that may have an impact on health care utilisation are socioeconomic status and the support and cohesion of family members; the immigrant population was heavily represented in our study, and we did not find this group to use health services more frequently than the native Spanish population, which was consistent with the results of Macipe Costa et al.<a class="elsevierStyleCrossRef" href="#bib0355"><span class="elsevierStyleSup">33</span></a> We even found that the mean age at the time of utilisation was slightly greater in children of immigrant parents compared to those of Spanish parents.</p><p id="par0140" class="elsevierStylePara elsevierViewall">Among the limitations of our study, we ought to highlight its small sample size, so we believe that it would be of interest to conduct further research on the subject in larger samples; furthermore, considering the complexity of the problem, we expect that the mere detection of abnormally high anxiety levels in parents will not prevent their continued overuse of services unless they are informed about this matter and/or undergo or are advised to pursue specialised assessment.</p><p id="par0145" class="elsevierStylePara elsevierViewall">To conclude, we ought to emphasise that improving the problem of health care overuse requires the coordinated implementation of different measures at every level of care,<a class="elsevierStyleCrossRef" href="#bib0360"><span class="elsevierStyleSup">34</span></a> to which end the recommendations for the management of urgent and non-deferrable conditions of the Technical Advisory Group on Primary Care Paediatrics of the Autonomous Community of Valencia<a class="elsevierStyleCrossRef" href="#bib0365"><span class="elsevierStyleSup">35</span></a> are significantly useful. This group considers that population-based health education measures and coordination between PC and specialty care are necessary, as is the involvement of the competent administrations, although there are also authors that consider such interventions ineffective.<a class="elsevierStyleCrossRef" href="#bib0370"><span class="elsevierStyleSup">36</span></a></p><p id="par0150" class="elsevierStylePara elsevierViewall">Excessive workloads and the associated stress do not contribute to a decent professional and occupational situation for paediatricians<a class="elsevierStyleCrossRef" href="#bib0375"><span class="elsevierStyleSup">37</span></a> nor, needless to say, to the quality of the care delivered to children, as demonstrated by the study conducted by Fernández San Martín et al.<a class="elsevierStyleCrossRef" href="#bib0380"><span class="elsevierStyleSup">38</span></a> about the job satisfaction of health care professionals in the Community of Madrid.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflicts of interest</span><p id="par0155" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres1132481" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1065083" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1132482" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1065084" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflicts of interest" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-12-19" "fechaAceptado" => "2018-03-07" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1065083" "palabras" => array:3 [ 0 => "Frequent attendance" 1 => "Primary care" 2 => "Psychosocial factors" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1065084" "palabras" => array:3 [ 0 => "Hiperfrecuentación" 1 => "Atención primaria" 2 => "Factores psicosociales" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hyper-attendance is a significant problem in paediatric primary care clinics. The aim of our study was to analyse the level of attendance in these clinics and its relationship with certain psychosocial aspects of the families attending them.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Observational descriptive study was conducted using questionnaires collected during a period of 6<span class="elsevierStyleHsp" style=""></span>months, as well as recording the frequency of attendance in the previous 6<span class="elsevierStyleHsp" style=""></span>months. A total of 346 questionnaires of children between 6<span class="elsevierStyleHsp" style=""></span>months and 13<span class="elsevierStyleHsp" style=""></span>years of age belonging to 2 urban primary care clinics in Madrid were completed. The raw data was analysed, and comparisons between groups and multivariate analysis were performed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The mean number of consultations in the last 6<span class="elsevierStyleHsp" style=""></span>months, of the total included in the study, was 3.06 in the primary care centre, and 0.77 in the emergency services. It was considered over-frequent for those who had attended the primary care health centre 6 or more times in this period (>P90), of which there were 33 children (9.53%). In the multivariate analysis, the variables related to being frequent users of primary care clinics were: the presence of high level of anxiety in the parents (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5.50; 95%<span class="elsevierStyleHsp" style=""></span>CI: 2.49–12.17, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001), and the age of the children (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.73; 95%<span class="elsevierStyleHsp" style=""></span>CI: 0.58–0.91, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.005). The model presented an area under the curve of 0.761 (95%<span class="elsevierStyleHsp" style=""></span>CI: 0.678–0.945, <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The frequency of visits in paediatric primary care clinics is directly related to the high level of anxiety of the parents, and inversely to the age of the children. It would be advisable to detect and, if possible, intervene in cases of high parental anxiety in order to try to reduce the over-frequency in the paediatric primary health care.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La hiperfrecuentación es un problema relevante en las consultas pediátricas de atención primaria, por lo que el objetivo de nuestro estudio ha sido analizar el nivel de frecuentación en dichas consultas y su relación con determinados aspectos psicosociales de las familias asignadas a las mismas.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Estudio descriptivo observacional realizado mediante cuestionarios recogidos durante un periodo de 6<span class="elsevierStyleHsp" style=""></span>meses y registrando la frecuentación de los 6<span class="elsevierStyleHsp" style=""></span>meses previos. Se han completado 346 encuestas de niños entre 6<span class="elsevierStyleHsp" style=""></span>meses y 13<span class="elsevierStyleHsp" style=""></span>años de edad pertenecientes a dos consultas urbanas de atención primaria de Madrid. Se analizaron datos crudos, comparaciones entre grupos y análisis multivariante.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">El promedio de consultas en los últimos 6<span class="elsevierStyleHsp" style=""></span>meses, del total de incluidos en el estudio, fue de 3,06 en el centro de salud y de 0,77 consultas en urgencias. Se consideró hiperfrecuentadores a los que habían acudido 6 o más veces al centro de salud en este periodo (>p90), que fueron 33 niños (9,53%). En el análisis multivariante, las variables relacionadas con ser hiperfrecuentador en las consultas del centro de salud fueron la presencia de elevado nivel de ansiedad en los padres (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>5,50; IC<span class="elsevierStyleHsp" style=""></span>95%: 2,49-12,17; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001) y la edad de los niños (OR<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,73; IC<span class="elsevierStyleHsp" style=""></span>95%: 0,58-0,91; p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,005). El modelo presentó un área bajo la curva de 0,761 (IC<span class="elsevierStyleHsp" style=""></span>95%: 0,678-0,945; p<span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0,0001).</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La frecuentación en las consultas pediátricas de atención primaria está directamente relacionada con el nivel elevado de ansiedad de los padres e inversamente con la edad de los niños. Sería recomendable detectar y a ser posible intervenir en los casos de elevada ansiedad parental para así intentar reducir la hiperfrecuentación asistencial.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Martín Martín R, Sánchez Bayle M, Teruel de Francisco C. Aspectos psicosociales relacionados con la hiperfrecuentación en las consultas pediátricas de atención primaria. An Pediatr (Barc). 2019;90:26–31.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1704 "Ancho" => 1598 "Tamanyo" => 80752 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">ROC curve of the logistic regression model of number of visits ≥6 in relation to anxiety and age.</p>" ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">SD, standard deviation.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Patient age in years, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.61 (2.69) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Maternal age in years, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">34.82 (5.88) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Paternal age in years, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37.95 (6.75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Number of children, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.66 (0.76) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Single-parent household, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">37 (10.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Immigrant family, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">187 (54.04) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Income level, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Low \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">65 (18.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Middle \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">131 (37.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>High \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">150 (43.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Educational attainment, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Elementary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">21 (6.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Secondary \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">108 (31.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Higher \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">217 (62.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Goldberg anxiety depression scale score</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Anxiety subscale, <span class="elsevierStyleItalic">mean (SD</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1.43 (2.72) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Depression subscale, <span class="elsevierStyleItalic">mean (SD</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.55 (1.75) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Score of 4 or more in the anxiety subscale of the GADS, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">57 (16.47) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Score of 2 or more in the depression subscale of the GADS, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">29 (8.28) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Visits made to primary care centre in the past 6 months, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.06 (2.57) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Urgent visits made in the past 6 months, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.77 (0.56) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">High-frequency utilisers of primary care services, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 (9.53) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">High-frequency utilisers of primary care + urgent/emergency care, n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">55 (15.98) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age of children born to immigrants at time of visit, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.98 (2.99) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age of children born to native Spaniards at time of consultation, mean (SD)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">3.17 (2.21) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1932342.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Epidemiological characteristics of the sample.</p>" ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anxiety score \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Depression score \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age (years) \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Visits to primary care centre \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.219<br><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.69<br>0.204 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.219<br><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Urgent visits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.060<br>0.239 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.044<br>0.409 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.147<br><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Total visits \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.196<br><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.044<br>0.417 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">0.224<br><span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1932344.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Spearman correlation coefficients.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>: 0.151; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>.0001.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">OR \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">95% CI \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">P</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.73 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.58–0.91 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">.005 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Anxiety ≥4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">5.50 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2.49–12.17 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top"><.0001 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1932343.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Results of the logistic regression analysis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:38 [ 0 => array:3 [ "identificador" => "bib0195" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Decreto 3160/1966, de 23 de diciembre. Estatuto Jurídico del Personal Médico de la Seguridad Social. BOE 30 December 1966;312:16486–16494." ] ] ] 1 => array:3 [ "identificador" => "bib0200" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Real Decreto 137/1984, de 11 de enero. Estructuras Básicas de Salud. BOE 1 February 1984;27:2627–2629." ] ] ] 2 => array:3 [ "identificador" => "bib0205" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley General de Sanidad 14/1986, de 25 de abril. BOE 29 April 1986;102:15207–15224." ] ] ] 3 => array:3 [ "identificador" => "bib0210" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Ley General de Salud Pública 33/2011, de 4 de octubre. BOE 5 October 2011;240:104593–104626." ] ] ] 4 => array:3 [ "identificador" => "bib0215" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Real Decreto 16/2012, de 20 de abril. BOE 24 April 2012;98:31278–31312." ] ] ] 5 => array:3 [ "identificador" => "bib0220" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La garantía de la calidad en atención primaria de salud" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Corbella" 1 => "P. Saturno" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "fecha" => "1990" "paginaInicial" => "397" "paginaFinal" => "399" "editorial" => "Instituto Nacional de Salud, Secretaría General" "editorialLocalizacion" => "Madrid" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0225" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urgencias pediátricas atendidas en una consulta de atención primaria (I): análisis de la demanda" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Fernández Cano" 1 => "G. Martín Carballo" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Aten Primaria" "fecha" => "2000" "volumen" => "26" "paginaInicial" => "76" "paginaFinal" => "80" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10927822" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0014256517301534" "estado" => "S300" "issn" => "00142565" ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0230" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urgencias pediátricas: más de lo mismo… ¿o peor?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Luaces Cubells" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Emergencias" "fecha" => "2017" "volumen" => "29" "paginaInicial" => "76" "paginaFinal" => "78" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28825246" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0235" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frecuentación en atención primaria. Un replanteamiento conceptual" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Sarría Santamera" 1 => "J. Timoner Aguilar" 2 => "M. Sandín Vázquez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Aten Primaria" "fecha" => "2005" "volumen" => "36" "paginaInicial" => "471" "paginaFinal" => "472" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16287566" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0014256511000324" "estado" => "S300" "issn" => "00142565" ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0240" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "¿Si es urgente para ti, es urgente para mí?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Vázquez Fernández" 1 => "C. Núñez Jiménez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Pediatr Aten Primaria" "fecha" => "2015" "volumen" => "24" "numero" => "Suppl." "paginaInicial" => "83" "paginaFinal" => "87" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0245" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Detección de morbilidad psíquica en la práctica médica. El nuevo instrumento EADG" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "A. Lobo" 1 => "C. Montón" 2 => "R. Campos" 3 => "J. García-Campayo" 4 => "M.J. Pérez Echevarria" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1993" "editorial" => "Luzán as" "editorialLocalizacion" => "Zaragoza" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0250" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperfrecuentación: percepción de los profesionales de atención primaria sobre la influencia de factores sociales y de organización del entorno sanitario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Sandín Vázquez" 1 => "P. Conde Espejo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cali.2011.03.006" "Revista" => array:6 [ "tituloSerie" => "Rev Calid Asist" "fecha" => "2011" "volumen" => "26" "paginaInicial" => "256" "paginaFinal" => "263" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21570888" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0255" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Demanda inducida por el profesional: aplicaciones de la teoría económica a la práctica clínica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.A. Bellón Saameño" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Aten Primaria" "fecha" => "2006" "volumen" => "38" "paginaInicial" => "293" "paginaFinal" => "298" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17020715" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S095362051500326X" "estado" => "S300" "issn" => "09536205" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0260" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperfrecuentadores en urgencias pediátricas: ¿es toda la culpa de los padres?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Piñeiro Pérez" 1 => "C. Muñoz Archidona" 2 => "M. de la Parte Cancho" 3 => "M. Mora Sitjá" 4 => "D. Hernández Martín" 5 => "E. Casado Verrier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Pediatr Aten Primaria" "fecha" => "2017" "volumen" => "19" "paginaInicial" => "137" "paginaFinal" => "145" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0265" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperfrecuentadores en urgencias. ¿Quiénes son? ¿Por qué consultan?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Rivas García" 1 => "G. Manrique Martín" 2 => "L. Butragueño Laiseca" 3 => "S. Mesa García" 4 => "A. Campos Segura" 5 => "V. Fernández Iglesia" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2017" "volumen" => "86" "paginaInicial" => "67" "paginaFinal" => "75" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0270" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Urgencias pediátricas: dos reflexiones… dos retos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Luaces Cubells" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2017" "volumen" => "86" "paginaInicial" => "59" "paginaFinal" => "60" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0275" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Estudio de la hiperfrecuentación en un distrito de atención primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "N. Menéndez Granados" 1 => "M. Vaquero Abellán" 2 => "M. Toledano Estepa" 3 => "M.M. Pérez Diaz" 4 => "R. Redondo Pedraza" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gaceta.2017.07.011" "Revista" => array:3 [ "tituloSerie" => "Gac Sanit" "fecha" => "2017" "itemHostRev" => array:3 [ "pii" => "S154235651730825X" "estado" => "S300" "issn" => "15423565" ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0280" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Health at a Glance 2017: OECD Indicators" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "OECD" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1787/health-glance-2017-en" "Libro" => array:3 [ "fecha" => "2017" "editorial" => "OECD Publishing" "editorialLocalizacion" => "Paris" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0285" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consultas pediátricas urgentes en un centro de salud" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "B. Herranz Jordán" 1 => "R. Hernández Merino" 2 => "R. Cáceres González" 3 => "L. Castaños Jover" 4 => "C. Rodríguez Valdés" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr" "fecha" => "1997" "volumen" => "47" "paginaInicial" => "591" "paginaFinal" => "594" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0290" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperfrecuentación en urgencias pediátricas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. Herranz Jordán" 1 => "J.J. Jiménez García" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2017" "volumen" => "87" "paginaInicial" => "121" "itemHostRev" => array:3 [ "pii" => "S0014256511000324" "estado" => "S300" "issn" => "00142565" ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0295" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperfrecuentación en las urgencias pediátricas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "C. Luaces Cubells" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2017" "volumen" => "87" "paginaInicial" => "122" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0300" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperfrecuentación y la oferta de atención pediátrica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Rivas Garcia" 1 => "G. Manrique Martín" 2 => "L. Butragueño Laiseca" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2017" "volumen" => "87" "paginaInicial" => "123" "itemHostRev" => array:3 [ "pii" => "S0014256518301085" "estado" => "S300" "issn" => "00142565" ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0305" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Butragueño Laiseca L, Manrique Martín G, Rivas García A, Campos Segura A, González Arias M, Fernández Iglesia V. Pacientes hiperfrecuentadores en urgencias de pediatría. 21 Reunión Anual de la Sociedad Española de Pediatría. 2016. Valencia." ] ] ] 23 => array:3 [ "identificador" => "bib0310" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Utilización de los servicios de urgencias hospitalarios por niños menores de dos años" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Oterino de la Fuente" 1 => "S. Peiró Moreno" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr" "fecha" => "2003" "volumen" => "58" "paginaInicial" => "23" "paginaFinal" => "28" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0315" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influencia de la asistencia a guarderías en la frecuentación en urgencias y atención primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Ordoñez Alonso" 1 => "B. Domínguez Aurrecoechea" 2 => "J.I. Pérez Candas" 3 => "P. López Vilar" 4 => "M. Fernández Francés" 5 => "M. Coto Fuente" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Pediatr Aten Primaria" "fecha" => "2016" "volumen" => "18" "paginaInicial" => "43" "paginaFinal" => "52" ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0320" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tipos de familia y ansiedad y depresión" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H. Vargas Murga" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Med Hered" "fecha" => "2014" "volumen" => "25" "paginaInicial" => "57" "paginaFinal" => "59" ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0325" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Factores asociados a la hiperfrecuentación en las consultas de pediatría de atención primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Tapia Collados" 1 => "V. Gil Guillen" 2 => "D. Orozco Beltrán" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Aten Primaria" "fecha" => "2005" "volumen" => "36" "paginaInicial" => "167" "paginaFinal" => "168" ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0330" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influencia de la ansiedad materna en la frecuentación de las consultas de pediatría de atención primaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Tapia Collados" 1 => "V. Gil Guillen" 2 => "D. Orozco Beltrán" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Aten Primaria" "fecha" => "2005" "volumen" => "36" "paginaInicial" => "64" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15989826" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0335" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Frecuentación a los servicios de urgencias hospitalarios: Relación con la utilización de la atención primaria en una población pediátrica" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Sansa Pérez" 1 => "T. Orús Escolá" 2 => "S. Juncosa Font" 3 => "M. Barredo Hernández" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr" "fecha" => "1996" "volumen" => "44" "paginaInicial" => "105" "paginaFinal" => "108" ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0340" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperfrecuentación en las consultas: ¿hay relación con la personalidad de la madre?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Igual Rosado" 1 => "E. Castro Nicolau" 2 => "I. Alonso Martínez" 3 => "M. Terradas Corominas" 4 => "E. de Frutos Gallego" 5 => "J. Cebriá Andreu" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr" "fecha" => "2003" "volumen" => "58" "paginaInicial" => "29" "paginaFinal" => "33" ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0345" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Relación entre ansiedad y dinámica familiar" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J. Montalbán Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Aten Primaria" "fecha" => "1991" "volumen" => "21" "paginaInicial" => "29" "paginaFinal" => "34" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9557354" "web" => "Medline" ] ] ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0350" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Determinantes del uso de las consultas de pediatría: estudio de morbilidad infantil y variables maternas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J. Soriano Faura" 1 => "A. Lázaro Armengola" 2 => "A. Gómez Gila" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Aten Primaria" "fecha" => "1999" "volumen" => "23" "paginaInicial" => "132" "paginaFinal" => "136" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10095283" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0355" "etiqueta" => "33" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diferencias en la utilización de los servicios de atención primaria entre niños autóctonos e inmigrantes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R.M. Macipe Costa" 1 => "L.A. Gimeno Feliu" 2 => "F. Barrera Linares" 3 => "M. Lasheras Barrio" 4 => "A. Charlotte Robert" 5 => "L. Luzón Oliver" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Pediatr Aten Primaria" "fecha" => "2013" "volumen" => "15" "paginaInicial" => "15" "paginaFinal" => "25" ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0360" "etiqueta" => "34" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Coordinación de las urgencias pediátricas ente atención primaria y hospital en la Comunidad de Madrid" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R. Gómez Alonso" 1 => "A. González Requejo" 2 => "A.I. Díaz Cirujano" 3 => "M.C. Martinoli Rubino" 4 => "T. Hernández de las Heras" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Pediatr Aten Primaria" "fecha" => "2004" "volumen" => "6" "paginaInicial" => "367" "paginaFinal" => "377" ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0365" "etiqueta" => "35" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Alvarez de Laviada Mulero T, Martinez Pons M, Mínguez Verdejo R, Sebastian Barberan V, Serrano Poveda E, Suarez Vicent E, et al. Recomendaciones para la atención de urgencias y consultas no demorables en la consulta de atención primaria. Informe GATPAP, 2017 [accessed 1 Feb 2018]. Available from: <a id="intr0010" class="elsevierStyleInterRef" href="https://www.aepap.org/sites/default/files/noticia/arcgivos-adjuntos/informe-gatpap.pdf">https://www.aepap.org/sites/default/files/noticia/arcgivos-adjuntos/informe-gatpap.pdf</a>" ] ] ] 35 => array:3 [ "identificador" => "bib0370" "etiqueta" => "36" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hiperfrecuentación en urgencias. Experiencia y fracaso de una consulta de educación sanitaria" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Piñeiro Pérez" 1 => "I. Carabaño Aguado" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2017" "volumen" => "87" "paginaInicial" => "362" ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0375" "etiqueta" => "37" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "La pediatría de atención primaria en el sistema público de salud del siglo <span class="elsevierStyleSmallCaps">xxi</span>. Informe SESPAS 2012" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "B. Domínguez Aurrecoechea" 1 => "C. Valdivia Jiménez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.gaceta.2011.08.004" "Revista" => array:7 [ "tituloSerie" => "Gac Sanit" "fecha" => "2012" "volumen" => "26" "numero" => "Suppl." "paginaInicial" => "82" "paginaFinal" => "87" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22196036" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0380" "etiqueta" => "38" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Satisfacción laboral de los profesionales de atención primaria del área 10 del Insalud de Madrid" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.I. Fernández San Martín" 1 => "A. Moinelo Camporro" 2 => "A. Villanueva Guerra" 3 => "C. Andrade Rosa" 4 => "M. Rivera Teijido" 5 => "J.M. Gómez Ocaña" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Salud Publica" "fecha" => "2000" "volumen" => "74" "paginaInicial" => "139" "paginaFinal" => "147" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10918805" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000009000000001/v1_201901020610/S2341287918302059/v1_201901020610/en/main.assets" "Apartado" => array:4 [ "identificador" => "26005" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000009000000001/v1_201901020610/S2341287918302059/v1_201901020610/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287918302059?idApp=UINPBA00005H" ]
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| 2019 February | 29 | 13 | 42 |
| 2019 January | 135 | 24 | 159 |
| 2018 December | 26 | 18 | 44 |
| 2018 November | 4 | 3 | 7 |
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