Ingresos hospitalarios en el área de la Bahía de Algeciras. Comparación con Andalucía y España (2001-2005)

Objectives

To describe hospital admissions data in the Bay of Algeciras from 2001 to 2005 compared with the rest of Andalusia and Spain and to analyze the relationship between these data and the most frequent diagnoses leading to excessive premature mortality in this area.

Methods

We carried out a cross-sectional study. The study population consisted of the residents of the municipalities of the Bay of Algeciras, obtained from the Population and Household Census of 2001. Age-adjusted annual average hospital admission rates were compared between the Bay of Algeciras (2001-2005) and the rest of Andalusia and Spain using the relative and attributable risk. Hospital admissions and premature mortality rates were compared by means of the relative risk of the most important causes.

Results

Hospital admissions in the Bay of Algeciras were significantly lower for most of the diagnoses studied. There was also excessive premature mortality, especially for circulatory diseases (RR for hospital admissions: 0.79 in men and 0.87 in women; RR for premature mortality: 1.39 in men and 1.70 in women). Notable specific diseases were diabetes in both genders and cerebrovascular disease and liver cirrhosis in men.

Conclusions

This study found a lower use of healthcare services and a higher risk of premature mortality due to severe diseases in this region. Further studies analyzing the potential socioeconomic and environmental determinants of the area are required.     

La auditoría energética: una herramienta de gestión en atención primaria

Objective

The aim of this study was to evaluate the viability of energy audit as a management tool in primary care to improve the energy efficiency and environmental performance of a health center by reducing its operating costs.

Method

We conducted 55 energy audits in health centers from 2005-2010. The health centers were sized between 500 and 3,500 m², were located in health areas with 3,500 to 25,000 users, and were built between 1985 and 2007.

Results

With an average investment of 11,601€ per site, energy consumption can be reduced by 10,801 kWh per year, saving 2,961€ with a mean payback period of 3.92 years, and preventing emission of 7,010 kg of CO₂.

Conclusions

Energy auditing is a practical tool to reduce the operating and maintenance costs of health centers and of improving the comfort of the facilities.     

Entorno de práctica de los profesionales de enfermería y competencia para la incorporación de la evidencia a las decisiones: situación en las Islas Baleares

Objectives

To determine the factors that nursing professionals perceive as facilitating evidence-based clinical practice (EBCP) in the Balearic Islands Health Service (Spain) by identifying possible differences according to nurses’ characteristics and their occupational settings.

Methods

We performed a multicenter, cross-sectional, observational study of 3,129 staff nurses in the Balearic Islands Health Service in 2009, who were surveyed using the Evidence-Based Practice Questionnaire (EBPQ) and the Nursing Work Index (PES-NWI). The strategy for the analysis encompassed an exploratory analysis, bivariate analysis with parametric and non-parametric tests according to the nature of the distributions (correlation, ANOVA, Kruskall-Wallis, chi square) and multivariate analysis of the main study variables and factors on the PES-NWI and EBPQ questionnaires. The analyses had a confidence level of 95%.

Results

A total of 1,753 questionnaires were received, corresponding to a participation rate of 56.02%. The results established significant differences between the two questionnaires in the analysis of the hospital setting and primary care (p < 0.001). These differences remained significant when the questionnaires were compared according to professional category and experience.

Conclusions

This study compared nursing practice environments with different characteristics. Of the factors included in the questionnaires, that with the greatest influence on EBP was the support of nursing managers. This study also found that the two validated instruments are plausible tools for assessing EBCP and help to establish areas for improvement both at the individual and organizational level.     

Barreras para la normalización de la telemedicina en un sistema de salud basado en la concertación de servicios

Objective

Despite the clear political will to promote telemedicine and the large number of initiatives, the incorporation of this modality in clinical practice remains limited. The objective of this study was to identify the barriers perceived by key professionals who actively participate in the design and implementation of telemedicine in a healthcare system model based on purchasing of healthcare services using providers’ contracts.

Methods

We performed a qualitative study based on data from semi-structured interviews with 17 key informants belonging to distinct Catalan health organizations.

Results

The barriers identified were grouped in four areas: technological, organizational, human and economic. The main barriers identified were changes in the healthcare model caused by telemedicine, problems with strategic alignment, resistance to change in the (re)definition of roles, responsibilities and new skills, and lack of a business model that incorporates telemedicine in the services portfolio to ensure its sustainability.

Conclusions

In addition to suitable management of change and of the necessary strategic alignment, the definitive normalization of telemedicine in a mixed healthcare model based on purchasing of healthcare services using providers’ contracts requires a clear and stable business model that incorporates this modality in the services portfolio and allows healthcare organizations to obtain reimbursement from the payer.     

Descripción de las agresiones sexuales atendidas en el servicio de urgencias de un centro hospitalario de referencia

Objective

To describe the factors related to adult sexual assaults attended in a referral hospital in the city of Barcelona (Spain).

Methods

We carried out an individual-based cross-sectional study of sexual assaults treated in the emergency department between 2005 and 2008.

Results

A total of 712 patients (95.5% female) were treated. The median age of assaulted women was 25 years. Complaints were made in 87.5% of cases and assaults were made by a single attacker in 84.5%. When the perpetrator was known, the profile of the victim (p ≤ 0.05) was as follows: the victim was assaulted at home (81.5%), the perpetrator acted alone (94.2%), the mechanism of aggression was penetration (89.3%) and the attack took place during the week (63.3%).

Conclusions

Analysis of sexual assaults allows for different risk groups to be established, which facilitates the development of specific protocols and guidelines for effective aid and full treatment.     

Estimación de la exposición al humo ambiental de tabaco: revisión de cuestionarios utilizados en España

Introduction

In the last few years, health surveys and epidemiological studies on smoking have introduced questions on environmental tobacco smoke (ETS) exposure. However, a standardized questionnaire is lacking.

Methods

Between January and May 2008, we reviewed surveys containing items on ETS exposure carried out in Spain by public administrations, scientific societies and research institutes. The wording of the questions was reviewed and classified according to the study type, target population, geographical setting and place of exposure.

Results

We identified 27 surveys that included questions on passive smoking. Most were health surveys (81.5%) and were aimed at the general population (70.4%). The most frequent geographical setting consisted of autonomous regions (48.1%) and the most common place of exposure was the home (88.9%)

Discussion

The results show wide variability in the questions used. Questionnaire items on ETS exposure should be homogenized to allow comparison of the results of surveys.     

Derivación a las consultas de gastroenterología desde atención primaria: evaluación de dos programas

Objectives

To analyze the effect of implementing a high-resolution clinic (HRC) and an increasing resolution capacity program in primary care (IRCPPC) for referrals to a gastroenterology outpatient clinic from primary care and the resources used.

Methods

A retrospective and observational study based on a review of referral sheets and databases was performed. We analyzed the number and reason for referrals, delay times and resource consumption in two periods: before (first 4 months of 2007) and after (first 4 months of 2009) the launch of the IRCPPC and HRC.

Results

In the first and second periods, 881 and 1076 patients, respectively, referred from primary health care were evaluated in the gastroenterology clinic, with a decrease in the delay time in the second period (80.8 ± 64.34 days vs 36.1 ± 29.12 days, p < 0.001). The most frequent reasons for referral were dyspepsia (27.7%), high-risk of colorectal cancer (17.1%), disturbance of bowel rhythm (18.2%), abdominal pain (16%), and gastroesophageal reflux (11.2%), with no differences between the two periods. Although delay times until the first visit (10.8 ± 9.03 days vs 42.8 ± 28.67 days, p < 0.001) and until discharge (39.6 ± 80.65 days vs 128.6 ± 135.34 days, p < 0.001) were lower in referrals to the HRC, the number of visits (3.6 ± 2.20 vs 3.2 ± 1.95, p = 0.015) and the cost of referrals (592.7 ± 421.50 € vs 486.0 ± 309.66 €, p < 0.001) was higher.

Conclusions

In the study period the number of referrals increased, while the delay time decreased. Although the HRC reduces delay times, it is associated with an increase in health resource use.     

Demandas y expectativas de la evaluación de tecnologías sanitarias en Galicia. Análisis cualitativo desde la perspectiva de decisores y clínicos

Objective

To explore perceptions of the use of health technology assessment (HTA) in the Galician public health system, identify opinions on the usefulness of the products and services developed by the Galician Health Technology Assessment Agency (avalia-t), and determine the barriers and facilitators to the transfer of results to clinical practice.

Method

We performed a qualitative study based on in-depth semi-structured interviews of 20 intentionally selected experts (10 health care professionals and 10 hospital decision makers). The interviews were tape recorded and transcribed for inductive thematic analysis.

Results

Interest in HTA activities was high, but most informants considered these activities to be underused as a tool to aid decision making in clinical practice. A series of key factors was identified to guarantee HTA use: greater dissemination of HTA activities and availability of the results, increased involvement and communication among health care professionals in the selection and prioritization of relevant research, contextualization and adaptation of results to the local context, increased organizational support and greater financial resources.

Conclusions

The present study allows end-user? opinions on the utility of the various products/services offered by HTA agencies to be contrasted in order to adapt HTA activity to their needs and requirements. The involvement of health care professionals in all HTA fields is perceived as one of the main lines of action for HTA agencies. Such involvement could be achieved by reinforcing personal contact and increasing feedback to collaborators.     

Tiempo de viaje y participación en el cribado del cáncer de mama en una región de alta dispersión poblacional

Objective

To analyze the association between travel time and participation in a breast cancer screening program adjusted for contextual variables in the province of Segovia (Spain).

Methods

We performed an ecological study using the following data sources: the Breast Cancer Early Detection Program of the Primary Care Management of Segovia, the Population and Housing Census for 2001 and the municipal register for 2006-2007. The study period comprised January 2006 to December 2007. Dependent variables consisted of the municipal participation rate and the desired level of municipal participation (greater than or equal to 70%). The key independent variable was travel time from the municipality to the mammography unit. Covariables consisted of the municipalities’ demographic and socioeconomic factors. We performed univariate and multivariate Poisson regression analyses of the participation rate, and logistic regression of the desired participation level.

Results

The sample was composed of 178 municipalities. The mean participation rate was 75.2%. The desired level of participation (≥70%) was achieved in 119 municipalities (67%). In the multivariate Poisson and logistic regression analyses, longer travel time was associated with a lower participation rate and with lower participation after adjustment was made for geographic density, age, socioeconomic status and dependency ratio, with a relative risk index of 0.88 (95% CI: 0.81-0.96) and an odds ratio of 0.22 (95% CI: 0.1-0.47), respectively.

Conclusion

Travel time to the mammography unit may help to explain participation in breast cancer screening programs.     

Logros y retos de género de la Encuesta Nacional de Salud de 2006: análisis de los cuestionarios de adultos y hogar

Objectives

To examine the ability of the 2006 Spanish Health Survey (SHS-2006) to analyze the population’s health from a gender perspective and identify gender-related inequalities in health, and to compare the 2006 version with that of 2003.

Method

A contents analysis of the adults and households questionnaires was performed from the gender perspective, taking gender as (a) the basis of social norms and values, (b) the organizer of social structure: gender division of labor, double workload, vertical/horizontal segregation, and access to resources and power, and (c) a component of individual identity.

Results

The 2006 SHS uses neutral language. The referent is the interviewee, substituting the head of the family/breadwinner of past surveys. A new section focuses on reproductive labor (caregiving and domestic tasks) and the time distribution for these tasks. However, some limitations in the questions about time distribution were identified, hampering accurate estimations. The time devoted to paid labor is not recorded. The 2006 version includes new information about family commitments as an obstacle to accessing healthcare and on the delay between seeking and receiving healthcare appointments.

Conclusions

The SHS 2006 introduces sufficient variations to confirm its improvement from a gender perspective. Future surveys should reformulate the questions about the time devoted to paid and reproductive labor, which is essential to characterize gender division of labor and double workload. Updating future versions of the SHS will also involve gathering information on maternity/paternity and parental leave. The 2006 survey allows delays in receiving healthcare to be measured, but does not completely allow other delays, such as diagnostic and treatment delays, to be quantified.     

La comunicación y la satisfacción de las primíparas en un servicio público de salud

Objective

To analyze first-time mothers communication with health professionals, and to explore satisfaction, needs and expectation towards healthcare services.

Method

Qualitative design using in-deep interviews and phenomenology was used. First-time mothers from Huercal-Overa (Almería) were intentionally selected in 2010 and were included in the study. A hermeneutic analysis was performed.

Results

Six meta-categories were obtained. Saturation of information was found with nine interviews. The meta-categories were the following: 1) Health professionals; 2) Pregnancy, partum and postpartum; 3) Communication; 4) Child nutrition; 5) Feelings; 6) Others. The mothers perceived as exciting this new experience and expressed feelings of fear, anguish and high sensitiveness. These feelings are increased by the information received from the family circle and the professionals which is referred low and contradictory. All professionals were positively considered, specially the midwife. The following negative experiences were identified: contractions, dilation and delivery. The end of the stay at the hospital was considered early and the time for consultation was short for the mothers. There is a demand about more information on breast feeding. Mothers wish health professionals to respect their decisions.

Conclusions

The study found some areas for improvement in the communication between firs-time mothers and health professionals which could be taken into account in satisfaction promotion plans in regards to healthcare services.     

Factores de riesgo de fracturas por fragilidad en una cohorte de mujeres españolas

Introduction

Fragility fractures are an important public health issue. The aim of this study was to analyze the association of the main osteoporotic risk factors related to fragility fracture in a cohort of women with an indication of bone densitometry (BD).

Methods

A retrospective cohort was followed-up until a fragile fracture occurred, in a population of women aged 40 to 90 years with a first visit for BD between January 1992 and February 2008. We calculated the incidence rate of fracture per 1000 women-years of follow-up, and the hazard ratio (HR) of fragile fracture using a Cox regression model.

Results

A total of 49,735 women were studied. The average age of participants was 57.8 years (SD: 8.5). Of these, 3631 women (7.1%) reported a new fragility fracture in post-baseline visits. Risk factors with higher adjusted HR were age ≥ 75 years compared with age < 55 years (HR: 3.8; 95% CI: 3.3-4.4) and having a BC result evaluated as osteoporosis compared to normal (HR: 2.0; 95% CI: 1.8-2.2). A personal history of humerus, hip or vertebral fractures had an adjusted HR of 1.2 (95% CI: 1.1-1.3).

Conclusions

The main risk factors for fragility fracture were advanced age, BD result and a personal history of fracture, although 74% of fractures were detected with a bone mineral density classified as normal or osteopenia. Other relevant factors were rheumatoid arthritis or having received prolonged corticosteroid therapy.     

Pago por desempeño explicado desde la teoría de costos de transacción

Objective

To evaluate the ability of transaction costs theory to explain incentives in the health care chain.

Methods

We performed a case study of CPS, a health insurance company in Bogota (Colombia), which preferred not to publish its name.

Results

CPS moves in the environment of high transaction costs and uses the hybrid form of governance at the outpatient level. Incentive intensity, administrative control and the contract all agree with the theory. At the hospital level, the market is used, despite greater uncertainty. Because of the discrete form (1.0) of the incentives and the absence of administrative control, it is difficult for CPS to relate payment to hospital performance.

Conclusions

Transaction costs theory explains the configuration of incentives. Another contribution made by this theory to the literature is the criterion to differentiate between the market and the hybrid. We propose that the market uses discrete-type (1.0) incentives, while the hybrid uses continuous, commission-like incentives.     

Brote de gastroenteritis por el consumo de agua de suministro público causado por Shigella sonnei

Objective

To investigate a waterborne outbreak in the population of València d’Àneu (Lleida, Spain).

Methods

A cohort study of consumption of mains water, bottled water and spring water was carried out. The sample was obtained by telephone contact with all private numbers in the municipality. We surveyed 58.3% of the population census (105/180) for water consumption, number of glasses drunk daily and symptoms. The water supply in the municipal system was sampled, and the presence of Enterobacteriaceae in the stool samples of 10 patients was determined. The association of each type of water was studied with estimation of relative risks (RR) and 95% confidence intervals (95% CI).

Results

The overall attack rate was 64.8% (68/105). The epidemic curve was consistent with an exposure of 6 days. Consumption of public supply water was associated with gastroenteritis (RR = 4.2, 95% CI: 1.5-11.9). In addition, a dose-response relationship was found (χ² = 34.1; p <0.001). There was a higher risk of illness in consumers of 2-3 glasses per day (RR = 4.3; CI 95%: 1.9-9.9) and in those drinking more than three glasses per day (RR = 4.9; 95% CI: 2.2 -10.9). The chlorinator of mains water froze and stopped working. Six stool cultures were positive for Shigella sonnei.

Conclusions

A waterborne outbreak of S. sonnei was caused by contamination of the public water supply. Investigation of illegal dumping of wastewater was recommended. Municipalities should ensure proper disinfection systems and prevent spillage near deposits.