Barriers and Benefits of the Scheduled Telephone Referral Model (DETELPROG): A Qualitative Approach.

The recently developed scheduled mobile-telephone referral model (DETELPROG) has achieved especially important results in reducing waiting days for patients, but it has been decided to explore what barriers and positive aspects were detected by both primary care physicians (PCPs) and hospital attending physicians (HAPs) regarding its use. For this, a qualitative descriptive study was carried out through six semi-structured interviews and two focus groups in a sample of eleven PCPs and five HAPs. Interviews were carried out from September 2019 to February 2020. Data were analysed by creating the initial categories, recording the sessions, transcribing the information, by doing a comprehensive reading of the texts obtained, and analysing the contents. The results show that DETELPROG gives the PCP greater prominence as a patient's health coordinator by improving their relationship and patient safety; it also improves the relationship between PCP and HAP, avoiding unnecessary face-to-face referrals and providing safety to the PCP when making decisions. The barriers for DETELPROG to be used by PCP were defensive medicine, patients' skepticism in DETELPROG, healthcare burden, and inability to focus on the patient or interpret a sign, symptom, or diagnostic test. For HAP, the barriers were lack of confidence in the PCP and complexity of the patient. As a conclusion, DETELPROG referral model provides a lot of advantages and does not pose any new barrier to face-to-face referral or other non-face-to-face referral models, so it should be implemented in primary care.

Identification and prioritisation of risks in a hospital pharmacy using healthcare failure mode and effect analysis.

OBJECTIVES: The goals of this project included identifying the processes and subprocesses performed in hospital pharmacies, identifying potential adverse events, detecting failure modes and the causes of errors, prioritising the risks identified and designing a map of risks for hospital pharmacies. METHODS: A task force composed of hospital pharmacy staff was committed to update the diagram of processes and design a map of processes performed in hospital pharmacies. Risks were identified by failure mode and effect analysis annd prioritised according to their risk priority index (RPI) and criticality. A risk map of adverse events was designed based on the diagram of processes and/or primary activities where the prioritised failure modes were most frequent. RESULTS: In total, 99 failure modes associated with 80 adverse events and 129 causes were identified in eight hospital pharmacy areas/subprocesses. The three areas with the highest percentages of failure modes were inpatient pharmaceutical care, pharmacy laboratory and pharmaceutical technology, and medication management. The 25 failure modes (first quartile) with the highest RPI scores (RPI≥20) and the 25 failure modes with the highest frequency and criticality scores were classified as priority. CONCLUSIONS: According to their RPI, priority failure modes mostly occurred in the area of inpatient pharmaceutical care (92%). However, according to their criticality, priority failure modes were found to homogeneously occur across all pharmaceutical care areas. As general recommendations pharmacists should assume responsibility and leadership in the implementation of safe medication use practices in healthcare centres.

DETELPROG Study. Effectiveness of a New Model of Scheduled Telephone Referral from Primary Care to Internal Medicine. A Randomised Controlled Study.

In Spain, the average waiting time for a specialist consultation is 58 days. A determinant factor that contributes to this situation is the poor communication between primary care and specialised care, which is mainly due to the waiting days for a consultation, number of avoided/avoidable face-to-face referrals, and waiting days for the resolution of the process. DETELPROG is a referral system in which the family physician requests a scheduled outpatient internal medicine consultation, integrated into the usual consultations agenda of both physicians, the family, and the outpatient clinic physician, in order to have a telephone consultation. A randomized controlled clinical trial has been carried out to assess the effectiveness of DELTELPROG. In a sample of 255 patients, the experimental group was referred via a scheduled telephone call, and those in the control group, by face-to-face hospital consultation area. The results showed statistically significant differences between both groups of 27 days (95% confidence interval (CI): 20-33) regarding specialised consultation, 47 days (95% CI: 17-74) as for the resolution of the process, and 91.7% for avoided face-to-face consultations. The DETELPROG resulted as a low coverage system (53%), which makes it a complementary referral model. It is necessary to make an in-depth analysis of the causes that have led to this technologically low coverage.

Efectividad de un nuevo modelo de derivación telefónica compartida entre atención primaria y atención hospitalaria / Effectiveness of a new model of telephone derivation shared between primary care and hospital care

Objetivo: Averiguar si la derivación telefónica desde Atención Primaria a consultas externas de Medicina Interna (CCEE de MI) reduce días de espera, con respecto a la derivación presencial. Averiguar la aceptación de la consulta telefónica por parte de los médicos de familia (MF) de Atención Primaria y de sus pacientes. Diseño: Ensayo clínico controlado aleatorizado sin enmascaramiento. Emplazamiento: Área de Gestión Sanitaria Norte de Huelva. Participantes: Ciento cincuenta y cuatro pacientes. Intervenciones: Los pacientes de los MF del grupo experimental fueron derivados vía telefónica (salvo cumplimiento criterios exclusión) y los del grupo control vía presencial. Mediciones: Número de días desde la solicitud de derivación hasta la consulta en MI. Número de derivaciones telefónicas y presenciales. Número de médicos y de pacientes rechazados. Causas de los rechazos. Resultados: Diferencia estadísticamente significativa, estimándose en 27 (21-34) días entre ambos grupos. De los 58 MF, 8 prealeatorización, y 6 de los 20 asignados al grupo experimental rechazaron participar por «suponer consumo excesivo de tiempo y esfuerzo». Para un 50% de los pacientes derivados por los 14 MF que quedaron finalmente en el grupo experimental se rechazó la vía telefónica, siendo la complejidad de los pacientes la principal causa. Conclusiones: La derivación telefónica reduce considerablemente los días de espera para CCEE de MI, elimina las principales barreras de la consulta telefónica a tiempo real, no supuso un mayor gasto de tiempo ni de esfuerzo para los médicos y no se consideró tan beneficiosa en pacientes complejo

Aim: The purpose of this study is to find out whether telephone referral from Primary Health Care to Internal Medicine Consult manages to reduce waiting days as compared to traditional referral. This study also aims to know how acceptable is the telephone referral to general practitioners and their patients. Design: No blind randomized controlled clinical trial. Setting: Northern Huelva Health District. Participants: 154 patients. Interventions: Patients referrals from intervention clinicians were sent via telephone consultation, whereas patients referrals from control clinicians were sent by traditional via. Measurements: Number of days from referral request to Internal Medicine Consult. Number of telephone and traditional referrals. Number of doctors and patients denied. Denial reasons. Results: A statistically significant difference was found between groups, with an average of 27 (21-34) days. Among General Practitioners, 8 of the first 58 total doctors after randomization and, subsequently, 6 of the 20 doctors of the test group refused to engage in the trial because they considered "excessive time and effort consuming". 50% of patients referred by the 14 General Practitioners finally randomized to the intervention group were denied referral by telephone due to patient's complexity. Conclusions: Telephone referral significantly reduces waiting days for Internal Medicine consult. This type of referral did not mean an "excessive time and effort consuming" to General Practitioners and was not all that beneficial to complex patients

[Effectiveness of a new model of telephone derivation shared between primary care and hospital care]. / Efectividad de un nuevo modelo de derivación telefónica compartida entre atención primaria y atención hospitalaria.

AIM: The purpose of this study is to find out whether telephone referral from Primary Health Care to Internal Medicine Consult manages to reduce waiting days as compared to traditional referral. This study also aims to know how acceptable is the telephone referral to general practitioners and their patients. DESIGN: No blind randomized controlled clinical trial. SETTING: Northern Huelva Health District. PARTICIPANTS: 154 patients. INTERVENTIONS: Patients referrals from intervention clinicians were sent via telephone consultation, whereas patients referrals from control clinicians were sent by traditional via. MEASUREMENTS: Number of days from referral request to Internal Medicine Consult. Number of telephone and traditional referrals. Number of doctors and patients denied. Denial reasons. RESULTS: A statistically significant difference was found between groups, with an average of 27 (21-34) days. Among General Practitioners, 8 of the first 58 total doctors after randomization and, subsequently, 6 of the 20 doctors of the test group refused to engage in the trial because they considered "excessive time and effort consuming". 50% of patients referred by the 14 General Practitioners finally randomized to the intervention group were denied referral by telephone due to patient's complexity. CONCLUSIONS: Telephone referral significantly reduces waiting days for Internal Medicine consult. This type of referral did not mean an "excessive time and effort consuming" to General Practitioners and was not all that beneficial to complex patients.

Rendimiento y optimización de la herramienta trigger en la detección de eventos adversos en pacientes adultos hospitalizados / Performance and optimisation of a trigger tool for the detection of adverse events in hospitalised adult patients

Objetivo: Caracterizar el rendimiento de los triggers utilizados en la detección de eventos adversos (EA) de pacientes adultos hospitalizados y definir un panel de triggers simplificado suficientemente sensible y específico, para la detección de EA. Método: Estudio transversal de altas de pacientes de un servicio de medicina interna para la detección de EA mediante revisión sistemática de la historia clínica y la identificación de 41 triggers (evento clínico relacionado frecuentemente con EA), determinando si hubo EA según el contexto en que apareció el trigger. Una vez identificado el EA, se procedió a la caracterización de los triggers que lo detectaron. Se aplicó regresión logística para la selección de los triggers con mayor capacidad de detección de EA. Resultados: Se revisaron 291 historias clínicas y se detectaron 562 triggers en 103 pacientes, de los cuales 163 estuvieron implicados en la detección de un EA. Los triggers que detectaron más EA fueron «A.1. Úlcera por presión» (9,82%), «B.5. Laxante o enema» (8,59%), «A.8. Agitación» (8,59%), «A.9. Sobresedación» (7,98%), «A.7. Hemorragia» (6,75%) y «B.4. Antipsicótico» (6,75%). Se obtuvo un modelo simplificado de triggers que incluyó la variable «Número de fármacos» y los triggers «Sobresedación», «Sondaje», «Reingreso en 30 días», «Laxante o enema» y «Cese brusco de la medicación». Este modelo obtuvo una probabilidad del 81% de clasificar correctamente las historias con EA y sin EA (p <0,001; intervalo de confianza del 95%: 0,763-0,871). Conclusiones: Un número elevado de triggers estuvieron asociados a EA. El modelo resumido permite detectar una gran cantidad de EA con un mínimo de elementos (AU)

Objective: To characterise the performance of the triggers used in the detection of adverse events (AE) of hospitalised adult patients and to define a simplified panel of triggers to facilitate the detection of AE. Method: Cross-sectional study of charts of patients from a service of internal medicine to detect EA through systematic review of the charts and identification of triggers (clinical event often related to AE), determining if there was AE as the context in which it appeared the trigger. Once the EA was detected, we proceeded to the characterization of the triggers that detected it. Logistic regression was applied to select the triggers with greater AE detection capability. Results: A total of 291 charts were reviewed, with a total of 562 triggers in 103 patients, of which 163 were involved in detecting an AE. The triggers that detected the most AE were 'A.1. Pressure ulcer' (9.82%), 'B.5. Laxative or enema' (8.59%), 'A.8. Agitation' (8.59%), 'A.9. Over-sedation' (7.98%), 'A.7. Haemorrhage' (6.75%) and 'B.4. Antipsychotic' (6.75%). A simplified model was obtained using logistic regression, and included the variable 'Number of drugs' and the triggers 'Over-sedation', 'Urinary catheterisation', 'Readmission in 30 days', 'Laxative or enema' and 'Abrupt medication stop'. This model showed a probability of 81% to correctly classify charts with EA or without EA (p <0.001; 95% confidence interval: 0.763-0.871). Conclusions: A high number of triggers were associated with AE. The summary model is capable of detecting a large amount of AE, with a minimum of elements (AU)

[Performance and optimisation of a trigger tool for the detection of adverse events in hospitalised adult patients]. / Rendimiento y optimización de la herramienta trigger en la detección de eventos adversos en pacientes adultos hospitalizados.

OBJECTIVE: To characterise the performance of the triggers used in the detection of adverse events (AE) of hospitalised adult patients and to define a simplified panel of triggers to facilitate the detection of AE. METHOD: Cross-sectional study of charts of patients from a service of internal medicine to detect EA through systematic review of the charts and identification of triggers (clinical event often related to AE), determining if there was AE as the context in which it appeared the trigger. Once the EA was detected, we proceeded to the characterization of the triggers that detected it. Logistic regression was applied to select the triggers with greater AE detection capability. RESULTS: A total of 291 charts were reviewed, with a total of 562 triggers in 103 patients, of which 163 were involved in detecting an AE. The triggers that detected the most AE were "A.1. Pressure ulcer" (9.82%), "B.5. Laxative or enema" (8.59%), "A.8. Agitation" (8.59%), "A.9. Over-sedation" (7.98%), "A.7. Haemorrhage" (6.75%) and "B.4. Antipsychotic" (6.75%). A simplified model was obtained using logistic regression, and included the variable "Number of drugs" and the triggers "Over-sedation", "Urinary catheterisation", "Readmission in 30 days", "Laxative or enema" and "Abrupt medication stop". This model showed a probability of 81% to correctly classify charts with EA or without EA (p <0.001; 95% confidence interval: 0.763-0.871). CONCLUSIONS: A high number of triggers were associated with AE. The summary model is capable of detecting a large amount of AE, with a minimum of elements.

Acciones para mejorar el servicio de dispensación de metadona en atención primaria / No disponible

No disponible

Sistema Español de Acreditación de Competencias Profesionales en Hepatología. Una propuesta de la Asociación Española para el Estudio del Hígado / No disponible

No disponible

[Accreditation of processes in hepatology]. / Acreditación de procesos en hepatología.

The Spanish Association for the Study of the Liver decided in 2006 to develop a project to assess the quality of the professionals, processes and medical units dealing with the management of patients with liver diseases in Spain. The current article reports the criteria proposed to assess the quality and the accreditation of the processes in hepatology. The processes considered include most patients with liver diseases and the accreditation system designed is highly specific. This document, together with a previous one published in gastroenterología y hepatología concerning the accreditation of the professionals and a third document dealing with the accreditation of liver units that will be published soon, form the basis of the quality assessment of hepatology in our country.

Acreditación de procesos en hepatología / Accreditation of processes in hepatology

La Asociación Española para el Estudio del Hígado tomó ladecisión en el año 2006 de iniciar un proyecto de acreditaciónde calidad de los profesionales, procesos y unidades dehepatología en nuestro país. El presente artículo resume loscriterios de calidad de los procesos en hepatología y su acreditación.Los procesos considerados engloban la práctica totalidadde los pacientes con enfermedades del hígado y elsistema de acreditación propuesto es altamente específico. Elpresente documento, junto con el previamente publicado enGASTROENTEROLOGÍA Y HEPATOLOGÍA sobre acreditación deprofesionales y un tercero de próxima aparición sobre acreditaciónde unidades de hepatología, constituyen la base sobrela que se fundamentará la acreditación de calidad en elejercicio de la hepatología en nuestro país (AU)

The Spanish Association for the Study of the Liver decidedin 2006 to develop a project to assess the quality of the professionals,processes and medical units dealing with the managementof patients with liver diseases in Spain. The currentarticle reports the criteria proposed to assess thequality and the accreditation of the processes in hepatology.The processes considered include most patients with liver diseasesand the accreditation system designed is highly specific.This document, together with a previous one publishedin GASTROENTEROLOGÍA Y HEPATOLOGÍA concerning the accreditationof the professionals and a third document dealingwith the accreditation of liver units that will be publishedsoon, form the basis of the quality assessment ofhepatology in our country (AU)

Acreditación de procesos en hepatología / Accreditation of processes in hepatology

La Asociación Española para el Estudio del Hígado tomó ladecisión en el año 2006 de iniciar un proyecto de acreditaciónde calidad de los profesionales, procesos y unidades dehepatología en nuestro país. El presente artículo resume loscriterios de calidad de los procesos en hepatología y su acreditación.Los procesos considerados engloban la práctica totalidadde los pacientes con enfermedades del hígado y elsistema de acreditación propuesto es altamente específico. Elpresente documento, junto con el previamente publicado enGASTROENTEROLOGÍA Y HEPATOLOGÍA sobre acreditación deprofesionales y un tercero de próxima aparición sobre acreditaciónde unidades de hepatología, constituyen la base sobrela que se fundamentará la acreditación de calidad en elejercicio de la hepatología en nuestro país

The Spanish Association for the Study of the Liver decidedin 2006 to develop a project to assess the quality of the professionals,processes and medical units dealing with the managementof patients with liver diseases in Spain. The currentarticle reports the criteria proposed to assess thequality and the accreditation of the processes in hepatology.The processes considered include most patients with liver diseasesand the accreditation system designed is highly specific.This document, together with a previous one publishedin GASTROENTEROLOGÍA Y HEPATOLOGÍA concerning the accreditationof the professionals and a third document dealingwith the accreditation of liver units that will be publishedsoon, form the basis of the quality assessment of hepatology in our country (AU)

Sistema Español de Acreditación de Unidades de Hepatología. Una propuesta de la Asociación Española para el Estudio del Hígado / Spanish accreditation system of liver units

No disponible

La medida de los resultados clínicos / Quality of the clinical practice

La práctica clínica pretende resolver los problemas de los enfermos. Es necesario evaluar nuestra práctica para asegurarnos que cumplimos nuestro propósito. La efectividad mide los resultados de la práctica clínica péro es necesario distinguir entre beneficios de una decisión diagnóstica y beneficios de una desición terapéutica. Los primeros se miden en términos de reducción de incertidumbre y los segundos en términos de efectividad. Un tratamiento es efectivo cuando de forma favorable el curso natural de la enfermedad. Los retos más importantes de la práctica clínica que afectan a la efectividad son: la necesidad de incrementar la base científica de las decisiones, el uso racional de la tecnología diagnóstica y terapéutica, el estudio y control de la variavilidad, la mejora de la continuidad asistencial y la consideración de las utilidades para el paciente en las decisiones clínicas. Los métodos de investigación de rsultados y los de mejora continua de la calidad contribuyen a mejorar la efectividad y entroncan con los fundamentos de la medicina de alcanzar la mayor excelencia profecional y los mejores cuidados posibles para los enfermos

La medida de los resultados clínicos / Quality of the clinical practice

La práctica clínica pretende resolver los problemas de los enfermos. Es necesario evaluar nuestra práctica para asegurarnos que cumplimos nuestro propósito. La efectividad mide los resultados de la práctica clínica péro es necesario distinguir entre beneficios de una decisión diagnóstica y beneficios de una desición terapéutica. Los primeros se miden en términos de reducción de incertidumbre y los segundos en términos de efectividad. Un tratamiento es efectivo cuando de forma favorable el curso natural de la enfermedad. Los retos más importantes de la práctica clínica que afectan a la efectividad son: la necesidad de incrementar la base científica de las decisiones, el uso racional de la tecnología diagnóstica y terapéutica, el estudio y control de la variavilidad, la mejora de la continuidad asistencial y la consideración de las utilidades para el paciente en las decisiones clínicas. Los métodos de investigación de rsultados y los de mejora continua de la calidad contribuyen a mejorar la efectividad y entroncan con los fundamentos de la medicina de alcanzar la mayor excelencia profecional y los mejores cuidados posibles para los enfermos(AU)

Gestión clínica: estrategias, instrumentos e incentivos / Clinical management: estrategy, instruments and incentive

La gestión clínica es un tema de gran actualidad que ha irrumpido con fuerza en el debate sanitario. La mayor parte de las actuales propuestas de reforma tienen en común el considerar que es necesario descentralizar las organizaciones sanitarias y que el profecional debe participar en la gestión de los recursos que utiliza en su práctica clínica. A diferencia de otras propuestas de reforma en el hospital, esta iniciativa ha ilusionado a los profecionales porque la gestión clínica habla de clínica y pacientes, ha adoptado el lenguaje de los profecionales y se fundamenta en principios éticos, científicos y asistenciales además de económicos. Representa un cambio cultural, a largo plazo, en el que lo importante es la tenacidad, la c0nstancia y la produncia para evitar el descrédito de la propuesta. Para que los profecionales desarrollen gestión clínica necesitan tener el mejor nivel de conocimiento de medicina o de enfermería, disponer de los instrumentos necesarios y un entorno de motivación adecuado(AU)