Impact of adherence to Mediterranean diet and/or drug treatment on glycaemic control in type 2 diabetes mellitus patients: DM2-CUMCYL study.

AIMS: This study aimed to analyse the association between adherence to treatment and glycaemic control in people with type 2 diabetes mellitus. METHODS: Multicentre, cross-sectional study in patients with type 2 diabetes mellitus recruited by primary care professionals in Castilla y León (Spain). Sociodemographic and clinical characteristics were reflected in self-reported questionnaire, which included the Morisky-Green Medication Adherence Scale and the 14-point Mediterranean Diet Adherence Screener. Medication non-adherence and poor glycaemic control were analysed by bivariable and multivariable analyses. RESULTS: Of 3536 included patients, the 33.8% reported non-adherence to pharmacological treatment, and the 33.7% had poor glycaemic control (HbA1c ≥58 mmol/mol [7.5%]); 50.6% of patients reported moderate-high adherence to the Mediterranean diet (≥9 points). The multivariable logistic regression model showed that educational level (OR 0.73; 95% CI 0.61-0.87; p < 0.001) and sedentarism (OR 1.64; 95% CI 1.36-1.98; p < 0.001) were associate with low adherence. Younger age, rural residence, smoking, time since diagnosis (OR 1.04; 95% CI 1.03-1.05; p < 0.001) and polypharmacy were associated with poor glycaemic control. CONCLUSION: Lower educational level and sedentarism were associated with low adherence. Younger age, rural residence, smoking, time since diagnosis and polypharmacy, increased risk of poor glycaemic control.

Análisis de la implantación de un sistema de notificación y registro de eventos adversos en el proceso asistencial de una mutua de accidentes de trabajo / Analysis of a register for reporting adverse events to a mutual insurance society for accidents at work. Adverse event reporting of occupational injuries

Objetivos. Describir los resultados de un sistema voluntario de notificación de eventos adversos, dentro de un programa de Seguridad de Pacientes en el proceso asistencial de una Mutua de Accidentes de Trabajo. Método. En 2008 se implantó un sistema de notificación y registro de eventos adversos (reales o potenciales) en Unión de Mutuas, mutua de accidentes de trabajo, con 36 centros asistenciales, que da cobertura a 259.922 trabajadores. El cuestionario de notificación, contempla todos los ámbitos de la asistencia sanitaria prestada por la Mutua. El acceso al cuestionario se realizó a través de la intranet, fue voluntario, anónimo. Se describen las notificaciones registradas entre el 1 de enero de 2009 y el 31 de diciembre de 2010. Resultados. Se cumplimentaron 116 cuestionarios, con un total de 205 incidentes. El perfil del notificador fue médico del primer nivel asistencial (57,7%), y una antigüedad en su puesto de trabajo entre 5-10 años. Del total de notificaciones, la asistencia sanitaria se consideró causante del incidente en el 43,5% de los casos, de los que el 85,9% de los incidentes hubieran podido evitarse. Del total de eventos notificados, un 71,7% estaban relacionados con cuidados en centro asistencial ambulatorio, y solo un 2,4% fue relacionado con procedimiento quirúrgico. Conclusiones. La mayoría de las notificaciones fueron incidentes evitables, y registrados por médicos del primer nivel asistencial. El cuestionario de notificación se mostró como una herramienta válida en nuestro entorno de trabajo para la detección de eventos adversos en el proceso asistencial(AU)

Objectives. To describe the results of a voluntary reporting system for adverse events in a Patient Safety Program of an occupational injuries mutual insurance company. Method. In 2008 a system of notification and registration of adverse events (actual or potential) was introduced in 2008 by the Union de Mutuas, an occupational injuries insurance company with 36 health centres, and provides coverage for 259,922 workers. The reporting questionnaire covers all areas of health care provided by the mutual company. Access to the questionnaire was conducted through the intranet, was voluntary and anonymous. The notifications registered between 1 January 2009 and 31 December 2010 are analysed. Results. A total of 16 questionnaires were completed, with a total of 205 incidents. The profile of the reporter was first-level health care (57.7%), and seniority in their job for 5-10 years. Of all the notifications, a health care cause of the incident was seen in 43.5% of cases, of which 85.9% of the incidents were preventable. Of all reported events, 71.7% were related to an ambulatory care medical centre, and only 2.4% was related to a surgical procedure. Conclusions. Most of the notifications were preventable incidents, and recorded by first-level medical care. The reporting questionnaire was shown to be a valid tool in our work environment for the detection of adverse events in the care process(AU)

[Analysis of a register for reporting adverse events to a mutual insurance society for accidents at work. Adverse event reporting of occupational injuries]. / Análisis de la implantación de un sistema de notificación y registro de eventos adversos en el proceso asistencial de una mutua de accidentes de trabajo.

OBJECTIVES: To describe the results of a voluntary reporting system for adverse events in a Patient Safety Program of an occupational injuries mutual insurance company. METHOD: In 2008 a system of notification and registration of adverse events (actual or potential) was introduced in 2008 by the Union de Mutuas, an occupational injuries insurance company with 36 health centres, and provides coverage for 259,922 workers. The reporting questionnaire covers all areas of health care provided by the mutual company. Access to the questionnaire was conducted through the intranet, was voluntary and anonymous. The notifications registered between 1 January 2009 and 31 December 2010 are analysed. RESULTS: A total of 16 questionnaires were completed, with a total of 205 incidents. The profile of the reporter was first-level health care (57.7%), and seniority in their job for 5-10 years. Of all the notifications, a health care cause of the incident was seen in 43.5% of cases, of which 85.9% of the incidents were preventable. Of all reported events, 71.7% were related to an ambulatory care medical centre, and only 2.4% was related to a surgical procedure. CONCLUSIONS: Most of the notifications were preventable incidents, and recorded by first-level medical care. The reporting questionnaire was shown to be a valid tool in our work environment for the detection of adverse events in the care process.

[Lights and shadows in patient safety: study and development of strategies. 2008 SESPAS Report]. / Luces y sombras en la seguridad de los pacientes: estudio y desarrollo de estrategias. Informe SESPAS 2008.

Study of the frequency of healthcare-related adverse events (AE) and of their effect on patients and impact on healthcare systems has markedly increased in recent years. Indepth individual analysis of the factors contributing to these events has allowed strategies to prevent or minimize the impact of AE to be developed. However, an epidemiologic perspective is needed to explore possible associations and generalize the recommendations that can be drawn from this type of analysis. Some aspects that should been considered while developing future strategies are discussed. These aspects include the importance of patient age and comorbidities on producing AE and the use of highly technological medicine, which is sometimes unnecessary. A culture of trust and confidentiality and a spirit of collaboration among organizations are indispensable to share and learn about the initiatives prompted by the study of AE and thereby improve patient safety in the national health service.

Luces y sombras en la seguridad de los pacientes: estudio y desarrollo de estrategias. Informe SESPAS 2008 / Lights and shadows in patient safety: study and development of strategies. 2008 SESPAS Report

El estudio sobre la frecuencia de los efectos adversos (EA) ligadosa la asistencia, su efecto en los pacientes y el impactoen los sistemas de salud ha experimentado un intenso impulsoen los últimos años. El análisis individual profundo de susfactores contribuyentes ha permitido el desarrollo de múltiplesestrategias para prevenirlos o minimizar su impacto, pero es necesariauna perspectiva epidemiológica para explorar estas posiblesasociaciones y generalizar las recomendaciones que sederiven de este análisis.Se comentan algunos de los aspectos que se deberían teneren cuenta para el desarrollo de estrategias futuras, como la importanciade la edad o las comorbilidades del paciente en la génesisde los EA y el alto grado de la instrumentalización de laasistencia (a veces innecesaria). Son imprescindibles una culturade confianza y confidencialidad y un espíritu de colaboraciónentre las organizaciones para poder compartir y aprenderde las iniciativas derivadas del estudio de los EA, y así mejorarla seguridad de los pacientes en el Sistema Nacional de Salud(AU)

Study of the frequency of healthcare-related adverseevents (AE) and of their effect on patients and impact on healthcaresystems has markedly increased in recent years. Indepthindividual analysis of the factors contributing to theseevents has allowed strategies to prevent or minimize the impactof AE to be developed. However, an epidemiologic perspectiveis needed to explore possible associations and generalizethe recommendations that can be drawn from thistype of analysis.Some aspects that should been considered while developingfuture strategies are discussed. These aspects include the importanceof patient age and comorbidities on producing AEand the use of highly technological medicine, which is sometimesunnecessary. A culture of trust and confidentiality anda spirit of collaboration among organizations are indispensableto share and learn about the initiatives prompted by thestudy of AE and thereby improve patient safety in the nationalhealth service(AU)

Aseguramiento de la calidad y acreditación sanitaria

Contiene: el aseguramiento y la acreditación sanitaria, semejanzas y diferencias entre las estrategias de mejora de la calidad en la industria y en la sanidad, modelo de calidad total del SNS, modelo europeo de excelencia EFQM y técnicas de benchmarking, diseño del modelo de acreditación en la Comunidad Valenciana, experiencia y modelo de acreditación en Cataluña, Sistema de Calidad en el Servicio Vasco de Salud, acreditación en el Sistema Sanitario Público de Andalucía, acreditación docente en el Sistema Nacional de Salud Español, acreditación de una unidad de hemodiálisis, experiencia de la Función Avedís Donabedian (FAD) en la aplicación del modelo de estándares internacionales de la Joint Commission of Accreditation, le modele français d`accreditation, orientaciones internacionales en el aseguramiento y la acreditación sanitaria, il modello italiano di accreditamiento sanitario, Health Services Accreditation in Canada, propuesta de creación de un organismo acreditador.

De las complicaciones y efectos adversos a la gestión de los riesgos de la asistencia sanitaria

Libro que aporta una particular perspectiva de los efectos adversos de la asistencia, estudia las complicaciones, instruye para distinguir los evitables de los no evitables y da las claves para la gestión de los riesgos de la asistencia, facilitando el intercambio de opiniones que van de la epidemiología a la magistratura.