Prevalence and risk factors for misuse of prescription psychotropic drug in patients with severe mental illness: A systematic review.

RESUMEN Objective. The misuse of prescription psychotropic drugs is a major health problem.

Prevalencia y factores de riesgo del uso problemático de psicofármacos de prescripción en población con trastorno mental grave: Una revisión sistemática / Prevalence and risk factors for misuse of prescription psychotropic drug in patients with severe mental illness: a systematic review

Objetivo. El uso problemático de psicofármacos de prescripción es un creciente problema de salud. Uno de los grupos más expuestos al consumo de estas sustancias son las personas con un trastorno mental grave. El objetivo de esta revisión es analizar cuál es la prevalencia y los factores de riesgo, del uso problemático de fármacos psicoactivos, con prescripción médica, en pacientes con trastorno mental grave. Método. Se llevó a cabo una revisión sistemática siguiendo el protocolo PRISMA consultando las bases de datos científicas Medline, Web Of Science, SCOPUS, Proquest y PsycINFO. La revisión se realizó desde enero de 2011 hasta diciembre de 2021. De cada documento se extrajo la información relativa al uso problemático de los psicofármacos prescritos y sus niveles de gravedad. Resultados. De un total de 477 trabajos, 5 cumplían con los criterios de inclusión. Entre un 26% y un 48,7% de pacientes con trastorno mental grave hace un uso problemático de los psicofármacos prescritos y desarrollan dependencia. Los problemas de consumo de otras drogas, tener una historia de prescripción de benzodiacepinas, considerar esencial el uso del fármaco, un uso prolongado, la impulsividad y los comportamientos autolesivos se mostraron como factores de riesgo a la hora de desarrollar un uso problemático de los psicofármacos recetados. Conclusiones. La población con trastorno mental grave convive con factores que la hacen vulnerable al riesgo de desarrollar un uso problemático de las sustancias psicoactivas prescritas. Son necesarios futuros estudios, que profundicen en los efectos y el tratamiento del uso problemático, de los psicofármacos prescritos, en estos pacientes. (AU)

Objective. The misuse of prescription psychotropic drugs is a major health problem. One of the most exposed groups to the use of these substances is people with a severe mental illness. The aim of this review is to assess the prevalence and risk factors of problematic use of psychoactive prescription drugs in patients with SMI. Method. A systematic review was conducted following a PRISMA protocol through the scientific databases PubMed, Web Of Science, SCOPUS, ProquestPsycho and PsycInfo. The review was conducted from January 2011 to December 2021. Information on the misuse of prescribed psychotropic drugs and the levels of dependence generated in the severe mental illness population was examined. Results. A total of 477 studies were identified, and 5 were selected according to the established criteria. Between 26% and 48.7% of patients with severe mental illness misuse prescribed psychotropic drugs and develop dependence. Other drug use problems, having a history of benzodiazepine prescription, perceive drug use as essential, prolonged use, impulsivity and self-harm behaviors were shown as risk factors for developing misuse of prescribed psychotropic drugs. Conclusions. The severe mental illness population lives with several factors that make them vulnerable to the risk of developing misuse of prescribed psychoactive substances. Future studies are needed, since the current evidence is limited, and does not delve into the effects and treatment of misuse of prescribed psychotropic drugs in these patients. (AU)

La participación ciudadana en salud. Revisión de revisiones / Public participation in health. A review of reviews

Fundamento: El objetivo de este estudio es sintetizar el conocimiento sobre el papel de la participación ciudadana en la definición, priorización, racionalización, supervisión o control de políticas, planes, gobernanza, inversión/desinversión, o diseño de servicios de salud. Material y métodos: Revisión de trabajos de revisión (narrativa o sistemática) sobre participación ciudadana indexados hasta agosto de 2016 en PubMed. Resultados: Se identificaron cuarenta y dos revisiones (dieciocho sistemáticas y veinticuatro narrativas). La participación tuvo un alcance provincial/regional o estatal. Los aspectos tratados abarcaron: qué es participación ciudadana, qué beneficios se esperan, quiénes participan, cómo y hasta qué punto y con qué resultados. El impacto de la participación apenas ha sido estudiado. Conclusiones: Existe moderada evidencia de que la participación ciudadana legitima las decisiones de las autoridades sanitarias y de que mejora los resultados de las políticas públicas. Existe consenso en cómo aplicar las técnicas de participación, pero es necesario ahondar en la medida de su impacto

Background: This study aims to synthesize knowledge about the role of the public’s participation in the definition, prioritization, rationalization, monitoring or control of policies, plans, governance, investment/disinvestment, and design of health services. Methods: Review of review articles (narrative or systematic) about consumer participation indexed in PubMed until August 2016. Results: Forty-two reviews were identified (eighteen systematic and twenty-four narrative). The extent of participation was provincial/regional or national. The issues addressed covered: What is public participation? What benefits are expected? Who participates in the representation of citizens? How and to what extent do citizens participate and with what outcomes? The impact of public participation has hardly been studied. Conclusions: There is moderate evidence in support of the argument that public participation legitimizes decisions of the Health Authorities, and improves outcomes of health policies. There is consensus on how participation techniques should be applied but there is a need to inquire more deeply into the level of impact of this participation

[Public participation in health. A review of reviews]. / La participación ciudadana en salud. Revisión de revisiones.

BACKGROUND: This study aims to synthesize knowledge about the role of the public's participation in the definition, prioritization, rationalization, monitoring or control of policies, plans, governance, investment/disinvestment, and design of health services. METHODS: Review of review articles (narrative or systematic) about consumer participation indexed in PubMed until August 2016. RESULTS: Forty-two reviews were identified (eighteen systematic and twenty-four narrative). The extent of participation was provincial/regional or national. The issues addressed covered: What is public participation? What benefits are expected? Who participates in the representation of citizens? How and to what extent do citizens participate and with what outcomes? The impact of public participation has hardly been studied. CONCLUSIONS: There is moderate evidence in support of the argument that public participation legitimizes decisions of the Health Authorities, and improves outcomes of health policies. There is consensus on how participation techniques should be applied but there is a need to inquire more deeply into the level of impact of this participation.

[The reputation of Spanish hospitals. Basis for developing a reputation index of hospitals]. / La reputación de los hospitales españoles. Bases para el desarrollo de un índice de reputación de los hospitales.

BACKGROUND: The reputation of the health centers is associated with: greater user preference in obtaining their services, better clinical outcomes and higher care quality and potential for attracting talented professionals. Reputation was evaluated using indexes and scales. The aim of this study is to analyze the attributes that should be gathered in a reputation index for Spanish hospitals. MATERIAL AND METHODS: Study based on qualitative techniques of consensus (nominal group technique + Delphi technique). RESULTS: Four dimensions were identified that form the reputation index: care quality, ethical behavior, credibility/confidence and biomedical innovation and research, which in turn are subdivided into 12 components in total. CONCLUSIONS: In building a reputation index consideration must be given to the combination of objective data (e.g. quality and safety outcomes) with other data that are subjective in nature (e.g., patient satisfaction). Future studies should go online to validate the reference standards in building a reputation index for hospitals.

La reputación de los hospitales españoles. Bases para el desarrollo de un índice de reputación de los hospitales / The reputation of Spanish hospitals. Basis for developing a reputation index of hospitals

Fundamento: La reputación de los centros sanitarios se relaciona con: mayor predilección de los usuarios por obtener sus servicios, mejores resultados clínicos y mayor calidad asistencial y potencial para atraer a profesionales con talento. La reputación se ha evaluado mediante índices y escalas. El objetivo de este estudio es analizar los atributos que debería reunir un índice de reputación para los hospitales españoles. Método y materiales: Estudio basado en técnicas cualitativas de búsqueda de consenso (técnica del grupo nominal + técnica Delphi). Resultados: Se identificaron cuatro dimensiones que estructuran el índice de reputación: calidad de la asistencia, comportamiento ético, credibilidad/confianza e innovación e investigación biomédica que a su vez se subdividen en 12 componentes en total. Conclusiones: En la construcción de un índice de reputación debería considerarse la combinación de datos objetivos (p.ej. resultados en calidad y seguridad) con otros de carácter subjetivo (p.ej. satisfacción de los pacientes). Futuros estudios deberían ir en la línea de validar los estándares de referencia para construir un índice de reputación para hospitales (AU)

Background: The reputation of the health centers is associated with: greater user preference in obtaining their services, better clinical outcomes and higher care quality and potential for attracting talented professionals. Reputation was evaluated using indexes and scales. The aim of this study is to analyze the attributes that should be gathered in a reputation index for Spanish hospitals. Material and methods: Study based on qualitative techniques of consensus (nominal group technique + Delphi technique). Results: Four dimensions were identified that form the reputation index: care quality, ethical behavior, credibility/confidence and biomedical innovation and research, which in turn are subdivided into 12 components in total. Conclusions: In building a reputation index consideration must be given to the combination of objective data (e.g. quality and safety outcomes) with other data that are subjective in nature (e.g., patient satisfaction). Future studies should go online to validate the reference standards in building a reputation index for hospitals (AU)

Valoración de dos aplicaciones para la autogestión de la medicación en pacientes mayores. Estudio cualitativo / Assessment of two applications of medication self-management in older patients. Qualitative study

Introducción: El envejecimiento de la población y el creciente uso de las tecnologías son dos realidades de la sociedad actual. El desarrollo de utilidades de apoyo a la autogestión de la medicación para ancianos polimedicados puede contribuir a incrementar su seguridad. Objetivo: Conocer el modo en que pacientes polimedicados de 64 años o más se organizan a la hora de tomar su medicación, y la valoración que realizan de la utilidad de dos aplicaciones de apoyo a esta acción, analizando específicamente sistemas de gestión, errores de medicación y aspectos positivos y por mejorar de cada uno de los desarrollos presentados. Pacientes y métodos: Se llevaron a cabo 7 grupos focales, con participación de 59 pacientes procedentes de asociaciones y centros de salud. En ellos se les mostraron las aplicaciones, se les animó a utilizarlas y se les realizaron una serie de preguntas sobre su estado de salud, el modo en que gestionaban su medicación y la valoración de las aplicaciones. Resultados: La mayoría de los participantes afirmaron utilizar diferentes estrategias de memoria para tomar correctamente su medicación y valoraron positivamente las aplicaciones, aunque algunos de ellos mostraron resistencia a utilizarlas en su rutina diaria. La interfaz sencilla y la facilidad de uso fueron las características de las aplicaciones más apreciadas por los pacientes. Conclusiones: Es posible fomentar entre pacientes mayores el uso de herramientas tecnológicas de apoyo a la administración de la medicación, con el propósito de reducir los errores e incrementar la seguridad de los usuarios. A la hora de diseñar aplicaciones de salud es necesario tener en cuenta las preferencias de aquellos a quienes se dirigen (AU)

Introduction: The aging population and the growing use of technology are two realities of modern society. Developing tools to support medication self-management to polymedicated elderly may contribute to increase their safety. Objective: To know how patients polymedicated and older than 64 years manage dose their medication and assessment the utility of two medication self-management applications, specifically analyzing management systems, medication errors and positive and improvable aspects of each of the tools presented. Patients and methods: Seven focal groups with 59 patients from associations and health departments were conducted. In such meetings, they received the applications and they were encouraged to use it. Then, a several group questions were asked them about their health status, how they managed their medication and their assessment about the applications. Results: Most participants reported to use memory strategies to take correctly their medication. They assessed positively the applications although some of them showed resistance to incorporate it in their daily routine. The simple interface and ease of use were the characteristics of the applications most appreciated by patients. Conclusions: Is possible to foster among elderly patients the use of technological tools to support the proper administration of medications with purpose is to decrease errors and increase safety. When designing health applications is necessary to take into account the preferences of those who are targeted (AU)

[Assessment of two applications of medication self-management in older patients. Qualitative study]. / Valoración de dos aplicaciones para la autogestión de la medicación en pacientes mayores. Estudio cualitativo.

INTRODUCTION: The aging population and the growing use of technology are two realities of modern society. Developing tools to support medication self-management to polymedicated elderly may contribute to increase their safety. OBJECTIVE: To know how patients polymedicated and older than 64 years manage dose their medication and assessment the utility of two medication self-management applications, specifically analyzing management systems, medication errors and positive and improvable aspects of each of the tools presented. PATIENTS AND METHODS: Seven focal groups with 59 patients from associations and health departments were conducted. In such meetings, they received the applications and they were encouraged to use it. Then, a several group questions were asked them about their health status, how they managed their medication and their assessment about the applications. RESULTS: Most participants reported to use memory strategies to take correctly their medication. They assessed positively the applications although some of them showed resistance to incorporate it in their daily routine. The simple interface and ease of use were the characteristics of the applications most appreciated by patients. CONCLUSIONS: Is possible to foster among elderly patients the use of technological tools to support the proper administration of medications with purpose is to decrease errors and increase safety. When designing health applications is necessary to take into account the preferences of those who are targeted.

Conjunto de indicadores de calidad y seguridad para hospitales de la Agencia Valenciana de Salud / A set of quality and safety indicators for hospitals of the «Agencia Valenciana de Salud»

Objetivos: Elaborar un conjunto de indicadores de calidad y seguridad en el contexto de los hospitales de la Agencia Valenciana de Salud. Material y métodos: Se utilizó la técnica Metaplan® para identificar propuestas sobre sostenibilidad y enfermería. Se empleó el catálogo de la Sociedad Española de Calidad Asistencial como punto de partida para los indicadores clínicos. Utilizando la Técnica Delphi 207 profesionales fueron invitados a participar en el proceso para identificar los indicadores más fiables y factibles. Finalmente, la propuesta resultante fue validada por los directivos de 12 hospitales, teniendo en cuenta la variabilidad, objetividad, factibilidad, fiabilidad y sensibilidad de los indicadores. Resultados: La tasa de participación osciló entre el 66,67 y 80,71%. De los 159 indicadores de la propuesta inicial se priorizaron y seleccionaron 68 (21 económicos o de gestión, 22 de cuidados de enfermería y 25 clínicos). De ellos 3 eran comunes a las 3 categorías y 2 no cumplían los criterios específicos de la fase de validación, por lo que el conjunto final consta de 63 indicadores. Conclusiones: Se ha elaborado un conjunto de indicadores de calidad y seguridad. El sistema de información actual permite su monitorización (AU)

Objectives: To prepare a set of quality and safety indicators for Hospitals of the «AgenciaValenciana de Salud». Material and methods: The qualitative technique Metaplan® was applied in order to gather proposals on sustainability and nursing. The catalogue of the «Spanish Society of Quality in Healthcare» was adopted as a starting point for clinical indicators. Using the Delphi technique, 207 professionals were invited to participate in the selecting the most reliable and feasible indicators. Lastly, the resulting proposal was validated with the managers of 12 hospitals, taking in to account the variability, objectivity, feasibility, reliability and sensitivity, of the indicators. Results: Participation rates varied between 66.67% and 80.71%. Of the 159 initial indicators, 68 were prioritized and selected (21 economic or management indicators, 22 nursing indicators, and 25 clinical or hospital indicators). Three of them were common to all three categories and two did not match the specified criteria during the validation phase, thus obtaining a final catalogue of 63 indicators. Conclusions: A set of quality and safety indicators for Hospitals was prepared. They are currently being monitored using the hospital information systems (AU)

What do Spaniards read about the prudent use of anti-microbial agents and what do they really do?

OBJECTIVES: The prudent use of antibiotics (PUA) is promoted not only by public information campaigns, but also in the printed media and on websites. This study assesses the correspondence between PUA information in the Spanish printed media and on websites and the messages put out by national campaigns. Spaniards' use of antibiotics following the campaigns was also analysed. METHODS: A two-phase descriptive study was carried out. First, antibiotics-related news in the Spanish printed media (January 2007-May 2009) and institutional and news media websites (March-May 2009) were systematically reviewed using a data collection tool. In addition, a telephone survey on antibiotics-related knowledge and behaviours was carried out with a random sample of 1526 people living in Spain who had recently received medical care. RESULTS: In total, 29 news items containing nine different messages were identified. All the messages were similar to those promoted by the campaigns. The survey showed that even after the campaigns, relevant gaps in knowledge about the PUA persist, particularly among men (p = .005), those living in rural areas (p = .02) and the elderly (p < .001). Keeping left-over antibiotics was associated with ignorance about the association between antibiotic use and resistance (OR 3.1, 95% CI 2.3-4.2). Also, patients who ask their doctor about drug interactions are less likely to self-medicate (p = .04). CONCLUSIONS: The information reaching the Spanish public via the media seems to be similar to the messages transmitted by public information campaigns. Nevertheless, there appears to be considerable room for improvement. Promoting an active role in patients might reduce self-medication.

[A set of quality and safety indicators for hospitals of the "Agencia Valenciana de Salud"]. / Conjunto de indicadores de calidad y seguridad para hospitales de la Agencia Valenciana de Salud.

OBJECTIVES: To prepare a set of quality and safety indicators for Hospitals of the «Agencia Valenciana de Salud¼. MATERIAL AND METHODS: The qualitative technique Metaplan® was applied in order to gather proposals on sustainability and nursing. The catalogue of the «Spanish Society of Quality in Healthcare¼ was adopted as a starting point for clinical indicators. Using the Delphi technique, 207 professionals were invited to participate in the selecting the most reliable and feasible indicators. Lastly, the resulting proposal was validated with the managers of 12 hospitals, taking into account the variability, objectivity, feasibility, reliability and sensitivity, of the indicators. RESULTS: Participation rates varied between 66.67% and 80.71%. Of the 159 initial indicators, 68 were prioritized and selected (21 economic or management indicators, 22 nursing indicators, and 25 clinical or hospital indicators). Three of them were common to all three categories and two did not match the specified criteria during the validation phase, thus obtaining a final catalogue of 63 indicators. CONCLUSIONS: A set of quality and safety indicators for Hospitals was prepared. They are currently being monitored using the hospital information systems.

Valoración de los resultados del Plan Oncológico 2007-2010 de la Comunidad Valenciana: el punto de vista de los pacientes, familiares, ciudadanos y profesionales / Results assessment of the Valencian Community Cancer Plan: The point of view of patients, relatives, citizens and professionals

Objetivo. Analizar la percepción de los resultados alcanzados por el Plan Oncológico de la Comunidad Valenciana (POCV) desde el punto de vista de sus agentes clave: pacientes, familiares de pacientes, ciudadanos y profesionales sanitarios. Métodos. Estudio descriptivo en el que se combinó un análisis cualitativo (2 entrevistas grupales con 34 participantes y 4 grupos focales con 37 participantes) y otro cuantitativo (470 encuestas de opinión). Resultados. La propia existencia de un POCV se destacó como factor positivo. Se ha conseguido que, entre la población, se transmita el mensaje de que el cáncer es «curable». Se han definido objetivos clave, unificado criterios y que los comités de tumores y las comisiones contribuyan, en mayor medida, a realizar una asistencia multidisciplinar. Se consideró innovador el POCV especialmente por la introducción del Programa de Consejo Genético. Los representantes de asociaciones ciudadanas y de pacientes consideraron el Programa de Prevención de Cáncer de Mama el más conocido y mejor valorado y el Programa de Cáncer Colorrectal el menos conocido. Tanto en los grupos cualitativos como en la consulta realizada a profesionales, los aspectos mejor valorados fueron los comités de tumores, la recomendación de la citología vaginal para la prevención del cáncer de cérvix o que se haya transmitido a la población que el cáncer puede curarse, son aspectos valorados positivamente. Conclusiones. Las valoraciones del POCV 2007-2010 son positivas en términos generales, con excepciones puntuales claramente identificadas. La información de tipo cualitativo y cuantitativo obtenida en los distintos análisis es prácticamente coincidente(AU)

Objective. To assess stakeholders’ perceptions (i.e. patients, relatives, the public, and professionals) about results of the Valencian Community Cancer Plan (POCV). Methods. Qualitative analysis (34 participants in 2 interview groups, and 37 participants in 4 focus groups) and quantitative analysis (470 opinion surveys) was combined in a descriptive study. Results. The POCV's existence is highlighted as a positive factor. It has managed to send the message that “cancer can be cured” to the population. The key aims have been defined, criteria have been unified, and there have been achieved the Tumor Committees contribute most to make a multidisciplinary care. The plan is considered innovative, especially because the Genetic Counseling Program was included. Citizens leaders and patient associations find the Breast Cancer Program as the best known and the most valued, while the Colorectal Cancer Program is the least known. In both methodologies, qualitative groups and the online survey conducted on the professionals, it is concluded that the Tumor Committees, the vaginal cytology recommendation for cervical cancer prevention, and the message transmission that “cancer can be cured” are positively assessed. Conclusions. POCV 07-10 assessments are generally positive, with occasional exceptions that are clearly identified. The qualitative and quantitative information obtained in the different analyses is almost coincident(AU)

[Results assessment of the Valencian Community Cancer Plan: the point of view of patients, relatives, citizens and professionals]. / Valoración de los resultados del Plan Oncológico 2007-2010 de la Comunidad Valenciana: el punto de vista de los pacientes, familiares, ciudadanos y profesionales.

OBJECTIVE: To assess stakeholders' perceptions (i.e. patients, relatives, the public, and professionals) about results of the Valencian Community Cancer Plan (POCV). METHODS: Qualitative analysis (34 participants in 2 interview groups, and 37 participants in 4 focus groups) and quantitative analysis (470 opinion surveys) was combined in a descriptive study. RESULTS: The POCV's existence is highlighted as a positive factor. It has managed to send the message that "cancer can be cured" to the population. The key aims have been defined, criteria have been unified, and there have been achieved the Tumor Committees contribute most to make a multidisciplinary care. The plan is considered innovative, especially because the Genetic Counseling Program was included. Citizens leaders and patient associations find the Breast Cancer Program as the best known and the most valued, while the Colorectal Cancer Program is the least known. In both methodologies, qualitative groups and the online survey conducted on the professionals, it is concluded that the Tumor Committees, the vaginal cytology recommendation for cervical cancer prevention, and the message transmission that "cancer can be cured" are positively assessed. CONCLUSIONS: POCV 07-10 assessments are generally positive, with occasional exceptions that are clearly identified. The qualitative and quantitative information obtained in the different analyses is almost coincident.

Calidad de la atención al paciente oncológico. Tiempos asistenciales recomendables entre sospecha clínica y definición del plan terapéutico en cáncer de mama y colorrectal / Quality assurance in cancer. Acceptable delays in deciding the therapeutic plan in breast cancer and colorectal cancer

Fundamento. Determinar tiempos recomendables para el tratamiento desde la sospecha clínica fundada en los procesos asistenciales de cáncer de mama y colorrectal considerando factibilidad y situación personal del paciente. Método. Estudio cualitativo de búsqueda de consenso entre profesionales. Primero, se revisaron mediante 4 sesiones grupales(N=19), los procesos asistenciales de cáncer de mama y cáncer colorrectal y se fijaron los tiempos deseables de ambos procesos. Segundo, mediante una modificación de la técnica Delphi (N=49), se validó la propuesta de tiempos de atención recomendables para cada proceso asistencial. Resultados. La tasa de respuesta en el estudio Delphi fue del 69% en el proceso de cáncer colorrectal y del 58% en el de mama. El tiempo recomendado entre sospecha clínica y plan terapéutico en el caso de cáncer de mama no infiltrante fue entre 5 y 6 semanas, dependiendo de la vía de acceso: atención primaria, especializada o unidad de prevención de cáncer de mama. Si el cáncer detectado fuese infiltrante y se recurriera a medicina nuclear para el estudio del ganglio centinela o vaciamiento axilar se recomendó de 5 a 7 semanas. En el caso de cáncer de colon y recto se consideró necesario un plazo de respuesta entre 7 a 13 semanas según la vía de acceso, tipo de tumor y curso. Conclusiones. El tratamiento en cáncer mama debe iniciarse antes de transcurrir mes y medio. En cáncer colorrectal podría precisarse hasta tres meses. La revisión de los procesos asistenciales contando con los profesionales y de forma interdisciplinaria favorece establecer criterios de calidad realistas(AU)

Background. To determine recommended delays for treatment once there is well-founded clinical suspicion in care processes for breast and colorectal cancer, taking into account resources and the psychological well-being of the patients. Method. A qualitative study among professionals. The study was conducted in two phases. Firstly, during 4 sessions (N=19) we conducted a revision of the care processes of breast cancer and colorectal cancer and fixed desirable times. Secondly, through a modification of the Delphi technique(N=49), the proposed times for each care process were validated. Results. Delphi response rates of 69% and 58% for colorectal and breast processes respectively. The recommended time in the case of non-invasive breast cancer was 5 to 6 weeks .If the cancer was invasive and nuclear medicine was used for sentinel node study or axillary clearance 5 to 7 weeks were recommended. In the case of cancer of the colon and rectum 7 to 13 weeks were considered necessary. Conclusions. Breast cancer treatment should be started before six weeks. In colorectal cancer up to three months could be required. An interdisciplinary review of care processes relying on professionals is useful for establishing realistic quality standards(AU)

Cita por Internet, SMS y portal vocal. Nuevas tecnologías para un viejo problema / Internet, SMS or voice portals tools. New technologies for an old problem

Objetivo. Analizar frecuencia de uso, efectividad y usabilidad de los sistemas automatizados de obtención de cita en atención primaria desde la perspectiva de los usuarios. Método. Estudio descriptivo transversal. Se realizó una encuesta telefónica a una muestra aleatoria de 6.193 pacientes (o responsables de pacientes pediátricos) atendidos en atención primaria en la Comunidad Valenciana. Resultados. Un total de 397 (13,4%) pacientes adultos y de 1.000 (31%) de los responsables de los pacientes pediátricos recurrieron a Internet. El Portal Vocal (225 -3,6%-) y SMS (57 -0,9%-) fueron menos utilizados. Internet fue más utilizado por los hombres (χ2 15,1, p<0,004) y por entre quienes tenían entre 51 y 70 años entre los pacientes adultos (χ2 40,5, p<0,001). Los pacientes crónicos (χ2 28,7, p<0,001) y aquellos con menor frecuentación (χ2 52, p<0,001) siguen recurriendo a canales tradicionales (acudir en persona o llamar por teléfono al propio centro). El uso de TIC (Tecnologías de la Información y la Comunicación) para obtener cita no supone demoras en la fecha de la consulta. La usabilidad es elevada (por encima del 90%) excepto en el caso del sistema basado en SMS (80,7%). Conclusiones. Entre los nuevos canales para obtener cita Internet es el preferido con expectativa de mayor crecimiento. La efectividad de las TIC para obtener cita es algo mayor que la de los canales tradicionales. La usabilidad de las TIC para obtener cita es similar o superior a la de los tradicionales con excepción de los mensajes desde móvil(AU)

Objective. To analyse the frequency of use, effectiveness and usability of automated systems for obtaining appointments in primary care from a user point of view. Methods. A cross-sectional study was conducted using a telephone survey of a random sample of 6193 patients (or parents or guardians of paediatric patients) treated in primary care in the Valencian Autonomous Community. Results. A total of 397 (13.4%) adult patients and 1000 (31%) of parents or guardians of the paediatric patients used the Internet. The Voice Portal (225, 3.6%) and SMS (57, 0.9%) was the least used. The Internet was mostly used by men (χ2 15.1, P<.004) and among adult patients aged between 51 and 70 years (χ2 40.5, P<.001). The traditional channels (telephone call or asking for an appointment personally) were used by chronic patients (χ2 28.7, P<.001) and those with who used the health sytem less (χ2 52, P<.001). The use of ICT is not responsible for delays in the date of appointment. Usability was very high (above 90%), except in the case of the system based on SMS (80.7%). Conclusions. The Internet is the preferred channel among ICT to obtain an appointment. Its use is expected to increase. The effectiveness of ICT to get an appointment is somewhat higher than traditional channels. The usability of ICT to get an appointment is similar or superior to the traditional channels. The exception is the messages from a mobile(AU)

[Patients informing of adverse events. Results in diabetes and kidney disease]. / Pacientes como informadores de eventos adversos. Resultados en diabetes y enfermedad renal.

BACKGROUND: Diabetes and kidney disease are risk factors for adverse events (AE). There are no other studies on the perception of risk in these patients. This study analyzes the frequency of adverse event triggers reported by diabetic and renal patients and their perception of the risk. MATERIAL AND METHODS: Descriptive study based on interviews with randomly selected patients. Field study conducted between February and May 2010 in three health centers and two hospitals in Alicante and Madrid. RESULTS: A total of 199 patients answered, 98 diabetic patients and 101 renal patients. Renal patients accumulated more AE triggers (21.8% referred to an AE trigger, 17.8% two AE triggers and 3% referred to > 3 AE triggers) than diabetic patients (16.3% referred to one AE trigger, 7.1% to two AE triggers and 7.1% referred to > 3 AE triggers). During the last year 6/98 diabetic patients and 10/101 renal patients required additional treatment due to a clinical error. The probability of the patient being the victim of a clinical error with serious consequences was 1:10. Women with renal illness believed themselves to have a greater probability of suffering an error (Chi2=12.7, p=0.002). Errors were attributed to a lack of time to attend to all patients and a lack of means and resources, without statistically significant differences between the subsamples. Interviewed patients considered that the risks of suffering a traffic accident or robbery were similar to the risk of an error with serious consequences. CONCLUSION: Information provided by patients can help improve safety procedures.

Pacientes como informadores de eventos adversos. Resultados en diabetes y enfermedad renal / Patients informing of adverse events. Results in diabetes and kidney disease

Fundamento. Diabetes y enfermedad renal son factores de riesgo de sufrir eventos adversos (EA). No contamos con estudios sobre la percepción del riesgo de estos pacientes. En este estudio se analiza la frecuencia con la que los pacientes diabéticos y renales describen indicios de un posible EA y su percepción de seguridad de la atención que reciben. Material y métodos. Estudio descriptivo basado en entrevistas a pacientes seleccionados al azar. Estudio de campo realizado entre febrero y mayo de 2010 en 3 centros de salud y 2 hospitales de Alicante y Madrid. Resultados. Respondieron 199 pacientes, 98 diabéticos y 101 con enfermedad renal. Estos últimos acumularon mayor número de indicios de EA (21,8% refirió un EA, 17,8% dos y un 3% 3 o más) que los diabéticos (16,3% un EA, 7,1% dos y 7,1% señaló 3 o más). En el último año, 6/98 diabéticos y 10/101 enfermos renales precisaron un tratamiento adicional. La probabilidad que el paciente cree tener de ser víctima de un error con consecuencias graves fue establecida en 1:10. Las mujeres con enfermedad renal creyeron tener una mayor probabilidad de sufrir un error (Chi2=12,7, p=0,002). Los errores clínicos se atribuyeron a la falta de tiempo para atender a todos los pacientes y a la insuficiencia de medios y recursos, sin diferencias estadísticamente significativas entre las submuestras. Los pacientes entrevistados consideraron similar el riesgo de error clínico, accidente de tráfico, atraco. Conclusiones. La información que proporcionan los pacientes puede contribuir a mejorar la seguridad de los procedimientos de trabajo(AU)

Background. Diabetes and kidney disease are risk factors for adverse events (AE). There are no other studies on the perception of risk in these patients. This study analyzes the frequency of adverse event triggers reported by diabetic and renal patients and their perception of the risk. Material and methods. Descriptive study based on interviews with randomly selected patients. Field study conducted between February and May 2010 in three health centers and two hospitals in Alicante and Madrid. Results. A total of 199 patients answered, 98 diabetic patients and 101 renal patients. Renal patients accumulated more AE triggers (21.8% referred to an AE trigger, 17.8% two AE triggers and 3% referred to > 3 AE triggers) than diabetic patients (16.3% referred to one AE trigger, 7.1% to two AE triggers and 7.1% referred to > 3 AE triggers). During the last year 6/98 diabetic patients and 10/101 renal patients required additional treatment due to a clinical error. The probability of the patient being the victim of a clinical error with serious consequences was 1:10. Women with renal illness believed themselves to have a greater probability of suffering an error(Chi2=12.7, p=0.002). Errors were attributed to a lack of time to attend to all patients and a lack of means and resources, without statistically significant differences between the subsamples. Interviewed patients considered that the risks of suffering a traffic accident or robbery were similar to the risk of an error with serious consequences. Conclusion. Information provided by patients can help improve safety procedures(AU)

[Internet, SMS or voice portals tools. New technologies for an old problem]. / Cita por Internet, SMS y portal vocal. Nuevas tecnologías para un viejo problema.

OBJECTIVE: To analyse the frequency of use, effectiveness and usability of automated systems for obtaining appointments in primary care from a user point of view. METHODS: A cross-sectional study was conducted using a telephone survey of a random sample of 6193 patients (or parents or guardians of paediatric patients) treated in primary care in the Valencian Autonomous Community. RESULTS: A total of 397 (13.4%) adult patients and 1000 (31%) of parents or guardians of the paediatric patients used the Internet. The Voice Portal (225, 3.6%) and SMS (57, 0.9%) was the least used. The Internet was mostly used by men (χ(2) 15.1, P<.004) and among adult patients aged between 51 and 70 years (χ(2) 40.5, P<.001). The traditional channels (telephone call or asking for an appointment personally) were used by chronic patients (χ(2) 28.7, P<.001) and those with who used the health sytem less (χ(2) 52, P<.001). The use of ICT is not responsible for delays in the date of appointment. Usability was very high (above 90%), except in the case of the system based on SMS (80.7%). CONCLUSIONS: The Internet is the preferred channel among ICT to obtain an appointment. Its use is expected to increase. The effectiveness of ICT to get an appointment is somewhat higher than traditional channels. The usability of ICT to get an appointment is similar or superior to the traditional channels. The exception is the messages from a mobile.

[Quality assurance in cancer. Acceptable delays in deciding the therapeutic plan in breast cancer and colorectal cancer]. / Calidad de la atención al paciente oncológico. Tiempos asistenciales recomendables entre sospecha clínica y definición del plan terapéutico en cáncer.

BACKGROUND: To determine recommended delays for treatment once there is well-founded clinical suspicion in care processes for breast and colorectal cancer, taking into account resources and the psychological well-being of the patients. METHOD: A qualitative study among professionals. The study was conducted in two phases. Firstly, during 4 sessions (N=19) we conducted a revision of the care processes of breast cancer and colorectal cancer and fixed desirable times. Secondly, through a modification of the Delphi technique (N=49), the proposed times for each care process were validated. RESULTS: Delphi response rates of 69% and 58% for colorectal and breast processes respectively. The recommended time in the case of non-invasive breast cancer was 5 to 6 weeks. If the cancer was invasive and nuclear medicine was used for sentinel node study or axillary clearance 5 to 7 weeks were recommended. In the case of cancer of the colon and rectum 7 to 13 weeks were considered necessary. CONCLUSIONS: Breast cancer treatment should be started before six weeks. In colorectal cancer up to three months could be required. An interdisciplinary review of care processes relying on professionals is useful for establishing realistic quality standards.

Buenas prácticas y satisfacción del paciente / Good practices and patient satisfaction

Objetivo. La Ley de Autonomía del Paciente (LAP) debe contribuir a lograr una atención sanitaria «centrada en el paciente». En este estudio pretendemos determinar en qué medida los pacientes consideran que se está cumpliendo con derechos básicos reconocidos en la LAP (buenas prácticas) y estudiar la relación entre este cumplimiento y el nivel de satisfacción declarado por el paciente. Material y métodos. Se entrevistó a 13.773 pacientes (el 31,7% tenía más de 60 años y el 53,6% fueron mujeres) atendidos en 21 hospitales públicos. La ocurrencia de buenas prácticas acordes a la LAP se analiza mediante estadísticos descriptivos; la relación entre buenas prácticas y satisfacción se estimó mediante regresión logística. Resultados. La información al alta médica fue una de las prácticas más consolidadas en todas las modalidades. Su nivel de cumplimiento osciló entre el 97,4% de padres de niños mayores de 6 años atendidos en Pediatría y el 76,2% de pacientes atendidas en plantas de Obstetricia. El proceso de acogida (odds ratio: 3,53; IC del 95%: 1,95–6,41), el consentimiento informado (odds ratio: 2,77; IC del 95%: 1,40–5,47) y conocer qué tipo de profesional lo está atendiendo en cada momento (odds ratio: 3,36; IC del 95%: 1,96–5,78) son algunos aspectos de la atención que incrementan la probabilidad de que el paciente se declare satisfecho. Conclusiones. El cumplimiento de los derechos de los pacientes es elevado en todas las modalidades de atención valoradas. Cuando se respetan estos derechos se incrementa la satisfacción del paciente(AU)

Objective. The Patient Autonomy Act should contribute to a “patient-centred” health care. The study objectives were to determine to what extent patients believe that their basic rights under the LAP (best practices) are being met. Secondly, to study the relationship between this performance and reported patient satisfaction levels. Materials & methods. A total of 13,773 patients were interviewed (31.7% >60 years and 53.6% women) receiving health care at 21 Spanish public hospitals. The number of “good practices” (GP) was analysed using descriptive statistics; relationship between GP and satisfaction was measured using logistic regression. Results. The medical discharge information was one of the most established practices. The compliance level ranged from 97.4% of parents of children over 6 years in paediatric service and 76.2% of patients attending obstetric services. The welcome process (Odds Ratio 3.53, IC-95% CI; 1.95–6.41, P<0.001), informed consent (Odds Ratio 2.77, 95% CI; 1.40–5.47), to recognize which type of professional was providing care at all the times (Odds Ratio 3.36, 95% CI; 1.96–5.78), were the aspects that increased probability that the patient felt satisfied. Conclusions. Compliance to patient rights was increased in all services analysed. When these rights are respected patient satisfaction increases(AU)