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.     

Evaluación del Observatorio de Salud de Asturias: métricas de web y redes sociales,y opinión de los profesionales de la salud

Objective

To evaluate the Health Observatory of Asturias (Observatorio de Salud de Asturias [OBSA]), which collects and disseminates health data from Asturias through a website and social networks.

Method

A cross-sectional study was conducted between 2012 and 2013. The study included a process evaluation that analyzed the reach of the OBSA's website, Facebook and Twitter accounts through web metrics and the use made by health professionals in Asturias of these media. Satisfaction was assessed through an online questionnaire. To estimate the potential effects of the OBSA, the study also included an evaluation of the results with a non-experimental design.

Results

The total number of visits to the website increased in 2012, with more than 37,000 visits. The questionnaire (n = 43) showed that 72.1% of the health professionals knew of the OBSA and that 81.5% of them had used it. Most health professionals reported they were satisfied with the OBSA and believed that it encouraged cooperation among professionals (51.6%).

Conclusion

The OBSA is known and consulted by most health professionals and is achieving some of its main objectives: to inform health staff and stimulate discussion. According to the results, information and communication technologies could play an important role in the presentation of health data in a more interactive and accessible way.     

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.     

Influencia del criterio de selección de pacientes para la toma de frotis en la estimación de la efectividad de la vacuna antigripal

Objective

To estimate the effectiveness of the influenza vaccine under different criteria for selecting patients for swabbing.

Method

A case-control study was performed of laboratory-confirmed cases (n = 909) and negative controls for influenza (n = 732) in the 2010-2011 to 2012-2013 seasons in Navarre (Spain). The adjusted vaccine effectiveness was estimated by including all swabs from patients with influenza-like-illness and selecting only the first two cases per physician and week.

Results

The first two patients per physician and week were less frequently vaccinated against influenza (7.9% vs. 12.5%, p = 0.021) and less often received confirmation of influenza (53.6% vs. 66.4%, p <0.001) than subsequent patients. These differences decreased after adjustment for covariates. The effectiveness of the influenza vaccine was 49% (95% CI: 23-66%) when all swabs were included and was 55% (95% CI: 27-72%) when we selected the first two swabs per week and physician.

Conclusion

The selection of the first two patients per physician and week may bias assessment of the effectiveness of the influenza vaccine, although this bias was small in the seasons analyzed.     

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.     

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.     

Efectividad de un programa multicomponente para dejar de fumar aplicado en atención primaria

Objective

To evaluate the effectiveness of a multicomponent program applied by nurses in primary care.

Method

A non-experimental pre-post study was carried out in 145 smokers from Area V of Asturias (Spain). The intervention consisted of a multicomponent group treatment program, applied for 7 weeks by primary care nurses.

Results

The mean age was 52 years. Men accounted for 39.73% of the study population. The abstinence rate at post-treatment was 51.1% (95% CI: 42.4 to 59.6). At 12 months, the abstinence rate was 41.1% (95% CI: 32.6 to 49.6). The change between the end of the intervention and follow-up at 6 and 12 months was statistically significant at both time points (p = 0.035 and p = 0.013, respectively). Among participants who had stopped smoking, there was a statistically significant decline in daily cigarette consumption. Factors that were statistically significantly associated with continued smoking at 12 months were heavier smoking before the intervention, higher scores on the Fagerström test, and a lower number of sessions attended.

Conclusions

The multicomponent treatment program was highly effective. The results suggest the desirability of specific training for health professionals to implement this type of intervention in primary care as an alternative to medical advice for smokers who need it.     

Impacto del suministro de harina de maíz fortificada en la anemia de preescolares de zonas indígenas de México

Objective

To estimate changes in anemia status in preschool age children at 9 months after the provision of soy- and iron-fortified cornflour.

Methods

A non-experimental pre-post evaluation study was performed in a sample of 98 boys and 96 boys aged between 6 and 24 months. We analyzed demographic, anthropometric, and biochemical variables.

Results

During the 9-month period, the hemoglobin level increased from 11.0 to 11.9 mg/dL (p < 0,001). The prevalence of anemia (hemoglobin <11.0 mg/dL) decreased from 52.6% to 25.3% (p < 0,001). The indicators of height for age and body mass index changed from -2.1 (-5.5 to 2.8) to -2.3 (-6.5 to 1.3) (p < 0,001) and from 0,4 (-3.1 to 2.9) to 0,7 (-2.2 to 3.9) (p < 0,001), respectively.

Conclusions

The decreased prevalence of anemia suggests that the provision of soy- (3%) and iron-fortified flour is a viable alternative for combating childhood anemia.     

Necesidades de información y uso de Internet en pacientes con cáncer de mama en España

Objective

To analyze information needs and search strategies among women with breast cancer in Spain. An additional aim was to explore how the internet, as a source of health information, influences the autonomy and active management of this disease among patients. The research was conducted in 2010 and 2011.

Method

This study forms part of a broader qualitative study that focuses on describing patients’ experiences of breast cancer and the trajectory of the disease, with the aim of creating a platform of integrated information resources for patients, relatives and healthcare professionals (PyDEsalud: http://www.pydesalud.com). We carried out 41 in-depth, semi-structured interviews with breast cancer patients in different stage of the disease, who were aged between 32 and 69 years. The interviewees’ were selected by intentional sampling, which included 15 Spanish regions. The field work was carried out from June to August, 2010. The interviews were recorded on videotape or audio. Based on patients’ narratives of their disease, a thematic-inductive analysis was performed of the information gathered.

Results

The findings show the importance of the internet as a source of health information. Moreover, the internet is a resource that is able to promote the empowerment process among patients and, consequently, to aid improvement in disease management.

Conclusions

Users need access to web sites with high quality health information, adapted to their needs and objectives.     

Costes de las terapias de las enfermedades neurodegenerativas: aplicación de un sistema de costes basado en las actividades

Objective

To apply the activity based costing (ABC) model to calculate the cost of therapy for neurodegenerative disorders in order to improve hospital management and allocate resources more efficiently.

Method

We used the case study method in the Francolí long-term care day center. We applied all phases of an ABC system to quantify the cost of the activities developed in the center. We identified 60 activities; the information was collected in June 2009.

Results

The ABC system allowed us to calculate the average cost per patient with respect to the therapies received. The most costly and commonly applied technique was psycho-stimulation therapy. Focusing on this therapy and on others related to the admissions process could lead to significant cost savings.

Conclusions

ABC costing is a viable method for costing activities and therapies in long-term day care centers because it can be adapted to their structure and standard practice. This type of costing allows the costs of each activity and therapy, or combination of therapies, to be determined and aids measures to improve management.     

Evaluación de un programa comunitario para reducir el aislamiento de personas mayores debido a barreras arquitectónicas

Objective

Social isolation impairs health. An intervention to reduce isolation due to architectural barriers in elderly persons was carried out in Barcelona (Spain). This study aimed to evaluate its effects on health.

Methods

We conducted a quasi-experimental before-after study. Isolated older people were identified in three deprived urban areas from 2009 to 2011. Participants had twice-weekly outings with volunteers in a stair-climbing power wheelchair. User satisfaction was evaluated and perceived health status, quality of life, and mental health before and after four outings were compared with McNemar tests.

Results

There were 74 participants (median age: 83 years; IQR: 78-89). Perceived health improved by 21%, mental health by 24%, and psychological distress was reduced by 16%. Most participants (98%) were satisfied.

Conclusion

The intervention improved perceived health and mental health. Elderly people with impaired mobility should not live in buildings with architectural barriers and, if this cannot be avoided, similar programs should be implemented.     

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.     

Impacto económico de los eventos adversos en los hospitales españoles a partir del Conjunto Mínimo Básico de Datos

Objective

To evaluate the incidence and costs of adverse events registered in an administrative dataset in Spanish hospitals from 2008 to 2010.

Methods

A retrospective study was carried out that estimated the incremental cost per episode, depending on the presence of adverse events. Costs were obtained from the database of the Spanish Network of Hospital Costs. This database contains data from 12 hospitals that have costs per patient records based on activities and clinical records. Adverse events were identified through the Patient Safety Indicators (validated in the Spanish Health System) created by the Agency for Healthcare Research and Quality together with indicators of the EuroDRG European project.

Results

This study included 245,320 episodes with a total cost of 1,308,791,871€. Approximately 17,000 patients (6.8%) experienced an adverse event, representing 16.2% of the total cost. Adverse events, adjusted by diagnosis-related groups, added a mean incremental cost of between €5,260 and €11,905. Six of the 10 adverse events with the highest incremental cost were related to surgical interventions. The total incremental cost of adverse events was € 88,268,906, amounting to an additional 6.7% of total health expenditure.

Conclusions

Assessment of the impact of adverse events revealed that these episodes represent significant costs that could be reduced by improving the quality and safety of the Spanish Health System.     

Consumo de riesgo de alcohol y factores asociados en adolescentes de 15 a 16 años de la Cataluña Central: diferencias entre ámbito rural y urbano

Objective

To determine the prevalence of risky alcohol consumption and associated risk factors among adolescents living in Central Catalonia (Spain) during the 2011-2012 academic year, depending on their area of residence.

Method

A cross-sectional study was carried out in a sample of 1268 10th grade students (4 th grade of secondary education) in Central Catalonia.

Results

Risky alcohol consumption was higher among adolescents in rural areas than in urban areas (59.6% versus 49.8%). Associated risk factors were drunkenness in siblings and friends, having positive expectations of alcohol consumption, and buying alcohol. Not living with both parents and poorer academic achievement were associated risk factors in rural areas, while higher socioeconomic status was a risk factor in urban areas.

Conclusions

Risky alcohol consumption was much higher among adolescents living in rural areas. The main associated factor was alcohol consumption among family and friends.     

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.     

Cumplimiento de las recomendaciones sobre actividad física en personas hipertensas asistidas en atención primaria

Objective

To determine the prevalence of adherence to physical activity recommendations in the hypertensive population of Lerida (Spain) attended in primary care and to identify related factors.

Methods

A cross sectional study was carried out in hypertensive adults. The dependent variable was adherence to physical activity recommendations measured with the Minnesota Questionnaire. The independent variables were sociodemographic factors, the information received, and attitudes to physical activity.

Results

A total of 786 hypertensive patients participated in this study; 53.9% were women and the mean age was 66.0 ± 10.2 years. Adherence to recommendations was found in 64.3% (95% CI: 60.9-67.6); this percentage was 65.2% in men (95% CI: 60.2-70.0) and 63.4% in women (95% CI: 58.8-67.9). Greater adherence was associated with age in men and with residence in a rural area in women. In both genders, greater adherence was associated with unpaid work and with having a favorable attitude to physical activity. No association was observed with the number of recommendations received in the last 6 months.

Conclusions

More than half the hypertensive population adhered to physical activity recommendations. To improve physical activity levels, recommendations can be tailored to the attitudes of individual patients.