Somatisation in primary care: experiences of primary care physicians involved in a training program and in a randomised controlled trial

Background: A new intervention aimed at managing patients with medically unexplained symptoms (MUS) based on a specific set of communication techniques was developed, and tested in a cluster randomised clinical trial. Due to the modest results obtained and in order to improve our intervention we need to know the GPs' attitudes towards patients with MUS, their experience, expectations and the utility of the communication techniques we proposed and the feasibility of implementing them. Physicians who took part in 2 different training programs and in a randomised controlled trial (RCT) for patients with MUS were questioned to ascertain the reasons for the doctors' participation in the trial and the attitudes, experiences and expectations of GPs about the intervention. Methods: A qualitative study based on four focus groups with GPs who took part in a RCT. A content analysis was carried out. Results: Following the RCT patients are perceived as true suffering persons, and the relationship with them has improved in GPs of both groups. GPs mostly valued the fact that it is highly structured, that it made possible a more comfortable relationship and that it could be applied to a broad spectrum of patients with psychosocial problems. Nevertheless, all participants consider that change in patients is necessary; GPs in the intervention group remarked that that is extremely difficult to achieve. Conclusion: GPs positively evaluate the communication techniques and the interventions that help in understanding patient suffering, and express the enormous difficulties in handling change in patients. These findings provide information on the direction in which efforts for improving intervention should be directed.

Initiatives for the improvement of continuous management training

[EN] Purpose. This work aims to present, from the company viewpoint, a structured account of management proposals and practices directed toward improving the intensity and effectiveness of continuous management training (CMT). Design/methodology/approach. The article takes as its main theoretical referents the Theory of Human Capital, the Resource-Based Vision and the contributions made via the new institutional economy with regard to the problems of information asymmetry between companies, employees and training providers and completes the proposals that derive from this theoretical approach. To do this, experience-based contributions are collected from a selection of company training and HR managers from twelve Basque companies characterised by their strong investment in management training. The methodology used was qualitative and obtained by different qualitative techniques: Focus Groups, Nominal Groups and the Delphi Method, which make up the so-called Hybrid Delphi. Findings and implications. The proposals are aimed at the main agents in training activity: training providers, associations and public agents engaged in management training and, particularly, companies themselves. The initiatives seek above all to increase training market transparency, to improve mutual commitments between companies and managers, and to link training and development with culture and strategic management, so that firms make optimal investment in management training. Originality/value. The methodology used is original, and the contributions are consistent with the theory, have a proven practical utility, and are presented in a hierarchy, which facilitates decision making.

Proposal and validation of methodologies for the categorisation of continuous variables in the development of prediction models

158 p.