Why do physicians go to work when they are sick? Presenteeism at different career stages.

INTRODUCTION AND OBJECTIVE: Physicians find it difficult to take on the role of the patient and they show unusual behaviors when ill. One of these behaviors is presenteeism, which is working while sick. The objective of this research is to analyze the factors that contribute to the phenomenon of presenteeism in Spanish physicians. MATERIAL AND METHODS: Mixed methodology study: one national survey through the General Council of Medical Associations website (quantitative part), 22 semistructured interviews with sick residents and practicing physicians, and three focus groups involving professionals from the occupational health services (qualitative). A bivariate analysis using parametric and non-parametric tests. The significance level was p<0.05 (95% confidence interval). Qualitative analysis using the comparative-constant method until saturation of information. RESULTS: Presenteeism is reported by 89.4% of doctors who responded to the survey, and it is more common among women. Contributing factors include fear of overburdening colleagues (the main reason and more common among women 58.14% vs 48.35%), self-perception of doing one's duty (the second reason and more common among men, 44.63% vs 33.14%) and economic impact and difficulty in accepting the role of a sick person. This behavior has an impact on patient safety, and is part of the hidden curriculum that also affects the training of medical professionals. CONCLUSIONS: Presenteeism is a widespread and accepted practice among medical professionals. Although normalized, and even appreciated as a way to avoid overburdening colleagues, presenteeism has important implications for clinical ethics and patient safety.

Social Prescribing Schemes in Primary Care in Spain (EvalRA Project): a mixed-method study protocol to build an evaluation model.

BACKGROUND: Social Prescribing is a Primary Health Care service that provides people with non-clinical care alternatives that may have an impact on their health. Social Prescribing can be more or less formal and structured. Social Prescribing Schemes are formal Social Prescribing of health assets by Primary Health Care teams in coordination and follow-up of patients with providers. The emerging evidence suggests that this service can improve people's health and well-being, create value and provide sustainability for the healthcare system. However, some evaluations note that the current evidence regarding social prescribing is insufficient and needs further investigation. The EvaLRA project aims to elaborate an evaluation model of Social Prescribing Schemes in Primary Health Care based on a set of structure, process, and outcomes indicators. METHODS: In the region of Aragon, the Community Health Care Strategy aims to promote the development of social prescription schemes in Primary Health Care teams. This study is divided into two stages. Stage 1: identification of primary health care teams that implement social prescribing schemes and establish a first set of indicators to evaluate social prescribing using qualitative consensus techniques with experts. Stage 2 evaluation of the relevance, feasibility and sensitivity of selected indicators after 6 and 12 months in primary health care teams. The results will provide a set of indicators considering structure, process and outcomes for social prescribing schemes. DISCUSSION: Current evaluations of the application of social prescribing schemes use different criteria and indicators. A set of agreed indicators and its piloting in primary health care teams will provide a tool to evaluate the implementation of social prescription schemes. In addition, the scorecard created could be of interest to other health systems in order to assess the service and improve its information system, deployment and safety.

Gender analysis of Spanish National Questionnaire on behaviours and attitudes of doctors towards their own illness (CAMAPE).

INTRODUCTION AND OBJECTIVES: Physicians' health is a key element for quality healthcare. Medical professionals have difficulty accepting their role as patients and it might be different among sexes. The aim was to describe behaviours and attitudes of doctors towards their own illness. MATERIALS AND METHODS: An online survey was launched through the General Council of Medical Associations webpage for all Spanish registered doctors. A bivariate analysis by sex was performed for all the questionnaire variables using parametric and non-parametric tests. The significance level was p<0.05 (95% confidence interval). RESULTS: A total of 4,308 registered doctors (1,858 men and 2,450 women) answered. Women were younger, single, and worked mainly in non-surgical specialities in the public sector. Men were older, married, and worked more frequently in public-private practice. Women had less chronic conditions, except for anxiety disorders (11.52% vs 15.18%). Both sexes, especially women, primarily self-treated (94.29% vs 95.02%), went to work while ill (88.16% vs 90.29%), visited their GP (56% vs 70%), and half of them underwent annual occupational health checks (40% vs 48%). Women self-prescribed more analgesics (93.43% vs 95.63%), more presenteeism (88% vs 90%) and felt more insecure when treating sick fellows (9.96% vs 20.12%) and requested training for it. More women agreed to make deontological recommendations about doctors' health (91.55% vs 96.16%) and considered revalidation may contribute to improve doctors' health (65.29% vs 66.16%). CONCLUSIONS: Male and female doctors show illness-health behaviours and attitudes at work to improve. There are differences among male and female doctors. Regarding, medical feminization, ethical recommendations may be of benefit regarding doctors' health-illness issues and considering gender perspective.

Behaviour and attitudes of Spanish physicians towards their own process of falling ill: Study protocol and validation of CAMAPE questionnaire.

Physicians have not learned their role as patients. Health programmes for doctors are focused on mental health. Nevertheless, anomalous behaviours of ill doctors exist independently of health problems. We present a study to describe behaviour and attitudes of doctors towards their own illness (CAMAPE) including the analysis of questionnaire validation. MATERIAL AND METHODS: A mix methodology study based on semi-structured interviews to ill physicians and focus groups with members of medical colleges, occupational medicine services and doctors of ill doctors was performed. A survey was designed. Survey validation process included content and face validity, construct validity through exploratory and confirmatory factor analysis and reliability by Cronbach's Alpha Index. RESULTS: A total of 27 interviews to ill doctors and 4 focus group were performed. Content and feasibility assessment was made by experts. Psychometric validation was performed with a sample of 4308 answers (2450 women, 56.87%). A 5-factor (F) model explained 78.08% variance. First factor (F1) "The work might worsen health". Second (F2) "Mental issues, toxic habits and the impact of a bad health on work performance"; Third (F3) presenteeism and sick leaves; Fourth (F4) the handling of an ill colleague and the role of medical colleges. Fifth (F5) the healthcare pathway and potential value of revalidation in medical profession. CONCLUSIONS: A comprehensive mixed study on the process of physicians becoming ill has been launched with a reliable questionnaire in a large sample of registered doctors. The analysis will help to formulate gender-sensitive policy and ethical recommendations in relation to sick doctors given the progressive feminisation of the medical profession.

[What regulations have launched autonomous communities to going forward on patient safety culture in healthcare organizations?] / ¿Qué normativas han desarrollado las comunidades autónomas para avanzar en cultura de seguridad del paciente en sus organizaciones sanitarias?

INTRODUCTION: Patient Safety Culture is based on learning from incidents, developing preventive strategies to reduce the likelihood to happen and recognizing and accompanying those who have suffered unnecessary and involuntary harm derived from the health care received. To go ahead on patient safety culture entails facilitating the implementation of these behaviors and attitudes in healthcare professionals. Objective was to describe the regulations of some autonomous communities and national proposals for regulations changes. MATERIAL AND METHODS: Search of normative changes made in the autonomous communities of Catalonia, Navarra and the Basque Country. Proposals for legislative changes at national level were agreed. RESULTS: Activities and normative changes made in the autonomous communities of Catalonia, Navarre and the Basque Country are described and proposals for normative changes at the national level at short-term and long-term changes are made. In such a way that it is easier to advance in creating culture of patient safety in the whole National Health System CONCLUSION: Currently there is no global regulation that facilitates to advance in patient safety culture. Changes at the national legislation level are essential. It is at the Inter-territorial Council where the proposed legislative amendment should be defined, promoted by the representatives of the health systems of the autonomous communities.

[Implemented actions in the Spanish National Health System to improve patient safety culture]. / Acciones desarrolladas para avanzar en seguridad del paciente en el Sistema Nacional de Salud español.

BACKGROUND: The Ministry of Health, Consumption and Social Welfare (MHCSW) since 2005 has been promoting, in collaboration with the Autonomous Communities (AC) and the Scientific Societies (SC), among them the Spanish Society for Healthcare Quality (SSHCQ), the Patient Safety Strategy (PSS). PSS 2015-2020 develops relevant aspects of patient safety (PS), such as risk management, reporting and learning systems (RLS), as well as promoting an adequate response when an adverse event (AE) unexpectedly occurs. The present work describes the current situation of the different AC in relation to these topics. MATERIAL AND METHODS: A Descriptive study, based on a survey developed ad hoc within the framework of the agreement between the MHCSW and SSHCQ, was conducted at national level. The questions' topics, prepared by consensus of the work team, considered the implementation of RLS and AE analysis, and legal protection for professionals involved in an AE in the AC. RESULTS: A total of 17 surveys were collected (16 AC and INGESA). All ACs had a RLS, a structure to support PS activities but very heterogeneous. Some ACs had a response plan to an AE and had established a coordination protocol with legal services to support patients and professionals involved in an AE. Some ACs had enacted some laws and regulations to facilitate PS culture. CONCLUSIONS: The ACs have risk management structures that lead the plans in PS, reporting and learning systems and have experience in the analysis of near miss and AE. However, a regulatory change that increases the legal safety of professionals to provide an adequate response to the AEs is a priority. This challenge should involve leaders of health organizations, scientific societies and professional associations, national and regional health authorities as it has been done in other European countries.

[Adaptation of the Medical Office Survey on Patient Safety Culture (MOSPSC) tool]. / Adaptación de la herramienta del cuestionario Medical Office Survey on Patient Safety Culture (MOSPSC).

OBJECTIVE: To adapt the Medical Office Survey on Patient Safety Culture (MOSPSC) Excel(®) tool for its use by Primary Care Teams of the Spanish National Public Health System. METHODS: The process of translation and adaptation of MOSPSC from the Agency for Healthcare and Research in Quality (AHRQ) was performed in five steps: Original version translation, Conceptual equivalence evaluation, Acceptability and viability assessment, Content validity and Questionnaire test and response analysis, and psychometric properties assessment. After confirming MOSPSC as a valid, reliable, consistent and useful tool for assessing patient safety culture in our setting, an Excel(®) worksheet was translated and adapted in the same way. It was decided to develop a tool to analyze the "Spanish survey" and to keep it linked to the "Original version" tool. The "Spanish survey" comparison data are those obtained in a 2011 nationwide Spanish survey, while the "Original version" comparison data are those provided by the AHRQ in 2012. RESULTS: The translated and adapted tool and the analysis of the results from a 2011 nationwide Spanish survey are available on the website of the Ministry of Health, Social Services and Equality. It allows the questions which are decisive in the different dimensions to be determined, and it provides a comparison of the results with graphical representation. CONCLUSIONS: Translation and adaptation of this tool enables a patient safety culture in Primary Care in Spain to be more effectively applied.

[26th Conference of the Spanish Society of Quality in Healthcare: a good balance between quality, innovation, science and participation]. / XXVI Congreso de la Sociedad Española de Calidad Asistencial: un buen equilibrio entre calidad e innovación, ciencia y participación.

The experience and learning process of preparing a scientific conference programme, organising and conducting a conference ccompletes the quality circle with the quantitative and qualitative assessment of the process and results. The transmission of this experience and learning process through this paper will improve the performance of committees of future conference venues, partners and participants and collaborators. The method for performing this evaluation is the assessment of the activities of both the scientific and organising committees of the XXVI Conference of the Spanish Society of Quality Healthcare in October 2008 in Zaragoza. The methodology evaluated the observance of the timetable and tasks assigned to the committees in the Congress Manual of the society along with the presentation of final results of the congress concerning scientific participation and overall satisfaction. There were a total of 1211 communications with a rejection rate of 9.1%. Of the total, 577 communications were presented in oral format and 544 in poster format. Aragon was the community of origin of 24% of communications. By subject areas, those of most interest were patient safety, organisational and management processes, and patient perspectives. A total of 83 participants attended 7 of the 11 workshops offered. The average attendance for each workshop was 12 people. The response rate to the assessment of workshops questionnaire was 54.2% with an average score of 4 (scale of 1 to 5). A total of 1131 people attended the conference of which 17% (193) were SECA associates. Out of a total of 1075 overall satisfaction conference questionnaires distributed there was a response rate of 9.30% (100). The scientific content was assessed with an average score of 3.6 and the organization with 3.87, both on a total score of 5 points. According to the number of abstracts received, number of conferences, level of satisfaction with the scientific program and organisation, we can conclude that the XXVI Conference of the Society has been a success, although we are still in our continuous quality improvement circle that will make conferences even better.

Desarrollo y aportaciones del Comité Científico del XXV Congreso de la Sociedad Española de Calidad Asistencial en Barcelona, 2007 / Development and opportunities from de scientific committee of 25 SECA congress held in Barcelona, 2007

Objetivo: Realizar la autoevaluación de la labor del Comité Científico (CC) del XXV Congreso de la Sociedad Española de Calidad Asistencial (SECA), celebrado en Barcelona en octubre de 2007 para aportar líneas de mejora en el desarrollo de la actividad más importante del SECA: el congreso anual. Material y métodos: Diseño: aplicar la metodología de evaluación PDCA (plan, do, check, act ‘planificar, hacer, verificar, actuar’) a las tareas desarrolladas por el CC del XXV Congreso. Plan: descripción de la preparación del congreso según el procedimiento de gestión de comunicaciones del CC del manual de congresos de la SECA. Do: descripción de la implementación de éste. Check: proceso de evaluación de las actividades realizadas. Act: propuestas de mejora para los siguientes congresos. Resultados: El CC (22 personas) desarrolló las labores de gestión de comunicaciones, la edición del libro y la gestión de las actividades científicas en el congreso. La gestión de comunicaciones se organizó en 11 parejas de revisores que evaluaron de forma ciega las comunicaciones recibidas: 348 orales y 457 pósteres, de las que se rechazó el 10,09%. Las comunicaciones se presentaron en 36 mesas orales y 24 sesiones de pósteres. El libro se ha editado con los resúmenes de comunicaciones, las ponencias de las mesas y las conferencias inaugural y de clausura. Premios: las comunicaciones con puntuación por encima de 7,5 optaron a premio y se evaluaron in situ por parte del CC. El congreso en línea también tuvo buena acogida. Conclusiones: La satisfacción de los congresistas con la parte científica del congreso fue buena y se han identificado áreas de mejora (AU)

Objective: To perform a self-assessment of the Scientific Committee of the 25th Conference of the Spanish Society for Quality in Healthcare held in Barcelona on October 2007 in order to identify improvement areas for future Conferences. Material and methods: Design: Applying PDCA methodology to the tasks undertaken by the Scientific Committee (SC) of the Conference. Plan: A description of the preparation of the conference based on the abstract management of the Scientific Committee. Do: description of the implementation. Check: evaluation of activities. A: improvement proposals for the coming conferences. Results: The SC (22 people) worked in the abstracts management, book publishing and development of the scientific aspects of the Conference. Abstracts evaluation was conducted by 11 pairs of blind evaluators who analysed 348 oral communications and 457 posters, and 10.09% were rejected. Oral communications were performed in a total of 36 oral presentations sessions and 24 poster sessions. The book was published with the abstracts, addresses and the Conference opening and closing sessions. Awards: communications graded over 7.5 applied for an award and were reassessed by the SC. The on-line conference was also well received. Conclusions The satisfaction with the Conference regarding the scientific activities was good; however, several areas of improvement were identified (AU)

[Development and opportunities from de scientific committee of 25 SECA congress held in Barcelona, 2007]. / Desarrollo y aportaciones del Comité Científico del XXV Congreso de la Sociedad Española de Calidad Asistencial en Barcelona, 2007.

OBJECTIVE: To perform a self-assessment of the Scientific Committee of the 25th Conference of the Spanish Society for Quality in Healthcare held in Barcelona on October 2007 in order to identify improvement areas for future Conferences. DESIGN: Applying PDCA methodology to the tasks undertaken by the Scientific Committee (SC) of the Conference. Plan: A description of the preparation of the conference based on the abstract management of the Scientific Committee. Do: description of the implementation. Check: evaluation of activities. A: improvement proposals for the coming conferences. RESULTS: The SC (22 people) worked in the abstracts management, book publishing and development of the scientific aspects of the Conference. Abstracts evaluation was conducted by 11 pairs of blind evaluators who analysed 348 oral communications and 457 posters, and 10.09% were rejected. Oral communications were performed in a total of 36 oral presentations sessions and 24 poster sessions. The book was published with the abstracts, addresses and the Conference opening and closing sessions. Awards: communications graded over 7.5 applied for an award and were reassessed by the SC. The on-line conference was also well received. CONCLUSIONS: The satisfaction with the Conference regarding the scientific activities was good; however, several areas of improvement were identified.

[Rational use of drugs. Viewpoint of the users in the 3d Health Area of Saragossa]. / Uso racional de los medicamentos. El punto de vista de los usuarios del Area 3 de Salud de Zaragoza.

OBJECTIVE: To know the role of drugs and their use from the point of view of the National Health System users. DESIGN: Development of a qualitative method: focal groups of discussion. SITE: Health Area 3 of Zaragoza (Spain) which belongs to the Spanish National Health System. POPULATION: Groups of eight people who are representative of the rural and urban population. MAIN MEASUREMENT AND RESULTS: There were different meeting of one hour and a half for each. All of them started with the same question: What utility, use, and functions have drugs for all of you? All the session were recorded on video-tape and cassette to facilitate its typewriting. The general opinion was that users did not like to take drugs, nevertheless, it was a tool to solve easily and fast a health problem. At the same time, it was a cheap resource comparing to others as massage, health resort, diets... Drugs are seen as interchange currency in the medical bureau. There were critical opinions against abusive consumption of drugs. There is a lack of information concerning the utility and actions of drugs. CONCLUSIONS: The speech of user groups shows opposing points of view related to health professional opinions concerning drugs request from users and the role of drugs in the relationship doctor-patient.