Características sociodemográficas y variabilidad geográfica relacionada con la satisfacción del paciente en Atención Primaria / Sociodemographic characteristics and geographic variability associated with patient satisfaction in Primary Care

Objetivos. La satisfacción del paciente con los servicios sanitarios juega un rol importante en los programas de mejora de la calidad asistencial. Los objetivos de este estudio fueron: identificar las características sociodemográficas del paciente relacionadas con su satisfacción respecto a la atención proporcionada por el médico de familia en los centros de Atención Primaria de Salud (APS) y describir la variabilidad geográfica de este fenómeno en el Servicio Nacional de Salud español. Material y métodos. Los datos se obtuvieron de la Encuesta Europea de Salud de 2009. Se analizaron las razones de prevalencia (brutas y ajustadas) de las características asociadas tanto con una satisfacción excelente como de insatisfacción mediante regresión de Poisson, así como su variabilidad geográfica. Resultados. Aproximadamente uno de cada 3 usuarios de la APS consideró que la atención proporcionada había sido excelente, mientras que el 6,7% se mostró insatisfecho. Existió una amplia variabilidad en la percepción de satisfacción entre los distintos servicios regionales de salud, prevalencias que oscilaron entre el 10,9 y el 55,2%. Por otra parte, esta valoración estuvo estrechamente relacionada con la edad, el nivel de salud autopercibida, la salud mental, los ingresos hospitalarios previos, el estatus de enfermedad crónica y las limitaciones en las actividades diarias. Conclusiones. La satisfacción con la atención proporcionada por el médico de APS es relativamente alta. No obstante, presenta una distribución heterogénea entre las comunidades autónomas y las características sociodemográficas y el nivel de salud del usuario (AU)

Background. Patient satisfaction with health services plays an important role in programs to improve the quality of care from the point of view of users. The objectives of this study were: To identify sociodemographic characteristics associated with patient satisfaction in the care provided by family doctors in Primary Health Care (PHC) centres, and describe the geographical variability of this phenomenon in the Spanish National Health Service. Material and methods. The data come from the European Health Survey (2009). Prevalence ratios (crude and adjusted) of the characteristics associated with both excellent satisfaction and dissatisfaction using Poisson regression, and their geographical variability are discussed. Results. About one in every 3 users of the PHC believes that the care provided was excellent, while 6.7% were dissatisfied. There is a wide variability in the perception of satisfaction among the various regional health services, with prevalence ranging between 10.9% and 55.2%. Moreover, this assessment is closely related to age, level of self-perceived health, mental health, previous hospitalisation, chronic disease status, and limitations in daily activities. Conclusions. Satisfaction with the care provided by the PHC physician is relatively high. However, the distribution between regions and socio-demographic characteristics and health status of the user is heterogeneous (AU)

[Sociodemographic characteristics and geographic variability associated with patient satisfaction in Primary Care]. / Características sociodemográficas y variabilidad geográfica relacionada con la satisfacción del paciente en Atención Primaria.

BACKGROUND: Patient satisfaction with health services plays an important role in programs to improve the quality of care from the point of view of users. The objectives of this study were: To identify sociodemographic characteristics associated with patient satisfaction in the care provided by family doctors in Primary Health Care (PHC) centres, and describe the geographical variability of this phenomenon in the Spanish National Health Service. MATERIAL AND METHODS: The data come from the European Health Survey (2009). Prevalence ratios (crude and adjusted) of the characteristics associated with both excellent satisfaction and dissatisfaction using Poisson regression, and their geographical variability are discussed. RESULTS: About one in every 3 users of the PHC believes that the care provided was excellent, while 6.7% were dissatisfied. There is a wide variability in the perception of satisfaction among the various regional health services, with prevalence ranging between 10.9% and 55.2%. Moreover, this assessment is closely related to age, level of self-perceived health, mental health, previous hospitalisation, chronic disease status, and limitations in daily activities. CONCLUSIONS: Satisfaction with the care provided by the PHC physician is relatively high. However, the distribution between regions and socio-demographic characteristics and health status of the user is heterogeneous.

Introducción de un sistema de acreditación para los documentos de consentimiento informado hospitalario / Introduction of an accreditation system for hospital informed consent forms

Objetivo: Describir la creación y funcionamiento de un sistema de acreditación de documentos de consentimiento informado (DCI) como intervención para mejorar su calidad formal y comprobar la mejora obtenida. Material y métodos: Tras una evaluación externa de la calidad de los DCI en un hospital de Murcia (España), se consensuaron los requisitos para los DCI y se diseñaron procedimientos de acreditación y uso. La efectividad se valoró comparando 2 evaluaciones externas del Programa EMCA (2011 y 2013), basadas en 19 criterios y muestras de 60 DCI para cada hospital público de la región. Resultados: Para ser acreditado un DCI debería cumplir 24 criterios: los 19 utilizados en evaluaciones externas, más 3 sobre legibilidad y 2 sobre validez científico-técnica. Se acordó un formulario para implementar los contenidos de cada DCI, que serían revisados y aprobados con vigencia de 5 años. Inicialmente se detectaron 8,2 defectos/DCI. La mejora obtenida fue del 89% (0,9 defectos/DCI), evidenciado mejoras significativas en 18 criterios y marcando benchmark para 16 de los 19 evaluados. Discusión: La acreditación supuso una mejora sustancial de los DCI del hospital (obteniendo el mejor resultado en las evaluaciones externas de su servicio de salud) y garantiza su contenido, legibilidad y comprensión. Ello obliga a valorar la conveniencia de su extensión a otros hospitales, aunque no esté clara la bondad de disponer de DCI comunes. Sin embargo, esta mejora es estructural y no garantiza que la globalidad del proceso de información/consentimiento que soporta se realice adecuadamente, precisando estrategias complementarias para su medición y mejora (AU)

Objective: To describe an accreditation system for informed consent forms (ICF) in a tertiary hospital, as an intervention to improve their quality, and to check the improvements achieved. Material and methods: Following an external evaluation of the ICF quality in a public hospital in Murcia (Spain), an accreditation committee set the ICF requirements and associated procedures. Effectiveness is assessed by comparing two external evaluations carried out by the EMCA Program (2011 and 2013) and based on 19 criteria and a sample of 60 ICF for every public hospital in Murcia Region. Results: To be accredited, every ICF must meet the 19 external criteria plus 5 based on legibility, readability and scientific and technical validity. A form to fill in the contents of every ICF was agreed, which would be reviewed, approved and validated for five years. Before the implementation, 8.2 defects/ICF were detected. The accreditation system obtained an 89% improvement (0.9 defects/ICF) and achieved significant improvements in 18 criteria, 16 of which are benchmarked. Discussion: The accreditation system achieved a substantial improvement in the ICF (obtaining a better result in external evaluations) and guarantees their contents, legibility and readability. This system needs to be extended to other hospitals, since it is not clear whether common ICFs would be suitable. However, this improvement is structural and does not guarantee that the overall information/consent procedure is done properly, thus complementary strategies for measurement and improvement are required (AU)

[Introduction of an accreditation system for hospital informed consent forms]. / Introducción de un sistema de acreditación para los documentos de consentimiento informado hospitalario.

OBJECTIVE: To describe an accreditation system for informed consent forms (ICF) in a tertiary hospital, as an intervention to improve their quality, and to check the improvements achieved. MATERIAL AND METHODS: Following an external evaluation of the ICF quality in a public hospital in Murcia (Spain), an accreditation committee set the ICF requirements and associated procedures. Effectiveness is assessed by comparing two external evaluations carried out by the EMCA Program (2011 and 2013) and based on 19 criteria and a sample of 60 ICF for every public hospital in Murcia Region. RESULTS: To be accredited, every ICF must meet the 19 external criteria plus 5 based on legibility, readability and scientific and technical validity. A form to fill in the contents of every ICF was agreed, which would be reviewed, approved and validated for five years. Before the implementation, 8.2 defects/ICF were detected. The accreditation system obtained an 89% improvement (0.9 defects/ICF) and achieved significant improvements in 18 criteria, 16 of which are benchmarked. DISCUSSION: The accreditation system achieved a substantial improvement in the ICF (obtaining a better result in external evaluations) and guarantees their contents, legibility and readability. This system needs to be extended to other hospitals, since it is not clear whether common ICFs would be suitable. However, this improvement is structural and does not guarantee that the overall information/consent procedure is done properly, thus complementary strategies for measurement and improvement are required.

Evaluación de la calidad formal de los documentos de consentimiento informado en 9 hospitales / Formal quality assessment of informed consent documents in 9 hospitals

Introducción. Los formularios de consentimiento informado tienen una gran importancia en el proceso de información médica. El objetivo de este estudio es diseñar criterios de calidad formal para estos documentos, que sean fiables, y su utilización para la valoración de los utilizados por los hospitales de un servicio regional de salud. Material y métodos. El diseño de los criterios se ha realizado a partir del análisis de la normativa vigente, estudios anteriores y consulta con expertos clave. El grado de concordancia interobservador se valoró mediante el índice kappa. La evaluación de los criterios se realizó en 1.425 documentos de 9 hospitales. Resultados. Se han diseñado 19 criterios con los que se evaluó la calidad de los formularios. Los valores kappa eran mayores de 0,60 en 17 de ellos y superiores a 0,52 en los otros 2. El promedio de defectos por documento fue de 7,6 con una razón de variación entre hospitales de 1,84. Más del 90% de los documentos presentaban defectos en la información sobre las consecuencias y contraindicaciones, y en cerca del 90% no constaba la entrega de copia. Más del 60% tenían incumplimientos relacionados con la finalidad del procedimiento, la declaración de haber comprendido y aclarado dudas y las alternativas. Conclusiones. Se ha obtenido una herramienta que permite valorar de modo fiable la calidad formal de los documentos de consentimiento informado. Los formularios valorados tienen un amplio margen para la mejora, relacionada con la entrega de copia y algunos aspectos de la información específica que el paciente debe recibir(AU)

Introduction. Informed consent forms are very important in the process of medical information. The aim of this study is to design reliable formal quality criteria of these documents and their application in the evaluation of those used in the hospitals of a regional health service. Material and methods. Criteria have been designed from the analysis of existing regulations, previous studies and consultation with key experts. The interobserver concordance was assessed using the kappa index. Criteria evaluation was performed on 1425 documents of 9 hospitals. Results. A total of 19 criteria used in the evaluation of the quality of informed consent forms have been obtained. Kappa values were higher than 0,60 in 17 of them and higher than 0,52 in the other 2. The average number of defects per document was 7.6, with a high-low ratio among hospitals of 1.84. More than 90% of the documents had defects in the information on consequences and contraindications, and in about 90% it did not mention the copy to the patient. More than 60% did not comply with stating the purpose of the procedure, a statement of having understood and clarified doubts, and the treatment options. Conclusions. A tool has been obtained to reliably assess the formal quality of the informed consent forms. The documents assessed have a wide margin for improvement related to giving a copy to the patient, and some aspects of the specific information that patients should receive(AU)

[Formal quality assessment of informed consent documents in 9 hospitals]. / Evaluación de la calidad formal de los documentos de consentimiento informado en 9 hospitales.

INTRODUCTION: Informed consent forms are very important in the process of medical information. The aim of this study is to design reliable formal quality criteria of these documents and their application in the evaluation of those used in the hospitals of a regional health service. MATERIAL AND METHODS: Criteria have been designed from the analysis of existing regulations, previous studies and consultation with key experts. The interobserver concordance was assessed using the kappa index. Criteria evaluation was performed on 1425 documents of 9 hospitals. RESULTS: A total of 19 criteria used in the evaluation of the quality of informed consent forms have been obtained. Kappa values were higher than 0,60 in 17 of them and higher than 0,52 in the other 2. The average number of defects per document was 7.6, with a high-low ratio among hospitals of 1.84. More than 90% of the documents had defects in the information on consequences and contraindications, and in about 90% it did not mention the copy to the patient. More than 60% did not comply with stating the purpose of the procedure, a statement of having understood and clarified doubts, and the treatment options. CONCLUSIONS: A tool has been obtained to reliably assess the formal quality of the informed consent forms. The documents assessed have a wide margin for improvement related to giving a copy to the patient, and some aspects of the specific information that patients should receive.

Lactancia materna en la Región de Murcia. ¿Seguimos con el problema? / Maternal breastfeeding in the Region of Murcia, does the

Objetivo: Conocer la prevalencia y la duración de la lactancia materna (LM) en la Región de Murcia. Método: Estudio transversal (junio de 2007), mediante encuestas a madres de niños menores de 24 meses realizadas en centros de vacunación. El ámbito de estudio estuvo comprendido por 77 zonas de salud de 6 áreas sanitarias de la región, y el muestreo fue proporcional al número de niños nacidos en el área. Se recogieron datos sociosanitarios del niño, de la madre y de la alimentación del niño. Se calculó la prevalencia de LM según las categorías definidas por la Organización Mundial de Salud (OMS) y se estudiaron los motivos de no iniciar y de abandonar la LM. Resultados: Se obtuvieron datos de 1.836 niños, con una tasa de respuesta del 95,2%. Al alta del hospital, un total de 1.643 niños (89,7%) fueron alimentados con LM; de éstos, el 76,7% (n= 1.405) lo hicieron sin suplementos nutritivos. Al tercer mes mantenían la LM completa el 44,4% y al sexto mes el 36,3%. La mediana de duración de LM exclusiva fue de 75 días y para la LM parcial de 129 días. Los motivos de no alimentar con LM fueron: enfermedad/ingreso (46,7%), falta de leche (28,6%) y decisión de la madre (19,3%). Entre las causas de abandono, cabe citar las siguientes: hipogalactia e insaciabilidad (29,3%) y escasa ganancia de peso (11%). Las variables que mostraron una asociación estadísticamente significativa (p <0,05) con la LM fueron el peso del niño, el tipo de parto y el área sanitaria, y, en relación con la madre, la edad, la paridad, la actividad laboral, el lugar de procedencia y el nivel de estudios. Conclusiones: Las cifras de LM en la Región de Murcia son similares a las de nuestro entorno, pero se alejan de las recomendadas por la OMS (AU)

Title: Maternal breastfeeding in the Region of Murcia, does the problem persist? Objective: To study the prevalence and duration of maternal breastfeeding (MB) in the Region of Murcia. Methods: Cross-sectional study (June, 2007). Mothers of infants under 24 months old were surveyed in immunization centers. The study was conducted through the 77 health zones of the 6 health areas of the Region. The sample size was proportion alto the number of newborns in these areas. Breast-fed baby, mother and child feeding social and health data were collected. The MB prevalence was calculated in accordance with the categories defined by the World Health Organization (WHO) and the reasons for not starting and for stopping MB were studied. Results: Data from 1,836 infants (response rate of 95.2%) has been obtained. Upon hospital discharge, the percentage of children fed with MB was of 89.7% (1,643), 76.7% (1,405) of which were breastfed without nourishing supplements. 44.4%of infants exclusively MB at 3 months and 36.3% at 6 months. The median duration of exclusive MB was of 75 days and of129 days for partial MB. The reasons for not being fed by MB were: disease/admission (46.7%), lack of milk (28.6%), and mother’s decision (19.3%). The reasons for discontinuing breastfeeding were: hypogalactia and insatiable appetite (29.3%), and not to put on weight (11%). The variables that showed statistically significant association (p < 0.05) regarding MB were child weight, type of childbirth, and health area, and, regarding the mother, age, parity, occupation, place of origin, and education. Conclusions: The MB figures in the Region of Murcia are similar to those in our environment, but are far from those recommended by the WHO (AU)

[Reliability of coding of diagnoses recorded in the computerized information system at primary health care centers]. / Fiabilidad de la codificación del diagnóstico registrado en las hojas de consulta del sistema de información informatizado de centros de atención primaria (SICAP).

OBJECTIVE: To find the reliability of the coding of diagnoses in the doctor's note in this computer system and to analyse where there are most discrepancies. DESIGN: An observational study. The concordance between the reason for consultation, codified by an external assessor, and the coding of the main diagnosis. SETTING: Health Districts 17 (Murcia/Barrio del Carmen) and 66 (Molina de Segura/La Ribera) in the Autonomous Community of Murcia. PATIENTS: A sub-sample of 228 consultations, belonging to a larger study of 1,904 general medical consultations (total: 98,768 consultations). MEASUREMENTS AND MAIN RESULTS: There were discrepancies between the coding of the reason for consultation and the diagnosis in 23% of the consultations recorded. The reason for consultation was not correctly recorded in 12.3%. The diagnostic group or section with the highest level of agreement was number XVIII or the supplementary section; and with the least agreement in XVII (injuries and adverse side-effects) and Number V covering mental disorders. CONCLUSIONS: Quality control of information and its validation enables errors and problems in the systems to be identified and corrected. This study points to the need to improve the filling-out of the reason for consultation and activity carried out, in order to obtain afterwards a more reliable coding of the diagnosis.

[Health services accessibility in the Murcia region]. / Accesibilidad a los dispositivos sanitarios de la región de Murcia.

OBJECTIVES: To find the geographical accessibility of primary care services and their support facilities. DESIGN: An observational, crossover study. SETTING: Primary health care. PATIENTS OR OTHER PARTICIPANTS: All those collective and single population groupings (354), included in the population register of the Murcia region with 100 or more inhabitants listed or with less inhabitants but with a health care post. MEASUREMENTS AND MAIN RESULTS: The time (crona) taken by the population of the different health districts and areas of the region to reach primary care and support services was determined by direct observation. Crona was defined as the average of three measurements of the time taken to reach these services by people using their normal means of transport and not exceeding the highway code's speed limits. 335 care posts were counted. Only 1,56% of the population, all belonging to Health Area 4, needed more than 30 minutes to reach their local doctor. 18,36% of the population needed more than 30 minutes to reach their referral hospitals. CONCLUSIONS: The number and distribution of facilities in the health care network guarantee adequate access to their services, except in Area 4. Specific studies will have to be designed to check that access problems are connected more to the road network and transport used than to the number and location of care centres.