How much convergence exists between registered process measures and patient reported experience measures? A study on Catalan primary healthcare.

The use of quality measures is important for transparency and the continuous improvement of performance. However, we do not know enough about the relationship between registered process measures and patient reported experience measures (PREMs) in primary healthcare. Recent studies point to areas of convergence that run contrary anticipated trends. This is a relevant question for healthcare management and governments as their position is stronger when system's guidelines and targets also matter to patients or, vice versa, when patient-centered measures are used to develop new process measures. Our aim is to study both type of measures, their logic and their level of convergence. We also assess the relationship between PREMs, patients' demographic characteristics and area socioeconomic level. We estimated pairwise correlations with patient experience aggregated at the health-center level and a series of multilevel regression models to assess the adjusted effect of four registered process measures on ratings of patient experience at the patient level. We use patient experience as measured by survey data, two composite quality indices and two single indicators regularly computed by the Catalan Health Service. Continuity of care with the same doctor and accessibility are positively associated with patient experience. No relationship was observed in the index created to measure quality of assistance. The index measuring the quality of prescriptions was positively associated with patient experience but only when analyzed separately. We conclude that registered process measures and PREMs are not entirely independent, hence improvements of the management side have the potential to impact patient experience.

[Administrative burden, motivation and well-being among primary care physicians: comparison of management models]. / Carga administrativa, motivación y bienestar entre médicos de atención primaria. Comparación entre modelos de gestión.

OBJECTIVE: To analyze the relationship between administrative burden and intrinsic motivation and between administrative burden and professional well-being among family and community medicine physicians. To analyze the extent to which attention to three basic needs (autonomy, sense of competence and relationship capacity) that one of the main motivation theories identifies as a generator of intrinsic motivation compensates for the negative effect of the administrative burden. To compare management models. METHOD: Data from a survey (542 valid questionnaires) carried out through the Catalan Society of Family and Community Medicine are used. Data analysis is based on multiple regression and ANOVA techniques. RESULTS: The perception of administrative burden and "red tape" are clearly demotivating and reduce job satisfaction. On the contrary, individual autonomy, networking opportunities between professionals and performance feedback are motivating and feed the perception of professional well-being. The EBA (Association Based Entity) model presents results above the ICS (Catalan Health Institute) and OSI (Integrated Health Organizations) models both in controlling the negative effect of administrative burden and in the management of basic psychological needs. CONCLUSIONS: The motivation and professional well-being of primary care physicians would benefit from reforms that limit the administrative burden of some procedures and red tape. At the primary health center level, greater attention to individual autonomy, improving relatedness between professionals and the sense of competence based on better information on individual performance can offset the negative effects of the administrative burden.

Carga administrativa, motivación y bienestar entre médicos de atención primaria. Comparación entre modelos de gestión / Administrative burden, motivation and well-being among primary care physicians: comparison of management models

Objetivo: Analizar la relación entre carga administrativa y motivación intrínseca y entre carga administrativa y bienestar profesional en los médicos especialistas en medicina familiar y comunitaria. Analizar en qué medida la atención a tres necesidades básicas (autonomía, sentido de competencia y capacidad de relación) que una de las principales teorías de la motivación identifica como generadora de motivación intrínseca compensa el efecto negativo de la carga administrativa y comparar modelos de gestión. Método: Se utilizan datos de una encuesta (542 cuestionarios válidos) realizada a través de la Sociedad Catalana de Medicina Familiar y Comunitaria. El análisis de los datos se fundamenta en las técnicas de regresión múltiple y ANOVA. Resultados: La percepción de carga administrativa y de papeleo inútil (red tape) es claramente desmotivadora y disminuye la satisfacción en el trabajo. Por el contrario, la autonomía individual, las oportunidades de relación entre profesionales y el feedback sobre rendimiento son motivadores y alimentan la percepción de bienestar profesional. El modelo EBA (entidades de base asociativa) presenta resultados por encima de los modelos ICS (Instituto Catalán de la Salud) y OSI (organizaciones sanitarias integradas) tanto en el control del efecto negativo de las cargas administrativas como en la gestión de las necesidades psicológicas básicas. Conclusiones: La motivación y el bienestar profesional de los médicos de atención primaria se verían beneficiados por reformas que limiten la carga administrativa de algunos trámites y el papeleo con una baja funcionalidad. A nivel de gestión de los centros, una mayor atención a la autonomía individual, a la capacidad de relación entre profesionales y al sentido de competencia sobre la base de una mejor información sobre el rendimiento individual puede compensar los efectos negativos de la carga administrativa.(AU)

Objective: To analyze the relationship between administrative burden and intrinsic motivation and between administrative burden and professional well-being among family and community medicine physicians. To analyze the extent to which attention to three basic needs (autonomy, sense of competence and relationship capacity) that one of the main motivation theories identifies as a generator of intrinsic motivation compensates for the negative effect of the administrative burden. To compare management models. Method: Data from a survey (542 valid questionnaires) carried out through the Catalan Society of Family and Community Medicine are used. Data analysis is based on multiple regression and ANOVA techniques. Results: The perception of administrative burden and “red tape” are clearly demotivating and reduce job satisfaction. On the contrary, individual autonomy, networking opportunities between professionals and performance feedback are motivating and feed the perception of professional well-being. The EBA (Association Based Entity) model presents results above the ICS (Catalan Health Institute) and OSI (Integrated Health Organizations) models both in controlling the negative effect of administrative burden and in the management of basic psychological needs. Conclusions: The motivation and professional well-being of primary care physicians would benefit from reforms that limit the administrative burden of some procedures and red tape. At the primary health center level, greater attention to individual autonomy, improving relatedness between professionals and the sense of competence based on better information on individual performance can offset the negative effects of the administrative burden.(AU)

¿Gestión pública, privada o por el tercer sector? Diferencias en los resultados en atención primaria de Cataluña / Public, private or third sector management? Differences in the results in Primary Care in Catalonia

Objetivo: Comparar los resultados de los equipos de atención primaria en Cataluña en función de su modelo de gestión y evaluar el impacto de un modelo de gestión conocido como gestión por entidades de base asociativa (EBA). Diseño: Llevamos a cabo un análisis comparado multidimensional siguiendo una lógica cuasi-experimental a partir de comparar los centros gestionados a través del modelo EBA con otros centros gestionados por el sector público a través del Instituto Catalán de la Salud (ICS) o por el tercer sector a través de consorcios hospitalarios. Localización: Barcelona, Cataluña, España. Participantes: Tenemos en cuenta 368 observaciones (centros de atención primaria) y 18 parámetros medidos en 2015. Intervenciones: Distintos métodos de gestión. Mediciones principales: Comparación de indicadores de actividad, efectividad en el proceso asistencial y eficiencia antes y después de controlar por el indicador socioeconómico del área básica de salud y las características de la región sanitaria. Test de diferencias significativas en las medias de los indicadores según modelo de gestión una vez realizado el emparejamiento conforme a variables clave mediante la técnica Propensity Score Matching. Resultados: Diferencias significativas en el indicador de carga de trabajo por profesional médico de familia, en cinco indicadores de efectividad en el proceso asistencial y en el coste por usuario. Conclusiones: La diversificación del modelo de gestión a través del modelo EBA muestra resultados que se pueden interpretar a favor del mantenimiento o de la ampliación de la aplicación de este modelo de gestión. Si bien los centros gestionados a través del modelo EBA se han implantado en áreas de nivel socioeconómico medio o alto, sus resultados continúan siendo significativamente positivos una vez se controla por el nivel socioeconómico de su área

Goal: Compare the performance of primary health centers managed by the public sector (ICS), the third sector (Hospitals) or by small private organizations known as EBAs. Design: Multidimensional comparative analysis. We follow a quasi-experimental logic comparing primary health centers managed by EBAs with other centers managed by the public sector (ICS) o by the third sector (hospitals). Localization: Barcelona, Catalonia, Spain. Participants: We have 368 observations (primary health centers) and 18 indicators measured in 2015. Intervention: Different management models (public, third sector, private). Main measures: We compare activity measures, measures of effectiveness in the process of medical assistance, and efficiency. We compare before and after controlling for the socio-economic level corresponding to the basic health area and the characteristics of the population and health region. We conduct a test of significant differences between the indicators corresponding to centers managed differently, after a process of matching using key variables and Propensity Score Matching. Results: Significant differences in the measure of work load for family doctors, in five measures of effectiveness in the process of assistance and in the cost per user. Conclusions: The diversity in the management model through EBAs shows results that can be interpreted in favor of the maintenance or the expansion of this model of management. The majority of EBAs have been implanted in areas of a medium or high level, but their results are still significantly positive once the socio economic level of the area is controlled

[Public, private or third sector management? Differences in the results in Primary Care in Catalonia]. / ¿Gestión pública, privada o por el tercer sector? Diferencias en los resultados en atención primaria de Cataluña.

GOAL: Compare the performance of primary health centers managed by the public sector (ICS), the third sector (Hospitals) or by small private organizations known as EBAs. DESIGN: Multidimensional comparative analysis. We follow a quasi-experimental logic comparing primary health centers managed by EBAs with other centers managed by the public sector (ICS) o by the third sector (hospitals). LOCALIZATION: Barcelona, Catalonia, Spain. PARTICIPANTS: We have 368 observations (primary health centers) and 18 indicators measured in 2015. INTERVENTION: Different management models (public, third sector, private). MAIN MEASURES: We compare activity measures, measures of effectiveness in the process of medical assistance, and efficiency. We compare before and after controlling for the socio-economic level corresponding to the basic health area and the characteristics of the population and health region. We conduct a test of significant differences between the indicators corresponding to centers managed differently, after a process of matching using key variables and Propensity Score Matching. RESULTS: Significant differences in the measure of work load for family doctors, in five measures of effectiveness in the process of assistance and in the cost per user. CONCLUSIONS: The diversity in the management model through EBAs shows results that can be interpreted in favor of the maintenance or the expansion of this model of management. The majority of EBAs have been implanted in areas of a medium or high level, but their results are still significantly positive once the socio economic level of the area is controlled.

Isoproterenol increases active lipoprotein lipase in adipocyte medium and in rat plasma.

White adipose tissue (WAT) lipoprotein lipase (LPL) activity channels diet fat towards storage in adipocytes. Adrenaline (ADR) is accepted to reduce WAT or adipocyte LPL activity (LPLa), but available data are not clear-cut regarding long exposure to ADR in vitro or in vivo. We studied the effects of long exposures to ADR or beta-adrenergic agonist on LPL: in isolated rat adipocytes (3 h) and in rats (>1 day). Isoproterenol (ISO) (1 microM) did not alter LPLmRNA nor LPLa in adipocytes, but increased LPLa in medium more than twofold (3.58 +/- 0.35 vs. 1.32 +/- 0.35 mU/10(6) adipocytes, P < 0.001). Effect was time (not present at 1 h, clear at 2 h) and concentration dependent (high sensitivity from 10 to 100 nM, max at 1 microM). Adenylate cyclase activator or cyclic AMP (cAMP) analogue produced a similar increase. Thus in adipocytes ISO produced an increase in LPLa release and/or a decrease in extracellular LPLa degradation. ADR or ISO treated rats had a two to fourfold decrease in WAT LPLa vs. unchanged LPLmRNA. This decrease was 10-fold in WAT heparin-releasable LPLa (5.7 +/- 0.6 vs. 57.3 +/- 10.2 mU/g, P < 0.001), which represents peri/extracellular LPLa. Plasma LPLa was increased 11-fold by ADR (3.30 +/- 0.58 vs. 0.32 +/- 0.08 mU/ml, P < 0.001) whereas only threefold by ISO (P > 0.01). We suggest that in vivo ADR increased release of active LPL to plasma from endothelial cells of LPL-rich tissue(s)-WAT was probably one of these tissues releasing LPL since it lost 90% of its peri/extracellular LPLa-and/or decreased degradation of plasma active LPL. Since liver LPLa was not increased, plasma active LPL might be kept away from hepatic degradation by binding to stabilising entities in plasma (fatty acids (FA), lipoproteins or soluble heparan sulphates (HS)). In conclusion, we believe this is the first report stating that: (a) ISO increases LPLa in isolated adipocyte medium, and (b) ADR administration to rats decreases WAT extracellular active LPL and increases preheparin plasma active LPL.