Assessing patient satisfaction with telephone-based consultations before, during and after the COVID-19 pandemic in Spain / Evaluación de la satisfacción de los pacientes con las consultas telefónicas antes, durante y después de la pandemia de COVID-19 en España

Objective: To validate a questionnaire to analyze the perception of users of primary care (PC) with telephone consultation (TC), and to study the satisfaction with TC by users of PC services. Design: A two-phase study was conducted. Firstly, a questionnaire on satisfaction with telemedicine services was validated. Secondly, a cross-sectional study on satisfaction with TC was conducted. Setting: PC. Participants: 405 users of PC services in Zaragoza (Spain). Main outcome measure: Our main outcome was the satisfaction with telemedicine services PC services. Factor analysis was carried out using the exploratory factor analysis with Varimax rotation. The reliability of the dimensions obtained was analyzed using Cronbach's alpha. The inferential analysis was conducted using parametric tests. Results: The questionnaire was a valid and reliable tool (α>0.9) to assess the satisfaction of PC service users with telemedicine services. Before COVID-19, the satisfaction of the users with PC was adequate (mean=6111/10). However, during the COVID-19 the attention in PC centers became mostly telephone-based and satisfaction lowered as disappointing (mean=3555/10). Regarding the future of telemedicine, users considered it as unsatisfactory (mean=2977/10). Being a woman, being unemployed and belonging to an area of low vulnerability led to a worse perception of telemedicine. Conclusion: This questionnaire was a valid and reliable tool to assess the satisfaction of PC service users with telemedicine services. Perceptions of patient satisfaction decreased during COVID-19. Thus, TC seems to be a good option when the patients consider it to be a complementary rather than a substitute tool to follow-up their conditions.(AU)

Objetivo: Validar un cuestionario para analizar la percepción de los usuarios de atención primaria (AP) con la consulta telefónica (CT) y estudiar la satisfacción de la CT por parte de estos. Diseño: Estudio en dos fases. Se validó un cuestionario sobre satisfacción con los servicios de telemedicina. Después, se realizó un estudio transversal sobre la satisfacción con la CT. Emplazamiento: AP. Participantes: Un total de 405 usuarios de servicios de AP en Zaragoza (España). Medición principal: Satisfacción con los servicios de telemedicina de AP. El análisis factorial se realizó a través del exploratorio con rotación Varimax. La fiabilidad de las dimensiones se analizó con el alfa de Cronbach. El inferencial se efectuó mediante pruebas paramétricas. Resultados: El cuestionario resultó válido y fiable (α>0,9) para evaluar la satisfacción de los usuarios con la telemedicina. Antes de la COVID-19, esta era adecuada (media=6,111/10) con la AP. Durante la pandemia la atención en AP pasó a ser mayoritariamente telefónica y la satisfacción disminuyó (media=3,555/10). Con respecto al futuro de la telemedicina, los usuarios lo consideraron insatisfactorio (media=2,977/10). Ser mujer, estar en paro y pertenecer a una zona de baja vulnerabilidad conllevó una peor percepción de la telemedicina. Conclusiones: Nuestro cuestionario fue un instrumento válido y fiable para evaluar la satisfacción de los usuarios de servicios de AP con la telemedicina, la cual disminuyó durante la COVID-19. La CT es una buena opción cuando los pacientes la consideran una herramienta complementaria y no sustitutiva para el seguimiento de sus dolencias.(AU)

Assessing patient satisfaction with telephone-based consultations before, during and after the COVID-19 pandemic in Spain.

OBJECTIVE: To validate a questionnaire to analyze the perception of users of primary care (PC) with telephone consultation (TC), and to study the satisfaction with TC by users of PC services. DESIGN: A two-phase study was conducted. Firstly, a questionnaire on satisfaction with telemedicine services was validated. Secondly, a cross-sectional study on satisfaction with TC was conducted. SETTING: PC. PARTICIPANTS: 405 users of PC services in Zaragoza (Spain). MAIN OUTCOME MEASURE: Our main outcome was the satisfaction with telemedicine services PC services. Factor analysis was carried out using the exploratory factor analysis with Varimax rotation. The reliability of the dimensions obtained was analyzed using Cronbach's alpha. The inferential analysis was conducted using parametric tests. RESULTS: The questionnaire was a valid and reliable tool (α>0.9) to assess the satisfaction of PC service users with telemedicine services. Before COVID-19, the satisfaction of the users with PC was adequate (mean=6111/10). However, during the COVID-19 the attention in PC centers became mostly telephone-based and satisfaction lowered as disappointing (mean=3555/10). Regarding the future of telemedicine, users considered it as unsatisfactory (mean=2977/10). Being a woman, being unemployed and belonging to an area of low vulnerability led to a worse perception of telemedicine. CONCLUSION: This questionnaire was a valid and reliable tool to assess the satisfaction of PC service users with telemedicine services. Perceptions of patient satisfaction decreased during COVID-19. Thus, TC seems to be a good option when the patients consider it to be a complementary rather than a substitute tool to follow-up their conditions.

Classification accuracy and resistance to coaching of the Spanish version of the Inventory of Problems -29 and the Inventory of Problems - Memory: a simulation study with mTBI patients.

Objective: The present study aims to evaluate the classification accuracy and resistance to coaching of the Inventory of Problems-29 (IOP-29) and the IOP-Memory (IOP-M) with a Spanish sample of patients diagnosed with mild traumatic brain injury (mTBI) and healthy participants instructed to feign. Method: Using a simulation design, 37 outpatients with mTBI (clinical control group) and 213 non-clinical instructed feigners under several coaching conditions completed the Spanish versions of the IOP-29, IOP-M, Structured Inventory of Malingered Symptomatology, and Rivermead Post Concussion Symptoms Questionnaire. Results: The IOP-29 discriminated well between clinical patients and instructed feigners, with an excellent classification accuracy for the recommended cutoff score (FDS ≥ .50; sensitivity = 87.10% for coached group and 89.09% for uncoached; specificity = 95.12%). The IOP-M also showed an excellent classification accuracy (cutoff ≤ 29; sensitivity = 87.27% for coached group and 93.55% for uncoached; specificity = 97.56%). Both instruments proved to be resistant to symptom information coaching and performance warnings. Conclusions: The results confirm that both of the IOP measures offer a similarly valid but different perspective compared to SIMS when assessing the credibility of symptoms of mTBI. The encouraging findings indicate that both tests are a valuable addition to the symptom validity practices of forensic professionals. Additional research in multiple contexts and with diverse conditions is warranted.

Facilitating Factors and Barriers in the Return to Work of Working Women Survivors of Breast Cancer: A Qualitative Study.

Several studies have identified the main barriers and facilitators that breast cancer survivors experience in the return to work (RTW). The authors conducted a qualitative study using focus group discussions with a group of female non-metastatic breast cancer survivors (n = 6), a group of health professionals from different medical specialties (n = 8), and a third group of company managers mainly composed of human resources managers (n = 7). The study was carried out between March and December 2021 in Zaragoza (Spain). Transcripts were analyzed using inductive content analysis to identify work-related barriers and facilitators and coded by the research team. Barriers identified included physical and cognitive symptoms, psychosocial problems, lack of knowledge and coordination (health professional, patients, and managers), legal vacuum, physical change, time constraints, work characteristics (lower skilled jobs), unsupportive supervisors and coworkers, family problems and self-demand. Facilitators included family and work support, physical activity and rehabilitation, personalized attention, interdisciplinary collaboration, legal advice for workers, knowledge about breast cancer in companies, positive aspects of work, elaboration of protocols for RTW in women with breast cancer. RTW in working women with breast cancer requires a personalized and holistic view that includes the perspectives of patients, healthcare professionals and company managers.

Association of occupational physical activity and disability pension in 756,159 Spanish workers: A prospective cohort study with 13 years follow-up.

Recent research from Nordic countries identified occupational physical activity (OPA) as a risk factor for disability pension, but further research accounting for exhaustive analyses in novel populations is warranted. Our objective was to assess the association between OPA and disability pension using administrative data. This prospective registry-based cohort study used data from the Spanish Continuous Working Life Sample (CWLS). Participants were followed up from baseline (January 1, 2006) to first event of disability pension, mortality, or end of follow-up (September 1, 2019). The assessment of OPA was based on registers of economic activity and their correspondence with a validated OPA index. To examine the association between OPA and disability pension, adjusted proportional hazard, and Fine-Gray models using mortality as competing risk were conducted. We retrieved data from 756,159 workers (57.7% men) with an average age of 38.5 years (SD 11.9). During 13.6 years from baseline to the end of follow-up (9,463,041 person-years), 18,191 men (4.2%) and 9631 (3.0%) women received a disability pension. In the fully adjusted model, participants exposed to higher levels of OPA showed higher risk for disability pension in an exposure-response fashion. Men and women exposed to very high OPA showed the highest HR for disability pension (2.31 [95% CI, 2.17 to 2.46] and 1.68 [95% CI, 1.56 to 1.81], respectively. These results warrant preventative measures to address early involuntary exit from the labour market in workers exposed to high physical work demands.

(Un)Broken: Lateral violence among hospital nurses, user violence, burnout, and general health: A structural equation modeling analysis.

Introduction: Workplace violence is a social problem yet to be solved. Although it is present in virtually all work environments, its prevalence in healthcare settings stands out, being perceived as something inherent to the job. Most studies in this context have focused on user violence against professionals. However, it has been observed that violence among colleagues in these types of jobs is a risk factor for the health of workers and has rarely been studied as a whole. Among the main consequences of exposure to violence reported in the literature, burnout syndrome, depression, anxiety, or somatic problems have been among the most studied. On the one hand, some authors claim that being exposed to workplace violence can increase the associated physical and psychological pathology and lead to a picture congruent with burnout. On the other hand, it has been hypothesized that violence is associated with burnout, which can trigger physical and psychological symptoms. Taking into account this background, the aim of this study is to explore workplace violence in health personnel, symptomatology, and burnout syndrome through mediation models that allow us to know the interrelationships between the variables. Methods: A cross-sectional design with a double descriptive-associative strategy was used. The sample was composed of 950 nursing professionals from public hospitals. The scales of physical and non-physical violence from users to professionals HABS-U, personal, social, and occupational violence among co-workers using the Health Aggressive Behavior Scale - Co-workers and Superiors (HABS-CS) scale, the burnout scale Maslach Burnout Inventory - General Survey (MBI-GS) which evaluates professional exhaustion, efficacy and cynicism, and the factors referring to depression, anxiety, somatization, and dysfunction of the GHQ-28 scale were applied. In order to calculate the models, workplace violence was used as a predictor of symptomatology, using the burnout variables as mediators. Regression coefficients with and without mediation model, direct and standardized estimates were obtained. For statistical power, Bootstrap analysis was used to calculate direct mediation effects. Results: After controlling the mediation effects of burnout and cynicism, physical and non-physical user violence toward healthcare personnel were significant predictors of the GHQ-28 scores. These same results were obtained when assessing the relationship between social, occupational, and personal violence among co-workers and GHQ-28 scores. Conclusion: Our results contribute to increase the evidence about the effects of violence on the health of professionals and to advance in the characterization of the possible consequent psychological damage. Regardless of the type of violence experienced, exposure to violence can lead to anxious, depressive or somatization symptoms, among others. Violence is also a predictor of burnout syndrome, which in turn accentuates the rest of the consequences studied. Despite the limitations of the proposed model, these results serve to highlight the complexity of the situation experienced by healthcare professionals. Moreover, it serves as a basis for proposing intervention/prevention programs to raise awareness and protect professionals from these risks. To this end, self-care tools should be proposed with which professionals take care of their own health through the management of violent situations and/or the improvement of occupational health.

The Impact of Different Forms of Coaching on the Structured Inventory of Malingered Symtomatology (SIMS).

BACKGROUND: Psychometric symptom validity instruments (SVTs) can be vulnerable to coaching, which can negatively affect their performance. Our aim was to assess the impact that different types of coaching may have on the sensitivity of the Structured Inventory of Malingered Symptomatology (SIMS). METHODS: A simulation design was used with 232 non-clinical adults divided into five experimental simulation conditions and 58 patients with anxious-depressive symptomatology derived from a traffic accident. All simulators received a basic scenario and, in addition, the second group was instructed on the symptomatology, the third was warned about the risk of exaggerating the presentation, the fourth received a combination of the two previous groups and the fifth received specific training on SVTs. RESULTS: The discriminative ability of the SIMS was higher in the basic and symptom information groups, and it decreased significantly in the specific training group on SVTs. CONCLUSIONS: SIMS seems not to be severely impacted by a variety of symptom coaching styles, although test coaching diminished its performance.

Sources of Conflict and Prevention Proposals in User Violence Toward Primary Care Staff: A Qualitative Study of the Perception of Professionals.

Background: Some studies indicate that at least one in four cases of workplace violence occurs in the health sector, with a higher incidence in Emergency Departments, Mental Health Services or Primary Care. Unlike other professional groups, healthcare workers perceive this type of behavior mainly from users or patients. This is the reason why both the detection of conflict between users and professionals and the ways to face and reduce these conflicts has been and is one of the main fields of study in this population. The aim of this study was to delve into the sources of conflict between users and professionals in Primary Care from the perspective of the professionals themselves. In addition, the aim was to explore the proposals for intervention/prevention of this conflict that the professionals perceived as necessary to improve the work environment. Methods: This study uses qualitative methodology conducting 8 focus groups with professionals related to Primary Health Care. The final sample was composed of 44 workers who were part of the regional management, labor unions, area coordinators, center coordinators and representatives of the professional groups of these centers (medicine, nursing and administration). Thematic analysis was used to extract topics and subtopics. Results: The results are divided into areas of conflict and intervention proposals. The professionals detect a lack of training or education in themselves, absence of functional multidisciplinary teams or competencies to improve the patient-professional relationship, among others. To address these shortcomings, they propose the creation of protocols for action in the face of aggression, the formation of spaces and channels of communication both among the center's own workers and between them and other organizations (e.g., hospitals), fostering a positive relationship with the user community and ongoing training in various topics such as self-safety, management of emotions, empathy or interpersonal communication. Conclusions: This study allows to highlight specific areas of user-professional conflict in Primary Care. Furthermore, the inclusion of intervention proposals by the professionals allows to propose starting points for the development of complete plans.

The Impact of Different Forms of Coaching on the Structured Inventory of Malingered Symtomatology (SIMS)(AU) / El Impacto de Diferentes Formas de Coaching en el Inventario Estructurado de Simulación de Síntomas (SIMS)(AU)

Background: Psychometric symptom validity instruments (SVTs) can be vulnerable to coaching, which can negatively affect their performance. Our aim was to assess the impact that different types of coaching may have on the sensitivity of the Structured Inventory of Malingered Symptomatology (SIMS). Methods: A simulation design was used with 232 non-clinical adults divided into five experimental simulation conditions and 58 patients with anxious-depressive symptomatology derived from a traffic accident. All simulators received a basic scenario and, in addition, the second group was instructed on the symptomatology, the third was warned about the risk of exaggerating the presentation, the fourth received a combination of the two previous groups and the fifth received specific training on SVTs. Results: The discriminative ability of the SIMS was higher in the basic and symptom information groups, and it decreased significantly in the specific training group on SVTs. Conclusions: SIMS seems not to be severely impacted by a variety of symptom coaching styles, although test coaching diminished its performance.(AU)

Antecedentes: Los instrumentos psicométricos de validez de síntomas (SVTs) pueden ser vulnerables a la preparación, lo que puede afectar negativamente a su rendimiento. Nuestro objetivo evaluar el impacto que diferentes tipos de preparación pueden tener en la sensibilidad del Inventario Estructurado de Simulación de Síntomas (SIMS). Método: Se utilizó un diseño de simulación con 232 adultos no clínicos divididos en cinco condiciones de simulación y 58 pacientes con sintomatología ansioso-depresiva derivada de un accidente de circulación. Todos los simuladores recibieron un escenario básico y, además, el segundo grupo fue instruido sobre la sintomatología a presentar, el tercero fue advertido sobre el riesgo de exagerar su presentación, el cuarto recibió una combinación de los dos grupos anteriores y el quinto recibió un entrenamiento específico sobre SVTs. Resultados: La capacidad discriminativa del SIMS fue más elevada en el grupo de escenario básico e información de síntomas, disminuyendo significativamente en el grupo de entrenamiento sobre SVTs. Conclusiones: El SIMS parece no verse afectado severamente por las diferentes formas de coaching, no obstante, la preparación específica sobre el test disminuye su rendimiento.(AU)

Citizen Stance towards Mandatory COVID-19 Vaccination and Vaccine Booster Doses: A Study in Colombia, El Salvador and Spain.

The infections and deaths resulting from Coronavirus Disease 2019 (COVID-19) triggered the need for some governments to make COVID-19 vaccines mandatory. The present study aims to analyze the position of 3026 adults in Colombia, El Salvador, and Spain regarding the possibility of making COVID-19 vaccine mandatory and the intention to be vaccinated with the booster or possible successive doses. Data from an online survey conducted from August to December 2021 among a non-representative sample of Spanish-speaking countries were collected. Multinomial Logistic Regression Models were used. A total of 77.4% of Colombians were in favor of mandatory vaccination compared to 71.5% of Salvadorians and 65.4% of Spaniards (p < 0.000). Women and people over 65 years of age were the groups most in favor of making the vaccine mandatory (p < 0.000). A total of 79.4% said they had received a third dose or would intend to receive the third dose or future doses, if necessary, compared with 9.4% who expressed doubts and 9.9% who refused to be vaccinated or did not intend to be vaccinated. Among the measures that could be taken to motivate vaccination, 63.0% and 60.6% were in favor of requiring a negative test to enter any place of leisure or work, respectively, compared to 16.2% in favor of suspension from work without pay. The acceptance of mandatory vaccination and of third or future doses varies greatly according to sociodemographic characteristics and work environment. As such, it is recommended that policy makers adapt public health strategies accordingly.

Profiles of lateral violence in nursing personnel of the Spanish public health system.

BACKGROUND: Workplace violence in healthcare settings has long been studied in scientific literature, particularly in the nursing profession. Research has explored mostly user violence probably for its high prevalence and impact on health and job satisfaction. Yet this focus may overshadow another dangerous type of workplace violence: coworker violence. Exerted by co-workers with similar status, lateral violence differs from that yielded by a co-worker with a higher rank, known as vertical. This study aims to deepen the knowledge about lateral violence perceived by nurses and its interaction with other variables commonly associated with workplace violence in healthcare: burnout, job satisfaction, and self-perceived health. METHOD: A random block sampling was performed, prompting a total sample of 925 nursing professionals from 13 public hospitals located in the southeast of Spain. The sample distribution (mean and standard deviation) and the response percentages according to the study variables of the ad-hoc questionnaire were analyzed and classified with cluster analysis. RESULTS: Through the cluster analysis, two subgroups were obtained: Cluster 1, composed of 779 participants, with low scores in the variables used for the classification, high levels of both extrinsic and intrinsic satisfaction, low levels of emotional exhaustion and cynicism, and low rates of somatization, anxiety, social dysfunction and depression; and Cluster 2, composed of 115 participants and characterized by moderate-high scores in the variables used for the classification, moderate extrinsic satisfaction, and low intrinsic satisfaction, high emotional exhaustion and cynicism and lower somatization, anxiety, social dysfunction, and depression scores. Excluded cases amounted to 31. CONCLUSION: Nursing professionals who experience lateral violence reveal a lower intrinsic satisfaction, feeling less self-accomplished in their job, and less positive work experience. Emotional exhaustion rises as a concerning progressive and long-term outcome of experiencing this type of violence.

Planning a Collection of Virtual Patients to Train Clinical Reasoning: A Blueprint Representative of the European Population.

BACKGROUND: Virtual patients (VPs) are a suitable method for students to train their clinical reasoning abilities. We describe a process of developing a blueprint for a diverse and realistic VP collection (prior to VP creation) that facilitates deliberate practice of clinical reasoning and meets educational requirements of medical schools. METHODS: An international and interdisciplinary partnership of five European countries developed a blueprint for a collection of 200 VPs in four steps: (1) Defining the criteria (e.g., key symptoms, age, sex) and categorizing them into disease-, patient-, encounter- and learner-related, (2) Identifying data sources for assessing the representativeness of the collection, (3) Populating the blueprint, and (4) Refining and reaching consensus. RESULTS: The blueprint is publicly available and covers 29 key symptoms and 176 final diagnoses including the most prevalent medical conditions in Europe. Moreover, our analyses showed that the blueprint appears to be representative of the European population. CONCLUSIONS: The development of the blueprint required a stepwise approach, which can be replicated for the creation of other VP or case collections. We consider the blueprint an appropriate starting point for the actual creation of the VPs, but constant updating and refining is needed.

Educación y formación para prevenir y minimizar las agresiones dirigidas al personal sanitario en el lugar de trabajo / Education and training for preventing and minimizing workplace aggression directed toward healthcare workers

No disponible

Assessment of Non-physical User Violence and Burnout in Primary Health Care Professionals. The Modulating Role of Job Satisfaction.

INTRODUCTION: Growing concern about workplace violence shows the need for an evaluation in specific contexts in order to identify the particularities of each professional group. The health sector consists of a group of professionals with high exposure to violence, specially from users. There are differences depending on the professional category or unit in which the professional works. In this regard, Primary Health Care (PHC) is characterized by a personalized and continuous patient treatment over time, which is not exempt from cases of violence. Among the commonly studied consequences of these situations are decreases in job satisfaction and burnout. OBJECTIVE: The main objective of this study is to analyze the modulating role of job satisfaction in the relationship between non-physical user violence and the onset of burnout. METHODS: Cross-sectional comparative descriptive design. The sample consisted of 574 professionals from 39 PHC centers of the Murcian Health Service. Data were collected using two-stage cluster sampling. For data analysis, descriptive analysis, correlations and stepwise hierarchical regression were used to analyze the interaction between the variables. RESULTS: Regression analysis draws a model where non-physical violence and low intrinsic and extrinsic job satisfaction act as modulators of non-physical violence, cynicism and emotional exhaustion. CONCLUSIONS: This study provides evidence of the psychological consequences of the perception of user violence in the PHC staff. Furthermore, it is evident that the emergence of burnout syndrome in these professionals is related to exposure to verbal or non-physical violence together with low job satisfaction. In this sense, a circular and bidirectional relationship between the variables studied is proposed as a possible explanatory model.

Changing Attitudes towards Occupational Medicine with Blended Learning Methods Is Possible among Medical Students in Spain: A Longitudinal Study.

Medical students generally express a low interest in Occupational Medicine. We aimed to assess the attitudes and changes in attitudes of students towards this area after completing a course on Occupational Medicine in two Medical Universities in Spain (Zaragoza and Castilla-La Mancha). The teaching method included blended learning as a model that used online virtual patient platforms (CASUS) and/or EMUTOM, as well as traditional methods such as face-to-face teaching. A total of 526 students (98 of whom attended the University of Castilla-La Mancha) participated during three academic years (2015-2016, 2016-2017 and 2017-2018). The validation of the questionnaire was carried out using reliability, exploratory and confirmatory factor analysis. For the analysis of internal consistency and discrimination, Cronbach's alpha was used. The adequacy of the factor analysis was measured by means of KMO, and a correlation matrix was examined by means of Bartlett's test of sphericity. To identify differences between students before and after completing the course, the Mann-Whitney U-test for independent samples was used. Our results show that despite a negative or neutral attitude towards Occupational Medicine, the acquisition of competences and skills in this area and their training were recognized as fundamental for their future professional performance as doctors in any specialty.

Attitudes toward School Violence against LGBTQIA+. A Qualitative Study.

School climate is one of the main concerns in terms of research and intervention worldwide. Although it can be directed toward any student, some groups seem to be more vulnerable, as is the case of the LGBTQIA+ (lesbian, gay, bisexual, transgender, queer and intersex +) students, among others. Attitudes toward violence are a construct of particular importance for action plans focused on improving school coexistence. The aim of this study is to examine attitudes toward school violence against LGBTQIA+ students and their relationship with violent behaviors. For this purpose, 96 Spanish students of Spanish elementary education (PE) and compulsory secondary education (CSE) participated in this qualitative study through focus groups for its subsequent thematic analysis. The results identify four types of attitudes toward violence, such as the use of violence as a form of fun, to feel better, when it is perceived as legitimate, and as a way of relating to the LGBTQIA+ community. In addition, a greater number of negative attitudes and violent behaviors toward homosexual boys and transgender minors are observed.