Disability and quality of life in heart failure patients: a cross-sectional study.

BACKGROUND: Although both hospitalization and mortality due to heart failure (HF) have been widely studied, less is known about the impact of HF on disability and quality of life. AIM: To assess the degree of disability and quality of life in HF patients attended at family medicine centres. DESIGN AND SETTING: Cross-sectional study of a cohort of HF patients attended at family medicine centres. METHODS: Disability was assessed with the WHODAS 2 questionnaire, which provides a global and six domain scores that is understanding and communication, getting around, self-care, getting along with people, life activities and participation in society. Quality of life was assessed with the Minnesota Living with Heart Failure Questionnaire, which furnishes a global and two domain scores, physical and emotional. RESULTS: A breakdown of the results showed that 28% of patients had moderate disability and 16.7% had severe disability, with the most important areas affected being: life activities, 8.9% extreme disability and 30.3% severe disability; getting around, 34.6% severe disability and 2% extreme disability; and participation in society, 53.3% moderate-severe disability. Quality of life was mildly affected. New York Heart Association (NYHA) Functional Classification and sex were the major determinants of disability and quality of life. Angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists were associated with better scores in the "getting around" and "life activity" domains. CONCLUSION: HF patients in primary care show an important degree of disability and an acceptable quality of life.

Un sistema de gestión de calidad en salud, situación actual y perspectivas en la atención primaria / Quality management system in health: present situation and prospects in the primary health care

El tema de la calidad parte de los propósitos y los requisitos establecidos que debe cumplir cualquier organización y de la satisfacción de las necesidades de las personas a las cuales presta un servicio. En materia de salud, dar una respuesta efectiva a los problemas o situaciones de salud que inciden sobre una población y sus individuos, identificados o no por ellos, mediante la aplicación de normas, procedimientos y protocolos diagnóstico-terapéuticos necesarios así como la verificación de los instrumentos y medios médicos que se utilizan. En la atención secundaria se trabaja en ello. En la atención primaria se han invertido cuantiosos recursos en los últimos años, ha mejorado la calificación profesional y técnica del personal y se llevan a cabo nuevos planes de formación, no obstante, las expectativas y el grado de satisfacción de los pacientes, familiares, de los propios trabajadores de la salud y de otros usuarios del sistema no se corresponde con estas transformaciones. En el trabajo se identifican los principales problemas que inciden en la calidad de la atención: la inexistencia de un sistema de gestión dirigido a la calidad y se proponen las vías para su creación. El Sistema de Gestión de la Calidad de las instituciones de salud tiene necesariamente que estar en correspondencia con la Excelencia, el Colectivo Moral y el Programa Revolución y aplicarse de forma creadora lo dispuesto sobre la Calidad por los órganos que dirigen esta actividad

The topic of quality stems from the purposes and the set requirements that every organization must fulfil and of the meeting of the needs of the people that receive that service. In terms of health, the topic of quality is about giving an effective answer to problems and health situations that affect members of a population, either identified or not by them, through the use of standards, procedures and protocols for therapeutic diagnosis and the checking-up of medical instruments and aids. At the secondary level of care, people are working in this regard. At the primary health care, huge resources have been invested in the last few years, professional and technical qualification of the health has improved and new formation programs have been implemented. However, the expectations and the level of satisfaction of patients, families, the health workers and other users are not in line with this transformation. This paper identified the main problems affecting quality of care such as lack of a quality management system, and suggested the ways to create it. The Quality Management System of the health institutions must be in line with Excellency, Outstanding Staff, and the Revolution Program and must implement in a creative way the provisions on quality passed by the bodies in charge of this activity nationwide