Gestión de coberturas de personal en atención primaria. Automatización del cálculo

The Santa Coloma de Gramenet Primary Care Service has designed a new tool to standardize and automate the process of planning the number of needed health care workers. The tool is divided in two parts: a calculator, which gives guidance on the foreseeable risk depending on the activity and the health care workers’ workload, and sentinel indicators; the main is the “welfare basic level”, that is the percentage structure of visited patients and their delay at 2, 3 and 7 calendar days, assessing the impact on the care of the population. The results of its use in the summer of 2010 have demonstrated its efficiency by lowering the needed workers with respect to 2009, achieving a better distribution according to the workload and improving the economic management. Given that the necessary data are accessible through computerized databases and its simple use, we believe it to be exportable to other fields.     

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.     

Variación espacial de la exposición a contaminación atmosférica en la ciudad de Valencia y su relación con un índice de privación

Objective

To evaluate spatial variation in exposure to nitrogen dioxide (NO₂) air pollution in the city of Valencia, Spain, and its association with socioeconomic deprivation and age.

Methods

Census tract population data were obtained from the National Statistics Institute of Spain. Outdoor NO₂ was monitored in 100 sites in the study area, through the use of passive samplers, in three campaigns between 2002 and April 2004. Land use regression (LUR) was used to obtain a map of NO₂ levels. The LUR predictions were compared with the NO₂ level obtained by: a) the nearest sampler of the monitoring network, b) the nearest passive sampler, c) the mean distance-weighted levels of the samplers in the neighborhood, and d) the NO₂ level obtained by using Kriging. For each census tract, the NO₂ levels were obtained. The association of NO₂ air pollution exposure with population age (≥65 years) and the 5-category deprivation index was analyzed.

Results

The LUR models showed less error than the other prediction methods. The safety levels proposed by the World Health Organization were exceeded in more than 99% of the population. An inverse relationship was found between NO₂ levels and the deprivation index (β = –2.01 μg/m³ in the most deprived quintile compared with lower deprivation, 95%CI: –3.07; –0.95) and a direct relationship was found with age (β = 0.12 μg/m³ per unit increase in percentage of the population ≥ 65 years, 95%CI: 0.08; 0.16).

Conclusions

The method allowed pollution maps to be obtained and the association between NO₂ levels and sociodemographic characteristics to be described.     

Percepción de los factores de riesgo de cáncer por la población española

Objective

To analyze the perception of the Spanish population of risk factors for cancer.

Methods

Data were extracted from the OncoBarometro 2010 survey. Multivariate logistic models were applied to analyze the perception of the population on the importance of various risk factors: smoking, alcohol, sun, food, weight, sexually transmitted diseases, family history, radiation exposure, exposure to toxic substances and air pollution. The answers were rated on a 0 to 10 scale and were converted to low (0-6) and high (7-10) categories. The measure of association used was the prevalence ratio (PR).

Results

The greatest importance was assigned to smoking (high importance: 83.1%), whereas the least importance was assigned to weight (26.5%). In general, the probability of perceiving risk factors as important was lower among men (PR sun: 0.87; PR sexually transmitted diseases: 0.78) and increased among people who received professional advice on cancer prevention (PR alcohol: 1.11; PR sun: 1.18; PR food; 1.31; PR weight: 1.92). In particular, knowledge of symptoms and extreme fear of cancer were associated with perceiving smoking as an important risk factor, whereas a high perceived vulnerability to cancer was associated with perceiving exposure to toxic substances, pollution and smoking as important risk factors.

Conclusions

Greater awareness is required of the association of cancer with overweight and sexually transmitted diseases. The recommendations given by health professionals on cancer prevention are key to increasing the population's awareness of risk factors for cancer.     

Plan de formación continuada en una unidad de gestión clínica

Continuing Care Unit (UCA) focused the attention of frail patients, polypathological patients and palliative care. UCA attend patients at home, consulting, day unit, telephone consulting and in two hospitals of the health area. From2002 UCA began as a management unit, training has been a priority for development. Key elements include: providing education to the workplace, including key aspects of the most prevalent health care problems in daily work, directing training to all staff including organizational aspects of patient safety and the environment, improved working environment, development of new skills and knowledge supported by the evidence-based care for the development of different skills. The unit can be the ideal setting to undertake the reforms necessary conceptual training of professionals to improve the quality of care.     

Medida de la importancia de las dimensiones de la satisfacción en la provisión de servicios de salud

Objective

Identifying users’ perceptions of the quality of care is essential to improve health services delivery. The main objective of this article was to describe the application of a methodology to identify factors that facilitate the identification of areas for improvement.

Method

A questionnaire was applied in three health areas in Catalonia (Spain) (primary care [n = 332], outpatient specialty care [n = 410] and hospital emergency care [n = 413]) to measure user satisfaction and assess the importance given to the aspects analyzed.

Results

The main areas for improvement in primary care identified by an importance-performance analysis involved the time devoted to patients as well as health professionals’ willingness to listen to their views. In hospital emergency care, the main area of improvement was related to the hospital's physical conditions.

Conclusions

The tools designed and implemented by the Catalan Health Service (Spain) have proved to be valid for the detection of priority areas to improve service delivery and promote regional equity.     

Identificación y priorización de actuaciones de mejora de la eficiencia en el Sistema Nacional de Salud

Objectives

To identify a significant number of interventions to improve efficiency and reduce waste in the Spanish National Health System (NHS), to prioritize these interventions according to their impact, and to assess the measures recently adopted by the Spanish government.

Material and methods

A meeting was held with 13 healthcare experts, structured according to a mixed method adapted from brainstorming, nominal group and Rand consensus methods.

Results

The panel proposed 101 possible actions to improve the efficiency of the Spanish NHS. The 11 measures announced by the Government in the Royal Decrees-Laws 4 and 8 of 2010 increased the total number of measures assessed to 112. The panel's proposals centered on accountability and good governance, the concentration of hospital equipment and services, reduction of preventive services of little value, utilization management (including copayments, but not as a sole element), management of the incorporation of new medicines and technologies, strengthening the role of primary care, reforming workforce policies, and a series of regulatory and managerial interventions. Government measures received an intermediate overall score, but scores of their financial impact were high.

Conclusions

There are several opportunities to improve the efficiency of the Spanish NHS beyond the “anticrisis” measures recently adopted by the Spanish Government. Most of these opportunities require feasible structural reforms, although their financial impact is less immediate than that of government measures.     

Patrón evolutivo de la incidencia de cáncer de tiroides en la Región de Murcia de 1984 a 2008

Objective

To study the trend pattern of the incidence of thyroid cancer.

Methods

We selected incident cases of thyroid cancer occurring in the Region of Murcia (Spain) in 1984-2008. The variables gathered were age, sex, date of diagnosis, and morphology. We calculated incidence rates and the annual percentage of change using Bayesian age-period-cohort models.

Results

During the study period, 1414 cases were diagnosed, representing an increase in adjusted rates from 2.9/100000 in 1984-1988 to 7.3 in 2004-2008. The incidence was 3.5 times higher in women than in men and the most frequent morphology was papillary carcinoma (67.7%). An increasing trend was found in both genders; these increments were more pronounced in papillary carcinoma. In women, the incidence increased with age, calendar year, and in those born in 1945-1963. The incidence of papillary microcarcinoma increased four-fold in women.

Conclusions

Thyroid cancer used to be a rare cancer but has become an emerging tumor. The greatest changes were found in papillary thyroid cancer, including a gradual increase in the proportion of microcarcinoma.     

Evaluación de la efectividad de un programa de mindfulness en profesionales de atención primaria

Objectives

To determine the long-term effects of a mindfulness program on burnout, mood states, empathy, and mindfulness in primary care professionals.

Methods

A repeated measures before-after study was performed in 87 participants working in primary care. The variables evaluated were scores of the Burnout Inventory (Maslach), mood states (Profile of Mood States [POMS]), empathy (Jefferson Scale of Physician Empathy [JSPE]) and mindfulness (Five Facet Mindfulness Questionnaire [FFMQ]), adherence to the intervention, and changes in attitudes. Evaluations were performed at baseline, at 8 weeks, and at 6 and 12 months. The intervention lasted for 1 year and consisted of two training phases, an intensive first phase lasting 28 hours, spread over 8 weeks, and a second, maintenance phase of 25 hours spread over 10 months. The effect of the intervention was assessed through observed change, standardized response mean (SRM), and linear mixed-effects models on repeated measures.

Results

The scores of all the scales improved significantly during the follow-up compared with baseline scores. The greatest differences were obtained at 12 months, especially in the the FFMQ (SRM: 1.4), followed by the POMS (SRM: 0,8). The greatest improvement in the maintenance phase was found in the difference between consecutive scores. The only scale that showed major changes in all phases was the FFMQ scale. At the end of the intervention, 89% of participants practiced the exercises of the program on their own and 94% reported improvements in self-care and greater professionalism.

Conclusions

A psychoeducational program based on mindfulness reduces burnout and improves mood states, empathy, and mindfulness, while encouraging better self-care.     

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.     

Influencia de la inmigración en los patrones de transmisión de la tuberculosis en Castellón (2004-2007)

Background

This study aimed to identify tuberculosis transmission patterns in Castellón in a period of major demographic changes.

Methods

A prospective study of patients with positive culture in the province of Castellon over a 4-year period (2004-2007) was carried out. Cases were described by year and nationality and were compared with those reported to the Department of Public Health. We studied the population with available molecular patterns, identified through restriction fragment length polymorphism (RFLP) and analyzed the variables from patient clusters, based on data collected in surveys of the Department of Health and the Laboratory Management Program.

Results

According to data from the Department of Public Health, the overall rate of tuberculosis per 100,000 inhabitants in the province of Castellón was 15.7 in 2004, 19.9 in 2005, 18.2 in 2006 and 17.5 in 2007. In our laboratory, strains were identified from 301 patients, representing 77% (301/390) of reported cases and 94% (301/321) of reported cases with a positive culture. The percentage of tuberculosis among foreigners increased with age, exceeding 50% in 2007. Molecular studies were available in 95% of patients (286); 58% were Spanish and 42% were foreigners, of whom 54% were Romanians. The cluster percentage was 40%, with 30% of mixed clusters. According to conventional contact studies, 85% of patients in clusters had been considered isolated cases.

Conclusions

The increased rate of tuberculosis in Castellón was mainly due to the increasing number of cases among foreigners, mostly Romanians. The availability of molecular studies in all patients with a positive culture allowed us to analyze how and where tuberculosis is transmitted in our province. Forty percent of the patients were grouped into clusters; of these, mixed clusters accounted for one third, indicating the high integration of immigrants in our area.     

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.     

Promoción de la participación ciudadana en cuidados de salud a través de PyDEsalud.com

This project supports the initiative promoted by the Spanish National Health System to provide informational materials, in printed or interactive format, to encourage public participation in decision making and healthcare. We present the newly created PyDEsalud.com, a web platform aimed at people with chronic diseases with a high socioeconomic impact, such as breast cancer, depression, and diabetes. This platform uses scientific methodology and contains three information service modules (Patients’ experiences, Shared decision making, and Research needs), aimed at promoting health education for patients and families.