Opiniones y percepciones de los pacientes sobre su participación en la toma de decisiones en las consultas de medicina de familia

ObjectivesTo find out the views of the patient on their participation in decision making (DM) when visiting their family physician.DesignA cross-sectional, qualitative and quantitative study.Setting and participantsPatients attending their family doctors in diverse geographical Health Centres.MeasurementsPersonal interviewing using different kinds of questions (close-ended, close-ended with options and open-ended questions).ResultsPatients participation: 658 (52 ± 17.4 years, 62% females, consulting with 97 doctors (from urban centres: 36 (458); rural centres: 22 (200). Most patients (94%; 620) declared to be satisfied with DM and up to 41% (266) thought that DM should be taken only by the doctor. Nevertheless, after the consultation 60% of patients (360) confirmed that they would have liked the physician to have asked them for their opinion, but the doctor did not encourage them to do this. Furthermore, patients considered information, discussion about options, ways to make decisions, medical advice, active listening and empathy as key aspects to encourage them to participate.ConclusionsAfter a medical consultation, most patients wanted to give their opinion about the proposals of treatment. Nevertheless, they felt that their doctors offered them these opportunities on very few occasions. Some types of questions are better than others in detecting of these kinds of needs, and are more useful to design strategies for involving patients in the DM process.     

Validación de un cuestionario para medir el conocimiento de los pacientes sobre sus medicamentos

ObjectivePatient knowledge of their medicines is closely associated to a better rational use of drugs, thus achieving better health outcomes from their use. The objective of this study is to design and validate a questionnaire to assess the level of knowledge patients have about their medicines.Design(A) Questionnaire: Literature review, some qualitative techniques (expert panel, brainstorming, Delphi method) and some pilot studies. (B) Questionnaire validation.SettingA community pharmacy in the city of Malaga.ParticipantsPatients attending the selected pharmacy, asking for at least one medicine.Main measurementsThe discriminant capacity of the items was assessed. Content and construct validity were analysed using the Spearman's Rho coefficient and Factor Analysis method. Reliability was assessed by measuring internal consistency, equivalence (inter-observer concordance) and test-retest reliability.ResultsThe final questionnaire, with 11 items explaining the different dimensions of knowledge found, was completed by 102 patients (a response rate of 95.3%) with a mean age of 46.6 years (SD 16.70). Mean time to complete it was 4.9 min (SD 2.2). Factor analysis showed a probable structure of 4 factors explaining the 67% of the total variance. The Spearman-Brown Rho coefficient was 0.30 (p<0.05). Cronbach α was 0.677, Kappa's coefficient=0.99 and intra-class correlation coefficient=0.745 (95% CI: 0.49–0.87).ConclusionsThe designed questionnaire is dynamic, valid and reliable, being able to measure the level of patient knowledge on the medicines they use.     

Desarrollo y validación de un cuestionario genérico para la evaluación de la satisfacción de los pacientes crónicos: Cuestionario SAT-Q

ObjectivesTo develop and validate a brief general questionnaire to assess satisfaction in patients with chronic disease.Designepidemiological, observational, multicentre cross-sectional study.Location4 Primary Health Care Centers from the IV Health Area in the Principality of Asturias.SubjectsA total of 202 patients diagnosed with chronic illness who were following a pharmacological regimen for at least one year.MethodsAn extensive literature review was conducted to create an initial item pool of 61 questions regarding patient satisfaction. Then, a forward-backward translation into Spanish was carried out. Next, both the expert (n=8) and patient (n=30) panels led to a new version of 34 items (concerning satisfaction with medication and satisfaction with health service). Finally, scale item reduction (item-total correlation and exploratory factorial analysis —EFA—) and psychometrical validation (feasibility, reliability and criterion validity) of the SAT-Q— were evaluated. Both the SAT-Q and the SF-12 (to assess patient health related quality of life) were applied.ResultsItem reduction analysis resulted in 18 items: general satisfaction with medication (3), adverse-events (3), oversights (2), effectiveness (3), convenience (4) and Health services (3). Internal consistency (Cronbach α) and Intraclass Correlation Coefficients were moderate-high. Moreover, significant positive correlations between SAT-Q scores and SF-12 Physical and Mental Summary Components were found (with the exception of oversights).ConclusionsA brief questionnaire for measuring satisfaction in chronic patients has been developed and preliminary validated.     

Sombras y sombras en la aplicación de la ley de dependencia

The aim of this study was to provide a brief overview of the most controversial aspects of the Spanish Act of Promotion of Personal Autonomy and Long-Term Care 39/2006, which, in the last few years, has led to heated debates between the state and the autonomous regions. Because of the funding problems due to initial poor planning, the decline of contributions from the Spanish Government in the last few years, including the suppression of the agreed level, and low cash collection from the user through copayment, the autonomous regions have had to provide significant economic resources to maintain this social policy in an environment characterised by a lack of transparency of the system. In addition, the regulatory reforms of mid-2012 to ease the burden on state and autonomous budgets have represented a clear setback to the spirit of the act and a loss of welfare to dependent individuals and their families. All these circumstances have contributed to a widely heterogeneous picture in the territorial implementation of the act, with clear differences in waiting lists, abuse in the granting of cash benefits in some regions, and differences in the number of applications for benefits and services.     

Validación de un cuestionario para evaluar la cultura de seguridad del paciente de los profesionales de atención primaria en España

ObjetiveTo validate a tool to measure patient safety culture in Spanish primary care professionals.MethodsMedical Office Survey on Patient Safety Culture (MOSPSC), from the Agency for Healthcare and Research in Quality (AHRQ). The process has been performed in five steps: original version traslation, conceptual equivalence evaluation, acceptability and viability assessment, content validity and questionnaire test and response analysis and psichometric properties assessment.SettingPrimary care.Subjects185 Primary care professionals from different Spanish regions represented the sample test.Main outcome measuresFrecuency, response pattern and discrimination power of each item.Cronbach's alpha coefficient and dimensions obtained through factor analysis.Results17, 8% of respondents answered all the items and 28, 7% of them did not answer, or answered the option “Don’t know/Does not apply”, to one to four items. All the sentences, with only one exception, present discrimination capacity. Cronbach's alpha coefficient results 0,96 and information is sumarized in 15 factors obtaining the same items in 7 of the total 12 factors in the original questionnaire.ConclusionsTraslated, adapted, extended and validated AHRQ questionnaire is, in this setting, a reliable and useful instrument and it must be used for international comparisons.     

El cambio de paradigma en la prevención de ictus en la fibrilación auricular. Retos y oportunidades emergentes para el médico de familia

Atrial fibrillation (AF), is the most prevalent sustained arrhythmia in general population, affecting up to 10% in patients of advanced age. AF doubles overall mortality and increases up to 5–6 times the risk of stroke, which have the characteristic of being particularly harmfull. The basis of treatment on AF are the rhythm or rate control and the prevention of thromboembolism. For the latter purpose the treatments that have been most effective are oral acticoagulants. For decades and until just a few years ago, the only oral drugs available for this purpose have been the anti-vitamin K, mainly represented in our country by acenocoumarol and lesser extent by warfarin. These drugs have been shown to reduce strokes and mortality compared to placebo and with antiplatelet drugs, so have been and continue to be the standard treatment and the comparator for all antithrombotic drugs in patients with AF. The variability in the therapeutic response, their food and drugs interactions and their narrow therapeutic window that entail the need to frequently monitoring, has led to look for new drugs that, at least maintaining their advantages, where able to avoid some of the drawbacks.Currently we have a number of new drugs that meet these premises, although they have the disadvantage of a higher direct cost. The arrival of these new oral anticoagulants (NOAC) make necessary to know them well, reach a consensus for a correct use and to make changes in the clinical management of these patients when they are used.In this article we review the indications and way of use of the different options (classics and news) of antithrombotic therapy in patients with AF, the situation of anticoagulated patients in our country, the characteristics of the NOAC, its recommendations for use and the challenges to that are subjected family physicians regarding these changes.     

Evaluación de la efectividad de un programa de mindfulness y autocompasión para reducir el estrés y prevenir el burnout en profesionales sanitarios de atención primaria

Objective

To evaluate the effectiveness of a Mindfulness and Self-Compassion Program on the levels of stress and burnout in Primary Care health professionals.

Educación para la salud en la escuela primaria: opinión del profesorado de la ciudad de Alicante

ObjectiveThis study explores the opinions of primary school teachers about health activities carried out in schools in Alicante city (Spain).MethodsAn exploratory study was conducted through qualitative content analysis. Three focus groups were conducted with 25 primary school teachers (14 women and 11 men) working in 14 public and 7 private schools in the city of Alicante. Participants were asked about the health activities carried on in their schools.ResultsTeachers distinguished between health education activities promoted by the school and those included in external programmes promoted by public and private institutions. External programmes were considered as impositions, lacking continuity and chosen according to passing fads. Although teachers demonstrated a more positive attitude towards activities arising from their own initiative, they identified health education as a secondary task. Teachers considered that improving their own health education training and promoting the involvement of parents, health professionals and public institutions were the most appropriate ways to promote health education in the school.ConclusionTeachers showed a more positive opinion and greater commitment towards health activities that complement and facilitate their teaching tasks. Their didactic programme and opinion should be taken into account to maximise the efficiency of the health promotion and education activities promoted by external organisations.     

Influencia de la lactancia materna y la alimentación en el desarrollo de alergias en los niños

ObjectiveTo evaluate the relationship between breastfeeding and the development of allergic diseases (AD).DesignA cases-controls study.SettingSantander University Hospital, Bucaramanga, Colombia, South America. Level II health care.ParticipantsA total of 1460 boys and girls between 3 and 7 years old attending an outpatient clinic.Main measurementsPartial (BF) and exclusive breastfeeding (EBF); relationship between the presence of allergic diseases and BF and EBF, adjusting for the confounding factors due to other exposures using logistic regression.ResultsOut of a total of 1460 patients, 41.6% (95%CI 39.0–44.2) received EBF, while 44.4% (95%CI 41.9–47.0) were partially breastfed. Among those who had an allergy, 34.8% (95%CI 32.4–37.3) had rhinitis, 27.8% (95%CI 25.6–30.2) asthma and 11.6% (95%CI 10.0–13.4) atopic dermatitis; 7.0% (95%CI 5.1–9.3) had the three conditions. To breastfeed exclusively for ?3 months is a protective factor for AD (OR 0.70, 95%CI 0.48–1.03). Breastfeeding for 3 months, regardless of whether or not it is exclusive, is a risk factor for AD (OR 2.05, 95%CI 1.47–2.86).ConclusionsThe recommendation to exclusively breastfeed for as long as possible continues to be valid, as there was a significant preventive impact on the development of AD with the length of time breastfed. Prospective studies including lung function tests and immunological analyses need to be performed to confirm these findings.