Capacidad de respuesta del sistema de salud en atención primaria valorada por pacientes con enfermedades crónicas / Evaluation of health center's primary care responsiveness by patients with chronic illnesses

Objetivo: Evaluar la capacidad de respuesta del sistema de salud percibida por pacientes crónicos de atención primaria, así como los factores asociados a esa percepción. Método: Estudio transversal basado en entrevistas a pacientes mayores de 18 años diagnosticados de al menos una enfermedad crónica que visitaron los centros de atención primaria durante junio y julio de 2015 en una zona básica de Salud de La Rioja. El resultado fue el índice de respuesta y los factores potencialmente relacionados incluyeron características sociodemográficas y de salud. Entrevistadores capacitados realizaron el cuestionario breve en español de la encuesta multipaís de la Organización Mundial de la Salud con 403 participantes. Se realizaron estadística descriptiva y regresión logística bivariable y multivariable.Resultados: El 87,10% de los participantes consideró buena la respuesta general. Los dominios que obtuvieron las puntuaciones más altas fueron confidencialidad (99,3%), dignidad (98,3%) y comunicación (97,3%). Los peor evaluados fueron atención rápida (38,6%) y calidad de los servicios básicos (31,8%). La clase social baja fue el factor más importante asociado a la capacidad de respuesta, concretamente con la autonomía y la atención rápida. Sexo, educación y ocupación estuvieron relacionados con comunicación, y los pacientes con peor salud percibida valoraron peor la respuesta general. Los dominios considerados más importantes fueron dignidad (33,5%) y atención rápida (30,5%). Conclusiones: Los dominios mejor evaluados fueron los relacionados con el respeto a las personas. La atención rápida tiene una baja valoración, pero una gran importancia, y por lo tanto requiere una acción prioritaria. (AU)

Objective: To evaluate the health systems’ response capacity according to the perception of chronic patients, and the factors related to that perception. Method: Source of data: patients diagnosed with at least one chronic disease who visited primary care centers during June and July 2015 in a basic health area of La Rioja. Design: cross-sectional descriptive study based on interviews to over 18s who visited primary care centers. The dependent variable was the health systems’ response capacity and independent variables were sociodemographic and health related. In order to collect data, trained interviewers conducted a short questionnaire in Spanish from the World Health Organization Multi-country Survey Study with 403 subjects. Descriptive statistics, bivariate and multivariate logistic regression were performed. Results: The overall health systems’ response capacity was considered good by 87.10%. The domains that scored highest were: confidentiality (99.3%), dignity (98.3%) and communication (97.3%). Those evaluated worst were: rapid service (38,6%) and quality of basic services (31.8%). Low social class was the most important factor associated with the responsiveness, mainly with autonomy and rapid service. Sex, educational level, and occupation were related to communication domain, and patients with worse perceived health rated the general response worse. The domains considered most important were dignity (33.5%) and rapid service (30.5%). Conclusions: The domains best evaluated were those related to respect for people. Rapid service has a low health systems’ response capacity, but a high importance, and therefore requires priority action. (AU)

Evaluation of primary care responsiveness by people with mental illness in Spain.

BACKGROUND: The health system responsiveness is a concept developed by the World Health Organization that measures patients' expectations for the non-medical care they receive. The aim of this study is to assess primary care responsiveness as seen by people with mental illness and to analyse the factors associated with poor responsiveness. METHODS: Cross-sectional descriptive study on 426 people with mental illness who had attended primary care consultations at least once in the previous 12 months. The responsiveness of the health system was determined through the short questionnaire "Multi-country Survey Study on Health and Health Systems Responsiveness". Differences in responsiveness by sociodemographic characteristics were compared through the Chi-squared test. Logistic regression identified the factors associated with poor responsiveness. RESULTS: Overall responsiveness was measured as good by 77.4% of patients, being this probability higher in the domains: dignity, confidentiality, and communication. The most valued domains by people with mental illness were prompt attention (42.4%), dignity (30.1%), and communication (17%). Only prompt attention scored high importance and poor responsiveness. In patients with an income lower than 900 euros per month and low level of studies, the probability of poor confidentiality responsiveness was multiplied by 3 and 2.7 respectively. CONCLUSIONS: People with mental illness perceive good responsiveness from primary care in terms of dignity, confidentiality, and communication. Prompt attention, as the domain of greatest importance and worst valuation, should be prioritised through the implementation of organisational measures in health centres to reduce waiting times, especially in urban areas.

[Evaluation of health center's primary care responsiveness by patients with chronic illnesses]. / Capacidad de respuesta del sistema de salud en atención primaria valorada por pacientes con enfermedades crónicas.

OBJECTIVE: To evaluate the health systems' response capacity according to the perception of chronic patients, and the factors related to that perception. METHOD: Source of data: patients diagnosed with at least one chronic disease who visited primary care centers during June and July 2015 in a basic health area of La Rioja. DESIGN: cross-sectional descriptive study based on interviews to over 18s who visited primary care centers. The dependent variable was the health systems' response capacity and independent variables were sociodemographic and health related. In order to collect data, trained interviewers conducted a short questionnaire in Spanish from the World Health Organization Multi-country Survey Study with 403 subjects. Descriptive statistics, bivariate and multivariate logistic regression were performed. RESULTS: The overall health systems' response capacity was considered good by 87.10%. The domains that scored highest were: confidentiality (99.3%), dignity (98.3%) and communication (97.3%). Those evaluated worst were: rapid service (38,6%) and quality of basic services (31.8%). Low social class was the most important factor associated with the responsiveness, mainly with autonomy and rapid service. Sex, educational level, and occupation were related to communication domain, and patients with worse perceived health rated the general response worse. The domains considered most important were dignity (33.5%) and rapid service (30.5%). CONCLUSIONS: The domains best evaluated were those related to respect for people. Rapid service has a low health systems' response capacity, but a high importance, and therefore requires priority action.

Mental Health Patients' Expectations about the Non-Medical Care They Receive in Primary Care: A Cross-Sectional Descriptive Study.

A health system's responsiveness is the result of patient expectations for the non-medical care they receive. The objective of this study was to assess mental patients' responsiveness to the health system in primary care, as related to the domains of dignity, autonomy, confidentiality, and communication. Data were collected from 215 people over the age of 18 with mental disorders, using the Multi-Country Survey Study (MCSS) developed by the World Health Organization. Of them, 95% reported a good experience regarding the dignity, confidentiality, communication, and autonomy domains. Regarding responsiveness, patients valued the dignity domain as the most important one (25.1%). Among the patients who experienced poor confidentiality, five out of seven earned less than 900 euros per month (Χ2 = 10.8, p = 0.004). Among those who experienced good autonomy, 85 out of 156 belonged to the working social class (90.4%), and among those who valued it as poor (16.1%), the highest proportion was for middle class people (Χ2 = 13.1, p = 0.028). The two students and 87.5% of retirees experienced this dimension as good, and most patients who valued it as poor were unemployed (43.5%) (Χ2 = 13.0, p = 0.011). Patients with a household income higher than 900 euros more frequently valued responsiveness as good, regarding those domains related to communication, with OR = 3.84, 95% CI = 1.05-14.09, and confidentiality, with OR = 10.48, 95% CI = 1.94-56.59. To conclude, as regards responsiveness in primary care, the dignity domain always obtained the best scores by people with mental disorders. Low economic income is related to a poor assessment of confidentiality. Working class patients, students, and retirees value autonomy as good.