[Patients' competences and health literacy assessment questionnaire]. / Valoración de las competencias en salud de los pacientes: Instrumento VACS.

OBJECTIVE: To design a questionnaire to identify patients with difficulties to obtain, understand and use health information. MATERIAL AND METHOD: Qualitative study through semi-structured interviews and a consensus technique. A review of the literature on health literacy was carried out. Five semi-structured interviews were conducted with experts in the field. A 12-item instrument was designed. Content validity was determined using the Health Consensus technique. Participants were health professionals and patient representatives (5 semi-structured interviews and 60 Health Consensus). An instrument to measure the level of skills and literacy in patients' health was developed. The measures were 7categories on the health competencies and literacy construct: Ability to search for information, ability to understand the information, ability to communicate with health professionals, capacity for operational understanding, competence in decision making, ability to move and navigate through the health system, and competencies in self-care. RESULTS: A 12-item questionnaire was designed. The median scores obtained in the Health Consensus ranged between 6.08 (1.43) and 7.22 (1.52), with an agreement level of between 73.87% to 84.19%. Finally, a 5-item instrument was obtained to assess the patients' health competencies. CONCLUSIONS: The questionnaire is a useful tool to detect those at risk of having difficulties in obtaining, understanding and using health information. This would allow professionals to focus their attention on the type of information patients need and better adapt it to their needs.

Quality of cancer care in Spain: recommendations of a patients' jury.

The aim of the study was to evaluate quality of cancer care in Spain through patient's views, experiences and perceptions; with the purpose of making recommendations to improve cancer care. A modified citizen's jury was organised with the participation of 30 members and four experts as witnesses. For 1 day jurors representing 13 of 17 Spanish Autonomous Communities were met to make recommendations for improving the quality of cancer care in Spain. Concerns were identified regarding care fragmentation, test delays, duplications and poor social and emotional support. Some recommendations highlighted the need to improve the access to psycho-oncology care as well as support in social care and counselling, addressing patients to specific care. Some strategies proposed by the jury included a 24-h call centre, continuity in palliative care and appropriate follow-up and support after the end of therapy. In conclusion, the experience of cancer should include access to multiple specialists, effective coordination of care, accurate information about the disease and treatment options, and timely attention to symptoms and psychosocial needs.

[Conflicts of interests in clinical research in primary health care]. / Conflictos de intereses en investigación clínica en el área de atención primaria de salud.

Conflicts of interests between professionals and patients in biomedical research, is an ethical problem. None of the laws in Spain mention whether the clinical researcher has to clarify to participants the reasons why it proposes them to participate in a clinical trial. In this article, conflicts of interests in research are discussed in the context of primary healthcare. In this area conflicts of interests might alter the confidence between patients and healthcare professionals. Finally, we suggest some practical strategies that can help participants make the decision to participate in a clinical trial more willingly and freely.

On health literacy and health outcomes: background, impact, and future directions.

This article presents an overview of an emerging area of research called health literacy. It draws attention to the undisputed relationship between literacy levels of the population, the complexity of health systems and health outcomes. Authors believe that instead of focusing on improving individual skills, health institutions and health care settings should concentrate their efforts on making their physical and social environment more accessible and easy to navigate for their users. A more balanced approach to health literacy action includes improving the quality and accessibility of information, professionals' communication skills, and eliminating structural barriers to healthful action.

[Depression and clinical practice guidelines: evidence or confusion. Study group on the prescription and psychotropic in primary care]. / Depresión y guías de práctica clínica: evidencia o confusión? Grupo de Estudio sobre la Prescripción de Psicotropos en Atención Primaria.

BACKGROUND: The need of designing clinical practice guidelines in the context of the evidence based medicine relates to different aspects concerning the characteristics of the clinical condition, the health care context, the utilization of health services, and the existing knowledge about the topic of study. The objective of this study was to review the guideline development method for managing depression in care and its implications in clinical practice. MATERIAL AND METHODS: Review and classification of scientific articles published between 1990 and 1997 about depression guidelines according to its method of development. RESULTS: Between 1990 and 1997, 2 clinical practice guidelines on the management of depression were published using systematic review, 3 guidelines were developed through unsystematic review, 4 guidelines were developed from experts' consensus, and 19 published articles reviewed the applicability of the existing guidelines in the primary health care sector. Different points of view about the use of these guidelines had been detected. CONCLUSIONS: In the context of the evidence-based medicine, one should take into account that the overall goal of guidelines development is to ensure its validity in different health care levels, as well as to gather professionals' acceptance of its use and applicability.

Socioeconomic status and preventive health-care use by children in Spain.

National health systems are intended to provide equal access to health-care services to whole populations. However, they do not seem to address successfully the problem of social class differentials in access to health care, in particular access to preventive care. This study examines the relationship between the socioeconomic status (SES) of families and the use of preventive health care by children under a national health system in Spain. The study is based on weighted multivariate ordinal logistic regression analyses of data from the 1987 Spanish National Health Survey for a sample of 5,622 children, one to 10 years of age. A positive relationship was found between preventive health-care use by children and the SES of their families. Adult respondents' level of education and total family income were the most influential variables in this relationship. As these increased, children were more likely to receive visual, hearing, and dental exams. In addition, there was a gradient effect between family income and rate at which children received these preventive health-care services. Universal access to care, like that available in Spain, does not guarantee that social inequalities in children's receipt of preventive health care will not persist. In order to succeed, health-care reform must deal with social issues beyond financial access to care.