[Professional and family perception on care and compliance with the end of life regulations. A qualitative study.] / Percepción profesional y familiar sobre la atención y cumplimiento de la normativa sobre el final de la vida. Un estudio cualitativo.

OBJECTIVE: The scope and types of health interventions in the dying process are the subject of a social and professional debate that has been increasing in recent years. The objective of the study was focused on analyzing the perceptions of professionals and relatives of patients who have recently died and assessing the degree of compliance with the rights established in the current legislation on this subject. METHODS: Qualitative research with a hermeneutical phenomenological approach carried out in 2019 by conducting and analyzing two discussion groups with health professionals from hospital and primary care, and four groups with relatives of recently deceased patients, divided by age ranges: 18- 30 years old, 31-45, 46-60 and over 60. RESULTS: The total number of people included in the study was 28 participants. Family members and professionals find it difficult to communicate with each other in the context of health care at the end of life. Family members and professionals agree on their preference to die at home. There are specific deficiencies in knowledge about the terminology used at the end of life. The term "euthanasia" is the one best known by family members. CONCLUSIONS: Deficiencies in knowledge of the rights established in the regulations related to the death process have been detected, both in relatives of patients and in professionals. These deficiencies contribute to breaches of legal regulations. Communication difficulties related to death between the professionals-patient-family trinomial are the most relevant related factor.

OBJETIVO: El alcance y los tipos de intervenciones sanitarias en el proceso de la muerte están siendo motivo de un debate social y profesional que se ha acrecentado en los últimos años. El objetivo del estudio se centró en analizar las percepciones de profesionales y familiares de pacientes que han fallecido recientemente y evaluar el grado de cumplimiento de los derechos establecidos en la legislación vigente a este respecto. METODOS: Investigación cualitativa de enfoque fenomenológico hermenéutico llevada a cabo en 2019 mediante la realización y análisis de dos grupos de discusión con profesionales de salud de atención hospitalaria y atención primaria, y cuatro grupos con familiares de pacientes fallecidos recientemente, divididos por rangos de edad: 18-30 años, 31-45, 46-60 y más de 60. RESULTADOS: El total de personas incluidas en el estudio fue de 28 participantes. Familiares y profesionales encuentran dificultades para comunicarse entre sí en el contexto de la atención sanitaria al final de la vida. Familiares y profesionales coinciden en su preferencia de fallecer en su domicilio. Existen carencias puntuales en el conocimiento sobre la terminología empleada en el final de la vida. El término "eutanasia" es el más conocido por los familiares. CONCLUSIONES: Se han detectado carencias en el conocimiento de los derechos establecidos en la normativa relativa al proceso de la muerte, tanto en familiares de pacientes como en profesionales. Estas carencias contribuyen a incumplimientos de la normativa legal. Las dificultades comunicativas relacionadas con la muerte entre el trinomio profesionales-pacientes-familiares son el factor relacionado más relevante.

Factors related to the development of health-promoting community activities in Spanish primary healthcare: two case-control studies.

OBJECTIVE: Spanish primary healthcare teams have the responsibility of performing health-promoting community activities (CAs), although such activities are not widespread. Our aim was to identify the factors related to participation in those activities. DESIGN: Two case-control studies. SETTING: Performed in primary care of five Spanish regions. SUBJECTS: In the first study, cases were teams that performed health-promoting CAs and controls were those that did not. In the second study (on case teams from the first study), cases were professionals who developed these activities and controls were those who did not. MAIN OUTCOME MEASURES: Team, professional and community characteristics collected through questionnaires (team managers/professionals) and from secondary sources. RESULTS: The first study examined 203 teams (103 cases, 100 controls). Adjusted factors associated with performing CAs were percentage of nurses (OR 1.07, 95% CI 1.01 to 1.14), community socioeconomic status (higher vs lower OR 2.16, 95% CI 1.18 to 3.95) and performing undergraduate training (OR 0.44, 95% CI 0.21 to 0.93). In the second study, 597 professionals responded (254 cases, 343 controls). Adjusted factors were professional classification (physicians do fewer activities than nurses and social workers do more), training in CAs (OR 1.9, 95% CI 1.2 to 3.1), team support (OR 2.9, 95% CI 1.5 to 5.7), seniority (OR 1.06, 95% CI 1.03 to 1.09), nursing tutor (OR 2.0, 95% CI 1.1 to 3.5), motivation (OR 3.7, 95% CI 1.8 to 7.5), collaboration with non-governmental organisations (OR 1.9, 95% CI 1.2 to 3.1) and participation in neighbourhood activities (OR 3.1, 95% CI 1.9 to 5.1). CONCLUSIONS: Professional personal characteristics, such as social sensitivity, profession, to feel team support or motivation, have influence in performing health-promoting CAs. In contrast to the opinion expressed by many professionals, workload is not related to performance of health-promoting CAs.

¿Qué hacemos en el barrio? Descripción de las actividades comunitarias de promoción de la salud en atención primaria: Proyecto frAC / What are we doing in neighborhoods? Description of health-promoting community activities in primary care: The FrAC Project

Objetivos: Describir las actividades comunitarias de promoción de la salud realizadas en atención primaria, y comparar los tipos y formas de llevarse a cabo en las distintas comunidades autónomas. Métodos: Estudio multicéntrico descriptivo realizado en atención primaria de cinco comunidades autónomas. Se incluyeron actividades comunitarias no puntuales, realizadas en el año previo, con participación del equipo de atención primaria, en las que la comunidad participaba activamente o era una actividad intersectorial. Responsables de 194 equipos respondieron sobre participación en actividades comunitarias. En caso afirmativo, se completaba un cuestionario. Variables: tema abordado, población diana, profesionales implicados, tiempo y ámbito de realización, evaluación, perspectivas teóricas, inscripción en redes, participación de la comunidad y otros agentes, y valoración de estas participaciones. Análisis: descriptivo estratificado por comunidades autónomas. Resultados: Se identificaron 183 actividades comunitarias en 104 equipos. Aunque varían entre las comunidades autónomas, destacan las actividades de salud general, alimentación y salud afectiva-sexual, dirigidas a población general, infancia o progenitores, y desarrolladas en centros educativos o de salud. La mediana de trayectoria es de 4 años y con 2,8 profesionales implicados. El 72,5% se realizan en horario laboral, el 75% son evaluadas y el 70% apoyadas en perspectivas teórico-metodológicas. En el 65% participan sectores no sanitarios, en el 60% la administración y en el 58,5% entidades cívicas. En el 85,8% participaba personal de enfermería, en el 38,5% de medicina y en el 35% de trabajo social. Hay variabilidad entre comunidades autónomas. Discusión Se aprecia variabilidad entre comunidades autónomas en los tipos y formas de aplicación de las actividades comunitarias realizadas por atención primaria, así como en el reconocimiento institucional y la implicación comunitaria en el desarrollo y la evaluación de la actividad (AU)

Objective: To describe the health-promoting community activities developed in primary health care and compare types of activities and how they are performed among autonomous regions. Methods: A descriptive multicenter study was carried out in primary care in 5 Spanish regions. We included community activities consisting of non-sporadic activities, carried out in the previous year, with the participation of the primary care team, and the active participation of the community or as a cross-sector activity. The persons responsible for each of the 194 teams were asked if the team participated in community activities and, if so, a questionnaire was completed by the person responsible for each activity. The variables consisted of the topic addressed, the target population, the professionals involved, the time and scope of implementation, evaluation, theoretical perspectives, network registration, the involvement of the community and other agents, and evaluation of this involvement. A descriptive analysis was performed, stratified by region. Results: We identified 183 community activities in 104 teams. Although there was wide variability among regions, most activities were related to general health, nutrition and emotional-sexual health and targeted the general population, children or parents and were carried out in educational or health centers. Participating professionals had a median of 4 years of experience and a median of 2.8 professionals were involved in each activity. A total of 72.5% of the activities were performed during working hours, 75% were evaluated, and 70% were supported by theoretical and methodological perspectives. Non-health sectors were involved in 65%, local government in 60%, and nongovernmental organizations in 58.5%. Nurses were involved in 85.8% of the activities, physicians in 38.5%, and social workers in 35%. Substantial variability was detected among regions. Discussion Wide variability was found in the types of activities and their application among the community activities developed by primary care, as well as in institutional recognition and community involvement in the development and evaluation of these activities (AU)

[What are we doing in neighborhoods? Description of health-promoting community activities in primary care: the FrAC Project]. / ¿Qué hacemos en el barrio? Descripción de las actividades comunitarias de promoción de la salud en atención primaria: Proyecto frAC.

OBJECTIVE: To describe the health-promoting community activities developed in primary health care and compare types of activities and how they are performed among autonomous regions. METHODS: A descriptive multicenter study was carried out in primary care in 5 Spanish regions. We included community activities consisting of non-sporadic activities, carried out in the previous year, with the participation of the primary care team, and the active participation of the community or as a cross-sector activity. The persons responsible for each of the 194 teams were asked if the team participated in community activities and, if so, a questionnaire was completed by the person responsible for each activity. The variables consisted of the topic addressed, the target population, the professionals involved, the time and scope of implementation, evaluation, theoretical perspectives, network registration, the involvement of the community and other agents, and evaluation of this involvement. A descriptive analysis was performed, stratified by region. RESULTS: We identified 183 community activities in 104 teams. Although there was wide variability among regions, most activities were related to general health, nutrition and emotional-sexual health and targeted the general population, children or parents and were carried out in educational or health centers. Participating professionals had a median of 4 years of experience and a median of 2.8 professionals were involved in each activity. A total of 72.5% of the activities were performed during working hours, 75% were evaluated, and 70% were supported by theoretical and methodological perspectives. Non-health sectors were involved in 65%, local government in 60%, and nongovernmental organizations in 58.5%. Nurses were involved in 85.8% of the activities, physicians in 38.5%, and social workers in 35%. Substantial variability was detected among regions. DISCUSSION: Wide variability was found in the types of activities and their application among the community activities developed by primary care, as well as in institutional recognition and community involvement in the development and evaluation of these activities.

Observational study on factors related to health-promoting community activity development in primary care (frAC Project): a study protocol.

INTRODUCTION: According to Spanish health regulations, primary care professionals have the responsibility to carry out health-promoting community activities (CAs). However, in practice, their implementation is not as widespread as it should be. The aims of this study were to identify factors within the team, the community and the professionals that influence the development of these activities and to describe the community interventions in progress. METHODS AND ANALYSIS: This study is an observational analytical retrospective study. The information will be collected from five Spanish regions: Catalonia, Madrid, the Balearic Islands, Navarra and Aragón. The authors will contact primary care teams (PCTs) and identify the CAs from the previous year. The research team will conduct a peer review whether the inclusion criteria are met. In the health centres where CAs are implemented, the authors will select professionals carrying them out and randomly select an identical number of professionals not doing these activities. In the centres where no CA is implemented, three professionals will be randomly selected. The selected professionals will complete the questionnaires for individual-level variables. Information about the registered population and the PCTs will be collected through questionnaires and secondary sources. OUTCOMES: Variables will be collected from the community, the PCTs, the individual professionals and CAs. ANALYSIS: A descriptive analysis of all the variables will be carried out, along with a bivariate and a logistic regression analysis, with CAs being the primary outcome. ETHICS AND DISSEMINATION: This study has been approved by the Research Ethics Committee of the Jordi Gol y Gurina Foundation in Barcelona and area 11 in Madrid. The questionnaire distributed to the professionals will be anonymous.