La investigación cualitativa, el rigor en el muestreo estructural / Qualitative research: rigour in structural sampling

No disponible

No disponible

[Perceptions and expectations on primary health care: a new form of identifying improvements in the care system]. / Percepciones y expectativas sobre la atención primaria de salud: una nueva forma de identificar mejoras en el sistema de atención.

OBJECTIVE: To analyse the opinions of the users of primary care on the care that they receive and to identify the principal areas of satisfaction. DESIGN: Qualitative study using discussion groups and open interviews during the period January-May 2003. SETTING: Health areas of Valladolid, Spain. PARTICIPANTS: The inclusion criteria were: to have attended a primary care clinic at sometime and to be between 35 and 80 years old. Recruitment was carried out through key informants, using the snowball technique. METHOD: 6 discussion groups and interviews with representatives of 3 nursing and 1 residents association were carried out. Structural sampling was carried out as regards the variables that influenced satisfaction. The conversations were recorded using tape recorders and literally transcribed on paper. The analysis of the texts was carried out by 2 investigators and concordance was sought between them. RESULTS: The principal areas related to satisfaction were: the treatment received from the professionals, which is considered a fundamental part of care, combined with the technical quality, continuity of the care, the admission services, the bureaucratic procedures, the barriers for accessing specialised services, and waiting lists. CONCLUSIONS: Personalized care, the time dedicated by the professional, the continuity of care, and waiting lists are the principal areas related to the perceived satisfaction of the patients. The possible responses to improve this situation are: the implementation of changes in the care management and organisation which would simplify the procedures, investment of resources (human and economic), changes in the model of the professional-patient relationship, and improvements in undergraduate and postgraduate training.

Percepciones y expectativas sobre la atención primaria de salud: una nueva forma de identificar mejoras en el sistema de atención / Perceptions and expectations of primary health care: a new form of identifying in the care system

Objetivo. Analizar las opiniones de los usuarios de atención primaria sobre la atención que reciben e identificar las principales áreas de satisfacción. Diseño. Estudio cualitativo mediante grupos de discusión y entrevistas abiertas durante el período enero-mayo de 2003. Emplazamiento. Áreas de salud de Valladolid. Participantes. Los criterios de inclusión fueron: haber acudido alguna vez a la consulta de atención primaria y tener entre 35 y 80 años. La captación se ha realizado a través de informadores clave, mediante la técnica de bola de nieve. Método. Se realizaron 6 grupos de discusión y entrevistas con representantes de 3 asociaciones de enfermos y una de vecinos. Se llevó a cabo un muestreo estructural en función de las variables que influyen en la satisfacción. Las conversaciones fueron recogidas en cintas magnetofónicas y transcritas literalmente en papel. El análisis de los textos ha sido realizado por dos investigadoras y se ha buscado la concordancia entre ambas. Resultados. Las áreas principales relacionadas con la satisfacción han sido: el trato recibido de los profesionales, que se valora como una parte fundamental de la atención, unida a la calidad técnica, la continuidad de los cuidados, los servicios de admisión, los trámites burocráticos, las barreras para acceder a los servicios especializados y las listas de espera. Conclusiones. La atención personalizada, el tiempo dedicado por el profesional, la continuidad de los cuidados y las listas de espera son las principales áreas relacionadas con la satisfacción percibida por los pacientes. Las posibles respuestas para mejorar esta situación son: la implementación de cambios en la gestión y la organización asistencial que simplifiquen los procesos, la inversión de recursos (humanos y económicos), los cambios en el modelo de relación profesional-paciente y la mejora en la formación de pregrado y posgrado

Objective. To analyse the opinions of the users of primary care on the care that they receive and to identify the principal areas of satisfaction. Design. Qualitative study using discussion groups and open interviews during the period January-May 2003. Setting. Health areas of Valladolid, Spain. Participants. The inclusion criteria were: to have attended a primary care clinic at sometime and to be between 35 and 80 years old. Recruitment was carried out through key informants, using the snowball technique. Method. 6 discussion groups and interviews with representatives of 3 nursing and 1 residents association were carried out. Structural sampling was carried out as regards the variables that influenced satisfaction. The conversations were recorded using tape recorders and literally transcribed on paper. The analysis of the texts was carried out by 2 investigators and concordance was sought between them. Results. The principal areas related to satisfaction were: the treatment received from the professionals, which is considered a fundamental part of care, combined with the technical quality, continuity of the care, the admission services, the bureaucratic procedures, the barriers for accessing specialised services, and waiting lists. Conclusions. Personalised care, the time dedicated by the professional, the continuity of care, and waiting lists are the principal areas related to the perceived satisfaction of the patients. The possible responses to improve this situation are: the implementation of changes in the care management and organisation which would simplify the procedures, investment of resources (human and economic), changes in the model of the professional-patient relationship, and improvements in undergraduate and postgraduate training

Hospitalizaciones en menores de un año en la ciudad de Madrid y su relación con el nivel social y la mortalidad infantil / Hospitalization rates in infants aged less than 1 year in madrid and their relationship with socioeconomic indicators and infant mortality

Antecedentes: La utilización de los hospitales representa una parte muy importante del total de servicios de salud que recibe la población. Trabajos previos han revelado la importante variabilidad existente en la frecuentación hospitalaria en la población infantil. Objetivo: Describir las tasas de hospitalización en menores de un año en los distritos municipales de la ciudad de Madrid y analizar su asociación con variables socioeconómicas y mortalidad infantil. Métodos: Estudio ecológico analítico. La unidad de análisis es el distrito sanitario de la ciudad de Madrid. Se incluyeron las siguientes variables: tasa de altas totales y de altas sensibles de atención extrahospitalaria (ACSC) en menores de un año, tasa de mortalidad infantil, porcentaje de universitarios, sin estudios, parados, sin teléfono y sin agua. Se han realizado análisis de correlación y de regresión lineal. Resultados: Las tasas medias de hospitalización y de ACSC son 280,10 94,09 y 52,65 29,29. Su coeficiente de variación fue 32,47 y 55,63. Las tasas de hospitalización mostraron una correlación significativa con el porcentaje de parados (0,71), porcentaje de universitarios (-0,66) y porcentaje sin estudios (0,88). Las tasas ACSC tienen correlación con porcentaje de parados (0,51), y porcentaje de universitarios (-0,48). En los modelos de regresión lineal las variables que permanecieron fueron el porcentaje de sin estudios para las tasas de altas (R2 0,78; p < 0,0000) y parados para las tasas ACSC (R2 0,26; p < 0,032). Conclusiones: Las hospitalizaciones, totales y ACSC, en menores de un año, muestran una importante variación en la ciudad de Madrid. Se observa una asociación entre estas tasas con indicadores socioeconómicos, pero no con la mortalidad infantil (AU)

[Hospitalization rates in infants aged less than 1 year in Madrid and their relationship with socioeconomic indicators and infant mortality]. / Hospitalizaciones en menores de un año en la ciudad de Madrid y su relación con el nivel social y la mortalidad infantil.

BACKGROUND: Hospital utilization represents a significant part of all the health services offered to the population. Previous studies have demonstrated considerable variability in hospital utilization among the pediatric population. OBJECTIVE: To describe hospitalization rates in infants aged less than 1 year in the municipal districts of the city of Madrid and to analyze their association with socioeconomic indicators and infant mortality. METHODS: Ecological study with the health district of the city of Madrid as the unit of analysis. The following variables were included: overall hospital discharge rates, ambulatory care sensitive condition (ACSC) discharge rates and infant mortality rates, as well as the percentages of university graduates, without primary education, unemployed, without telephone and without tap water. Correlation and multiple regression analysis were performed. RESULTS: The mean overall and ACSC discharge rates were 280.10 94.09 and 52.65 29.29. Their coefficient of variation was 32.47 and 55.63. Discharge rates showed significant correlation with the percentage of unemployed (0.71), university graduates (-0.66) and those without primary education (0.88). ACSC rates were correlated with the percentage of unemployed (0.51) and of university graduates (-0.48). The variables included in the multiple lineal regression models were the percentage without primary education for discharge rates (R2 0.78; p < 0.0000) and the percentage of unemployed for ACSC rates (R2 0.26; p < 0.032). CONCLUSIONS: Overall and ACSC discharge rates in infants showed significant variation across the health district of the city of Madrid. These rates were significantly associated with socioeconomic indicators, but not with infant mortality.

[Requests for HIV tests and their performance in primary health care. Study of the Sentinel Physician Network of Castilla y León in Spain, 1990-1996]. / Solicitud y realización del test del VIH en atención primaria. Estudio de la Red de Médicos Centinelas de Castilla y León 1990-1996.

AIM: To describe the patterns of requests for and the carrying out of the HIV test in Primary Health Care and the epidemological characteristics of the individuals who have undergone the test. METHOD: A retrospective descriptive study of requests for the HIV test in Primary Health Care, in the area covered by the Sentinel Network of Castile and Leon between 1991 and 1996. The validity of the results was assured through an initial study of geographical representativity and populational diversity, with periodical adjustments. The information was obtained through weekly reports from Sentinel doctors. RESULTS: The request rate per 100.000 inhabitants showed a tendency to increase until 1993, levelling off in 1995 and 1996. There were significant differences between percentage of test requested by doctors (55.9%) and patients (40%), as well as between males/females and average for age of these. Of the 63.1% of patients with known risk factor: 17.5% were injected drug users (IDUs) and 11.2% were through unsafe heterosexual contact; these factors being modified over time. The predominant risk factors among males were: heterosexual contact (31.1%) and the use of injected drugs (27.9%). The case was similar for females: 22.7% and 6.9% respectively. The results were positive in 3.2% of the HIV tests. CONCLUSIONS: An increase in requests and tests carried out between 1991 and 1993 was detected. The figures later stabilized and, in general, they were lower than in other studies. The doctor was predominantly the origin of the request. A decrease in IDUs and an increase in the percentage of unsafe heterosexual contact, were detected, both in line with data from other research. Primary Health Care had a predominant place in early detection of risk practice and in the areas of prevention, education and information.