[Quality of care indicators for benign prostatic hyperplasia. A qualitative study]. / Indicadores de calidad en hiperplasia benigna de próstata. Un estudio cualitativo.

OBJECTIVE: To assess quality of care indicators for benign prostatic hyperplasia (BPH), and to evaluate their strengths and weaknesses for incorporation into health information systems. DESIGN: Structured expert meeting, using procedures adapted from the nominal group techniques and the Rand consensus method. SETTING: Valencian School of Health Studies. PARTICIPANTS AND/OR CONTEXTS: Forty panellists (74% doctors, 70% from primary care settings) with experience in the management of BPH from 15 departments of the Valencia Health Agency. METHOD: Three workshops were held simultaneously (examination and diagnosis, drug therapy, and appropriateness and results), and the 15 quality indicators selected by the coordination group were assessed. RESULTS: Eleven of the 15 indicators scored in the range of high relevance. The 5 best rated were: the use of alpha-blockers + 5-alpha reductase inhibitor from certain severity level, digital rectal examination in the initial assessment, follow-up with the International Prostate Symptoms Score (IPSS), the rate of urgent catheterization in Hospital Accident & Emergency Units, initial assessment with the IPSS and the use of alpha-blockers prior to catheter removal for acute retention of urine. CONCLUSIONS: Some of the assessed indicators can be useful for incorporation into health information systems.

[Development and validation of a new questionnaire to assess health care satisfaction and the device in stomized patients: espejo questionnaire]. / Cuestionario espejo. Valorar la satisfacción de pacientes ostomizados con la atención sanitaria y el dispositivo.

OBJECTIVES: To develop a questionnaire to measure the satisfaction of stomatised patients with healthcare professionals and with the stomal device. METHODS: An initial review of the literature was performed and in meetings with experts, the most relevant items were selected. In a pilot study with patients that had been recently stomatised (three months from intervention), the comprehensibility and discriminatory ability of each item was tested. Items were eliminated on the grounds of frequent "no response" or low correlation with others on the provisional scale (determined by means of Cronbach's alpha). RESULTS: Following meetings with experts, 12 items were eliminated by reason of irrelevance or low frequency of use. Subsequently by means of administration of the questionnaire to a sample of 72 patients, five more items were selected for elimination. An analysis of the 13 items that remained confirmed an acceptable level of reliability (Cronbach's alpha of 0.917) and also the significant differences in the global scores between the patients who have had stoma for more than three months (higher satisfaction) and patients who had been recently stomatised. The items in the questionnaire referred to aspects of easy and comfort of use of the stoma, as well as satisfaction with information received and interaction with healthcare professionals from the point of view of the patient. CONCLUSIONS: This is the first questionnaire to measure satisfaction with healthcare professionals and the stomal device from the perspective of the stomatised patient. In a subsequent study the other properties of the measurement tool (validity responsiveness and longitudinal validation) will be evaluated.

A prospective, longitudinal, multicenter, cohort quality-of-life evaluation of an intensive follow-up program for patients with a stoma.

The creation of a stoma can profoundly affect a patient's quality of life. A prospective, 3-month multicenter study was conducted to evaluate stoma patient quality of life among volunteers receiving standard clinical follow-up (S) and those receiving intensive follow-up via telephone (I). A total of 336 patients volunteered to participate; 187 in the S group and 149 in the I group; mean age 63+/-14 years, 65.85% male; the majority (64.3%) had a colostomy. The Stoma Quality of Life Index (SQLI) score was determined at the initial and final visits. No statistically significant difference between the I and S groups was found at baseline except for the subcategory social concerns (P = 0.0123). At 3 months, statistically significant changes were observed between the overall SQLI score of both groups--scores were 58.8 (17.7) and 72.8 (14.6) at baseline and 3 months, respectively (P < 0.0001); in particular, for the subcategories patient satisfaction (P = 0.0173) and medical experience (P = 0.0330). Patients in the I group showed a positive but not statistically significant change in three subscales of the SQLI questionnaire; the I group presented slightly lower differences in the percentage of complications related to the stoma, need for emergency assistance, and for hospitalization. Differences in quality-of-life perceptions also were reflected among geographic areas. Preoperative ostomy nurse care was found to be associated with a greater probability for improvement in select SQLI subscales. The results of this study confirm that personal support and help received pre- and post surgery from ostomy care nurses may enhance ostomate overall quality of life and when additional intensive follow-up was introduced, certain aspects of quality of life improved. The study underscores the need for clinician awareness of their role in patient quality of life.