Social Prescribing Schemes in Primary Care in Spain (EvalRA Project): a mixed-method study protocol to build an evaluation model.

BACKGROUND: Social Prescribing is a Primary Health Care service that provides people with non-clinical care alternatives that may have an impact on their health. Social Prescribing can be more or less formal and structured. Social Prescribing Schemes are formal Social Prescribing of health assets by Primary Health Care teams in coordination and follow-up of patients with providers. The emerging evidence suggests that this service can improve people's health and well-being, create value and provide sustainability for the healthcare system. However, some evaluations note that the current evidence regarding social prescribing is insufficient and needs further investigation. The EvaLRA project aims to elaborate an evaluation model of Social Prescribing Schemes in Primary Health Care based on a set of structure, process, and outcomes indicators. METHODS: In the region of Aragon, the Community Health Care Strategy aims to promote the development of social prescription schemes in Primary Health Care teams. This study is divided into two stages. Stage 1: identification of primary health care teams that implement social prescribing schemes and establish a first set of indicators to evaluate social prescribing using qualitative consensus techniques with experts. Stage 2 evaluation of the relevance, feasibility and sensitivity of selected indicators after 6 and 12 months in primary health care teams. The results will provide a set of indicators considering structure, process and outcomes for social prescribing schemes. DISCUSSION: Current evaluations of the application of social prescribing schemes use different criteria and indicators. A set of agreed indicators and its piloting in primary health care teams will provide a tool to evaluate the implementation of social prescription schemes. In addition, the scorecard created could be of interest to other health systems in order to assess the service and improve its information system, deployment and safety.

[Safe surgery and COVID-19: A narrative review]. / Cirugía segura y COVID-19: una revisión narrativa.

BACKGROUND: The interruption of surgical care in Spain caused by the pandemic must end. Recovery from this activity must be carried out on an elective basis and in conjunction with possible cases of COVID-19. The objective of this review was to incorporate good practice criteria related to COVID-19 into the context of safe surgery, which would make it possible to develop a proposed surgical safety checklist adapted to patients with this disease. METHODS: Narrative literature review, following the PRISMA protocol, in the Medline and Cochrane directories, using the MeSH terms (coronavirus, infections, safety, surgical procedures, operative, checklist) and the Boolean operator AND. In addition, recommendations from scientific bodies and societies were reviewed (grey literature). RESULTS: Thirty-three final studies were included with recommendations for safe surgery and surgical safety checklist adapted for COVID-19, the most frequent being aspects related to treatment (41.3%) and prevention and control measures (27.6%). CONCLUSIONS: The existence of a broad consensus on good practices recommended for COVID surgical patients makes it possible to make a proposal for surgical safety checklist to these patients.

Impacto en prensa escrita tras el primer caso de difteria en España desde 1986 / No disponible

Objetivo: Investigar la cobertura mediática y el contenido de los mensajes comunicados por la prensa escrita ante el caso de un menor no vacunado, fallecido por difteria en España en junio de 2015. Métodos: Estudio cualitativo, basado en el análisis de contenido de las noticias publicadas en los 6 periódicos nacionales de mayor difusión, del 1 al 30 de junio de 2015. Se analizó también el tipo de titular, la ubicación y extensión de la noticia, la existencia de fotografías e infografías, y el día de la semana de publicación. Resultados: Se identificaron 40 noticias relacionadas; 5 de ellas fueron portada (13%), 27 (68%) se publicaron en días laborables, y 5 (13%) contenían infografías. Se observaron importantes cambios cronológicos, tanto en la extensión como en la cobertura y el contenido de las noticias relacionadas. Conclusiones: La cobertura mediática y el tipo de mensajes difundidos presentó importantes áreas de mejora. El modo y frecuencia de difusión de noticias de relevancia sanitaria condicionan el éxito de autoridades y profesionales de la salud en el control de las enfermedades inmunoprevenibles. Es crucial la olaboración mutua con los profesionales de la comunicación, para asegurar una información sanitaria útil, completa, contrastada y veraz

Objective: To investigate the media coverage and content of the messages communicated by the written press in the case of an unvaccinated minor, who died of diphtheria in Spain in June 2015. Methods: Qualitative study, based on content analysis of news published in 2015 in the 6 most widely distributed national newspapers, from June 1 to 30. The type of headline, the location and extent of the news, the existence of graphic support, and the day of the publication were also analyzed. Results: 40 related news were identified; 5 of them were front page (13%), 27 (68%) were published on working days, and 5 (13%) contained infographics. Important chronological changes were observed, both in the extensión, coverage and contents of the news. Conclusions: Media coverage and the type of messages disseminated presented important areas for improvement. How and how often news of high health relevance are disseminated condition significantly the success of health authorities and professionals in the control immunopreventable diseases. Mutual collaboration with communication professionals is crucial to ensure useful, complete, contrasted and truthful information

[Efficiency indicators to contribute to sustainability of health services in Spain]. / Indicadores de eficiencia para contribuir a la sostenibilidad de los servicios de salud en España.

OBJECTIVE: Identifying a minimum set of efficiency indicators calculated from current information sources. Interventions adopted from the analysis of these indicators could contribute to health services sustainability. METHOD: We applied the discussion group technique. A total of 23 quality coordinators from around the country and the representatives of the regional quality societies in SECA (Spanish Society for Quality in Healthcare) participated. RESULTS: Ten efficiency indicators useful for integrated management areas were identified and accepted, 5 in the area of primary care and 5 for hospital management. CONCLUSION: The efficiency indicators agreed upon could contribute to the sustainability of the health system without this affecting the quality of care.

Indicadores de eficiencia para contribuir a la sostenibilidad de los servicios de salud en España / Efficiency indicators to contribute to sustainability of health services in Spain

Objetivo. Identificar un conjunto mínimo de indicadores de eficiencia que puedan ser calculados a partir de las fuentes de información actuales a partir de los cuales puedan adoptarse medidas que contribuyan a la sostenibilidad de los servicios de salud. Método. Grupos de discusión con participación de 23 coordinadores de calidad de centros e institucionales sanitarias de todo el país y los representantes de las sociedades autonómicas de calidad en Sociedad Española de Calidad Asistencial (SECA). Resultados. Se identificaron y priorizaron por consenso 10 indicadores de eficiencia útiles para áreas integradas de gestión, 5 en el ámbito de la atención primaria y 5 en el ámbito de la gestión hospitalaria. Conclusión. Los indicadores de eficiencia consensuados pueden contribuir a la sostenibilidad del sistema de salud sin por ello mermar la calidad de la atención prestada (AU)

Objective. Identifying a minimum set of efficiency indicators calculated from current information sources. Interventions adopted from the analysis of these indicators could contribute to health services sustainability. Method. We applied the discussion group technique. A total of 23 quality coordinators from around the country and the representatives of the regional quality societies in SECA (Spanish Society for Quality in Healthcare) participated. Results. Ten efficiency indicators useful for integrated management areas were identified and accepted, 5 in the area of primary care and 5 for hospital management. Conclusion. The efficiency indicators agreed upon could contribute to the sustainability of the health system without this affecting the quality of care (AU)

Conjunto de indicadores de calidad y seguridad para hospitales de la Agencia Valenciana de Salud / A set of quality and safety indicators for hospitals of the «Agencia Valenciana de Salud»

Objetivos: Elaborar un conjunto de indicadores de calidad y seguridad en el contexto de los hospitales de la Agencia Valenciana de Salud. Material y métodos: Se utilizó la técnica Metaplan® para identificar propuestas sobre sostenibilidad y enfermería. Se empleó el catálogo de la Sociedad Española de Calidad Asistencial como punto de partida para los indicadores clínicos. Utilizando la Técnica Delphi 207 profesionales fueron invitados a participar en el proceso para identificar los indicadores más fiables y factibles. Finalmente, la propuesta resultante fue validada por los directivos de 12 hospitales, teniendo en cuenta la variabilidad, objetividad, factibilidad, fiabilidad y sensibilidad de los indicadores. Resultados: La tasa de participación osciló entre el 66,67 y 80,71%. De los 159 indicadores de la propuesta inicial se priorizaron y seleccionaron 68 (21 económicos o de gestión, 22 de cuidados de enfermería y 25 clínicos). De ellos 3 eran comunes a las 3 categorías y 2 no cumplían los criterios específicos de la fase de validación, por lo que el conjunto final consta de 63 indicadores. Conclusiones: Se ha elaborado un conjunto de indicadores de calidad y seguridad. El sistema de información actual permite su monitorización (AU)

Objectives: To prepare a set of quality and safety indicators for Hospitals of the «AgenciaValenciana de Salud». Material and methods: The qualitative technique Metaplan® was applied in order to gather proposals on sustainability and nursing. The catalogue of the «Spanish Society of Quality in Healthcare» was adopted as a starting point for clinical indicators. Using the Delphi technique, 207 professionals were invited to participate in the selecting the most reliable and feasible indicators. Lastly, the resulting proposal was validated with the managers of 12 hospitals, taking in to account the variability, objectivity, feasibility, reliability and sensitivity, of the indicators. Results: Participation rates varied between 66.67% and 80.71%. Of the 159 initial indicators, 68 were prioritized and selected (21 economic or management indicators, 22 nursing indicators, and 25 clinical or hospital indicators). Three of them were common to all three categories and two did not match the specified criteria during the validation phase, thus obtaining a final catalogue of 63 indicators. Conclusions: A set of quality and safety indicators for Hospitals was prepared. They are currently being monitored using the hospital information systems (AU)

[A set of quality and safety indicators for hospitals of the "Agencia Valenciana de Salud"]. / Conjunto de indicadores de calidad y seguridad para hospitales de la Agencia Valenciana de Salud.

OBJECTIVES: To prepare a set of quality and safety indicators for Hospitals of the «Agencia Valenciana de Salud¼. MATERIAL AND METHODS: The qualitative technique Metaplan® was applied in order to gather proposals on sustainability and nursing. The catalogue of the «Spanish Society of Quality in Healthcare¼ was adopted as a starting point for clinical indicators. Using the Delphi technique, 207 professionals were invited to participate in the selecting the most reliable and feasible indicators. Lastly, the resulting proposal was validated with the managers of 12 hospitals, taking into account the variability, objectivity, feasibility, reliability and sensitivity, of the indicators. RESULTS: Participation rates varied between 66.67% and 80.71%. Of the 159 initial indicators, 68 were prioritized and selected (21 economic or management indicators, 22 nursing indicators, and 25 clinical or hospital indicators). Three of them were common to all three categories and two did not match the specified criteria during the validation phase, thus obtaining a final catalogue of 63 indicators. CONCLUSIONS: A set of quality and safety indicators for Hospitals was prepared. They are currently being monitored using the hospital information systems.

Cómo valoran los pacientes en situación de baja laboral al médico inspector: la experiencia del Institut Català d’Avaluacions Mèdiques (ICAM) en Cataluña / How the patients on sick leave assess the Medical Inspector: The Institut Català d’Avaluacions Mèdiques (ICAM) experience in Catalonia

Objetivo. Analizar la opinión que tienen los pacientes en incapacidad laboral de los médicos evaluadores/inspectores y explorar si esta valoración está condicionada por el resultado del dictamen médico. Material y métodos. Estudio descriptivo, transversal, basado en encuestas telefónicas a una muestra aleatoria de pacientes atendidos en Cataluña por incapacidad laboral temporal (IT) o permanente (IP). El estudio de campo ha sido realizado en noviembre de 2011. Muestreo por conglomerados considerando: tiempo desde la consulta y provincia donde fue atendido. Se utilizó una escala valorada mediante coeficiente de Correlación Intraclase (0,93, IC 95% 0,92-0,94) y prueba de Spearman-Brown de la división por mitades (0,93). Resultados. Respondieron 609 pacientes, de los que 400 (65,7%) realizaron una valoración positiva de la atención del médico. Cuando la IP fue denegada la valoración del médico fue peor (p=0,002); no sucedió igual en la IT. Los pacientes en IP que no continuaron en esta situación manifestaron que las decisiones del médico respondían a otros intereses distintos a la salvaguarda de los derechos del paciente (Odds Ratio 2,8; IC95% 1,7-4,8). Cuando el dictamen es negativo los pacientes centraron sus críticas en el médico evaluador (p<0,001) y no en la organización. Conclusiones. Un dictamen negativo en el caso de IP se asocia a una valoración negativa de la actuación, capacidad e independencia de criterio del médico. No sucede lo mismo en el caso de la IT (AU)

Objective. To analyse the patient perception of the medical inspector, and to examine whether this perception is related with the outcome of the medical report. Material and Methods. A cross-sectional study based on telephone interviews with a random sample of patients visited in Catalonia in 2010 for temporary (TSL) or permanent (PSL) sick leave. The study was conducted in November 2011. A stratified sample considering the time from the consultation and province where patients were visited was used. The scale was assessed by Intraclass Correlation coefficient (0.93, 95% CI; 0.92-0.94) and testing with the Spearman-Brown split-half coefficient (0.93). Results. A total of 609 patients were surveyed. A majority of them (400; 65.7%) had a positive opinion of the medical inspector. When PSL was denied, the assessment was worse (P=.002), this was different when TSL was cancelled. Patients who did not continue in PSL stated that doctor's decisions were determined by non-medical interests, and not oriented to the defence of the patient's rights (odds ratio 2.8, 95% CI; 1.7 to 4.8). When the perceptions were negative, patients focus their criticism on the role of medical inspector (P<.001), and not about the organisational aspects. Conclusions. When inspectors cancel PSL, patient's perception is strongly associated with a negative assessment of their performance, capacity and independence of the physician. This is not so in the case of TSL (AU)

[How the patients on sick leave assess the Medical Inspector: The Institut Català d'Avaluacions Mèdiques (ICAM) experience in Catalonia]. / Cómo valoran los pacientes en situación de baja laboral al médico inspector: la experiencia del Institut Català d'Avaluacions Mèdiques (ICAM) en Cataluña.

OBJECTIVE: To analyse the patient perception of the medical inspector, and to examine whether this perception is related with the outcome of the medical report. MATERIAL AND METHODS: A cross-sectional study based on telephone interviews with a random sample of patients visited in Catalonia in 2010 for temporary (TSL) or permanent (PSL) sick leave. The study was conducted in November 2011. A stratified sample considering the time from the consultation and province where patients were visited was used. The scale was assessed by Intraclass Correlation coefficient (0.93, 95% CI; 0.92-0.94) and testing with the Spearman-Brown split-half coefficient (0.93). RESULTS: A total of 609 patients were surveyed. A majority of them (400; 65.7%) had a positive opinion of the medical inspector. When PSL was denied, the assessment was worse (P=.002), this was different when TSL was cancelled. Patients who did not continue in PSL stated that doctor's decisions were determined by non-medical interests, and not oriented to the defence of the patient's rights (odds ratio 2.8, 95% CI; 1.7 to 4.8). When the perceptions were negative, patients focus their criticism on the role of medical inspector (P<.001), and not about the organisational aspects. CONCLUSIONS: When inspectors cancel PSL, patient's perception is strongly associated with a negative assessment of their performance, capacity and independence of the physician. This is not so in the case of TSL.