[Health care for patients with multimorbidity. The perception of professionals]. / La atención sanitaria a pacientes con multimorbilidad. La percepción de los profesionales.

OBJECTIVE: To explore the perceptions of health professionals about the characteristics of health care for patients with multimorbidity. DESIGN: Qualitative study of phenomenological trajectory made between January and September 2015 through 3 group interviews and 15 individual interviews. LOCATION: Aragonese Health Service. PARTICIPANTS: Medical and nursing professionals of the Aragon Health Service belonging to various services: Internal Medicine, Primary Care, Emergency and Management. A pharmacist was also included. METHODS: A non-probabilistic intentional sampling was carried out that allowed for the selection of professionals in terms of discourse representation criteria, allowing to know and interpret the phenomenon studied in depth, in its different visions. We interviewed health professionals with different profiles who knew in depth the characteristics of care provided to patients with multimorbidity. The interviews were recorded, transcribed literally and interpreted, through the social analysis of the discourse. RESULTS: Professional culture oriented to individual pathologies, lack of coordination among professionals, high prevalence of multi-prescriptions, Clinical Practice Guidelines oriented to individual pathologies and specialist training focused on individual diseases. CONCLUSIONS: Both the professional culture and the organization of the healthcare system have been oriented towards the attention to individual pathologies, which results in the difficulty to offer a more integrated care to patients with multimorbidity.

Epidemiology of substance abuse among migrants compared to native born population in primary care.

BACKGROUND AND OBJECTIVES: Research in the United States tends to indicate that immigrants from most sociogeographic regions have considerably lower substance use disorder (SUD) rates than native born individuals. We aimed to analyze the differences between immigrants and native born population regarding substance abuse and dependence. This objective was approached using data from the ARACAT cross-sectional multicenter study in primary care settings of two different Spanish regions: Aragon and Catalonia. METHODS: Three thousand six patients (1,503 immigrants randomly selected and 1,503 native born paired by age and gender) were interviewed using the Mini-International Neuropsychiatric Interview. RESULTS: Reported substance abuse and dependence were more prevalent in the native born population than in immigrants (alcohol abuse 5.1% vs. 2.6% p < .0001, alcohol dependence 3.3% vs. 2.6% n.s., other abuse 3.4% vs. .4% p < .0001, other dependence .5% vs. 4.0% p < .0001). Large differences were detected between different ethnic groups. Sociodemographic characteristics such as female gender, older age, higher level of education or stable housing (among others), were found to be protective against different SUDs. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: Immigrants have lower levels of alcohol and substance abuse, however, those that do consume show higher levels of both comorbid mental disorders and problematic alcohol/substance use. It would appear to be the case that issues specific to immigrant cultures, such as extreme stigmatization of substance and alcohol use, may serve to promote social marginalization and inhibit treatment access.

[Patient safety culture in directors and managers of a health service]. / Cultura de la seguridad del paciente en directivos y gestores de un servicio de salud.

OBJECTIVE: To assess patient safety culture in directors/managers. METHODS: Cross-sectional descriptive study carried out from February to June 2011 among the executive/managing staff of the Aragón Health Service through semi-structured interviews. RESULTS: A total of 12 interviews were carried out. All the respondents admitted that there were many patient safety problems and agreed that patient safety was a priority from a theoretical rather than practical perspective. The excessive changes in executive positions was considered to be an important barrier which made it difficult to establish long-term strategies and achieve medium-term continuity. CONCLUSIONS: This study recorded perceptions on patient safety culture in directors, an essential factor to improve patient safety culture in this group and in the organisations they run.