Relevancia del contexto socioeconómico y sanitario en la satisfacción del paciente / Relevance of the socioeconomic and health context in patient satisfaction

Objetivo: Determinar qué factores de los contextos socioeconómico y sanitario influyen sobre la percepción de la satisfacción de la población con los servicios de salud. Método: Los datos provienen de la Encuesta Europea de Salud de 2009. En los 22.188 sujetos encuestados se estudió la relación entre percepción de la satisfacción con los servicios sanitarios recibidos y las variables tanto individuales como contextuales, aplicando un análisis multinivel. Resultados: Los factores de los contextos socioeconómico y sanitario que influyen sobre la satisfacción son las mayores tasas de población sin estudios, en la cual la percepción de excelencia es menos probable (odds ratio [OR]: 0,48-0,82) y la insatisfacción es más prevalente (OR: 1,46-1,63). Asimismo, la proporción de personas insatisfechas es menor cuando el gasto per cápita en servicios sanitarios es muy elevado (>1400 Euros) (OR: 0,49-0,87) y la ratio entre médicos de atención primaria de salud y habitantes es alta (>60) (OR: 0,50-0,85). Además, la prevalencia de insatisfacción describe una tendencia lineal positiva con la tasa de paro (OR: 1,12; p=0,0001) y la magnitud relativa del sector servicios (OR:1,03; p=0,001). Por el contrario, esta tendencia lineal es negativa conforme aumenta el índice de cobertura de la prestación sanitaria (OR: 0,88; p=0,04). Conclusiones: Los factores individuales que determinan la satisfacción del paciente son el sexo, la edad, la salud mental y el país de nacimiento. Además, hay diferencias en la satisfacción del paciente entre las comunidades autónomas de acuerdo con determinantes socioeconómicos, como el producto interior bruto per cápita, las tasas de población sin estudios, las tasas de paro o la ratio número de habitantes/consultorios. Los estudios de satisfacción del usuario, además de ajustarse por variables individuales como el sexo, la edad o el nivel de salud, también deberían tomar en consideración características del entorno socioeconómico del área geográfica de residencia (AU)

Objective: To determine which factors of the socioeconomic and health contexts influence the perception of the satisfaction of the population with the health services. Methods: The data come from the European Health Survey of 2009. In the 22,188 subjects surveyed, the relationship between the perception of satisfaction with the health services received and the individual and contextual variables was studied, applying a multilevel analysis. Results: The factors of the socioeconomic and health contexts that influence satisfaction are: higher rates of low level of studies where the perception of excellence is less likely (odds ratio [OR]: 0.48-0.82) and dissatisfaction is more prevalent (OR: 1.46-1.63). Likewise, the proportion of unsatisfied citizens is lower when per capita expenditure on health services is very high (>1400 Euros) (OR: 0.49-0.87) and the ratio "primary health care physicians/inhabitants" is high (>60) (OR: 0.500.85). In addition, the prevalence of dissatisfaction describes a positive linear trend with the unemployment rate (OR: 1.12; p=0.0001) and the relative magnitude of the services sector (OR: 1.03; p=0.001). By contrast, this linear trend is negative as the Health Care Coverage Ratio increases (OR: 0.88; p=0.04). Conclusions: The individual factors that determine patient satisfaction are: sex, age, mental health and country of birth. In addition, there are differences in patient satisfaction among the autonomous communities according to socio-economic determinants such as GDP per capita, low-level study rates, unemployment rates or number of inhabitants/doctor's ratio. User satisfaction studies as well as being adjusted for individual variables such as sex, age or health level should also take into account characteristics of the socioeconomic environment of the geographic area where they reside (AU)

[Relevance of the socioeconomic and health context in patient satisfaction]. / Relevancia del contexto socioeconómico y sanitario en la satisfacción del paciente.

OBJECTIVE: To determine which factors of the socioeconomic and health contexts influence the perception of the satisfaction of the population with the health services. METHODS: The data come from the European Health Survey of 2009. In the 22,188 subjects surveyed, the relationship between the perception of satisfaction with the health services received and the individual and contextual variables was studied, applying a multilevel analysis. RESULTS: The factors of the socioeconomic and health contexts that influence satisfaction are: higher rates of low level of studies where the perception of excellence is less likely (odds ratio [OR]: 0.48-0.82) and dissatisfaction is more prevalent (OR: 1.46-1.63). Likewise, the proportion of unsatisfied citizens is lower when per capita expenditure on health services is very high (>1400 €) (OR: 0.49-0.87) and the ratio "primary health care physicians/inhabitants" is high (>60) (OR: 0.500.85). In addition, the prevalence of dissatisfaction describes a positive linear trend with the unemployment rate (OR: 1.12; p=0.0001) and the relative magnitude of the services sector (OR: 1.03; p=0.001). By contrast, this linear trend is negative as the Health Care Coverage Ratio increases (OR: 0.88; p=0.04). CONCLUSIONS: The individual factors that determine patient satisfaction are: sex, age, mental health and country of birth. In addition, there are differences in patient satisfaction among the autonomous communities according to socio-economic determinants such as GDP per capita, low-level study rates, unemployment rates or number of inhabitants/doctor's ratio. User satisfaction studies as well as being adjusted for individual variables such as sex, age or health level should also take into account characteristics of the socioeconomic environment of the geographic area where they reside.

Adaptación cultural al español y baremación del Adolescent Peer Relations Instrument (APRI) para la detección de la victimización por acoso escolar: Estudio preliminar de las propiedades psicométricas / Cultural adaptation to Spanish and assessment of an Adolescent Peer Relationships Tool for detecting school bullying: Preliminary study of the psychometric properties

Fundamentos y objetivos: El acoso escolar es un problema de magnitud creciente para el que existen escasos instrumentos breves validados al español. El objetivo de este estudio es adaptar y validar una escala breve de medición del bullying. Material y métodos: Se realizó una adaptación transcultural, mediante la técnica de traducción-retrotraducción, de la escala Adolescent Peer Relations Instrument-Bullying (APRI). La versión adaptada al español del cuestionario APRI se administró a una muestra de 1.428 escolares de entre 12-14años de la comarca del Mar Menor de Murcia (España). Se utilizó el análisis factorial exploratorio, con rotación oblicua, para evaluar la validez de la estructura interna, el alfa de Cronbach para analizar su consistencia y el test de Kruskal-Wallis para comprobar su capacidad de discriminación entre sujetos con distintos grados de bullying según la escala Kidscreen-52 de aceptabilidad social. Resultados: En la versión adaptada del APRI se identificaron 2 factores (victimización física y victimización verbal/social) similares a los de la escala original. El cuestionario tiene una elevada consistencia interna (alfa de Cronbach=0,94) y capacidad de discriminación (p<0,01), con tamaños de efecto considerables entre los distintos grupos de grado de bullying. Conclusiones: La estructura interna de versión en español del APRI es análoga a la original, y sus puntuaciones confirman una elevada fiabilidad y validez de constructo. Serán necesarios estudios posteriores, con rangos de edad más amplios y técnicas de análisis confirmatorio, para ratificar la equivalencia de la versión adaptada con la original (AU)

Background and objectives: School bullying is a growing problem. The current study is aimed at culturally adapting and assessing the psychometric properties of a brief scale to measure bullying. Material and methods: A cross-cultural adaptation of the brief scale —Adolescent Peer Relations Instrument-Bullying (APRI)— was performed using the translation and back-translation technique. The Spanish version of APRI questionnaire was administered to a sample of 1,428 schoolchildren aged 12-14years in the region of Mar Menor in Murcia (Spain). Exploratory factor analysis, with oblique rotation, was used to assess the validity of the internal structure, the Cronbach's alpha to analyse their consistency, and the Kruskal-Wallis test to check their ability to discriminate between subjects with varying degrees of bullying according to Kidscreen-52 scale of social acceptability. Results: Two factors were identified in the adapted version of APRI (physical victimisation and verbal/social victimisation), similar to those in the original scale. The questionnaire has high internal consistency (Cronbach's alpha=0.94) and discrimination capacity (P<01), with significant effect sizes between degrees of bullying. Conclusions: The internal structure of the APRI Spanish version is similar to the original, and its scores confirm high reliability and construct validity. Further studies need to be performed with broader age ranges and confirmatory analysis techniques, to ratify the equivalence of the adapted version with the original version (AU)

[Cultural adaptation to Spanish and assessment of an Adolescent Peer Relationships Tool for detecting school bullying: Preliminary study of the psychometric properties]. / Adaptación cultural al español y baremación del Adolescent Peer Relations Instrument (APRI) para la detección de la victimización por acoso escolar: Estudio preliminar de las propiedades psicométricas.

BACKGROUND AND OBJECTIVES: School bullying is a growing problem. The current study is aimed at culturally adapting and assessing the psychometric properties of a brief scale to measure bullying. MATERIAL AND METHODS: A cross-cultural adaptation of the brief scale -Adolescent Peer Relations Instrument-Bullying (APRI)- was performed using the translation and back-translation technique. The Spanish version of APRI questionnaire was administered to a sample of 1,428 schoolchildren aged 12-14years in the region of Mar Menor in Murcia (Spain). Exploratory factor analysis, with oblique rotation, was used to assess the validity of the internal structure, the Cronbach's alpha to analyse their consistency, and the Kruskal-Wallis test to check their ability to discriminate between subjects with varying degrees of bullying according to Kidscreen-52 scale of social acceptability RESULTS: Two factors were identified in the adapted version of APRI (physical victimisation and verbal/social victimisation), similar to those in the original scale. The questionnaire has high internal consistency (Cronbach's alpha=0.94) and discrimination capacity (P<01), with significant effect sizes between degrees of bullying. CONCLUSIONS: The internal structure of the APRI Spanish version is similar to the original, and its scores confirm high reliability and construct validity. Further studies need to be performed with broader age ranges and confirmatory analysis techniques, to ratify the equivalence of the adapted version with the original version.

[Economic recession (2006-2012) and changes in the health status of the Spanish population]. / Recesión económica (2006-2012) y cambios en el estado de salud de la población española.

OBJECTIVE: To analyze the relationship of mental health problems in Spanish population with the economic recession (2006-2012), and find out how it affects the self-perception of health status. MATERIALS AND METHODS: Cross-sectional study using the National Health Survey of Spain, 2006/2007 and 2011/2012. Using logistic regression models, three indicators linked to mental health and perceived health were analyzed. RESULTS: In 2011/2012 the consumption of anti-anxiety medications and sleeping pills increased in men and women. Mental dysfunction increased during the economic crisis in the male population. The perception of optimal health did not suffer significantly in either men or women. CONCLUSIONS: The economic recession showed a changing relation to the mental and general health of the population, coinciding with an increase in mental health disorders, such as anxiety.

Recesión económica (2006-2012) y cambios en el estado de salud de la población española / Economic recession (2006-2012) and changes in the health status of the Spanish population

Objetivo. Analizar la relación de los problemas de salud mental en población española con la recesión económica (2006-2012) y establecer en qué sentido afecta a la autopercepción del estado de salud. Material y métodos. Estudio transversal comparativo utilizando la Encuesta Nacional de Salud de España, 2006/2007 y 2011/2012. Mediante modelos de regresión logística, se analizaron tres indicadores relacionados con la salud mental y la salud percibida. Resultados. En 2011/2012 aumentó el consumo de medicamentos ansiolíticos y somníferos en hombres y mujeres. La disfunción mental aumentó durante el periodo de crisis económica en la población de varones. La percepción de una salud óptima no sufrió cambios significativos en hombres ni en mujeres. Conclusiones. La recesión económica mostró una relación variable con la salud mental y general de la población, y coincidió con un aumento de los trastornos de salud mental, como la ansiedad.

Objective. To analyze the relationship of mental health problems in Spanish population with the economic recession (2006-2012), and find out how it affects the self-perception of health status. Materials and methods. Cross-sectional study using the National Health Survey of Spain, 2006/2007 and 2011/2012. Using logistic regression models, three indicators linked to mental health and perceived health were analyzed. Results. In 2011/2012 the consumption of anti-anxiety medications and sleeping pills increased in men and women. Mental dysfunction increased during the economic crisis in the male population. The perception of optimal health did not suffer significantly in either men or women. Conclusions. The economic recession showed a changing relation to the mental and general health of the population, coinciding with an increase in mental health disorders, such as anxiety.

How do care-provider and home exercise program characteristics affect patient adherence in chronic neck and back pain: a qualitative study.

BACKGROUND: The aim of this study is to explore perceptions of people with chronic neck or low back pain about how characteristics of home exercise programs and care-provider style during clinical encounters may affect adherence to exercises. METHODS: This is a qualitative study consisting of seven focus groups, with a total of 34 participants presenting chronic neck or low back pain. The subjects were included if they were receiving physiotherapy treatment and were prescribed home-based exercises. RESULTS: Two themes emerged: home-based exercise programme conditions and care provider's style. In the first theme, the participants described their positive and negative experiences regarding time consumption, complexity and effects of prescribed exercises. In the second theme, participants perceived more bonding to prescribed exercises when their care provider presented knowledge about the disease, promoted feedback and motivation during exercise instruction, gave them reminders to exercise, or monitored their results and adherence to exercises. CONCLUSIONS: Our experiential findings indicate that patient's adherence to home-based exercise is more likely to happen when care providers' style and the content of exercise programme are positively experienced. These findings provide additional information to health care providers, by showing which issues should be considered when delivering health care to patients presenting chronic neck or back pain.

Predictive factors of adherence to frequency and duration components in home exercise programs for neck and low back pain: an observational study.

BACKGROUND: Evidence suggests that to facilitate physical activity sedentary people may adhere to one component of exercise prescriptions (intensity, duration or frequency) without adhering to other components. Some experts have provided evidence for determinants of adherence to different components among healthy people. However, our understanding remains scarce in this area for patients with neck or low back pain. The aims of this study are to determine whether patients with neck or low back pain have different rates of adherence to exercise components of frequency per week and duration per session when prescribed with a home exercise program, and to identify if adherence to both exercise components have distinct predictive factors. METHODS: A cohort of one hundred eighty-four patients with chronic neck or low back pain who attended physiotherapy in eight primary care centers were studied prospectively one month after intervention. The study had three measurement periods: at baseline (measuring characteristics of patients and pain), at the end of physiotherapy intervention (measuring characteristics of the home exercise program) and a month later (measuring professional behaviors during clinical encounters, environmental factors and self-efficacy, and adherence behavior). RESULTS: Adherence to duration per session (70.9% +/- 7.1) was more probable than adherence to frequency per week (60.7% +/- 7.0). Self-efficacy was a relevant factor for both exercise components (p < 0.05). The total number of exercises prescribed was predictive of frequency adherence (p < 0.05). Professional behaviors have a distinct influence on exercise components. Frequency adherence is more probable if patients received clarification of their doubts (adjusted OR: 4.1; p < 0.05), and duration adherence is more probable if they are supervised during the learning of exercises (adjusted OR: 3.3; p < 0.05). CONCLUSION: We have shown in a clinic-based study that adherence to exercise prescription frequency and duration components have distinct levels and predictive factors. We recommend additional study, and advise that differential attention be given in clinical practice to each exercise component for improving adherence.

Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study.

UNLABELLED: Escolar-Reina P, Medina-Mirapeix F, Gascón-Cánovas JJ, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Self-management of chronic neck and low back pain and relevance of information provided during clinical encounters: an observational study. OBJECTIVE: To assess the relative influence of information provided during physical therapy on a patient's adherence to self-management strategies in relation to other predictors of adherence (patient and pain characteristics, use of self-management strategies before intervention). DESIGN: A longitudinal observational study of the relationship between the information provided during physical therapy and adherence to self-management strategies. SETTING: Data came from a clinical-based population in 8 primary health care centers. PARTICIPANTS: Patients (N=184) with chronic neck or low back pain (77% under the age of 59y) were surveyed at the beginning and 1 month after completion of physical therapy. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Specific and overall adherence to 2 types of strategies: (1) nonpharmacologic pain management strategies, and (2) neck/back care in activities of daily life. RESULTS: Adherence to strategies of nonpharmacologic self-management of pain was more probable when patients received information explaining the effectiveness of the self-management strategies (adjusted odds ratio [AOR]=10.1; P<.05) and information about their illness (AOR=3.4; P<.05) during clinical encounters. Information provided by the physical therapist did not have any influence on the adherence to neck/back care in activity of daily life (P>.05). CONCLUSIONS: Information provided during clinical encounters is associated with adherence to different kinds of self-management strategies. While further study is required, it is suggested that more attention be given to clinical practice strategies for improving adherence to self-management of chronic pain.

Personal characteristics influencing patients' adherence to home exercise during chronic pain: a qualitative study.

OBJECTIVE: To identify the beliefs and perceptions of patients with chronic neck and low back pain that influence adherence to home exercise during exacerbation and/or remission of pain. DESIGN: Qualitative study using a focus group technique. SUBJECTS: Thirty-four patients (23 women, age range 26-70 years) with chronic neck or low back pain who had participated in a home exercise programme. METHODS: Seven focus groups were formed. Participants were sampled purposefully from all patients with chronic neck or low back pain who attended for physiotherapy at 4 primary healthcare centres. Patients were interviewed about how they perceived their adherence to a home exercise programme during chronic pain. Data were analysed using a phenomenographic method. RESULTS: Several themes about patients' beliefs and perceptions were identified as factors related to adherence. These factors change when pain or disabilities appear, decrease or disappear for an extended period. Beliefs about illness and treatment are more likely when pain is present and when pain disappears for an extended period. However, patients consider perceptions about barriers, social support and physical environment when pain decreases. CONCLUSION: These findings may represent an important potential for improving the adherence of patients with chronic pain to home exercise programmes.