[Burnout and teamwork in primary care teams]. / Burnout y trabajo en equipo en los profesionales de Atención Primaria.

OBJECTIVE: To estimate the prevalence of burnout and the perception of teamwork in Primary Care teams from Barcelona. DESIGN: Multicenter cross-sectional. LOCATION: Primary Health Care Teams from Barcelona. Institut Català de la Salut. PARTICIPANTS: All permanent employees or temporary professionals of all categories from 51 teams (N=2398). A total of 879 responses (36.7%) were obtained. MEASUREMENTS: The Maslach Burnout Inventory questionnaire, with 3 dimensions, was sent by emotional exhaustion (AE), depersonalization (DP), and personal accomplishment (RP). Burnout is considered present when two or more dimensions scored high marks. Perception of teamwork and evaluation of leaders was evaluated using an ad hoc questionnaire. RESULTS: The prevalence of burnout was17.2% (two or more dimensions affected), and 46.2% had at least one of the three dimensions with a high level. A high level of AE was found in 38.2%, of DP in 23.8%, and 7.7% had low RP. Almost half (49.2%) believe that teamwork is encouraged in their workplace. Social workers overall, have a higher average of dimensions affected at a high level, followed by administrative personnel, dentists, doctors and nurses (p<0.001). Permanent staff have a greater degree of emotional exhaustion (p<0.002). Those who rated their leaders worst and least rated teamwork had more emotional exhaustion, depersonalization and higher level of burnout in general (p<0.001). CONCLUSIONS: The level of burnout among professionals is considerable, with differences existing between occupational categories. Teamwork and appreciating their leaders protect from burnout.

Prescription in patients with chronic heart failure and multimorbidity attended in primary care.

BACKGROUND: Multimorbidity and polypharmacy pose challenges to improving the quality of care. OBJECTIVES: To determine the association between prescription of recommended treatment in ambulatory patients with chronic heart failure and multiple comorbidities and hospitalisation events. DESIGN: A population-based retrospective cohort study in Catalonia (north-east Spain). PARTICIPANTS: We included 7173 newly registered patients with chronic heart failure (59% women; mean [SD] age 76.3 [10.7] years). Patients were selected from the electronic patient records of primary care practices and followed for three years. OUTCOME MEASURES: Prescription of angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) and beta-blockers (BBs). RESULTS: Prescription of ACEI/ARBs in patients managed in primary care without a hospitalisation event during the follow-up rose from 50.8 to 83.5% for 0 and ≥4 comorbidities, respectively, and for ACEI/ARBs and BB from 13.1 to 30.6% for 0 and ≥4 comorbidities respectively. Patients with a hospitalisation event were treated more often (ACEI/ARBs or 1.47 [1.17 to 1.85]; ACEI/ARBs and BB or 1.41 [1.17 to 1.69]). Comorbid conditions receiving more treatment were hypertension (ACEI/ARBs or 3.75 [3.33 to 4.22]; ACEI/ARBs and BB or 1.40 [1.23 to 1.59]), diabetes mellitus (ACEI/ARBs or 1.79 [1.57 to 2.04]; ACEI/ARBs and BB or 1.33 [1.18 to 1.49]) and ischaemic heart disease (ACEI/ARBs or 1.25 [1.10 to 1.42]; ACEI/ARBs and BB or 3.01 [2.68 to 3.38]). CONCLUSION: Prescription of recommended treatment in patients with chronic heart failure increased as the number of comorbidities increased. Family physicians can provide equivalent care to more complex patients and those less complex, according to the number of comorbidities.

Quality indicators for patient safety in primary care. A review and Delphi-survey by the LINNEAUS collaboration on patient safety in primary care.

BACKGROUND: Quality indicators are measured aspects of healthcare, reflecting the performance of a healthcare provider or healthcare system. They have a crucial role in programmes to assess and improve healthcare. Many performance measures for primary care have been developed. Only the Catalan model for patient safety in primary care identifies key domains of patient safety in primary care. OBJECTIVE: To present an international framework for patient safety indicators in primary care. METHODS: Literature review and online Delphi-survey, starting from the Catalan model. RESULTS: A set of 30 topics is presented, identified by an international panel and organized according to the Catalan model for patient safety in primary care. Most topic areas referred to specific clinical processes; additional topics were leadership, people management, partnership and resources. CONCLUSION: The framework can be used to organize indicator development and guide further work in the field.

[The Catalan Patient Council: the direct voice of the patient in health policies in Catalonia]. / El Consejo Consultivo de Pacientes de Cataluña: la voz directa del paciente en las políticas de salud en Cataluña.

The transition from a more paternalistic model of care focused on the disease and on the medical professional's authority towards a more participatory model centered on the rights and duties of informed patients represents a significant change in public health policy. One of the most widespread methods of social participation in Catalonia today is the tendency to form associations around a particular disease. This kind of organizational participation is a pioneering tool in the debate around public health policy. The Government of the Generalitat de Catalunya undertook to promote the Strategic Plan of patient participation within the public health system. The Department of Health created the Patient Advisory Council of Catalonia (CCPC, as per the acronym in Catalan). This initiative constitutes a permanent consultative and participatory body for patient representatives in the Catalan healthcare system. The CCPC was set up with a solid determination to place the patient at the centre of the healthcare system, including them in the decision-making processes which directly affect them. This patient participation plan has defined and developed 8 different lines approved by the government, with consensus approval between regional government and the organisations. The CCPC has proven itself to be an effective tool for fostering active patient participation in health policy and its relationship with the system has evolved from that of a monologue to becoming the mechanism for dialogue it is today.

Survival in Mediterranean ambulatory patients with chronic heart failure. A population-based study.

INTRODUCTION AND OBJECTIVES: Scarce research has been performed in ambulatory patients with chronic heart failure in the Mediterranean area. Our aim was to describe survival trends in our target population and the impact of prognostic factors. METHODS: We carried out a population-based retrospective cohort study in Catalonia (north-east Spain) of 5659 ambulatory patients (60% women; mean age 77 [10] years) with incident chronic heart failure. Eligible patients were selected from the electronic patient records of primary care practices from 2005 and were followed-up until 2007. RESULTS: During the follow-up period deaths occurred in 950 patients (16.8%). Survival after the onset of chronic heart failure at 1, 2, and 3 years was 90%, 80%, 69%, respectively. No significant differences in survival were found between men and women (P=.13). Cox proportional hazard modelling confirmed an increased risk of death with older age (hazard ratio=1.06; 95% confidence interval, 1.06-1.07), diabetes mellitus (hazard ratio=1.53; 95% confidence interval, 1.33-1.76), chronic kidney disease (hazard ratio=1.73; 95% confidence interval, 1.45-2.05), and ischemic heart disease (hazard ratio=1.18; 95% confidence interval, 1.02-1.36). Hypertension (hazard ratio=0.73; 95% confidence interval, 0.64-0.84) had a protective effect. CONCLUSIONS: Service planning and prevention programs should take into consideration the relatively high survival rates found in our area and the effect of prognostic factors that can help to identify high risk patients.

[Experience of the quality improvement plan for the La Mina Health Centre (1989-2004)]. / Experiencia del plan de mejora de la calidad del Centro de Salud La Mina (1989-2004).

OBJECTIVES: To describe how well the problems detected by a quality improvement plan (QIP) for a health care team (HCT) were solved; and to analyse the identification methods, the quality causes and dimensions affected by the problems detected, and the participation of professionals. DESIGN: Descriptive study. Evaluation of the situation in December 2004 of the problems identified since 1989. SETTING: Urban HCT, with 58 professionals caring for a population of 18,897 inhabitants in the La Mina District, Barcelona, Spain. PARTICIPANTS: Five-hundred and thirty problems identified. MAIN MEASUREMENTS: Number and kind of detections and problems; identification methods; quality dimensions; causes; degree of solution, by method and cause; degree of solution of the QIP (of "internal" problems, excluding the problems caused externally or by patients); professional participation. RESULTS: In 312 meetings, there were 963 detections (annual average, 60.1; SD, 18.8), corresponding to 530 problems (annual average, 33.1; SD, 12.4). Of these 530 problems, 411 improved (77.5%). Of the 258 "internal" problems, 225 improved. The degree of solution of the QIP was 87.2%. The identification method that detected most problems (53.02% of the total) was the active listening of the quality improvement group. The quality dimensions most affected by the problems were effectiveness (31.7%) and accessibility (20.4%). The most frequent cause of problems and, at the same time, the category with the highest improvement rate (81.6%) was internal organization; 83.9% of professionals took part in the QIP. CONCLUSIONS: Having a QIP at our centre facilitated the management of the quality of care delivery.