ABSTRACT
OBJECTIVE: To evaluate the understanding of the population on prostate cancer screening. DESIGN: Descriptive study. SETTING: Primary care teams in the province of Barcelona, Spain, from april to september 2005. PARTICIPANTS AND CONTEXT: Men between 50 and 70 years old without prostate symptoms and seen in the clinics of 12 primary care teams. METHOD: Systematic sample. VARIABLES: age, marital status, educational level, and self-perceived health status. Appraisal of knowledge through a 14-question questionnaire referring to the key ideas, previously defined by a group of experts, requisite before deciding on prostate cancer screening. RESULTS: N=221. Mean age, 59.9 (SD, 5.9); educational level, primary or lower: 63.4%; 89.1% (95% CI, 84.4-92.6) did not have sufficient knowledge about prostate cancer screening. In the questions on what PSA is and what it is for, over 50% said they did not know; 63.3% recognised that prostate cancer was a highly prevalent illness; 84.6% replied that early detection of prostate cancer avoids deaths; 49.8% did not know whether the doctor had doubts on this question; and 38.9% thought he didn't. There were no differences in knowledge for any of the variables studied. CONCLUSIONS: Although prostate cancer screening is widely known about, the information of the population is scant and often wrong. Existing scientific uncertainty on the use of screening is the aspect that is least known by users.
Subject(s)
Health Knowledge, Attitudes, Practice , Mass Screening , Prostatic Neoplasms/diagnosis , Aged , Humans , Male , Middle Aged , Risk Factors , Spain , Surveys and QuestionnairesABSTRACT
Objetivo. Valorar los conocimientos de la población sobre el cribado del cáncer de próstata. Diseño. Estudio descriptivo. Emplazamiento. Equipos de atención primaria (EAP) de la provincia de Barcelona, durante el período comprendido entre abril y septiembre de 2005. Participantes y contexto. Participaron varones de 50-70 años de edad atendidos en las consultas de 12 EAP, sin sintomatología prostática. Método. Se realizó una muestra sistemática. Las variables analizadas fueron: edad, estado civil, nivel de estudios y estado de salud autopercibido. Se llevó a cabo una valoración de los conocimientos mediante un cuestionario de 14 preguntas referidas a las ideas clave (previamente definidas por un grupo de expertos) que son necesarias para poder decidir sobre el cribado del cáncer de próstata. Resultados. Se incluyó a 221 varones. Su edad media era de 59,9 años (desviación estándar [DE] = 5,9); el 63,4% tenía un nivel de estudios primario o inferior. El 89,1% (intervalo de confianza del 95%, 84,4-92,6) no tienen conocimientos suficientes sobre el cribado del cáncer de próstata. En las preguntas referentes a qué es y para qué sirve el antígeno prostático específico, más del 50% responde que no lo saben. El 63,3% reconoce que el cáncer de próstata es una enfermedad con una alta prevalencia. El 84,6% responde que la detección precoz del cáncer de próstata evita muertes. El 49,8% no sabe si el médico tiene dudas sobre este tema y el 38,9% cree que no las tiene. No existen diferencias en los conocimientos para ninguna de las variables estudiadas. Conclusiones. A pesar de la amplia extensión del cribado del cáncer de próstata, la información que tiene la población es muy escasa y a menudo errónea. La incertidumbre científica existente sobre la utilidad del cribado es el aspecto más desconocido por los usuarios
Objective. To evaluate the understanding of the population on prostate cancer screening. Design. Descriptive study. Setting. Primary care teams in the province of Barcelona, Spain, from april to september 2005. Participants and context. Men between 50 and 70 years old without prostate symptoms and seen in the clinics of 12 primary care teams. Method. Systematic sample. Variables: age, marital status, educational level, and self-perceived health status. Appraisal of knowledge through a 14-question questionnaire referring to the key ideas, previously defined by a group of experts, requisite before deciding on prostate cancer screening. Results. N=221. Mean age, 59.9 (SD, 5.9); educational level, primary or lower: 63.4%; 89.1% (95% CI, 84.4-92.6) did not have sufficient knowledge about prostate cancer screening. In the questions on what PSA is and what it is for, over 50% said they did not know; 63.3% recognised that prostate cancer was a highly prevalent illness; 84.6% replied that early detection of prostate cancer avoids deaths; 49.8% did not know whether the doctor had doubts on this question; and 38.9% thought he didn't. There were no differences in knowledge for any of the variables studied. Conclusions. Although prostate cancer screening is widely known about, the information of the population is scant and often wrong. Existing scientific uncertainty on the use of screening is the aspect that is least known by users
Subject(s)
Humans , Middle Aged , Male , Middle Aged , Mass Screening , Prostatic Neoplasms/epidemiology , Prostatic Neoplasms/prevention & control , Primary Health Care/methods , Health Knowledge, Attitudes, Practice , Prostate-Specific Antigen/analysis , Prostate-Specific Antigen , Surveys and Questionnaires , Patient Education as Topic/methods , Spain/epidemiology , Continuity of Patient Care/statistics & numerical data , Patient Care/statistics & numerical data , Patient Care/standards , Patient Care Management/methodsABSTRACT
BACKGROUND: The development of tools to aid in prostate cancer screening-related decision-making is a challenge for healthcare professionals and institutions. This study is aimed at evaluating citizen comprehension of a document prepared by experts informing as to prostate cancer screening benefits and risks. METHODS: Phenomenological qualitative study conducted in Barcelona (November 2004-January 2005). The data was gathered by means of seven interviews with males within the 50-70 age range of different educational levels attended in primary care. A descriptive-narrative theme-based categorical content analysis was made of the narrative discourse. RESULTS: This document provides knowledge regarding the aforementioned aspects, although the males possessing a lower level of education point out words and concepts found difficult to understand. In all of the educational strata, the screening-related doubts entertained are due to the prostate-specific antigen not having been precisely stated, the concept most difficult to understand being that of early cancer detection possibly not being beneficial. They are of the opinion that this document is useful for what they consider as being a decision which must be made by the patient with the collaboration of the professionals. Those interviewed are satisfied with the decision made following the information furnished. CONCLUSIONS: The educational level, the locus of control and health beliefs-attitudes condition the comprehension-assimilation of the information. Citizen participation in the preparation of tools to aid in decision-making processes concerning prostate cancer screening affords the possibility of attaining more useful documents. Further research is necessary on the effects this type of information has on citizens.
Subject(s)
Attitude to Health , Cognition , Health Education , Informed Consent , Interviews as Topic , Mass Screening/methods , Prostatic Neoplasms/epidemiology , Aged , Catchment Area, Health , Health Promotion , Humans , Male , Middle Aged , Patient Education as Topic , Risk Factors , Spain/epidemiologyABSTRACT
Fundamento: El desarrollo de herramientas de ayuda a la decisión sobre el cribado del cáncer de próstata, constituye un reto para los profesionales- instituciones sanitarias. El objetivo del estudio es valorar la comprensión por los ciudadanos de un documento elaborado por expertos que informa sobre beneficios y riesgos del cribado del cáncer de próstata. Métodos: Estudio cualitativo fenomenológico, realizado en Barcelona (noviembre 2004-enero 2005). Los datos se obtuvieron mediante siete entrevistas con hombres de 50-70 años y diferentes niveles educativos atendidos en atención primaria. Se realizó un análisis de contenido de categorías temáticas descriptivo-interpretativo del corpus narrativo. Resultados: El documento aporta conocimientos sobre los conceptos expuestos, si bien los hombres de menor nivel educativo señalan palabras y conceptos de difícil comprensión. En todos los estratos educativos las dudas al cribado son provocadas por la falta de precisión del antígeno prostático específico, y el concepto más difícil de entender es que la detección precoz del cáncer de próstata pueda no ser beneficiosa. Opinan que el documento es útil para la decisión que creen corresponde al paciente con la colaboración de los profesionales. Los informantes están satisfechos con la decisión adoptada tras la información recibida. Conclusiones: El nivel educativo, el locus de control y las creencias- actitudes condicionan la comprensión-asunción de la información. La participación de ciudadanos en la elaboración de instrumentos de ayuda a la decisión sobre el cribado del cáncer de próstata permite conseguir documentos más útiles
Background: The development of tools to aid in prostate cancer screening-related decision-making is a challenge for healthcare professionals and institutions. This study is aimed at evaluating citizen comprehension of a document prepared by experts informing as to prostate cancer screening benefits and risks. Methods: Phenomenological qualitative study conducted in Barcelona (November 2004-January 2005). The data was gathered by means of seven interviews with males within the 50-70 age range of different educational levels attended in primary care. A descriptive-narrative themebased categorical content analysis was made of the narrative discourse. Results: This document provides knowledge regarding the aforementioned aspects, although the males possessing a lower level of education point out words and concepts found difficult to understand. In all of the educational strata, the screening-related doubts entertained are due to the prostate-specific antigen not having been precisely stated, the concept most difficult to understand being that of early cancer detection possibly not being beneficial. They are of the opinion that this document is useful for what they consider as being a decision which must be made by the patient with the collaboration of the professionals. Those interviewed are satisfied with the decision made following the information furnished. Conclusions: The educational level, the locus of control and health beliefs-attitudes condition the comprehension-assimilation of the information. Citizen participation in the preparation of tools to aid in decision- making processes concerning prostate cancer screening affords the possibility of attaining more useful documents. Further research is necessary on the effects this type of information has on citizens
Subject(s)
Male , Middle Aged , Aged , Humans , Mass Screening , Comprehension , Information Services , Primary Health Care/methods , Prostatic Neoplasms/prevention & control , Qualitative Research , Primary Prevention/methods , Patient Education as Topic/methods , Decision Making , Patient RightsABSTRACT
OBJECTIVE: To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation. METHODS: Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: "Which features should be evaluated in the services that should be provided by PHC?". A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account. RESULTS: Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified. CONCLUSION: There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams.
Subject(s)
Focus Groups , Health Personnel , Patients , Primary Health Care , Humans , Primary Health Care/standards , SpainABSTRACT
Objetivo: Definir los componentes del producto de la atención primaria de salud (APS) a partir de las opiniones de profesionales y usuarios, para establecer indicadores de evaluación. Métodos: Estudio con metodología cualitativa, con técnicas grupales: grupo nominal (profesionales) y grupos focales (usuarios). Ámbito de realización: APS de Catalunya. Se realizaron 7 grupos: a) médicos de familia y pediatras; b) enfermeras y trabajadoras sociales; c) personal de la unidad de admisión y atención al usuario; d) otros médicos especialistas; e) usuarios, y f) gestores, farmacéuticos y farmacólogos y técnicos de salud. Los participantes respondieron a la pregunta: «Respecto a los servicios que debería ofrecer la APS, ¿cuáles son los aspectos que se deberían valorar?». Se realizó un análisis de contenido. Los datos textuales se descompusieron en unidades, posteriormente agrupadas en categorías, siguiendo el criterio de analogía. Se tuvo en cuenta el contexto de interpretación del equipo investigador. Resultados: Profesionales y usuarios identifican 4 dimensiones del producto de la APS, coincidentes con sus atributos básicos: a) accesibilidad a los servicios; b) coordinación y continuidad del equipo de APS con otros niveles asistenciales; c) relación entre profesionales y usuarios, y d) calidad científico-técnica de los equipos de atención primaria y cartera de servicios. Equidad, satisfacción y eficiencia aparecen en los discursos como ejes transversales de todos los componentes del producto identificados. Conclusión: Hay una gran coincidencia en la definición del producto entre profesionales y usuarios. La relación profesional-paciente aparece como un elemento clave en todos los grupos. Estas 4 dimensiones deberían formar parte de la evaluación de los equipos de APS
Objective: To identify the components of the primary health care (PHC) product defined by health professionals and users in order to establish indicators for evaluation. Methods: Qualitative methodology was used with group techniques: a nominal group (health professionals) and focus groups (users). The study was performed in PHC centers in Catalonia (Spain). There were 7 groups: a) family physicians and pediatricians; b) nurses and social workers; c) staff from admissions units and customer services; d) other medical specialists; e) users; f) managers, pharmacists, pharmacologists, and technicians. Participants responded to the question: «Which features should be evaluated in the services that should be provided by PHC?». A content analysis was performed. Textual data were broken down into units and then grouped into categories, following analogy criteria. The interpretative context of the research team was taken into account. Results: Health professionals and users identified 4 dimensions of the PHC product, coinciding with its basic attributes: a) access to services; b) coordination and continuity of the PHC teams with other levels of healthcare; c) relationship between health professionals and users, and d) scientific-technical quality of the PHC teams and the portfolio of services. Equity, satisfaction and efficiency appeared as keystones in all the components of the product identified. Conclusion: There was broad agreement in the product definition among health professionals and users. The relationship between health professionals and patients was a key element in all groups. The four dimensions should be included in the evaluation of PHC teams
Subject(s)
Humans , Quality Indicators, Health Care , Health Services Accessibility/standards , Professional-Patient Relations , Primary Health Care , Health Personnel , Patients , 25783 , SpainABSTRACT
OBJECTIVE: To identify, from a systematic review of the literature, the attributes of Family Medicine (FM) that influence the primary health care outcome as measured by users' satisfaction, improvement in patient health and in costs. DATA SOURCES: Literature search of Medline and the Cochrane library using MeSH terms 'Primary Health' or 'Family Practice' or 'Family Physicians' and 'Outcome Assessment' or 'Process Assessment'. Papers were excluded if they lacked a based on primary data, if no single component of FM was assessed; if indicators of evaluation were not related to health, satisfaction or costs. RESULTS: A total of 356 articles were initially identified and 19 finally met the inclusion criteria. Study methods were a systematic review of randomized control trials, a double-blind randomized trial, 4 systematic reviews of observational studies, 2 cohort studies and 12 descriptive cross-sectional studies. CONCLUSIONS: There was evidence of relationships between the attributes of FM and the service outcomes measured by indicators of satisfaction, health and cost. User satisfaction was associated with accessibility, continuity of care, consultation time and the doctor-patient relationship. Improvement in patient's health was related to continuity, consultation time, doctor-patient relationship and the implementation of preventive activities. Coordination of care showed mixed results with health outcomes. Continuity, consultation time, doctor-patient communication and prevention were cost-effective in the primary care setting.
Subject(s)
Family Practice , Patient Satisfaction/economics , Primary Health Care , Continuity of Patient Care , Cost-Benefit Analysis , Family Practice/economics , Female , Health Services Accessibility , Humans , Male , Office Visits , Physician-Patient Relations , Referral and Consultation , SpainABSTRACT
BACKGROUND AND OBJECTIVE: Comparison of safety and effectiveness of the intramuscular (IM) (deltoid) vs subcutaneous (s.c.) administration of the flu vaccine (FV) in patients on oral anticoagulation therapy. PATIENTS AND METHOD: It was a phase IV, simple blind, 2-parallel groups, randomized trial developed in an urban primary care setting. We included patients taking oral anticoagulation therapy without FV contraindications. The IM administration of the FV in the experimental group was compared with a SC administration in the control group. RESULTS: 59 patients were included. The two groups were comparable at the beginning of the study. INR was not modified following s.c. (p = 0.38) or i.m. (p = 0.49) administration. No systemic side effects were observed. More cutaneous lesions were observed in the S.C. group (71.4%) when compared with the i.m. group (25.8%; p < 0.0001). For the remaining variables, we observed a tendency towards more reported pain in the SC group (35.7 vs 22.6%) and a larger brachial diameter (42 vs 29%) without significant differences. 3.2% of patients in the i.m. group and 7.1% in the s.c. group developed influenza symptoms without significant differences. CONCLUSIONS: Even though the results must be interpreted with caution, currently there appears to be no apparent contraindication for the i.m. administration of the FV. When it is administered subcutaneously, it tends to cause more side effects.
Subject(s)
Anticoagulants/administration & dosage , Influenza Vaccines/administration & dosage , Administration, Oral , Drug Interactions , Female , Humans , Injections, Intramuscular , Injections, Subcutaneous , Male , Middle Aged , Single-Blind MethodABSTRACT
FUNDAMENTO Y OBJETIVO: Comparar la seguridad y la efectividad de la administración intramuscular deltoidea de la vacuna antigripal (VAG) respecto a la subcutánea en pacientes que reciben anticoagulantes orales. PACIENTES Y MÉTODO: Ensayo clínico aleatorizado de fase IV, simple ciego, llevado a cabo por un equipo de atención primaria (EAP) urbano en pacientes con anticoagulación oral sin contraindicación para la VAG. Las variables analizadas fueron la edad, el sexo, la diámetro braquial, las lesiones elementales, el dolor (según una escala analógica visual), los efectos secundarios sistémicos, la razón normalizada internacional (INR) y la aparición de episodio gripal hasta junio de 2002. RESULTADOS: Se incluyó a 59 pacientes (28 en los que la VAG se administró por vía subcutánea y 31 por vía intramuscular). No se modificó el INR después de la administración subcutánea (p= 0,38) ni intramuscular (p = 0,49). No se observaron efectos secundarios sistémicos. Se observaron más lesiones cutáneas en la administración subcutánea (71,4%) que en la intramuscular (25,8%) (p < 0,0001), número necesario a tratar (NNT) 2 (intervalo de confianza [IC] del 95%, 1-4). En el resto de variables se observa una tendencia a que el grupo de administración subcutánea presente más dolor (el 35,7 frente al 22,6%) y un mayor diámetro braquial (el 42,9 frente al 29,0%), sin diferencias significativas. Presentaron clínica compatible con gripe un 3,2% del grupo intramuscular y un 7,1% del grupo de administración subcutánea, sin ser diferencias significativas. CONCLUSIONES: Aunque los resultados deben interpretarse de forma prudente, no hay ninguna justificación actual para contraindicar la administración de la vacuna antigripal por vía intramuscular; incluso la administración por vía subcutánea presenta más efectos secundarios
BACKGROUND AND OBJECTIVE: Comparison of safety and effectiveness of the intramuscular (IM)(deltoid) vs subcutaneous (s.c.) administration of the flu vaccine (FV) in patients on oral anticoagulation therapy. PATIENTS AND METHOD: It was a phase IV, simple blind, 2-parallel groups, randomized trial developed in an urban primary care setting. We included patients taking oral anticoagulation therapy without FV contraindications. The IM administration of the FV in the experimental group was compared with a SC administration in the control group. RESULTS: 59 patients were included. The two groups were comparable at the beginning of the study. INR was not modified following s.c. (p = 0.38) or i.m. (p = 0.49) administration. No systemic side effects were observed. More cutaneous lesions were observed in the S.C. group(71.4%) when compared with the i.m. group (25.8%; p < 0.0001). For the remaining variables, we observed a tendency towards more reported pain in the SC group (35.7 vs 22.6%) anda larger brachial diameter (42 vs 29%) without significant differences. 3.2% of patients in theim. group and 7.1% in the s.c. group developed influenza symptoms without significant differences. CONCLUSIONS: Even though the results must be interpreted with caution, currently there appears to be no apparent contraindication for the i.m. administration of the FV. When it is administered subcutaneously, it tends to cause more side effects
