Predictors of health professionals' satisfaction with continuing education: A cross-sectional study.

OBJECTIVES: to verify which organizational, methodological, and resource-related characteristics of Continuing Health Education (CHE) help to best predict the professionals´ satisfaction. METHOD: a cross-sectional study with multivariate logistic regressions to predict a high mean satisfaction with different dimensions of educational actions used: Overall satisfaction, Utility, Methodology, Organization and resources, and Teaching Capacity. 25,281 satisfaction questionnaires have been analysed completed by health professionals attending 1,228 training activities in Andalusia (Spain), during the period from March 2012 to April 2015. RESULTS: the characteristics that best predict a high overall satisfaction are the following: clinical session type as opposed to the workshop (Odds Ratio [OR]=2.07, p<0.001); face-to-face attendance modality (OR=3.88, p<0.001) or semi-personal-attendance (OR=2.83, p<0.001), as opposed to e-learning; and 1-2 days in duration (OR=2.38, p<0.001) as opposed to those of between 3 and 14 days. A lower number of hours (OR=0.99, p<0.001) and a lower number of professionals (OR=0.98, p<0.05) also increase the probability. Having the educational actions accredited increases the probabilities in the following dimensions: Utility (OR=1.33, p<0.05), Methodology (OR=1.5, p<0.01) and Teaching capacity (OR=1.5, p<0.01). CONCLUSION: the study provides relevant information on aspects that improve professional satisfaction, such as that e-learning activities should improve their content, teaching methods, and styles, or that face-to-face clinical sessions are the type of CHE with the greatest satisfaction.

Predictors of health professionals' satisfaction with continuing education: A cross-sectional study / Preditores de satisfação dos profissionais de saúde com a educação continuada: um estudo transversal / Variables predictoras de la satisfacción de los profesionales de la salud con la educación continua: un estudio transversal

Objectives: to verify which organizational, methodological, and resource-related characteristics of Continuing Health Education (CHE) help to best predict the professionals´ satisfaction. Method: a cross-sectional study with multivariate logistic regressions to predict a high mean satisfaction with different dimensions of educational actions used: Overall satisfaction, Utility, Methodology, Organization and resources, and Teaching Capacity. 25,281 satisfaction questionnaires have been analysed completed by health professionals attending 1,228 training activities in Andalusia (Spain), during the period from March 2012 to April 2015. Results: the characteristics that best predict a high overall satisfaction are the following: clinical session type as opposed to the workshop (Odds Ratio [OR]=2.07, p<0.001); face-to-face attendance modality (OR=3.88, p<0.001) or semi-personal-attendance (OR=2.83, p<0.001), as opposed to e-learning; and 1-2 days in duration (OR=2.38, p<0.001) as opposed to those of between 3 and 14 days. A lower number of hours (OR=0.99, p<0.001) and a lower number of professionals (OR=0.98, p<0.05) also increase the probability. Having the educational actions accredited increases the probabilities in the following dimensions: Utility (OR=1.33, p<0.05), Methodology (OR=1.5, p<0.01) and Teaching capacity (OR=1.5, p<0.01). Conclusion: the study provides relevant information on aspects that improve professional satisfaction, such as that e-learning activities should improve their content, teaching methods, and styles, or that face-to-face clinical sessions are the type of CHE with the greatest satisfaction.

Objetivo: verificar quais características organizacionais, metodológicas e relacionadas a recursos da educação continuada em saúde (ECS) ajudam a predizer melhor a satisfação dos profissionais. Método: estudo transversal com regressões logísticas multivariadas para predizer uma alta satisfação média com diferentes dimensões das ações educativas utilizadas: Satisfação Geral, Utilidade, Metodologia, Organização e Recursos, e Capacidade de Ensino. Foram analisados 25.281 questionários de satisfação preenchidos por profissionais de saúde que participaram de 1.228 atividades de treinamento na Andaluzia (Espanha), no período de março de 2012 a abril de 2015. Resultados: características que melhor predizem uma alta Satisfação Geral são as seguintes: Método de sessão clínica em oposição a workshops (Odds Ratio[OR]=2,07;p<0,001); modalidade presencial (OR=3,88;p<0,001) ou semipresencial (OR=2,83;p<0,001) em oposição a e-learning; e 1-2 dias de duração (OR=2,38;p<0,001) em oposição a 3-14 dias. Um menor número de horas (OR=0,99;p<0,001) e de profissionais (OR=0,98;p<0,05) também aumenta a probabilidade. A acreditação das ações educativas aumenta as probabilidades nas dimensões: Utilidade (OR=1,33;p<0,05), Metodologia (OR=1,5;p<0,01) e Capacidade de Ensino (OR=1,5;p<0,01). Conclusão: o estudo fornece informações relevantes sobre aspectos que melhoram a satisfação profissional, como a opinião de que atividades e-learning precisam melhorar seu conteúdo, métodos e estilos de ensino, ou de que sessões clínicas presenciais são o tipo de ECS com maior satisfação.

Objetivo: verificar qué características organizativas, metodológicas y de recursos de la Educación Continua en Salud (ECS) ayudan a predecir mejor la satisfacción de los profesionales. Método: se utiliza un estudio transversal con regresiones logísticas multivariadas para predecir un alto promedio de satisfacción con los diferentes tipos de acciones educativas: Satisfacción general, Utilidad, Metodología, Organización y recursos y Capacidad docente. Se han analizado 25.281 cuestionarios de satisfacción respondidos por los profesionales de la salud que asistieron a 1228 actividades formativas, en Andalucía (España), durante el período de marzo a abril de 2012. Resultados: características que mejor predicen una alta Satisfacción general: Tipo de sesión clínica frente al taller (OddsRatio [OR]=2,07, p<0,001); modalidad de asistencia presencial (OR=3,88, p<0,001) o semipersonal (OR=2,83, p<0,001), frente al aprendizaje electrónico (e-learning); y 1-2 días de duración (OR=2,38, p<0,001) frente a 3-14 días. Una menor cantidad de horas (OR=0,99, p<0,001) y una menor cantidad de profesionales (OR=0,98, p<0,05) también aumentan la probabilidad. Acreditar las acciones educativas aumenta las probabilidades en las siguientes dimensiones: Utilidad (OR=1,33, p<0,05), Metodología (OR=1,5, p<0,01) y Capacidad docente (OR=1,5, p<0,01). Conclusión: el estudio aporta información relevante sobre aspectos que mejoran la satisfacción profesional, como que las actividades de aprendizaje electrónico deben mejorar sus contenidos, métodos y estilos de enseñanza o que las sesiones clínicas personales son el tipo de ECS con mayor satisfacción.

Effect of a Mobile App on Preoperative Patient Preparation for Major Ambulatory Surgery: Protocol for a Randomized Controlled Trial.

BACKGROUND: Inadequate preoperative patient preparation causes organizational, economic, and emotional problems to patients and professionals. In Spain, no current evidence is available on either the rate of compliance or the impact of good compliance with preoperative recommendations by patients in the ambulatory setting. However, it is known that around 25% of surgical cancellations in the major ambulatory surgery (MAS) are due to poor compliance with these recommendations and, therefore, avoidable. Introducing innovative tools based on mobile health (mHealth) apps may help patients meet the preoperative recommendations and, consequently, reduce the rate of cancellations in the ambulatory setting. OBJECTIVE: The objective of this study was to evaluate the effectiveness of the Listeo+ mHealth app as a tool for improving compliance with preoperative recommendations in MAS versus standard of care (SOC). METHODS: A multicenter, randomized, open-label clinical trial that compares SOC with the additional use of Listeo+, a specific mHealth app for MAS preoperative patient monitoring, is being conducted. The study will include patients aged ≥18 years with surgical indication for MAS who meet the necessary technological and connectivity requirements. Patients in the control group will receive written preoperative recommendations, while those in the intervention group will additionally use the Listeo+ mHealth app. There will be a competitive recruitment of 790 patients during 6 months in 4 hospitals in Andalusia (Spain) that belong to the National Health System. The primary efficacy outcome is the level of compliance with preoperative recommendations. Secondary outcomes include the rate of cancellations, associated resource consumption, and perceived usability and utility with Listeo+ by participants of the intervention group. Simple randomization 1:1 procedure will be used to allocate patients to each study group. RESULTS: The technological development of Listeo+ and the integration and interoperability of information systems was completed in September 2017. Subsequently, simulation tests were performed with Listeo+, and a pilot study was initiated with real patients that concluded successfully in October 2017. Patient recruitment began in December 2017 in the 4 participating centers. After an intermediate analysis performed 10 months after the start of the recruitment phase, the data collection and cleaning phases are estimated to be completed in April 2019, and the analysis with the final results will be conducted in July 2019. CONCLUSIONS: Progress in the integration and interoperability of information systems represents a major step forward in the field of mHealth. The app will allow health professionals to monitor in real-time patients' preparation and critical preoperative recommendations fulfillment. We expect a reduction in avoidable preoperative cancellations due to a lack of or a poor patient preparation. Self-assessed Web-based questionnaires and focus group will provide important information about the perceived usability and utility of Listeo+ app among patients and health care professionals. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/10938.

Buenas prácticas en higiene de manos de las enfermeras que han acreditado su competencia profesional / Good practices in hand hygiene among nurses with accredited professional competence

Objetivo: analizar los conocimientos sobre higiene de manos demostrados por las enfermeras que han acreditado sus competencias con el Programa de Acreditación de la Agencia de Calidad Sanitaria de Andalucía (ACSA) y determinar si existen diferencias en función a las características individuales de dichos profesionales. Método: estudio descriptivo transversal basado en el Hand Hygiene Knowledge Questionnaire for Health-Care Workers de la OMS (traducido y validado para el entorno español) realizado sobre 2.136 pruebas aportadas por las enfermeras durante sus procesos de acreditación, desde julio de 2011 hasta enero de 2016. La recogida de datos se realizó a través de la aplicación informática ME_jora P. Para los análisis se utilizaron el software SPSS v.13 y R Package. Resultados: las enfermeras mostraron un alto nivel de conocimientos respecto a la higiene de manos, presentándose diferencias significativas en cuanto al número de respuestas correctas en función del sexo, la edad, el puesto de trabajo y el nivel de acreditación conseguido. Conclusiones: el conocimiento sobre aspectos críticos de la higiene de las manos del conjunto de enfermeras analizadas fue notable. Las enfermeras con mayor nivel de acreditación (experto y excelente) son las que presentaron mayor media de respuestas correctas, teniendo más probabilidades de ser referentes en higiene de manos (AU)

Objective: to analyze the knowledge about hand hygiene demonstrated by nurses with their competence accredited through the Accreditation Program by the Agency for Healthcare Quality from Andalusia (ACSA), and to determine if there are differences according to the individual characteristics of said professionals. Method: a descriptive transversal study based on the Hand Hygiene Knowledge Questionnaire for Health-Care Workers by the WHO (translated and validated for the Spanish setting), conducted on 2,136 tests provided by nurses during their accreditation processes, from July, 2011 to January, 2016. Data collection was conducted through the computer application ME_jora P. The SPSS v.13 software and R Package were used for analysis. Results: nurses showed a high level of knowledge regarding hand hygiene; there were significant differences in terms of correct answers according to gender, age, position, and the level of accreditation achieved. Conclusions: there was a remarkable level of knowledge on essential aspects of hand hygiene among the nurses tested. Those nurses with the highest level of accreditation (Expert and Excellent) presented the highest mean level of correct answers, and had more probabilities to become leaders in terms of hand hygiene (AU)

[The accreditation of professional competence: the analysis of nursinginterventions to control anxiety in surgical patients]. / Accreditamento della competenza professionale:un'analisi degli interventi infermieristici per ridurre l'ansia nel paziente chirurgico.

. The accreditation of professional competence: the analysis of nursing interventions to control anxiety in surgical patients. INTRODUCTION: The preoperative anxiety is a state of discomfort or unpleasant tension resulting from concerns about illness, hospitalization, anesthesia, surgery or the unknown. Nurses play a vital role reducing preoperative anxiety. An accreditation program was developed in Andalusia (Spain) to measure nurses' competences in this and others fields. AIMS: To analyze the accredited nurses' interventions spectrum to reduce anxiety in surgical patients and to check if their range of interventions depends upon their professional skills accreditation level. METHODS: Cross-sectional study. From 20016 to 2014, 1.282 interventions performed by 303 operating room nurses accredited through the Professional Skills Accreditation Program of the Andalusian Agency for Health Care Quality (ACSA) were analyzed with the latent class analysis (LCA) and multinomial logistic regression. RESULTS: Two-thirds of the sample was accredited in Advanced level, about 31% in Expert level and 2.6% in Excellent level. Mean age of patients was 58.5±19.8 years. Three professional profiles were obtained from the LCA. Those nurses classified in Class I (22.4% of the sample) were more likely to be women, to can for younger patients, and to be accredited in Expert or Excellent Level and to perform the larger range of interventions, becoming therefore the most complete professional profile. CONCLUSION: Those nurses who perform a wider range of interventions and specifically two evidence based interventions such Calming Technique and Coping Enhancement are those who have a higher level of accreditation level.

Intervenciones para potenciar la adherencia terapéutica realizadas por las enfermeras acreditadas según el modelo ACSA / Interventions to promote treatment adherence conducted by the nurses accredited according to the ACSA model

OBJETIVOS: describir las intervenciones realizadas por enfermeras de hospitalización acreditadas bajo el modelo de la Agencia de Calidad Sanitaria de Andalucía (ACSA), encaminadas a potenciar y mejorar la adherencia al régimen terapéutico por parte de los pacientes; y comprobar si había diferencias en la realización de estas intervenciones según las características sociodemográficas del profesional y del paciente, así como el nivel de acreditación alcanzado por la enfermera. MÉTODO: estudio descriptivo transversal sobre 2.196 informes de práctica clínica aportados por las 1.098 enfermeras acreditadas desde 2010 hasta 2016 en la Comunidad de Andalucía. VARIABLES: sexo, edad y nivel de acreditación de las enfermeras, intervenciones realizadas y edad de los pacientes. La recogida de datos se realizó a través de la aplicación informática ME_jora P. Para el análisis bivariante se utilizó el test Chi cuadrado. RESULTADOS: 'Educación para la salud', 'Enseñanza: proceso de enfermedad' y 'Asesoramiento' fueron las intervenciones llevadas a cabo por la mayoría de las enfermeras para mejorar la adherencia terapéutica. La intervención menos realizada fue 'Potenciación de la disposición de aprendizaje'. Las enfermeras mujeres de mayor edad y acreditadas en nivel experto o excelente son las que desarrollan más intervenciones para potenciar la adherencia terapéutica. CONCLUSIONES: las enfermeras acreditadas adaptan sus intervenciones a las características sociodemográficas básicas de los pacientes. La acumulación de experiencia y conocimientos demostrados es un predictor de la realización de intervenciones más variadas y complejas para mejorar la adherencia terapéutica. Serían necesarios estudios que profundicen en las diferencias respecto a la patología del paciente

OBJECTIVES: to describe the interventions conducted by hospitalization nurses accredited under the model of the Agency for Healthcare Quality in Andalusia (ACSA), with the objective of promoting and improving adherence to the therapeutic regimen; and to confirm if there were differences in these interventions according to the sociodemographical characteristics of the professional and the patient, as well as the level of accreditation achieved by the nurse. METHOD: a descriptive transversal study on 2,196 clinical practice reports provided by the 1,098 nurses accredited from 2010 to 2016 in the Community of Andalusia. VARIABLES: gender, age, and accreditation level of the nurses, interventions conducted, and patient age. Data collection was conducted through the ME_jora P computer application. Chi Square Test was used for bivariate analysis. RESULTS: 'Education for Health', 'Education: the disease process', and 'Counselling' were the interventions conducted by the majority of nurses in order to improve treatment adherence. The least conducted intervention was 'Promotion of willingness to learn'. The older female nurses with accreditation at an Expert or Excellent level are those who conduct more interventions in order to promote treatment adherence. CONCLUSIONS: accredited nurses will adapt their interventions to the basic sociodemographic characteristics of patients. The experience acquired and knowledge demonstrated is a predictor for conducting more varied and complex interventions in order to improve treatment adherence. It would be necessary to conduct in depth studies about the differences in terms of patient conditions

Fiabilidad y validez para un cuestionario de satisfacción con la formación continuada en salud: el cuestionario de satisfacción del discente / Reliability and validity of a continuous training satisfaction questionnaire in health: the Learning Satisfaction Questionnaire

Introducción: La formación continuada es el proceso de enseñanza y aprendizaje activo que tiene lugar a lo largo de toda la vida profesional. Valorar el grado de satisfacción con dicho proceso se presenta como una tarea necesaria. Si bien la mayoría de cuestionarios que evalúan la satisfacción del alumnado contemplan las diferentes dimensiones del proceso formativo como la metodología empleada, la adecuación de los contenidos o la calidad de los docentes, no todos han comprobado la fiabilidad y validez de los mismos. El objetivo del estudio es observar las características psicométricas del cuestionario de satisfacción del discente (CSD) enmarcado en la herramienta 'eValúa' de la línea de proyectos para el desarrollo profesional continuo de la Agencia de Calidad Sanitaria de Andalucía, España. Sujetos y métodos: Análisis estadísticos de las puntuaciones del CSD (n = 1.628), usando análisis de fiabilidad, análisis de componentes principales y correlaciones de los factores. Resultados: El CSD fue muy fiable, con un α de Cronbach global de 0,979. Las dimensiones del cuestionario mostraron cargas factoriales elevadas (Utilidad: R = 85,9; α = 0,91. Metodología: R = 77,4; α = 0,95. Organización y recursos: R = 73,25; α = 0,92. Capacidad docente: R = 90; α = 0,97. Valoración global: R = 96,6; α = 0,96). Las dimensiones 'utilidad' y 'metodología' fueron las que presentaron niveles de correlación más altas con la totalidad del cuestionario y con las dos preguntas de valoración global con la formación. Conclusiones: El CSD se presenta como una herramienta fiable y válida para la medición de la satisfacción con la formación continuada en salud. Dadas las altas correlaciones ítem-total que presentaron algunos ítems, se propone repasar su diseño para evitar concurrencias entre preguntas

Introduction: Continuing training is conceived as the learning and permanent asset process to which all health professionals are entitled and obliged. Although most questionnaires that assess participants satisfaction look at the different dimensions of the learning process, such as methodology used, content appropriateness or teachers performance quality, not all have proven its reliability and validity. The aim of the study is to observe the psychometric characteristics of Teaching Satisfaction Questionnaire (CSD) framed in the evaluation tool ‘eValúa’, designed by the Continuing Professional Development Project of the Andalusian Agency for Healthcare Quality (Spain). Subjects and methods: Statistical analysis of the scores of CSD with a sample of 1628 cases using reliability analysis, principal component analysis, and correlation of the factors that are derived from the five dimensions that make up the questionnaire. Results: The CSD was highly reliable with an overall Cronbach’s α of 0.979. The dimensions of the questionnaire showed high factor loadings (Utility: R = 85.9; α = 0.91. Methodology: R = 77.4; α = 0.95. Organization and resources: R = 73.25; α = 0.92. Teaching capacity: R = 90; α = 0.97. Global satisfaction: R = 96.6; α = 0.96). The 'utility' and 'methodology' dimensions were those that showed the highest levels of correlation with both the entire questionnaire and the two global satisfaction questions. Conclusions: The CSD is presented as a reliable and valid tool for measuring satisfaction with continuing education in health. Given the high item-total correlations some items showed, a review of the questionnaire design is proposed to avoid concurrency between questions. Future analysis of the differences in satisfaction with training according to different socio-professional characteristics was raised

[Hand hygiene: health professionals' knowledge and areas for improvement]. / Higiene de las manos: conocimientos de los profesionales y áreas de mejora.

The objective of this study was to analyze knowledge on hand hygiene among staff workers in the Andalusian Public Health System (Spain). This was a cross-sectional study with surveys (2011) using the Hand Hygiene Knowledge Assessment Questionnaire for Healthcare Workers with the latent class analysis technique. The average number of questions answered correctly was 17.51±3.68. Questions with lower percentages of correct responses were those on hand hygiene for prevention of microorganism transmission to patients and those on hand- rubbing versus hand-washing. We obtained a model with 7 latent classes. Workers with lower knowledge tended to be younger, males, and non-healthcare workers. Having received previous training did not necessarily ensure excellent knowledge. The study concludes that hand hygiene training programs need to be revised in order to improve knowledge on conceptual characteristics involved in the transmission of microorganisms via the hands.

Higiene de las manos: conocimientos de los profesionales y áreas de mejora / Hand hygiene: health professionals' knowledge and areas for improvement / A higiene das mãos: as competências profissionais e as áreas de melhoria

El objetivo fue analizar los conocimientos sobre la higiene de las manos de los profesionales del Sistema Sanitario Público Andaluz (España). Estudio mediante encuestas en 2011, utilizando el Hand Hygiene Knowledge Questionnaire for Health-Care Workers con la técnica de análisis de clases latentes. La media de respuestas correctas fue de 17,51 ± 3,68. Las preguntas con porcentajes de respuestas correctas más bajos son las referidas a la prevención, mediante la higiene de las manos, de la transmisión de microorganismos después de la exposición al paciente y aquellas relacionadas con la utilización de preparados de base alcohólica. Se obtuvo un modelo de 7 clases latentes. Principales diferencias socio-demográficas: los profesionales con conocimientos más bajos suelen ser hombres, jóvenes y no sanitarios; el haber recibido formación previa no discrimina a los que presentan excelentes conocimientos. Concluimos que la revisión de los programas de formación en higiene de las manos es necesaria para mejorar los conocimientos sobre aspectos conceptuales de la transmisión de microorganismos a través de las manos.

The objective of this study was to analyze knowledge on hand hygiene among staff workers in the Andalusian Public Health System (Spain). This was a cross-sectional study with surveys (2011) using the Hand Hygiene Knowledge Assessment Questionnaire for Healthcare Workers with the latent class analysis technique. The average number of questions answered correctly was 17.51±3.68. Questions with lower percentages of correct responses were those on hand hygiene for prevention of microorganism transmission to patients and those on hand- rubbing versus hand-washing. We obtained a model with 7 latent classes. Workers with lower knowledge tended to be younger, males, and non-healthcare workers. Having received previous training did not necessarily ensure excellent knowledge. The study concludes that hand hygiene training programs need to be revised in order to improve knowledge on conceptual characteristics involved in the transmission of microorganisms via the hands.

O objetivo foi analisar o conhecimento sobre a higiene das mãos dos profissionais do Sistema de Saúde Andaluz (Espanha). Os inquéritos foram realizados em 2011, por meio do questionário Hand Hygiene Knowledge Questionnaire for Health-Care Workers, usando a técnica da análise de classe latente. Questões com porcentagens mais baixas de acertos são as relacionadas com a prevenção da transmissão de micro-organismos após exposição ao paciente por higiene das mãos e aquelas relacionadas com a utilização de preparações à base de álcool. Obtivemos um modelo de sete classes latentes. Principais diferenças sociodemográficas: os profissionais de conhecimentos mais baixos são homens, jovens e profissionais não relacionados à saúde; ter recebido treinamento anterior e não discriminar as pessoas com grande conhecimento. Concluímos que é necessária a revisão dos programas de formação de higiene das mãos para melhorar o conhecimento sobre aspectos conceituais da transmissão de micro-organismos pelas mãos.

[Health professionals facing hand hygiene improvement: state-of-the-art strategies versus extended strategies]. / Profesionales de salud ante la mejora de la higiene de las manos: estrategias clásicas versus estrategias avanzadas.

BACKGROUND: The hand hygiene (HH) is one of the preventive practices more .widely and effectively implemented in the control of healthcare associated infections. However, there are several barriers to compliance. OBJECTIVES: To assess which strategy, state-of-the-art strategies (availability of alcohol-based preparations, posters, instructions and training) or extended strategies (feedbacks, formal and informal leadership), are seen as more effective to improve hand hygiene (HH) compliance. METHODS: Analytical study using a self-completed questionnaire developed by the World Health Organization. 2,068 questionnaires, completed by healthcare professionals (HP) in Andalusia (Spain), were received from 2010 to 2012. Analytical technique: Structural equation modeling and multi group measurement invariance. RESULTS: Once the reliability of the proposed constructs was achieved (Cronbach α=0.73, 0.84, 0.70), it was found that those HP working in centers with the highest level of commitment with HH are those who see extended strategies as more effective (χ2=298.3, df=39, CFI=0.972, TLI=0.961, RMSEA=0.057, SRMR=0.028). DISCUSSION: Our results have shown that hospitals' HP, compared to primary care HP, see state-of-the-art strategies as more effective, as well as they give less importance to HH, meanwhile nurses, compared to physicians, see effective both strategies. HP contemplate the combination of state-of-the-art and extended strategies as an effective way to improve the HH compliance. In addition, extended strategies are considered more effective amongst the most "advanced" healthcare settings in terms of their commitment to HH. CONCLUSIONS: The results highlight the need for commitment at management, collective and individual level in order to maintain patient safety.

[Inter-rater reliability of healthcare professional skills' portfolio assessments: The Andalusian Agency for Healthcare Quality model]. / Fiabilidad inter-jueces en evaluaciones portafolio de competencias profesionales en salud: el modelo de la Agencia de Calidad Sanitaria de Andalucía.

UNLABELLED: This study aims to determine the reliability of assessment criteria used for a portfolio at the Andalusian Agency for Healthcare Quality (ACSA). DATA: all competences certification processes, regardless of their discipline. PERIOD: 2010-2011. Three types of tests are used: 368 certificates, 17 895 reports and 22 642 clinical practice reports (N=3 010 candidates). The tests were evaluated in pairs by the ACSA team of raters using two categories: valid and invalid. RESULTS: The percentage agreement in assessments of certificates was 89.9%; for the reports of clinical practice, 85.1%; and for clinical practice reports, 81.7%. The inter-rater agreement coefficients (kappa) ranged from 0.468 to 0.711. DISCUSSION: The results of this study show that the inter-rater reliability of assessments varies from fair to good. Compared with other similar studies, the results put the reliability of the model in a comfortable position. Criteria were reviewed and progressive automation of evaluations was done.

El objetivo de este estudio es analizar la fiabilidad inter-jueces de las calificaciones realizadas por el equipo de evaluadores, pertenecientes al programa de certificación de competencias profesionales de la Agencia de Calidad Sanitaria de Andalucía (ACSA). Se estudiaron todos los procesos de certificación de competencias profesionales durante el periodo 2010-2011, independientemente de su disciplina. Se han analizado tres tipos de pruebas: 368 certificados, 17.895 informes de reflexión y 22.642 informes de práctica clínica (N = 3.010 profesionales). El porcentaje de acuerdo en las evaluaciones de certificados fue de un 89,9% (k = 0,711); 85,1% para los informes de práctica clínica (k = 0,455); y 81,7% para los informes de reflexión (k = 0,468). Los resultados de este macro-estudio muestran que la fiabilidad inter-jueces de las evaluaciones varía de ajustada a buena. En comparación con otros estudios similares, los resultados sitúan la fiabilidad del modelo en una posición cómoda. Entre las mejoras incorporadas, se incluyen la revisión de criterios y una progresiva automatización de las evaluaciones.

Profesionales de salud ante la mejora de la higiene de las manos: estrategias clásicas versus estrategias avanzadas / Health professionals facing hand hygiene improvement: state-of-the-art strategies versus extended strategies

Background: The hand hygiene (HH) is one of the preventive practices more .widely and effectively implemented in the control of healthcare associated infections. However, there are several barriers to compliance. Objectives: To assess which strategy, state-of-the-art strategies (availability of alcohol-based preparations, posters, instructions and training) or extended strategies (feedbacks, formal and informal leadership), are seen as more effective to improve hand hygiene (HH) compliance. Methods: Analytical study using a self-completed questionnaire developed by the World Health Organization. 2,068 questionnaires, completed by healthcare professionals (HP) in Andalusia (Spain), were received from 2010 to 2012. Analytical technique: Structural equation modeling and multi group measurement invariance. Results: Once the reliability of the proposed constructs was achieved (Cronbach α = 0.73, 0.84, 0.70), it was found that those HP working in centers with the highest level of commitment with HH are those who see extended strategies as more effective (χ2 = 298.3, df = 39, CFI = 0.972, TLI = 0.961, RMSEA = 0.057, SRMR = 0.028). Discussion: Our results have shown that hospitals' HP, compared to primary care HP, see state-of-the-art strategies as more effective, as well as they give less importance to HH, meanwhile nurses, compared to physicians, see effective both strategies. HP contemplate the combination of state-of-the-art and extended strategies as an effective way to improve the HH compliance. In addition, extended strategies are considered more effective amongst the most "advanced" healthcare settings in terms of their commitment to HH. Conclusions: The results highlight the need for commitment at management, collective and individual level in order to maintain patient safety.

Introducción: La higiene de las manos (HM) es una de las prácticas preventivas de mayor difusión y eficacia en el control de las infecciones asociadas a la atención en salud. Sin embargo, existen diversas barreras para su cumplimiento. Objetivos: Evaluar si son las estrategias clásicas (disponibilidad de preparados de base alcohólica, carteles, instrucciones y formación) de mejora de la HM o las estrategias avanzadas (feedbacks de cumplimiento, liderazgo formal e informal) las que se conciben como más eficaces entre los centros más involucrados con la HM. Métodos: Estudio analítico usando el cuestionario auto-cumplimentado desarrollado por la Organización Mundial de la Salud. Se recibieron 2.068 cuestionarios completos entre 2010-2012 por parte de profesionales sanitarios (PS) en Andalucía (España). Técnica analítica: modelos de ecuaciones estructurales y análisis de invarianza factorial. Resultados: Una vez se verificó la fiabilidad de los constructos propuestos (α de Cronbach: 0,73; 0,84; 0,70), se comprobó cómo aquellos PS que trabajaban en los centros más comprometidos con la HM, son aquellos que ven las estrategias avanzadas como más eficaces (χ2: 298,3; gl: 39; CFI: 0,972; TLI: 0,961; RMSEA: 0,057; SRMR: 0,028). Discusión: Se ha probado cómo en el ámbito hospitalario se ven más eficaces las estrategias clásicas y se le da menos importancia a la HM y cómo las enfermeras confían más que los médicos en todas las estrategias de mejora de la HM. Los PS contemplan la combinación de estrategias clásicas y avanzadas como el método más eficaz para la mejora de la HM. Sin embargo, las estrategias avanzadas se consideran más eficaces en aquellos centros más "maduros" en cuanto a su compromiso con la HM. Conclusiones: Los resultados ponen de manifiesto la necesidad del compromiso directivo, colectivo e individual para la seguridad del paciente.

[Predisposition of citizens to use Internet-based channels to communicate with doctors in Spain]. / Predisposición ciudadana en España a utilizar canales de comunicación con el médico basados en internet.

OBJECTIVE: Analyze factors affecting the predisposition of Spanish citizens to use Internet-based communication channels (E-mail, blogs, social networks, and online recommendations). METHODS: Secondary data were analyzed by applying a boosted regression tree (BRT) to the results obtained from the survey "Use and Applications of Information and Communications Technology in Health," administered to a representative sample of the Spanish population between 16 and 85 years of age who use the Internet. RESULTS: Model forecasts achieved different degrees of precision for each of the communication channels: for E-mail, AUC (area under the curve) = 0.79; for the physician's blog or personal website, AUC = 0.736; for social networks, AUC = 0.73; for recommendations of websites related to health problems, AUC = 0.768. Being young was the most important parameter in citizen predisposition to communicate through social networks (relative influence; RI = 21.05%), while population density was the most important parameter in likelihood that the physician would have a blog or personal health-related website (RI = 19.48%). Having a positive perception of the technology when facilitating health-related transactions was the most important characteristic in wanting to receive recommendations on health-related Internet resources (RI = 18.66%), while having a higher level of education was the best predictor of wanting to establish E-mail communication (RI = 18.98%). CONCLUSIONS: Many of Spanish people are open to using physician-patient interaction channels on the Internet.

Predisposición ciudadana en España a utilizar canales de comunicación con el médico basados en internet / Predisposition of citizens to use Internet-based channels to communicate with doctors in Spain

OBJETIVO: Analizar los factores que condicionan la predisposición de los ciudadanos españoles a utilizar los canales de comunicación basados en internet (correo electrónico, blogs, redes sociales y recomendaciones sobre recursos en internet). MÉTODOS: Análisis de datos secundarios mediante la técnica de árboles de regresión impulsados (BRT, Boosted Regression Trees) sobre los resultados obtenidos de la encuesta "Uso y aplicaciones de las tecnologías de la información y la comunicación en el ámbito sanitario", representativa de la población española de entre 16 y 85 años que utiliza internet. RESULTADOS: Las predicciones de los modelos alcanzaron diferentes grados de precisión para cada canal de comunicación: a través de correo electrónico, AUC (Area Under the Curve, área bajo la curva) = 0,79; que el médico tenga un blog o página web personal, AUC = 0,736; a través de redes sociales, AUC = 0,73; recibir recomendaciones de páginas web relacionadas con problemas de salud, AUC = 0,768. Ser joven fue el parámetro más importante para explicar la disposición ciudadana a comunicarse a través de redes sociales (IR [influencia relativa] = 21,05%), mientras que la densidad poblacional lo fue para estar dispuesto a que el médico tenga un blog o página web personal sobre salud (IR = 19,48%). Tener una percepción positiva de las tecnologías a la hora de facilitar los trámites en salud es la característica más importante para desear recibir recomendaciones sobre recursos de internet en salud (IR = 18,66%) mientras que tener un mayor nivel educativo fue lo que mejor predice el deseo de establecer comunicación a través de correo electrónico (IR=18,98%). CONCLUSIONES: Una buena parte de la población española se encuentra suficientemente preparada para utilizar canales de interacción médico-paciente a través de internet.

OBJECTIVE: Analyze factors affecting the predisposition of Spanish citizens to use Internet-based communication channels (E-mail, blogs, social networks, and online recommendations). METHODS: Secondary data were analyzed by applying a boosted regression tree (BRT) to the results obtained from the survey "Use and Applications of Information and Communications Technology in Health," administered to a representative sample of the Spanish population between 16 and 85 years of age who use the Internet. RESULTS: Model forecasts achieved different degrees of precision for each of the communication channels: for E-mail, AUC (area under the curve) = 0.79; for the physician's blog or personal website, AUC = 0.736; for social networks, AUC = 0.73; for recommendations of websites related to health problems, AUC = 0.768. Being young was the most important parameter in citizen predisposition to communicate through social networks (relative influence; RI = 21.05%), while population density was the most important parameter in likelihood that the physician would have a blog or personal health-related website (RI = 19.48%). Having a positive perception of the technology when facilitating health-related transactions was the most important characteristic in wanting to receive recommendations on health-related Internet resources (RI = 18.66%), while having a higher level of education was the best predictor of wanting to establish E-mail communication (RI = 18.98%). CONCLUSIONS: Many of Spanish people are open to using physician-patient interaction channels on the Internet.

Evaluación y mejoría del dolor en niños atendidos por enfermeras acreditadas: estudio descriptivo / Pain assessment and improvement in children treated by accredited nurses: descriptive study

Antecedentes: la evaluación del dolor es una tarea compleja que requiere de un esfuerzo considerable dada su naturaleza multidimensional. Esta evaluación es, si cabe, más compleja en el caso de los niños debido a las dificultades de comunicación y dominio del lenguaje. Objetivos: analizar la reducción del dolor logrado por enfermeras acreditadas, en función de la edad de los niños atendidos. Metodología: se utilizaron 161 evaluaciones del dolor percibido en niños de entre 0 y 15 años, realizadas por 93 enfermeras acreditadas entre septiembre de 2006 y julio de 2011. Para la elaboración de los análisis descriptivos se utilizó el test estadístico Chi-cuadrado. Se calcularon las Odds ratio para la probabilidad de reducir el dolor a 0 en los niños según su edad. Resultados: los resultados evidenciaron que las enfermeras presentan un mayor nivel de competencias en la reducción del dolor en niños de edades comprendidas entre 2 y 3 años, observándose hasta los 10 años una leve tendencia negativa en la capacidad de reducir el dolor a cero por parte de las enfermeras, a medida que aumenta la edad del niño. Conclusiones: este trabajo aborda la evaluación del dolor, realizada por el conjunto de enfermeras de cuidados infantiles, que trabajan en los servicios de salud públicos de Andalucía, y que han sido acreditadas por la Agencia de Calidad Sanitaria de Andalucía, España. Las enfermeras utilizaron distintos tipos de escalas de medición del dolor, en función del desarrollo cognitivo de los niños atendidos.

Background. Pain assessment is a complex task that requires considerable effort due to its multidimensional nature. This assessment is, if anything, more complex in the case of children due to the difficulties of communication and language proficiency. Aim. To analyse pain reduction achieved by accredited nurses depending on the age of the children treated. Method. 161 assessments of perceived pain in children aged 0 to 15 years conducted by 93 accredited nurses between September 2006 and July 2011 were used. Chi-square tests were applied for descriptive analysis. Odds ratio for probabilities of reducing pain to 0 was calculated according the age of the children. Results. The results show that nurses have a higher level of competency in reducing pain in children aged between 2 and 3 years, showing a mild negative trend in the ability to reduce pain to zero, with increasing child's age. Conclusions. This paper addresses the assessment of pain, held by all child-care nurses who work in Public Health Services of Andalusia (Spain), which have been accredited by the Andalusian Agency for Healthcare Quality. Nurses have used different types of pain measurement scales, depending on the cognitive development of children treated.

Revisión sistemática sobre recomendaciones de seguridad del paciente para centros sociosanitarios / Recommendations on the safety of patients for socio-health centers: Systematic review

El objetivo de esta revisión sistemática se centra en la búsqueda de recomendaciones sobre seguridad del paciente que en diferentes contextos sociosanitarios (residencias para personas de edad avanzada y centros de estancia prolongada) se orientan a lograr una atención más segura. Se seleccionaron 134 artículos en MEDLINE, EMBASE y CINAHL hasta octubre de 2012. De ellos, 17 cumplían finalmente los criterios de inclusión, y 5 estudios más se añadieron en la búsqueda secundaria. Fueron escasos los estudios con un nivel de evidencia científica alto o muy alto según la escala SIGN. Los estudios analizados se centran principalmente en el personal de enfermería. La mayoría de las recomendaciones se basan en aspectos relacionados con la medicación, la formación del personal, las úlceras por presión o caídas, la adherencia a guías y protocolos, así como aspectos relacionados con la cultura organizacional

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[Recommendations on the safety of patients for socio-health centers: systematic review]. / Revisión sistemática sobre recomendaciones de seguridad del paciente para centros sociosanitarios.

We did a systematic review to find recommendations on patient safety oriented toward improving the quality of care in nursing homes, residential facilities, housing for the elderly and long-term care facilities, among others. One hundred and thirty-four articles were selected in MEDLINE, EMBASE and CINAHL up to October 2012. Of these, 17 met inclusion criteria and 5 studies were added in the secondary search for further detailed analysis. Few studies with high or very high level of scientific evidence on the scale SIGN were identified. Analyzed studies focused primarily on nursing staff. Most of the recommendations are oriented toward medication-related issues, staff training, pressure ulcers or falls, adherence to guidelines and protocols and topics referred to organizational culture.

Stakeholder analysis: theAndalusian Agency For Healthcare Quality case.

The aim of this study was to identify the different groups that can affect or be affected by an agency charged with the promoting and guaranteeing of health care quality in Andalusian region (Spain) and to provide a framework with the stakeholders included in different categories. The study adopted a cross-sectional research design. A case study with structured interviews among Andalusian Agency for Healthcare Quality Steering Committee members was carried out in 2010 to define stakeholders' categories and map the interest groups using 5 attributes: influence, importance, legitimacy, power, and urgency. After identification and categorization, stakeholders were weighted qualitatively according to the attributes of importance and influence using 4 possible levels. A matrix was made with the collected data relating both attributes. Furthermore, 8 different types of stakeholders were identified according to attributes power, legitimacy, and urgency. The study concludes that identifying and classifying stakeholders are fundamental to ensuring the success of an organization that must respond to needs and expectations, especially those of its clients. Moreover, knowing stakeholder linkages can contribute to increase organizational worth. This is essential for organizations basically directed to the provision of services in the scope of health care.