Healthcare professionals' opinions, barriers and facilitators towards low-value clinical practices in the hospital setting / Opiniones, barreras y facilitadores de los profesionales de la salud hacia las prácticas clínicas de poco valor en el ámbito hospitalario

OBJECTIVE: To explore healthcare professionals' opinions about low-value practices, identify practices of this kind possibly present in the hospital and barriers and facilitators to reduce them. Low-value practices include those with little or no clinical benefit that may harm patients or lead to a waste of resources. METHOD: Using a mixed methodology, we carried out a survey and two focus groups in a tertiary hospital. In the survey, we assessed doctors' agreement, subjective adherence and perception of usefulness of 134 recommendations to reduce low-value practices from local and international initiatives. We also identified low-value practices possibly present in the hospital. In the focus groups with professionals from surgical and medical fields, using a phenomenological approach, we identified additional low-value practices, barriers and facilitators to reduce them. RESULTS: 169 doctors of 25 specialties participated (response rate: 7%-100%). Overall agreement with recommendations, subjective adherence and usefulness were 83%, 90% and 70%, respectively. Low-value practices form 22 recommendations (16%) were considered as possibly present in the hospital. In the focus groups, the professionals identified seven more. Defensive medicine and scepticism due to contradictory evidence were the main barriers. Facilitators included good leadership and coordination between professionals. CONCLUSIONS: High agreement with recommendations to reduce low-value practices and high perception of usefulness reflect great awareness of low-value care in the hospital. However, there are several barriers to reduce them. Interventions to reduce low-value practices should foster confidence in decision-making processes between professionals and patients and provide trusted evidence

OBJETIVO: Explorar las opiniones de profesionales sanitarios sobre las prácticas de poco valor, identificar aquellas posiblemente presentes en el hospital y las barreras y los facilitadores para reducirlas. Las prácticas de poco valor incluyen aquellas con poco beneficio clínico que pueden perjudicar a los pacientes o desperdiciar recursos. MÉTODO: Usando una metodología mixta se llevaron a cabo una encuesta y varios grupos focales en un hospital terciario. En la encuesta se evaluó el grado de acuerdo, la adherencia subjetiva y la percepción de utilidad de 134 recomendaciones para reducir las prácticas de poco valor de iniciativas locales e internacionales, y se identificaron aquellas que podrían estar realizándose en el hospital. En dos grupos focales con profesionales de campos médicos y quirúrgicos, utilizando un enfoque fenomenológico, se identificaron prácticas de poco valor adicionales, barreras y facilitadores para reducirlas. RESULTADOS: En la encuesta participaron 169 médicos de 25 especialidades (tasa de respuesta: 7-100%). El acuerdo con las recomendaciones, la adherencia subjetiva y la utilidad fueron del 83%, el 90% y el 70%, respectivamente. Se identificaron prácticas de poco valor de 22 recomendaciones (16%) posiblemente presentes en el hospital. En los grupos focales se identificaron siete prácticas de poco valor adicionales; la medicina defensiva y el escepticismo debido a evidencia contradictoria como principales barreras; y un buen liderazgo y la coordinación entre profesionales como facilitadores. CONCLUSIONES: El alto grado de acuerdo con las recomendaciones para reducir las prácticas de poco valor y la alta percepción de utilidad reflejan una gran concienciación sobre este problema en el hospital. Sin embargo, existen numerosas barreras para eliminarlas. Las intervenciones para reducirlas deberían fomentar la confianza en la toma de decisiones entre profesionales y pacientes, y proporcionar una evidencia confiable

Healthcare professionals' opinions, barriers and facilitators towards low-value clinical practices in the hospital setting.

OBJECTIVE: To explore healthcare professionals' opinions about low-value practices, identify practices of this kind possibly present in the hospital and barriers and facilitators to reduce them. Low-value practices include those with little or no clinical benefit that may harm patients or lead to a waste of resources. METHOD: Using a mixed methodology, we carried out a survey and two focus groups in a tertiary hospital. In the survey, we assessed doctors' agreement, subjective adherence and perception of usefulness of 134 recommendations to reduce low-value practices from local and international initiatives. We also identified low-value practices possibly present in the hospital. In the focus groups with professionals from surgical and medical fields, using a phenomenological approach, we identified additional low-value practices, barriers and facilitators to reduce them. RESULTS: 169 doctors of 25 specialties participated (response rate: 7%-100%). Overall agreement with recommendations, subjective adherence and usefulness were 83%, 90% and 70%, respectively. Low-value practices form 22 recommendations (16%) were considered as possibly present in the hospital. In the focus groups, the professionals identified seven more. Defensive medicine and scepticism due to contradictory evidence were the main barriers. Facilitators included good leadership and coordination between professionals. CONCLUSIONS: High agreement with recommendations to reduce low-value practices and high perception of usefulness reflect great awareness of low-value care in the hospital. However, there are several barriers to reduce them. Interventions to reduce low-value practices should foster confidence in decision-making processes between professionals and patients and provide trusted evidence.

[Use of the Smartphone to Promote Healthy Habits among Teen-agers, Spain]. / Utilización del teléfono móvil para el fomento de hábitos saludables en adolescentes. Estudio con grupos focales.

OBJECTIVE: The PEGASO Project aims to design a technological system aimed at European adolescents to promote healthy lifestyles. The objective was to explore teenagers and their parents and teachers perceptions with regards to mobile technology use in promoting a healthier lifestyle, in terms of food and physical activity. METHODS: Qualitative study based on primary data obtained through four focus groups analysis (three teenager groups between 13 and 15 y and 1 parent/teacher group). Verbatim transcriptions have been analysed following content analysis perspective. RESULTS: Four different categories were identified: 1: social and cultural context, 2: adolescents and health, 3: role of technology in teenagers' lives and 4: use of technology to acquire healthier habits. Each category helped to arise various subcategories linked to the relation between teens and health: holistic health concept, health/disease perception directly related with feeling physically fit and social acceptance. With regards to technology, the arisen themes were: feeling connected with others, importance of entertainment/games, omnipresent use of Smartphones and risk of excessive dependence on technology. The difference between teens and adults with regards to health and technology categories were not significant. CONCLUSIONS: Both teens and adults think that for technology to be effective in acquiring healthier habits it has to help teens to improve and maintain their self-esteem, in an entertaining way and using their own communication codes, mainly audio-visual ones, always under the umbrella of a holistic and integrated perception of health.

Utilización del teléfono móvil para el fomento de hábitos saludables en adolescentes. Estudio con grupos focales / Use of the smartphone to promote healthy habits among teen-agers, Spain

Fundamento: El Proyecto PEGASO pretende diseñar un sistema tecnológico dirigido a adolescentes europeos para fomentar hábitos de vida saludables. El objetivo de este estudio fue explorar las percepciones de adolescentes, sus progenitores y profesores el uso de las tecnologías móviles, la salud y la influencia de las tecnologías en la promoción de estilos de vida saludables en cuanto a alimentación y actividad física. Métodos: Estudio cualitativo basado en datos primarios obtenidos mediante análisis de cuatro grupos focales (tres de adolescentes entre 13 y 15 años y uno de adultos, formado por padres y profesores) que se realizaron en abril y mayo de 2015. Las transcripciones se analizaron bajo la perspectiva del análisis del contenido. Resultados: Emergieron cuatro categorías: 1: marco social y cultural, 2: adolescentes y salud, 3: papel de la tecnología en la vida de los adolescentes y 4: uso de la tecnología para adquirir hábitos más saludables. En cada categoría se identificaron subcategorías vinculadas al nexo entre adolescentes y salud: concepto holístico de salud, identificación de salud/enfermedad con edad adulta, relación de la salud con sentirse en buena forma y aceptación social. En relación al papel que juega la tecnología en la vida de los adolescentes, las subcategorías obtenidas fueron: conexión con otros, elemento de entretenimiento/juego, uso omnipresente del móvil y riesgos asociados a la dependencia excesiva de la tecnología. Las diferencias entre adolescentes y adultos fueron mínimas. Conclusiones: Tanto adolescentes como sus progenitores y profesores consideraron que la tecnología puede ser un buen aliado para fomentar hábitos saludables. El uso de la tecnología es eficaz en la medida que les ayude a mejorar y mantener su autoestima, de forma divertida y utilizando sus propios códigos de comunicación (fundamentalmente audiovisuales), partiendo de una percepción holística e integrada de la salud (AU)

Background: The PEGASO Project aims to design a technological system aimed at European adolescents to promote healthy lifestyles. The objective was to explore teenagers and their parents and teachers perceptions with regards to mobile technology use in promoting a healthier lifestyle, in terms of food and physical activity. Methods: Qualitative study based on primary data obtained through four focus groups analysis (three teenager groups between 13 and 15 y and 1 parent/ teacher group). Verbatim transcriptions have been analysed following content analysis perspective. Results: Four different categories were identified: 1: social and cultural context, 2: adolescents and health, 3: role of technology in teenagers’ lives and 4: use of technology to acquire healthier habits. Each category helped to arise various subcategories linked to the relation between teens and health: holistic health concept, health/disease perception directly related with feeling physically fit and social acceptance. With regards to technology, the arisen themes were: feeling connected with others, importance of entertainment/games, omnipresent use of Smartphones and risk of excessive dependence on technology. The difference between teens and adults with regards to health and technology categories were not significant. Conclusions: Both teens and adults think that for technology to be effective in acquiring healthier habits it has to help teens to improve and maintain their self-esteem, in an entertaining way and using their own communication codes, mainly audio-visual ones, always under the umbrella of a holistic and integrated perception of health (AU)