Evaluación de la interconsulta virtual por los profesionales de atención primaria: dimensiones de la calidad y oportunidades de mejora / Evaluation of virtual consultation by primary care professionals: quality dimensions and opportunities for improvement

Objetivo: Conocer la opinión de los médicos de Atención Primaria de Aragón, sobre la interconsulta virtual y su repercusión sobre las distintas dimensiones de la calidad asistencial. Diseño: Estudio transversal, mediante encuesta, de elaboración propia. Se habilitó la recogida de respuestas entre el 14 de abril y el 31 de mayo de 2023. Emplazamiento: Médicos con labor asistencial en atención primaria de Aragón. Participantes: Médicos especialistas e internos residentes en Medicina Familiar y Comunitaria. Mediciones: Características del puesto de trabajo, variables Likert valorando la interconsulta virtual como herramienta y su repercusión en dimensiones de la calidad asistencial, detección de ventajas e inconvenientes y preguntas de respuesta libre planteando líneas de mejora. Resultados: Total de 202 respuestas. El 90,1% de los participantes consideran útil la interconsulta virtual, el 67,8% cree que mejora la calidad de la derivación. Las principales ventajas identificadas son su contribución al enriquecimiento profesional y la visión integral del paciente, y la mejora de la comunicación entre primer y segundo nivel asistencial; el principal inconveniente el papel de Atención Primaria como intermediario en la información al paciente. Las dimensiones de la calidad mejor valoradas fueron eficiencia y equidad, siendo la seguridad la menos valorada. Conclusiones: La interconsulta virtual puede favorecer la comunicación y coordinación asistencial y potenciar la capacidad de resolución de atención primaria. Su éxito radica en formación y tiempo para su uso, consensuar protocolos y homogeneizar la distribución de recursos; no obstante, existen todavía oportunidades de mejora, principalmente en el ámbito de la seguridad.(AU)

Objective: To know the opinion of Aragon primary care physicians about virtual consultation and its impact on the different healthcare quality domains. Design: Cross-sectional study through a self-developed survey. Data collection was enabled from April 14th to May 31st, 2023. Site: Physicians with healthcare duties in primary care in Aragon. Participants: Specialist physicians and resident interns in Family and Community Medicine. Meansurements: Job characteristics, Likert variables assessing virtual consultation as a tool and its impact on healthcare quality domains, identification of advantages and disadvantages, and free answer questions proposing improvement strategies. Results: 202 responses. 90.1% of participants consider virtual consultation useful, while 67.8% believe that it improves the quality of referrals. The main advantages identified are its contribution to professional enrichment and the integral visión of the patient, and the improvement of communication between the primary and secondary levels of care; the main drawback is the role of Primary Care as an intermediary in patient information. Efficiency and equity were the most highly rated quality domains, with safety being the least valued. Conclusions: Virtual consultation can promote communication and coordination of care, and enhance the primary care resolution capacity. Its success relies on training and time for its use, as well as on reaching a consensus on protocols and to homogenize resource distribution. Nevertheless, there are still opportunities for improvement, mainly in the realm of safety.(AU)

Virtual Consultation in Dermatology: Access Inequalities According to Socioeconomic Characteristics and the Place of Residence.

Virtual consultation has been implemented as a tool to improve the cooperation and coordination between primary care and other specialties. However, in its use in dermatology, inequities have been described. The aim of this study was to identify individual and geographical factors affecting the likelihood of accessing this resource. We conducted a cross-sectional study. The study population was individuals living in Aragón, a region in the north-east of Spain, who were users of the Aragon Health Service in 2021. To explore the differences in individual and area characteristics, between patients with virtual and non-virtual dermatology consultation, we performed bivariate analyses. To analyse the use of virtual consultation in dermatology, a multilevel methodology stratified by sex was developed. We analysed 39,174 dermatology visits, with 16,910 being virtual (43.17%). The rates of virtual consultation were higher in urban areas and the most affluent areas, for older persons, chronic complex patients and people with more advantageous socioeconomic positions. The best multilevel model conducted showed inequalities by socioeconomic position and area of residence. There are individual and area inequalities in the use of teledermatology. As this tool should improve equity of access, teledermatology interventions must address and adapt to the needs of the local patient population.

COVID-19 Vaccination Coverage and Associated Factors in Patients with Multiple Sclerosis.

Our objective was to know the COVID-19 vaccination coverage in multiple sclerosis (MS) patients and its factors associated. A retrospective cohort study was carried out. Patients seen at the MS unit of the University Clinical Hospital of Zaragoza between 2017 and 2021 were included. Variables were obtained by reviewing the specialized and primary care records. Associations between receiving COVID-19 full primo-vaccination, as well as one booster dose since autumn 2022, and the other variables were analyzed using bivariate analysis and multiple logistic regression models. Of the 359 included patients, 90.3% received the COVID-19 full primo-vaccination. Having been born in Spain (aOR = 3.40) and having received the 2020-2021 influenza vaccine (aOR = 6.77) were associated with receiving the COVID-19 full primo-vaccination. Vaccination with a COVID-19 booster dose was detected in 141 patients (39.3%). Sex (man) (aOR = 2.36), age (60 years or over) (aOR = 6.82), type of MS (Primary Progressive/Secondary Progressive) (aOR = 3.94), and having received the 2022-2023 influenza vaccine (aOR = 27.54) were associated with receiving such a booster dose. The COVID-19 booster dose was administered at the same time as the 2022-2023 influenza vaccine in 57.8% (67/116) of the patients vaccinated with both vaccines. The COVID-19 full primo-vaccination coverage is higher than in other countries. However, the decrease in vaccination coverage with the booster dose makes it necessary to develop strategies to improve it that are not limited to administering the flu vaccine together with the COVID-19 booster dose. Such strategies should be in focus, especially for women under 60 years of age.

[Evaluation of virtual consultation by primary care professionals: quality dimensions and opportunities for improvement]. / Evaluación de la interconsulta virtual por los profesionales de atención primaria: dimensiones de la calidad y oportunidades de mejora.

OBJECTIVE: To know the opinion of Aragon primary care physicians about virtual consultation and its impact on the different healthcare quality domains. DESIGN: Cross-sectional study through a self-developed survey. Data collection was enabled from April 14th to May 31st, 2023. SITE: Physicians with healthcare duties in primary care in Aragon. PARTICIPANTS: Specialist physicians and resident interns in Family and Community Medicine. MEANSUREMENTS: Job characteristics, Likert variables assessing virtual consultation as a tool and its impact on healthcare quality domains, identification of advantages and disadvantages, and free answer questions proposing improvement strategies. RESULTS: 202 responses. 90.1% of participants consider virtual consultation useful, while 67.8% believe that it improves the quality of referrals. The main advantages identified are its contribution to professional enrichment and the integral visión of the patient, and the improvement of communication between the primary and secondary levels of care; the main drawback is the role of Primary Care as an intermediary in patient information. Efficiency and equity were the most highly rated quality domains, with safety being the least valued. CONCLUSIONS: Virtual consultation can promote communication and coordination of care, and enhance the primary care resolution capacity. Its success relies on training and time for its use, as well as on reaching a consensus on protocols and to homogenize resource distribution. Nevertheless, there are still opportunities for improvement, mainly in the realm of safety.

Influenza Vaccination among Multiple Sclerosis Patients during the COVID-19 Pandemic.

In the context of the COVID-19 pandemic, the co-circulation of influenza and SARS-CoV-2 viruses may have severe complications for vulnerable populations. For this reason, the World Health Organization pointed to the 2020-2021 anti-influenza campaign as being of special relevance. Our aim was to assess the 2020-2021 influenza vaccination coverage, and its associated factors, among patients in a Spanish multiple sclerosis (MS) unit. A cross-sectional study was conducted. People attending the MS unit of the Clinical Hospital of Zaragoza during 2020 were included. Variables were obtained by reviewing records. Associations with 2020-2021 influenza vaccination were analyzed using bivariate analysis and a multiple logistic regression model. A total of 302 patients were studied; 62.6% were women, whose mean age (standard deviation) was 47.3 (11.5) years. The 2020-2021 influenza vaccination coverage was 55.3% (59.8% in women and 47.8% in men). A total of 89.7% had at least one other indication for vaccination (e.g., immunosuppressive treatment in 225 patients). The variables associated with getting vaccinated were being female (adjusted odds ratio (95% confidence interval) (aOR (95%CI) = 2.12 (1.12-3.99)), having received the 2019-2020 influenza vaccine (aOR (95%CI) = 31.82 (14.71-68.86)) and being born in Spain (aOR (95%CI) = 12.91 (1.07-156.28)). Coverage is moderate compared to other countries. It is necessary to develop strategies to improve it, especially in men and those born outside Spain.

Influenza Vaccination Coverage among Multiple Sclerosis Patients: Evolution over Time and Associated Factors.

Our objective was to determine the influenza vaccination rate in a Spanish cohort of multiple sclerosis (MS) patients. A retrospective cohort study was carried out. Patients who attended the MS unit of the Lozano Blesa Hospital of Zaragoza between January 2015 and 2020 were included. The variables were obtained by reviewing the specialized and primary care records. Associations between receiving the vaccine in each flu season and the other variables were analyzed using bivariate analysis and multiple logistic regression models. A total of 260 patients were studied, with a median age of 31 years at the time of diagnosis. A total of 62.3% (162/260) were women. Vaccination coverage ranged from 20.4% in the 2015−2016 and 2016−2017 seasons to 41.5% in the 2019−2020 season (p = 0.000). Having been vaccinated in the previous season (ORa: 16.47−390.22; p = 0.000) and receiving a vaccination recommendation from the hospital vaccination unit (ORa: 2.44−3.96; p < 0.009) were associated with being vaccinated. The coverage is in an intermediate position compared to other countries. It is necessary to improve the referral system of these patients to the hospital vaccination unit because the information obtained by this service contributed to higher vaccination rates.

[Patient participation in its own safety]. / La participación del paciente en su seguridad.

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.

[Prevention of infections related to health care in primary care. Lessons from the pandemic]. / Prevención de infecciones relacionadas con la asistencia sanitaria en atención primaria. Lecciones de la pandemia.

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.

[Influenza vaccination in medical and nursing students in the Covid-19 era: how to improve it?] / Vacunación antigripal en estudiantes de medicina y enfermería en la era Covid-19: ¿Cómo mejorarla?

OBJECTIVE: Influenza vaccination coverages among health care students are low. The aim of this study was to find out which measures, according to medical and nursing students, could contribute to improve these vaccination rates. METHODS: A cross-sectional study that included medical and nursing students of the University of Zaragoza who were doing internships in health centers during the 2020-2021 school year. The information was obtained in December 2020 by a self-administered online questionnaire, in which they were asked to describe the measures that, in their opinion, are necessary to increase their influenza vaccination coverage. A qualitative analysis of the content of the answers was carried out, extracting themes, sub-themes and selecting the most representative verbatims. RESULTS: The questionnaire was answered by 83 students (response rate: 5.9%); 64 (77.1%) were women, and 74.7% of them were studying medicine. The main measures proposed were improving the accessibility of the vaccine, improving the training on influenza vaccine, promoting vaccination by the teaching staff, and increasing the diffusion of information about the vaccination campaign. CONCLUSIONS: This study has found measures to be applied specifically to medical and nursing students to potentially improve their influenza vaccination coverage. For its implementation, collaboration between universities and health services is necessary.

OBJETIVO: Las coberturas de vacunación antigripal en estudiantes sanitarios son bajas. El objetivo de este estudio fue conocer las medidas que, según los estudiantes de medicina y enfermería, podrían contribuir a mejorar dichas tasas de vacunación. METODOS: Estudio transversal que incluyó a los alumnos de medicina y enfermería de la Universidad de Zaragoza que realizaban prácticas en centros sanitarios durante el curso académico 2020-2021. La información se obtuvo en diciembre 2020 utilizando un cuestionario on line auto-cumplimentado, en el que se solicitaba que describieran las medidas que, en su opinión, son necesarias para incrementar sus coberturas de vacunación antigripal. Se realizó un análisis cualitativo del contenido de las respuestas, extrayendo temas, subtemas y seleccionando los verbatims más representativos. RESULTADOS: 83 estudiantes respondieron el cuestionario (tasa de respuesta: 5,9%); 64 (77,1%) eran mujeres, cursando medicina el 74,7%. Las principales medidas propuestas estaban relacionadas con mejorar la accesibilidad de la vacuna, mejorar la formación sobre la vacuna antigripal, promover la vacunación por parte del personal docente y aumentar la difusión de la información sobre la campaña de vacunación. CONCLUSIONES: Este estudio ha identificado medidas a aplicar específicamente en los estudiantes de medicina y enfermería con las que potencialmente mejorar sus coberturas de vacunación antigripal. Para su implementación, es necesaria la colaboración entre las universidades y los servicios de salud.

An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study.

BACKGROUND: The COVID-19 pandemic has affected the response capacity of the health care workforce, and health care professionals have been experiencing acute stress reactions since the beginning of the pandemic. In Spain, the first wave was particularly severe among the population and health care professionals, many of whom were infected. These professionals required initial psychological supports that were gradual and in line with their conditions. OBJECTIVE: In the early days of the pandemic in Spain (March 2020), this study aimed to design and validate a scale to measure acute stress experienced by the health care workforce during the care of patients with COVID-19: the Self-applied Acute Stress Scale (EASE). METHODS: Item development, scale development, and scale evaluation were considered. Qualitative research was conducted to produce the initial pool of items, assure their legibility, and assess the validity of the content. Internal consistency was calculated using Cronbach α and McDonald ω. Confirmatory factor analysis and the Mann-Whitney-Wilcoxon test were used to assess construct validity. Linear regression was applied to assess criterion validity. Back-translation methodology was used to translate the scale into Portuguese and English. RESULTS: A total of 228 health professionals from the Spanish public health system responded to the 10 items of the EASE scale. Internal consistency was .87 (McDonald ω). Goodness-of-fit indices confirmed a two-factor structure, explaining 55% of the variance. As expected, the highest level of stress was found among professionals working in health services where a higher number of deaths from COVID-19 occurred (P<.05). CONCLUSIONS: The EASE scale was shown to have adequate metric properties regarding consistency and construct validity. The EASE scale could be used to determine the levels of acute stress among the health care workforce in order to give them proportional support according to their needs during emergency conditions, such as the COVID-19 pandemic.

Effectiveness of an intervention to improve the vaccination coverage against Streptococcus pneumoniae in patients with chronic kidney disease.

Pneumococcal vaccination is recommended for chronic kidney disease (CKD) patients. We evaluated the impact of implementing a hospital vaccine consultation on their vaccination coverages. A sample was drawn from consecutive cases referred to our clinic between November 2014 and June 2018. 101 patients were analyzed: 4 had received the pneumococcal conjugated vaccine 13-valent at the time of the first appointment, whereas 93 had received it after being seen (RR (95%-CI) = 23.3 (8.88-60.85)). Moreover, 5 had received the pneumococcal polysaccharide vaccine 23-valent at the time of the first appointment, whereas 90 had received it after being seen (RR (95%-CI) = 18.0 (7.64-42.42)). Implementing a hospital-based vaccine consultation represents an effective intervention to improve pneumococcal vaccination coverage in these patients.

Higher incidence of adverse events in isolated patients compared with non-isolated patients: a cohort study.

OBJECTIVE: To determine whether isolated patients admitted to hospital have a higher incidence of adverse events (AEs), to identify their nature, impact and preventability. DESIGN: Prospective cohort study with isolated and non-isolated patients. SETTING: One public university hospital in the Valencian Community (southeast Spain). PARTICIPANTS: We consecutively collected 400 patients, 200 isolated and 200 non-isolated, age ≥18 years old, to match according to date of entry, admission department, sex, age (±5 years) and disease severity from April 2017 to October 2018. EXCLUSION CRITERIA: patients age <18 years old and/or reverse isolation patients. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome as the AE, defined according to the National Study of Adverse Effects linked to Hospitalisation (Estudio Nacional Sobre los Efectos Adversos) criteria. Cumulative incidence rates and AE incidence density rates were calculated. RESULTS: The incidence of isolated patients with AEs 16.5% (95% CI 11.4% to 21.6%) compared with 9.5% (95% CI 5.4% to 13.6%) in non-isolated (p<0.03). The incidence density of patients with AEs among isolated patients was 11.8 per 1000 days/patient (95% CI 7.8 to 15.9) compared with 4.3 per 1000 days/patient (95% CI 2.4 to 6.3) among non-isolated patients (p<0.001). The incidence of AEs among isolated patients was 18.5% compared with 11% for non-isolated patients (p<0.09). Among the 37 AEs detected in 33 isolated patients, and the 22 AEs detected in 19 non-isolated patients, most corresponded to healthcare-associated infections (HAIs) for both isolated and non-isolated patients (48.6% vs 45.4%). There were significant differences with respect to the preventability of AEs, (67.6% among isolated patients compared with 52.6% among non-isolated patients). CONCLUSIONS: AEs were significantly higher in isolated patients compared with non-isolated patients, more than half being preventable and with HAIs as the primary cause. It is essential to improve training and the safety culture of healthcare professionals relating to the care provided to this type of patient.

Measures to Improve Influenza Vaccination Coverage in Spanish Medical Students.

Objective: To find out what measures medical students believe could help improve their influenza vaccination coverage. Method: On 5 November, 2019, the Dean of the Zaragoza Medical School sent an e-mail to the students asking them to fill out a questionnaire through Google Forms, in which they were asked to describe, in an open field, the measures that they believed could contribute to improving their flu vaccination coverage. The content of the responses was analyzed in a classic way, extracting descriptors and selecting the most representative verbatim accounts. Results: The main measures proposed were to improve the training on influenza and its vaccine, to improve the accessibility of the vaccine in time and space, to provide incentives to get vaccinated, to create visible and positive attitudes towards the vaccine, and to increase the diffusion of information about the vaccination campaign. Conclusion: This qualitative study has found potential measures to be applied specifically to medical students to improve their vaccination coverage in our country.

Risk Analysis for Patient Safety in Surgical Departments: Cross-Sectional Design Usefulness.

(1) Background: Identifying and measuring adverse events (AE) is a priority for patient safety, which allows us to define and prioritise areas for improvement and evaluate and develop solutions to improve health care quality. The aim of this work was to determine the prevalence of AEs in surgical and medical-surgical departments and to know the health impact of these AEs. (2) Methods: A cross-sectional study determining the prevalence of AEs in surgical and medical-surgical departments was conducted and a comparison was made among both clinical areas. A total of 5228 patients were admitted in 58 hospitals in Argentina, Colombia, Costa Rica, Mexico, and Peru, within the Latin American Study of Adverse Events (IBEAS), led by the Spanish Ministry of Health, the Pan American Health Organization, and the WHO Patient Safety programme. (3) Results: The global prevalence of AEs was 10.7%. However, the prevalence of AEs in surgical departments was 11.9%, while in medical-surgical departments it was 8.9%. The causes of these AEs were associated with surgical procedures (38.6%) and nosocomial infections (35.4%). About 60.6% of the AEs extended hospital stays by 30.7 days on average and 25.8% led to readmission with an average hospitalisation of 15 days. About 22.4% resulted in death, disability, or surgical reintervention. (4) Conclusions: Surgical departments were associated with a higher risk of experiencing AEs.

Recomendaciones para la recuperación de las segundas víctimas del SARS-CoV-2 / No disponible

OBJETIVO: Enunciar un conjunto de recomendaciones para incrementar la resiliencia de las organizaciones y los profesionales sanitarios frente al impacto de la crisis ocasionada por la pandemia de SARS-CoV-2. MÉTODO: Estudio cualitativo para la búsqueda de consenso con participación de 30 profesionales de diferentes disciplinas (medicina preventiva, calidad asistencial, seguridad del paciente, atención primaria, psiquiatría y psicología). Principales resultados: Tras la identificación de las principales fuentes de estrés y la definición de los objetivos de la fase de recuperación, se consensuaron un total de 17 recomendaciones, 13 de ellas con foco organizacional y las cuatro restantes, centradas en profesionales. CONCLUSIONES: La recuperación del sistema sanitario tras la pandemia por la COVID19 pasa por restaurar la moral y el bienestar de sus profesionales, de lo contrario la calidad asistencial y la seguridad de los pacientes se verán comprometidas. Estas recomendaciones pretenden ser un punto de partida en esta dirección

OBJECTIVE: To provide a set of recommendations to increase the resilience of health care organizations and professionals to the impact of the SARS-CoV-2 pandemic crisis. METHOD: Consensual qualitative study with the participation of 30 professionals from different disciplines (preventive medicine, quality of care, patient safety, primary care, psychiatry and psychology). MAIN RESULTS: After the identification of the main sources of stress and the definition of the objectives of the recovery phase, a total of 17 recommendations were agreed upon, 13 of them with an organizational focus and the remaining four focused on professionals. CONCLUSIONS: The recovery of the health system after the COVID19 pandemic requires restoring the morale and well-being of its professionals, otherwise the quality of care and patient safety will be compromised. These recommendations are intended as a starting point in this direction

[Influenza vaccination coverages and related factors among splenectomy patients from a health sector in Zaragoza (Spain)]. / Cobertura de vacunación antigripal y factores asociados en pacientes esplenectomizados de un sector de salud de Zaragoza (España).

OBJECTIVE: Influenza vaccination coverage in risk groups has been put forward as a healthcare quality indicator. Our objective was to determine the vaccination rate in splenectomized patients. METHODS: We carried out a cross-sectional study that included splenectomized patients in the Zaragoza III Sector from January 2012 to December 2016. The patients were identified through the database of the Clinical Documentation and File Management Services of the Sector Hospital under code 41.5 of the ICD-9. The variables (sociodemographic and surgical variables, and having received information and advice regarding vaccination when they were admitted to the Immunization Unit) were obtained after a review of the patients' records in the Specialized and Primary Care Services. The association with being vaccinated during the campaign corresponding to the surgery date was studied with bivariate analysis and multiple logistic regression model. RESULTS: 81 patients were analyzed; 60.5% were men, with an average age of 56.3 years. Neoplasms and hematological diseases were the most common motives for surgery (64.2%). The vaccination rate was 58%. Having been advised to vaccinate (OR=6.53; 95%CI=1.88-22.69) and having been vaccinated in the previous season (OR=4.79; 95%CI= 1.48-15.57) were associated with vaccination. CONCLUSIONS: The coverage rate ranks in an intermediate position when compared with other countries. It is necessary to improve the referral system of these patients to the Immunization Unit because the information obtained by this service leads to better results.

OBJETIVO: La cobertura vacunal antigripal en grupos de riesgo ha sido postulada como un indicador de la calidad asistencial. El objetivo de este estudio fue conocer dicha tasa de vacunación en esplenectomizados. METODOS: Se realizó un estudio transversal que incluyó a los esplenectomizados del sector Zaragoza III entre enero de 2012 y diciembre de 2016. La identificación de los pacientes se realizó a través de la base de datos del Servicio de Archivos y Documentación Clínica del hospital del sector, utilizando el código 41.5 de la Clasificación Internacional de Enfermedades (9ª edición). Las variables (sociodemográficas, quirúrgicas y el haber recibido información y consejo para vacunarse al ser atendido en la consulta hospitalaria de vacunas) fueron obtenidas revisando las historias de atención especializada y primaria. Se analizó la asociación con la vacunación en la campaña correspondiente a la fecha de la cirugía mediante un análisis bivariado y un modelo de regresión logística múltiple. RESULTADOS: Fueron estudiados 81 pacientes. El 60,5% eran hombres, con una edad media de 56,3 años. Las neoplasias y las enfermedades hematológicas fueron los motivos más frecuentes de cirugía (64,2%). La tasa de vacunación fue del 58%. Recibir la recomendación de vacunación (OR=6,53; IC95%=1,88-22,69) y haber sido vacunado en la temporada anterior (OR=4,79; IC95%=1,48-15,57) se asociaron con la acción de vacunarse. CONCLUSIONES: La cobertura se encuentra en una posición intermedia comparada con otros países. Se ha de mejorar la sistemática de derivación de estos pacientes a la consulta hospitalaria de vacunas, dado que la información facilitada en ella contribuye a obtener mejores resultados.

[Impact of an intervention to improve the vaccination coverage against streptococcus pneumoniae in hiv patients]. / Evaluación del impacto de una intervención para mejorar las coberturas de vacunación frente a neumococo en pacientes con VIH.

OBJECTIVE: People affected by the human immunodeficiency virus (HIV) have a higher risk of invasive pneumococcal disease. Therefore, vaccination against streptococcus pneumoniae is recommended for that group. The objective of this study was to analyze the impact of implementing a hospital appointment to assess vaccination status as part of the vaccination schedule of HIV patients. METHODS: We carried out a quasi-experimental uncontrolled before and after study with a sampling of consecutive cases of HIV patients referred to our department from November 1, 2014 to June 30, 2018. The study compared the vaccination coverage on the date of the appointment for an assessment of their vaccination status in our department and after the appointment. The analysis used the chi-squared test and the values on the date of the first appointment were taken as a reference. RESULTS: 209 patients were analyzed, and a statistically significant improvement was observed regarding their vaccination coverage: 2.9% of the patients had been vaccinated on the date in which they made an appointment for assessment by our department, and 88.0% were vaccinated after they left (OR [95%CI]: 30.7 [13.92-67.58]) with the 13-valent pneumococcal conjugate vaccine; and 16.3% had been vaccinated on the date they made the first appointment vs. 83.7% after they came to the appointment (OR [95%CI]: 5.2 [3.76-7.04]) with the 23-valent polysaccharide pneumococcal vaccine. CONCLUSIONS: Implementing a hospital appointment for vaccination is an effective intervention to improve vaccination coverage against streptococcus pneumoniae in HIV patients.

OBJETIVO: Las personas infectadas por el virus de la inmunodeficiencia humana (VIH) presentan riesgo elevado de sufrir la enfermedad neumocócica invasiva, motivo por el que se recomienda su vacunación frente al neumococo. El objetivo de este trabajo fue evaluar el impacto de implementar una consulta hospitalaria de vacunas en las coberturas de vacunación de estos pacientes. METODOS: Se elaboró un estudio cuasiexperimental sin grupo control, de tipo antes/después, en el que se realizó un muestreo de casos consecutivos de pacientes con VIH remitidos a nuestra consulta entre el 1 noviembre de 2014 y el 30 junio de 2018. Las coberturas en el momento de la fecha de la cita para la valoración de su estado vacunal (en nuestra consulta) y después de ser atendido se compararon usando la prueba chi-cuadrado. Como referencia se utilizaron las del momento de la fecha de la primera cita. RESULTADOS: Se analizaron 209 pacientes, en los que se obtuvieron mejoras estadísticamente significativas en sus coberturas vacunales: 2,9% en el momento de la fecha de la cita para la valoración en nuestra consulta y 88% después de ser atendidos en nuestra consulta (RR [IC95%]= 30,7 [13,92-67,58]) para la vacuna antineumocócica conjugada 13-valente, y 16,3% en el momento de la primera cita y 83,7% después de ser atendidos en nuestra consulta (RR [IC95%]=5,2 [3,76-7,04]) para la vacuna antineumocócica polisacárida 23-valente. CONCLUSIONES: Implementar una consulta hospitalaria de vacunas representa una intervención efectiva para mejorar las coberturas de vacunación frente al neumococo en pacientes con VIH.

Circulando hacia la seguridad del paciente: realidad y deseo / The road to patient safety: facts and desire

Objetivo: Valorar diferencias entre necesidad e implementación de prácticas seguras recomendadas para la seguridad del paciente y utilidad del uso de señales de tráfico para promover su implementación. Método: El estudio constó de dos fases: 1) revisión de recomendaciones sobre prácticas seguras de diferentes organizaciones y 2) encuesta a una muestra de oportunidad de profesionales del ámbito asistencial, organizativo y académico de la seguridad del paciente de España y Latinoamérica para evaluar necesidad y la implementación percibida de las prácticas seguras y la utilidad de las señales para tal fin. Resultados: Se recibieron 365 cuestionarios. Todas las prácticas seguras identificadas fueron valoradas como necesarias (media y límite inferior del intervalo de confianza por encima de 3 sobre 5 puntos). Sin embargo, la implementación se valoró como insuficiente en seis de ellas: escritura ilegible, conciliación de medicación, estandarización de comunicación, sistemas de alerta rápida, aplicación de procedimientos por profesionales o equipos entrenados, y cumplimiento de voluntades del paciente al final de la vida. Mejorar cumplimiento de la higiene de manos, aplicación de precauciones de barrera, asegurar la identificación correcta de los pacientes y utilizar listados de verificación fueron las cuatro prácticas en las que más del 75% de los encuestados encuentran mayor grado de consenso sobre la utilidad de las señales de tráfico para mejorar su implementación. Conclusiones: Las diferencias entre necesidad percibida e implementación real de las prácticas seguras consideradas indican áreas de mejora. El lenguaje común de las señales de tráfico es un instrumento sencillo para mejorar su cumplimiento

Objective: To evaluate differences between the need and degree of implementation of safe practices recommended for patient safety and to check the usefulness of traffic sign iconicity to promote their implementation. Method: The study was developed in two stages: 1) review of safe practices recommended by different organizations and 2) a survey to assess the perceptions for the need and implementation of them and the usefulness of signs to improve their implementation. The sample consisted of professionals from Spain and Latin America working in healthcare settings and in the academic field related to patient safety. Results: 365 questionnaires were collected. All safe practices included were considered necessary (mean and lower limit of confidence interval over 3 out of 5 points). However, in six of the patient safety practices evaluated the implementation was considered insufficient: illegible handwriting, medication reconciliation, standardization of communication systems, early warning systems, procedures performed or equipment used only by trained people, and compliance with patient preferences at the end of life. Improve compliance of with hand hygiene and barrier precautions to prevent infections, ensure the correct identification of patients and the use of checklists are the four practices in which more than 75% of respondents found a high degree of consensus on the usefulness of traffic sings to broaden their use. Conclusion: The differences between perceived need and actual implementation in some safe practices indicate areas for improvement in patient safety. With this aim, the common language and the iconicity of traffic signs could constitute a simple instrument to improve compliance with safe practices for patient safety

[Assessment of the effectiveness of an intervention to improve immunization coverage in splenectomy patients]. / Evaluación de la efectividad de una intervención para mejorar las coberturas vacunales en pacientes esplenectomizados.

OBJECTIVE: Splenectomized patients have an increased risk of sepsis caused by encapsulated bacteria. Pneumococcal, meningococcal and Haemophilus influenzae B vaccination is recommended in this group. The aim of our study was to assess the impact of the introduction of an immunization hospital clinic on their immunization coverages. METHODS: Quasi-experimental study. The control group included patients splenectomized between January 2012-April 2014, and the intervention group included patients splenectomized between May 2014-December 2016. The global and specific immunization coverages were compared between both groups using a Chi-square test. RESULTS: 80 patients were analyzed. The most commonly administered vaccine was the 23-valent pneumococcal polysaccharide vaccine (65.0%). A significant improvement was observed both in the global immunization rate (17.1% in the pre-intervention study vs. 57.8% in the post-intervention study) (RR: 3.37; 95% CI: 1.56-7.27) and in the specific immunization rate for the Haemophilus influenzae B, meningococcal C and 13-valent pneumococcal conjugate vaccines. CONCLUSIONS: Introducing an immunization hospital clinic is an effective measure to improve the immunization coverage of splenectomy patients.

OBJETIVO: Los pacientes esplenectomizados presentan riesgo elevado de sepsis por bacterias encapsuladas, motivo por el que se recomienda vacunarles frente a neumococo, meningococo y Haemophilus infl uenzae B. El objetivo de nuestro trabajo fue evaluar el impacto de implementar una consulta hospitalaria de vacunas en sus coberturas de vacunación. METODOS: Estudio cuasiexperimental. Constituyeron el grupo control los esplenectomizados entre enero 2012-abril 2014, y el grupo intervención los operados entre mayo 2014-diciembre 2016. Se compararon las coberturas vacunales global y específica para cada vacuna según grupo utilizando la prueba chi-cuadrado. RESULTADOS: Se analizaron 80 pacientes. La vacuna más administrada fue la antineumocócica polisacárida 23-valente (65,0%). Hubo una mejora significativa en la tasa de vacunación global (17,1% en el periodo preintervención versus 57,8% en el postintervención) (RR=3,37; IC95%:1,56-7,27) así como específicamente para las vacunas frente a Haemophilus influenzae de tipo B, antimeningocócica C y antineumocócica conjugada 13-valente. CONCLUSIONES: Implementar una consulta hospitalaria de vacunas representa una medida efectiva para mejorar las coberturas vacunales de estos pacientes.