[Job satisfaction and improvement factors in primary care professionals]. / Satisfacción laboral y factores de mejora en profesionales de atención primaria.

BACKGROUND: The quality of services in a health system is related to the level of satisfaction of its professionals. The aim of this article is to determine job satisfaction in primary care professionals and rank those factors capable of improving it. METHODOLOGY: Descriptive study carried out in Navarre in 2010. A validated questionnaire was sent by post to the population of the study: primary care doctors, pediatricians and nurses. Variables on socio-demographic data were collected and job satisfaction was self-evaluated on a scale of 1 to 10. Respondents were asked to rank 10 factors that could improve the previously mentioned satisfaction. Averages were compared and bivariate analysis was carried out using the chi-square test, studying the association between variables through the Odds Ratio (OR). The adjusted analysis was realized through unconditional logistic regression. RESULTS: We collected 432 questionnaires (77.5%). Average satisfaction was 6.7 (scale of 1 to 10), higher in nursing. Women showed a higher average than men (6.90:6.34). The workers at urban health centers (OR: 1.71; CI: 1.10-2.65) showed a higher risk of dissatisfaction with respect to professionals at rural centers. The training activities of the professional is the most highly valued item, followed by economic questions and questions of care pressure, with no differences found by profession. CONCLUSION: Job satisfaction is a dimension of quality management in primary care and its study enables identification of problems or opportunities for improvement with an impact on the quality of the services offered.

Satisfacción laboral y factores de mejora en profesionales de atención primaria / Job satisfaction and improvement factors in primary care professionals

Fundamento. La calidad de los servicios en un sistema sanitario está relacionada con el nivel de satisfacción de sus profesionales. El objetivo de este trabajo es conocer la satisfacción laboral y jerarquizar aquellos factores capaces de mejorarla, en profesionales de atención primaria. Metodología. Estudio descriptivo realizado en 2010 en Navarra. Se remitió por correo un cuestionario validado a la población de estudio: médicos, pediatras y enfermería de atención primaria. Se recogen variables de datos sociodemográficos y autocalificación de su satisfacción laboral en escala de 1 a 10. Se solicita la jerarquización de 10 factores que puedan mejorar la satisfacción previa señalada. Se realizó comparación de medias y análisis bivariante mediante el test de la Chi cuadrado, estudiando la asociación entre variables mediante la Odds Ratio (OR). El análisis ajustado se realizó mediante regresión logística no condicional. Resultados. Se recogieron 432 cuestionarios (77,5%). La satisfacción media fue 6,7 (escala 1 a 10), más alta en enfermería. Las mujeres presentaron una media superior a los hombres (6,90: 6,34).Los trabajadores de centros de salud urbanos (OR:1,71; IC:1,10-2,65) presentaron un mayor riesgo de insatisfacción respecto a los profesionales de centros rurales. Las actividades formativas de los profesionales es elítem más valorado, seguido de razones económicas y de presión asistencial, no encontrándose diferencias por profesión. Conclusión. La satisfacción laboral es una dimensión de la gestión de calidad en atención primaria y su estudio permite identificar problemas u oportunidades de mejora con impacto en la calidad de los servicios que se ofertan (AU)

Background. The quality of services in a health system is related to the level of satisfaction of its professionals. The aim of this article is to determine job satisfaction in primary care professionals and rank those factors capable of improving it. Methodology. Descriptive study carried out in Navarre in 2010. A validated questionnaire was sent by post to the population of the study: primary care doctors, pediatricians and nurses. Variables on socio-demographic data were collected and job satisfaction was self-evaluated on a scale of 1to 10. Respondents were asked to rank 10 factors that could improve the previously mentioned satisfaction. Averages were compared and bivariate analysis was carried out using the chi-square test, studying the association between variables through the Odds Ratio (OR). The adjusted analysis was realized through unconditional logistic regression. Results. We collected 432 questionnaires (77.5%). Average satisfaction was 6.7 (scale of 1 to 10), higher in nursing. Women showed a higher average than men (6.90:6.34).The workers at urban health centers (OR: 1.71; CI: 1.10-2.65) showed a higher risk of dissatisfaction with respect to professionals at rural centers. The training activities of the professional is the most highly valued item, followed by economic questions and questions of care pressure, with no differences found by profession. Conclusion. Job satisfaction is a dimension of quality management in primary care and its study enables identification of problems or opportunities for improvement with an impact on the quality of the services offered (AU)

Identificación de problemas y propuestas para mejorar la atención de las urgencias extrahospitalarias en Navarra: un estudio Delphi / Identification of problems and proposals for improving outpatient emergency care in Navarre: a Delphi study

Fundamento. Las urgencias extrahospitalarias de Navarra sufrieron modificaciones en la organización hace dos años, destacando la creación del servicio de urgencias rural (SUR) que coexiste geográficamente con el servicio normal de urgencias. El objetivo del estudio es conocer la opinión de expertos sobre los problemas y las recomendaciones de mejora que afectan a las urgencias extrahospitalarias. Metodología. Se realizó un estudio Delphi con la participación de 37 expertos (médicos y enfermeras). Por medio del correo electrónico se realizan 3 rondas de cuestionarios sucesivos. El último cuestionario identifica el grado de acuerdo con las ideas del grupo y se identifican los 15 problemas y recomendaciones más relevantes, seleccionando aquellas ideas que alcancen, al menos, el 50 % de acuerdo y una prioridad superior al percentil 25. Agrupamos las ideas mediante análisis de clúster jerárquico. Resultados. Se identifican 4 clúster de problemas, destacando entre ellos que “la población utiliza las urgencias para patología banal, como una consulta más” con una puntuación de 297 puntos. De las recomendaciones, con 3 clúster identificados, destaca la “necesidad de diseñar un plan estratégico de atención a las urgencias con unos recursos acorde a las necesidades” (310 puntos de prioridad) y “enviar mensajes claros a la población sobre uso correcto de urgencias” (192 puntos de prioridad). Conclusión. El método Delphi identifica problemas y áreas de mejora a través del consenso (AU)

Background. Two years ago there were alterations to outpatient A and E departments in Navarre; in particular, a rural A and E service (Servicio de Urgencias Rural, SUR) was set up, which coexists geographically with the normal A and E service. The aim of this study is to determine the opinion of experts on problems and recommendations for improvements that affect outpatient A and E services. Methodology. A Delphi study was carried out with the participation of 37 experts (doctors and nurses). Threes successive rounds of questionnaires were completed using email. The final questionnaire identified degree of agreement with the group’s ideas, and the 15 most relevant problems and recommendations were identified; those ideas that were selected achieved at least 50% agreement and their priority was above 25%. We grouped the ideas using a hierarchic cluster analysis. Results. Four cluster problems were identified; the most outstanding amongst them being “the population uses A and E for banal pathologies, just like any other consultation” with a score of 297 points. Outstanding amongst the recommendations, with 3 identified clusters, were the “need to design a strategic plan for A and E care with resources appropriate to the needs” (310 priority points) and “sending clear messages to the population on the correct use of A and E” (192 priority points). Conclusion. The Delphi method identifies problems and improvement areas through consensus (AU)

Efectividad de la atención primaria de salud en el diagnóstico y tratamiento de la hipertensión arterial / Effectiveness of primary health care in the diagnosis and treatment of arterial hypertension

La hipertensión arterial (HTA) es un importante problema de salud pública, por su elevada morbimortalidad cardiovascular y sus costes económicos y sociales. Fundamento: Identificar la prevalencia de HTA detectada en atención primaria y su grado de control; conocerlos tipos de tratamientos utilizados y factores asociados a su control. Pacientes y métodos: Estudio transversal comparativo de dos años en el Centro de Salud de Villava. Se analizan los datos de la historia clínica informatizada en los años 2003 y 2006. Se estudian las variables: edad, género, pensión arterial sistólica y diastólica, colesterol total, HDL, LDL, triglicéridos, tabaquismo, índice de masa corporal en ambos años. Tratamiento hipotensor en el año 2006. Mediante regresión logística se identifican las variables del año 2006 asociadas a buen control. Resultados: Prevalencia detectada de HTA en ≥ 18 años: 2003: 11,6% (IC:10,9-12,3); 2006: 16,6% (IC:15,8-17,4)(p<0,001). En hipertensos con registro de presión arterial estaban controlados (PA:<140/90) en 2003: 45,1% (IC: 41,0-48,0) y en 2006: 40,4% (IC: 37,7-43,2) (p<0,05). Variables asociadas a buen control: ser varón [OR 1,60 (IC: 1,26-2,03)]tratamiento con ARA II [OR 2,16 (IC: 1,50-3,09)] y ser diabético[OR 1,50 (IC: 1,10-2,03]. Se asocian a mal control: presentar enfermedad vascular cerebral, vasculopatía periférica y el tratamiento con IECA. Conclusiones: La prevalencia de HTA detectada es baja. El nivel de control es superior para la PAD que para la PAS. El tratamiento con ARA II, ser varón o ser diabético se asocia a mejor control. La vasculopatía periférica, la cardiopatía isquémica, la enfermedad vascular cerebral, el tratamiento con IECA y edad se asocian a peor control (AU)

Arterial hypertension (AHT) is a significant public health problem due to its high cardiovascular morbidity and mortality and its economic and social costs. Background: To identify the prevalence of AHT detected in primary care and its degree of control; to determine the types of treatment used and factors associated with its control. Patients and methods: Transversal comparative study of two years in the Villava Health Centre. The computerised clinical history data for the years 2003 and 2006 was analysed. The following variables were studied: age, gender, systolic and diastolic arterial pressure, total cholesterol, HDL, LDL, triglycerides, tobacco use, body mass index in both years. Hypotensor treatment in the year 2006. The variables for the year 2006 associated with good control were identified through logistic regression. Results: AHT prevalence detected in ≥ 18 year olds: 2003: 11.6% (CI:10.9-12.3); 2006: 16.6% (CI:15.8-17.4) (p<0.001). Control of hypertense persons with a register of arterial tension (AP:<140/90) in 2003: 45.1% (CI: 41.0-48.0) and in 2006: 40.4% (CI: 37.7-43.2) (p<0.05). Variables associated with good control: being male [OR 1.60 (IC: 1.26-2.03)] treatment with ARA II [OR 2.16 (CI: 1.50-3.09)] and being diabetic [OR 1.50 (CI: 1.10-2.03]. Associated with poor control: presenting cerebral vascular disease, peripheral vasculopathy and treatment with ACE inhibitors. Conclusions: A low prevalence of AHT was detected. The level of control was higher for the DAP than for the SAP. Treatment with AIIRA, being male and being diabetic were associated with a better control. Peripheral vasculopathy, ichaemic cardiopathy, cerebral vascular disease, ACE inhibitors use and age were associated with a poorer control (AU)

[Evaluation of the social care program for persons with severe mental disorders: a Delphi study]. / Valoración del programa social de atención a personas con trastorno mental grave: un estudio Delphi.

BACKGROUND: In January 2005 the Government of Navarre approved the "Care Program for Persons with Severe Mental Disorder" (PA-TMG). This article is intended to ascertain the opinion of experts regarding the PA-TMG. To identify the elements of agreement in the evaluation of positive aspects and aspects that can be improved. To make recommendations on the basis of their opinions. METHODS: A Delphi study was designed with 34 experts in health or social care of mentally ill persons. By means of repeated questionnaires, ideas that achieved a consensus of (3)90% were identified and a level of priority was assigned. The percentages of agreement and descriptive statistics of priority were presented, and the recommendations of analysis of the areas of consensus were drawn up. RESULTS: Out of the 34 participating experts, 25 (71.4%) completed the study: 1 sociologist, 5 social workers, 3 psychiatrists, 5 psychologists, one representative of the families, 3 occupational therapists, 1 technician in social integration and 6 family doctors. Sixty-four percent evaluated the Plan positively, and 72% were of the opinion that it was drawn up without sufficient professional participation. All thought that it could be improved by widening the participation of experts. CONCLUSIONS: The principal ideas on which there was consensus were: socio-health care must be guaranteed by the public administration; good systems of information and evaluation must be established; the Plan must have its own budget; professional follow-up of the patient by the different mechanisms must be guaranteed; a lot of the decision making must be decentralised; access to social benefits for these patients must be universalised.

Valoración del programa social de atención a personas con trastorno mental grave: un estudio Delphi / Evaluation of the social care program for persons with severe mental disorders: a Delphi study

Fundamento. En enero de 2005 el Gobierno de Navarra aprobó el “Programa de Atención a Personas con Trastorno Mental Grave” (PA-TMG). El objetivo del presente trabajo es conocer la opinión de expertos acerca del PA-TMG. Identificar los elementos de acuerdo en la valoración de aspectos positivos y aspectos mejorables. Realizar recomendaciones a partir de su opinión. Material y métodos. Se diseñó un estudio Delphi con 34 expertos en la atención sanitaria o social de enfermos mentales. Mediante cuestionarios repetidos se identificaron las ideas que alcanzaran un consenso >=90%, y se asignó un nivel de prioridad. Se presentan los porcentajes de acuerdo, estadísticos descriptivos de la prioridad, y se elaboran las recomendaciones de análisis de las áreas de consenso. Resultados. De los 34 expertos participantes, finalizaron el estudio 25 (71,4%): 1 socióloga, 5 trabajadoras sociales, 3 psiquiatras, 5 psicólogos, 1 representante de las familias, 3 terapeutas ocupacionales, 1 técnico en integración social y 6 médicos de familia. Valoran positivamente el Plan el 64% y 72% opinan que se ha elaborado sin suficiente participación profesional. Todos piensan que podría mejorarse si se amplia la participación de expertos. Conclusiones. Las principales ideas consensuadas han sido que: la atención socio-sanitaria debe garantizarse por los poderes públicos; se deben establecer buenos sistemas de información y de evaluación; el Plan debe tener presupuesto propio; debe garantizar el seguimiento profesional del paciente por los diferentes dispositivos; se deben descentralizar muchas tomas de decisiones; se debe universalizar el acceso a un catálogo de prestaciones sociales para estos enfermos

Background. In January 2005 the Government of Navarre approved the “Care Program for Persons with Severe Mental Disorder” (PA-TMG). This article is intended to ascertain the opinion of experts regarding the PA-TMG. To identify the elements of agreement in the evaluation of positive aspects and aspects that can be improved. To make recommendations on the basis of their opinions. Methods. A Delphi study was designed with 34 experts in health or social care of mentally ill persons. By means of repeated questionnaires, ideas that achieved a consensus of >=90% were identified and a level of priority was assigned. The percentages of agreement and descriptive statistics of priority were presented, and the recommendations of analysis of the areas of consensus were drawn up. Results. Out of the 34 participating experts, 25 (71.4%) completed the study: 1 sociologist, 5 social workers, 3 psychiatrists, 5 psychologists, one representative of the families, 3 occupational therapists, 1 technician in social integration and 6 family doctors. Sixty-four percent evaluated the Plan positively, and 72% were of the opinion that it was drawn up without sufficient professional participation. All thought that it could be improved by widening the participation of experts. Conclusions. The principal ideas on which there was consensus were: socio-health care must be guaranteed by the public administration; good systems of information and evaluation must be established; the Plan must have its own budget; professional follow-up of the patient by the different mechanisms must be guaranteed; a lot of the decision making must be decentralised; access to social benefits for these patients must be universalised

[Incidence of influenza and influenza vaccine effectiveness in the 2004-2005 season]. / Incidencia de la gripe y efectividad de la vacuna antigripal en la temporada 2004-2005.

BACKGROUND: To quantify the incidence of flu in different groups of the population of Navarra in the 2004-2005 season, and to evaluate the effectiveness of anti-flu vaccination. METHODS: The analysis of influenza cases in the system of compulsory notificable diseases was complemented by the individualised notifications in the network of sentinel doctors that covers a population of 22,339 inhabitants. The coverage and effectiveness of the vaccine was studied. RESULTS: Vaccine coverage in (3)65 year olds reached 62%. The incidence of influenza was 42.6 cases per 1,000 inhabitants. It reached a maximum in mid-January, exceeding 750 weekly cases per 100,000 inhabitants and 1,900 cases per 100,000 children. The highest rate of influenza was observed in under-15 year olds (49.4 cases per 1,000 inhabitants) and the lowest in non-institutionalised (3)65 year olds (2.6 per 1,000 inhabitants), although it was higher in geriatric residences (62.1 per 1,000; p<0.0001). Seventy-nine percent of the cases from 5 to 64 years resulted in absenteeism from school or work. The flu virus was identified in 42/65 (65%) nasopharyngeal smears, 90% being influenza virus A(H3). The incidence of influenza was 3.08% in the unvaccinated and 0.45% in the vaccinated (p<0.001). The global effectiveness of the anti-flu vaccine was 65%, and in (3)65 years old it was 73%. CONCLUSION: Although its effectiveness is not total, the vaccine is the main measure for preventing influenza. The network of sentinel doctors provide useful information for the coordination of care and public health activities against flu.

Incidencia de la gripe y efectividad de la vacuna antigripal en la temporada 2004-2005 / Incidence of influenza and influenza vaccine effectiveness in the 2004-2005 season

Fundamento. Cuantificar la incidencia de gripe en distintos grupos de la población de Navarra en la temporada 2004-2005 y evaluar la efectividad de la vacunación antigripal.Métodos. El análisis de los casos de gripe del sistema de enfermedades de declaración obligatoria se ha complementado con las notificaciones individualizadas de la red de médicos centinela que atiende a una población de 22.339 habitantes. Se estudió la cobertura y efectividad de la vacuna. Resultados. La cobertura vacunal en Ž65 años alcanzó el 62%. La incidencia de gripe fue de 42,6 casos por 1.000 habitantes. Alcanzó el máximo a mediados de enero, superando 750 casos semanales por 100.000 habitantes y 1.900 casos por 100.000 niños. La mayor tasa de gripe se observó en menores de 15 años (49,4 casos por 1.000 habitantes) y la menor en Ž65 años no institucionalizados (2,6 por 1.000 habitantes), aunque fue mayor en residencias geriátricas (62,1 por 1.000; p<0,0001). El 79% de los casos de 5 a 64 años causó absentismo escolar o laboral. Se identificó el virus de la gripe en 42/65 (65%) frotis nasofaríngeos, siendo el 90% virus gripal A(H3). La incidencia de gripe fue del 3,08% en los no vacunados y del 0,45% en vacunados (p<0,001). La efectividad global de la vacuna antigripal fue del 65%, y en Ž65 años del 73%.Conclusión. Aunque su efectividad no es total, la vacuna es la principal medida para la prevención de la gripe. La red de médicos centinela aporta información útil para la coordinación de actividades asistenciales y de salud pública frente a la gripe

Background. To quantify the incidence of flu in different groups of the population of Navarra in the 2004-2005 season, and to evaluate the effectiveness of anti-flu vaccination. Methods. The analysis of influenza cases in the system of compulsory notificable diseases was complemented by the individualised notifications in the network of sentinel doctors that covers a population of 22,339 inhabitants. The coverage and effectiveness of the vaccine was studied. Results. Vaccine coverage in Ž65 year olds reached 62%. The incidence of influenza was 42.6 cases per 1,000 inhabitants. It reached a maximum in mid-January, exceeding 750 weekly cases per 100,000 inhabitants and 1,900 cases per 100,000 children. The highest rate of influenza was observed in under-15 year olds (49.4 cases per 1,000 inhabitants) and the lowest in non-institutionalised Ž65 year olds (2.6 per 1,000 inhabitants), although it was higher in geriatric residences (62.1 per 1,000; p<0.0001). Seventy-nine percent of the cases from 5 to 64 years resulted in absenteeism from school or work. The flu virus was identified in 42/65 (65%) nasopharyngeal smears, 90% being influenza virus A(H3). The incidence of influenza was 3.08% in the unvaccinated and 0.45% in the vaccinated (p<0.001). The global effectiveness of the anti-flu vaccine was 65%, and in Ž65 years old it was 73%. Conclusion. Although its effectiveness is not total, the vaccine is the main measure for preventing influenza. The network of sentinel doctors provide useful information for the coordination of care and public health activities against flu

Brotes de gripe en población vacunada de residencias geriátricas en la temporada 2004-2005 / Influenza outbreaks in highly-vaccinated older institutionalised people in the 2004-2005 season

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[The attitudes of primary care physicians towards the opening of health centers]. / Actitudes de los médicos de atención primaria hacia la puesta en marcha de los centros de salud.

OBJECTIVE: To measure doctors' attitudes to the opening of Health Centres. DESIGN: Descriptive study. SITE. Primary Care services on the island of Gran Canaria. PARTICIPANTS: Doctors with tenure. MAIN MEASUREMENTS AND RESULTS: From a self-administered Likert type questionnaire, it could be observed that the proportion of those polled who did not reply was linked to the number who had a "Fiscal Licence" (Odds Ratio O.R. = 6.26), a ratio which did not disappear when stratified by age (O.R. = 5.88 for those less than or equal to 40 and O.R. = 3.08 for those greater than 40). The scale presented high internal consistency (Cronbach alpha 0.937), indicating favorable attitudes from doctors integrated into Health Centres and both positive and negative attitudes in doctors of a traditional cut. Those specialising in Family Medicine, those under 40 years old, those who had no other health job and those connected with Trades Unions showed more favorable attitudes. CONCLUSIONS: Individual and group characteristics are linked to different attitudes. The knowledge, evaluation and behaviour components of doctor's attitudes must be improved, by involving the reference groups of both individuals and groups.