ABSTRACT
En este trabajo se describen los factores que han propiciado la expansión de las prácticas de bajo valor (PBV) junto con las principales iniciativas para revertirlas. El artículo destaca las estrategias que han demostrado ser más útiles a lo largo de los años, desde la adecuación de la práctica clínica a las recomendaciones no hacer, pasando por la prevención cuaternaria y el abordaje de los riesgos asociados al intervencionismo. Revertir las PBV requiere un proceso planificado con un enfoque multifactorial que involucre a los diferentes agentes implicados. Además ha de tener en cuenta las barreras que dificultan la desimplementación de las PBV e incorpore las herramientas que facilitan la adherencia a las recomendaciones no hacer. El papel del médico de familia es especialmente relevante en la prevención, detección y desimplementación de las PBV, por su carácter coordinador e integrador de la atención que reciben los pacientes, y porque en el primer nivel asistencial se gestionan y resuelven la mayor parte de las demandas asistenciales.(AU)
This manuscript describes the factors that have led to the spread of low-value practices (LVP) and the main initiatives to reverse them. The paper highlights the strategies that have proven to be most useful over the years, from the alignment of clinical practice with do not do recommendations, to quaternary prevention and the risks associated with interventionism. Reversing LVP requires a planned process with a multifactorial approach engaging the different actors involved. It considers the barriers to de-implementation of low-value interventions and incorporates tools that facilitate adherence to do not do recommendations. Family doctor has an especially relevant role in LVP prevention, detection and de-implementation, due to their coordinating and integrating nature in the patients healthcare, and because most of the citizens healthcare demands are managed and resolved at the first level of care.(AU)
Subject(s)
Humans , Primary Health Care , Patient Safety , Patient Care , 55790ABSTRACT
This manuscript describes the factors that have led to the spread of low-value practices (LVP) and the main initiatives to reverse them. The paper highlights the strategies that have proven to be most useful over the years, from the alignment of clinical practice with "do not do" recommendations, to quaternary prevention and the risks associated with interventionism. Reversing LVP requires a planned process with a multifactorial approach engaging the different actors involved. It considers the barriers to de-implementation of low-value interventions and incorporates tools that facilitate adherence to "do not do" recommendations. Family doctor has an especially relevant role in LVP prevention, detection and de-implementation, due to their coordinating and integrating nature in the patients' healthcare, and because most of the citizens' healthcare demands are managed and resolved at the first level of care.
ABSTRACT
Patient-centered approach to care and regulatory advances developed in recent years have promoted patient involvement in decision-making about diagnostic tests and treatments. In other aspects, such as participating in their own safety, there is still a lot to do. Until recently, the patient has been considered as a simple health services receiver, not as an active part of the system, much less as a safety barrier against failures and errors that occur in health care. Some patients have been activated thanks to their experiences. However, many others do not. That is why it is necessary to proactively sensitize, inform and train patients to participate in their own safety. It is not about holding them responsible, but about facilitating and promoting their participation by reinforcing their safety during the care process. The health system must be committed, and the patient informed and trained. We provide tools and online resources to apply in primary care.
Subject(s)
Patient Participation , Patient Safety , Humans , Primary Health CareABSTRACT
The health system failed to guarantee the safety of both professionals and citizens who came to the centers at the beginning of the pandemic. The lack of materials and guidelines for the prevention of infections caused in Spain the worst catastrophe in the history of patient safety and occupational health in healthcare. It also happened in other countries but Spain had the highest rates of infected health workers in the world. It was a largely avoidable event. We review what measures have been taken to prevent infections in primary care centers, such as hand hygiene, masks and personal protection material or the maintenance of social distance, among others. We update the recommendations and raise the perspectives in a situation that requires flexibility and adaptability to maintain quality and safe care.
Subject(s)
Hand Hygiene , Pandemics , Delivery of Health Care , Humans , Pandemics/prevention & control , Patient Safety , Primary Health CareABSTRACT
New information technologies have transformed the way care is delivered within health services, permeating almost every aspect of health care. As the complexity of the system increases, it becomes more difficult to work optimally without the assistance of new technologies. Although its implementation represents a breakthrough, either because of the advancement involved in the proper use of any technology in health care, or because of the development of specific applications that improve patient safety, other factors such as incorrect design, implementation and poor maintenance, inadequate training, along with overconfidence and dependency, can make technologies compromise patient safety. This article describes the beneficial effects, and those that are not so, of the introduction in our country of the electronic medical record and the electronic prescription on the healthcare quality and safety.
Subject(s)
Electronic Health Records , Quality of Health Care , Delivery of Health Care , Humans , Prescriptions , Risk AssessmentABSTRACT
The greatest asset of any health system is its professionals, and they must be cared for in order to take care. It is necessary to emphasize that they are key for the resilience of our health systems. This is particularly important in crisis times and especially important for primary health care.During the COVID-19 pandemic, working conditions have been the main common latent factor for patient safety incidents. Primary Care professionals have worked in unsafe working conditions, with lack of means of protection, great uncertainty, lack of scientific knowledge and rapidly changing work protocols for dealing with cases and contacts of COVID-19 infection, with a high care pressure, long working hours, suspension of vacations, and even changes in their jobs. All of this has contributed to their becoming, not only the first victims of the pandemic, but also the second victims of the adverse events that occurred during it.Therefore, in this article we analyze the main risks and damages suffered by professionals in Primary Care and provide keys to contribute to their protection in future similar situations.
Subject(s)
COVID-19 , Patient Safety , Humans , Pandemics , Primary Health Care , SARS-CoV-2ABSTRACT
The COVID-19 pandemic has forced the adoption of drastic changes in primary care, modifying the organization and work dynamics previously established. From one day to the next, professionals had to adapt to the new situation to be able to attend cases and contacts tracing, to avoid contagion and to maintain attention to other health problems. At the beginning of the pandemic, professionals had to establish new practices and care circuits in primary care in an improvised way, due to lack of updated guidelines, without adequate means of protection, evaluating their risks and benefits on the fly. We present the main organizational changes in the first level of care and describe, from the point of view of patient safety and the consequences for patients and professionals of the priority care for COVID-19. Finally, we consider how to incorporate the knowledge acquired during the pandemic, analyzing the advantages and disadvantages of the adopted measures to maintain as much as possible a safe, accessible and quality primary care.
Subject(s)
COVID-19 , Pandemics , Humans , Pandemics/prevention & control , Primary Health Care , Quality of Health Care , SARS-CoV-2ABSTRACT
Mejorar el estado de salud de la población general no es tarea fácil. Hacerlo en el caso de colectivos desfavorecidos es aún más complicado. Presentamos una intervención inédita de educación para la salud desarrollada en el Centro Penitenciario Araba/Álava mediante una estrategia de comunicación altamente eficaz y eficiente. Con acciones informativas sencillas, vehiculizadas por un canal de comunicación existente, se ha conseguido mejorar la adherencia a la medicación de la población reclusa. El Programa «Tu medicación te aporta un plus», desarrollado en un contexto de escasez de recursos y dirigido a un target de población con necesidades complejas, se ha retroalimentado a través de la participación de las personas reclusas y está plenamente implantado, con una trayectoria de más de 3 años. Detallamos su puesta en marcha y los resultados obtenidos, especialmente el impacto en la salud mental y calidad de vida de la población reclusa. Aportamos una estrategia de comunicación y educación en salud de bajo coste, que promueve el empoderamiento individual y colectivo, y es válido y aplicable tanto en el ámbito penitenciario como en otros contextos comunitarios: centros educativos, sociales y sanitarios. El objetivo del estudio es mejorar la salud y la calidad de vida de las personas reclusas a través de un programa de intervención adaptado a sus características y necesidades
Improving the health of the general population is not an easy task. In the case of disadvantaged groups it is even more complicated. We report an unprecedented health education intervention carried out at Araba/Álava Prison Centre by means of a highly effective and efficient communication strategy. With simple explanatory actions, conveyed by an existing communication channel, it was possible to improve the prison population's medication adherence. "Your medication gives you a plus" Programme, carried out against a backdrop of scarcity of resources and targeted at a population with complex needs, has been fed back through the participation of inmates and has been fully implemented over more than three years. We outline implementation of the programme and its results, especially the impact on mental health and quality of life of the prison population. We provide a low-cost health education and communication strategy, which promotes individual and group empowerment, and is valid and applicable both in the prison setting and in other community contexts: educational, social and health centres
Subject(s)
Humans , Male , Female , Prisoners/psychology , Community Participation , Prisons/organization & administration , Health Communication/methods , Health Status , Health Education/methods , Quality of Life , Treatment Adherence and Compliance , Mental Health , Professional-Patient Relations , Surveys and Questionnaires , Medication Systems/organization & administration , Literacy/statistics & numerical dataABSTRACT
En la actualidad la tecnología, su comprensión y aplicabilidad en muchos escenarios de la vida diaria de las personas, así como la producción de transformaciones radicales en cuanto a la irrupción y asentamiento de nuevos modelos socio sanitarios, resulta un tema de profunda complejidad. Por ello, para entender dichas transformaciones y como son percibidas por la ciudadanía, resulta necesario incorporar sus voces, discursos y narrativas sobre eHealth
Nowadays, technology, its understanding and applicability in many daily arenas, as well as the production of radical transformations in terms of the emergence and establishment of new social and health models, is a matter of deep complexity. Therefore, to understand these transformations and how they are perceived by citizens, it is necessary to incorporate their voices, discourse and narratives about eHealth
