[The opinion of the users as opportunity for improvement in primary health care]. / La opinión de los usuarios como oportunidad de mejora en atención primaria.

OBJECTIVES: To determine those aspects of Primary Care Center (PCC) that displeases more the clients/users, to investigate its determinants, and to apply the intervention or corresponding interventions. DESIGN: Results evaluation oriented. Detection of dissatisfaction reasons through cross observational study from survey self-fulfilled on 200 individuals selected through random cluster sampling. A continuous improvement group was implemented in order to the factors causing detected problems and their possible solutions were analyzed. LOCATION: Rambla PCC, Sant Feliu de Llobregat. Catalonian Health Institute. PARTICIPANTS AND CONTEXT: Users/clients of the PCC who were in the waiting room. Improvement Group: Professionals of Sant Feliu Primary Care Team and Baix Llobregat Nord Primary Care Service. INTERVENTIONS: Reorganization of the family doctors' agendas and reduction of bureaucratic tasks in the physicians' offices. PRINCIPAL MEASUREMENTS: Respondents socio-demographic data, and reasons for their dissatisfaction. Determinants of the problem were analyzed. The principal cause of discomfort was the delay of previous appointment. RESULTS: Among reasons for discomfort expressed by the users, the most frequent was lag time with 16% (95% CI, 10.9-21.1). This complaint referred both to wait for obtaining visit and to be in the waiting room before being visited. As determinants of delay there were identified a high number of patients, visits duplicity, bureaucratic visits, high number of urgent visits and an insufficient previous appointment visits. CONCLUSIONS: Patient's opinions help us to know how public health services are accomplishing their expectations. Process improvement is indispensable in order to provide a quality product, but it must be endowed with resources adequacy to population needs.

La opinión de los usuarios como oportunidad de mejora en atención primaria / The opinion of the users as opportunity for improvement in primary health care

Objetivos. Determinar los aspectos del centro de atención primaria (CAP) que desagradan más a los clientes/usuarios, investigar sus determinantes y aplicar la intervención o intervenciones correspondientes. Diseño. Evaluación orientada hacia los resultados. Detección de los motivos de insatisfacción a través de un estudio observacional transversal a partir de una encuesta autocumplimentada en 200 individuos seleccionados mediante muestreo aleatorio por conglomerados. Constitución de un grupo de mejora continua para investigar los factores determinantes de los problemas detectados y sus posibles soluciones. Emplazamiento. CAP Rambla, Sant Feliu de Llobregat, del Instituto Catalán de la Salud. Participantes y contexto. Usuarios/clientes de la sala de espera del CAP. Grupo de mejora: profesionales del Equipo de Atención Primaria Sant Feliu y del Servicio de Atención Primaria Baix Llobregat Nord. Intervenciones. Reorganización de las agendas de los médicos de cabecera y disminución de las tareas burocráticas en las consultas. Mediciones principales. Variables sociodemográficas de los encuestados y motivos de insatisfacción de éstos. Se procedió a analizar los determinantes del problema. La variable principal fue la demora de la cita previa. Resultados. Entre los motivos de insatisfacción expresados por los usuarios, el más frecuente fue el tiempo de demora, con un 16% (intervalo de confianza [IC] del 95%, 10,9-21,1). Esta queja se refería tanto a la espera para obtener un visita como al tiempo en la sala de espera. Como determinantes de la demora se identificaron el número elevado de pacientes, la duplicación de visitas, las visitas burocráticas, el número elevado de visitas urgentes y la cita previa insuficiente. Conclusiones. La opinión de los usuarios nos ayuda a conocer en qué medida los servicios públicos de salud están cumpliendo sus expectativas. La mejora de los procesos es un paso fundamental para la mejora continua, pero debe ir acompañada de recursos adecuados a las necesidades de la población

Objectives. To determine those aspects of Primary Care Center (PCC) that displeases more the clients/users, to investigate its determinants, and to apply the intervention or corresponding interventions. Design. Results evaluation oriented. Detection of dissatisfaction reasons through cross observational study from survey self-fulfilled on 200 individuals selected through random cluster sampling. A continuous improvement group was implemented in order to the factors causing detected problems and their possible solutions were analyzed. Location. Rambla PCC, Sant Feliu de Llobregat. Catalonian Health Institute. Participants and context. Users/clients of the PCC who were in the waiting room. Improvement Group: Professionals of Sant Feliu Primary Care Team and Baix Llobregat Nord Primary Care Service. Interventions. Reorganization of the family doctors' agendas and reduction of bureaucratic tasks in the physicians' offices. Principal measurements. Respondents socio-demographic data, and reasons for their dissatisfaction. Determinants of the problem were analyzed. The principal cause of discomfort was the delay of previous appointment. Results. Among reasons for discomfort expressed by the users, the most frequent was lag time with 16% (95% CI, 10.9-21.1). This complaint referred both to wait for obtaining visit and to be in the waiting room before being visited. As determinants of delay there were identified a high number of patients, visits duplicity, bureaucratic visits, high number of urgent visits and an insufficient previous appointment visits. Conclusions. Patient's opinions help us to know how public health services are accomplishing their expectations. Process improvement is indispensable in order to provide a quality product, but it must be endowed with resources adequacy to population needs

[Analysis of the claims in a specialist primary care center]. / Análisis de las reclamaciones en un centro de atención primaria de salud de especialidades.

OBJECTIVE: To analyze the written claims attended at a specialists unit of a Primary Health Care Center in Nou Barris, Barcelona. DESIGN: Evaluative observational study. SETTING: Health Care District of Nou Barris, with a population of 170,849. Period of study covers claims attended between 1-6-1996 to 31-12-1998. PARTICIPANTS: 220 claims registered at a specialist unit of a primary health care center. MEASUREMENTS: Claimer's age and gender, heath care net of origin, claim's motive, claimed person or service and health care activity. Statistical analyses performed included descriptive techniques and Khi-square (chi 2) tests (alpha = 0.05). RESULTS: Cumulative incidence of claims was 4.03 per 10,000 person-year in 1996, 4.70 in 1997 and 5.88 in 1998 (p = 0.0128). 220 claims were analyzed, 53.1% of them came from women. Mean age was 51.12 +/- 15.8 years. 60% of claims came from people using the traditional health care net, and 40% from reformed health care net. Mean time of response was 12.3 +/- 12.7 days. Ophthalmology was the most claimed service (18.64%), followed by "the system" (13.64%), and "the center" (13.64%). 64% of claims pointed to specialists, and don't adjusted with their health care activity (p = 0.0001). Relative risk of being claimed at the specialists unit was 2.91, compared to the rest of the primary health care centers of Nou Barris in 1998. CONCLUSIONS: Health care user's claims become useful to detect some difficult aspects. However, improvements in the methodology of their evaluation are needed.

Análisis de las reclamaciones en un centro de atención primaria de salud de especialidades / Analysis of claims to specialists in a primary health care center

Objetivo. Analizar las reclamaciones presentadas en la Unidad de Atención al Usuario del Centro de Atención Especializada de la Dirección de Atención Primaria (DAP) Nou Barris de Barcelona ciudad. Diseño. Investigación evaluativa observacional. Emplazamiento. DAP de Nou Barris que atiende una población de 170.849 personas, según datos censales de 1996. El período de estudio comprende las reclamaciones presentadas entre el 1 de junio de 1996 y el 31 de diciembre de 1998. Participantes. Cada una de las 220 reclamaciones registradas en el centro de atención especializada. Mediciones. Edad y género del demandante, modelo asistencial de procedencia, motivo de la reclamación, persona o servicio reclamado y actividad de la consulta. Se ha utilizado la descripción estadística y las pruebas de ji-cuadrado (*2) pertinentes. El riesgo * ha sido del 5 por ciento. Resultados. La incidencia acumulada del número de reclamaciones ha sido de 4,03 por 10.000 personas-año en 1996, de 4,70 en 1997 y de 5,88 en 1998 (p = 0,0128). De las 220 reclamaciones registradas, un 53,1 por ciento corresponde a mujeres. La edad media es de 51,12 ñ 15,80 años. El 60 por ciento de las reclamaciones proviene de la asistencia no reformada y el 40 por ciento de la reformada. El tiempo medio de demora en la respuesta es de 12,3 ñ 12,7 días. Las reclamaciones más frecuentes van dirigidas a oftalmología (18,64 por ciento), al sistema (13,64 por ciento) y al centro (13,64 por ciento). El 64 por ciento de las reclamaciones van dirigidas a médicos especialistas y no se ajustan a la actividad asistencial desarrollada (p = 0,0001). El riesgo relativo de presentar reclamaciones en el centro de atención especializada fue de 2,91 respecto del resto de centros de la DAP Nou Barris en 1998. Conclusiones. Las reclamaciones de los usuarios de la atención primaria de salud son un instrumento útil para detectar algunos aspectos conflictivos. Sin embargo, hay que mejorar la metodología de evaluación de las mismas (AU)

[Factors conditioning absenteeism among primary care physicians]. / Factores condicionantes del absentismo laboral entre los médicos de atención primaria.

OBJECTIVES: To find whether the variables age, gender, speciality, training and type of contract of primary care doctors, as well as the size of their patient lists and the sort of centre where they work, affect their absenteeism, as measured by time off work sick. DESIGN: An observational, crossover study. SETTING: Nou Barris, sub-division of Barcelona City, primary care (PC) district during 1994. PARTICIPANTS: Doctors. MEASUREMENTS AND MAIN RESULTS: In the PC district there were 121 doctors, counting PC teams (PC), traditional system (TS) and specialists. Bivariant epidemiological and statistical techniques were used to verify the relationships between variables. Alpha risk was 5%. 40% of the District's doctors had some time off sick during the year. There were 79 occasions of time off (74 were for short-term sickness and 5 for maternity). Total days lost were 2,477, an average of 31.35. Time off work was related to the age of the doctors and the number of patients attending. Centres where the reform had been implemented had very few cases of time off. CONCLUSIONS: Cases of time off work for sickness among primary care doctors are mainly concentrated in the non-reformed network. It would be useful to study ways of increasing these doctors' motivation.