[Morbidity due to chronic diseases and their health care in Asturias: a gender analysis]. / Morbilidad por enfermedades crónicas y su atención sanitaria en Asturias: análisis de género.

OBJECTIVE: To determine gender differences in the magnitude and complexity of chronic diseases and gender inequalities in health care in the adult population of Asturias in 2022. METHOD: A cross-sectional population study in people (>14 years) with at least one diagnosis of chronic disease (780,566 inhabitants). SOURCES OF INFORMATION: computer program for morbidity groups (Ministry of Health), Electronic medical record of primary care and hospital. Comparative analysis by sex and age, the mean values of chronic diseases and complexity index (Student's t test and one-way ANOVA), and probability (odds ratio and 95% CI) of suffering from specific chronic diseases, making one or more visits to the hospital emergency department or one or more admissions to hospital. RESULTS: 89.9% of women and 82.1% of men were registered with at least one chronic disease. The mean was higher in women (4.36) than in men (3.22) (p<0.001). Complexity index: men 4.56 and women 5.85 (p<0.001). Results show that women are more likely to attend the hospital emergency department, with an attendance rate of 50% for the diseases cited, compared with men at 29%. The rate of hospital admission is higher in men in 13 of the 14 diseases studied (85%). CONCLUSIONS: Gender analysis can also be applied to secondary sources of the National Health System. Despite the greater magnitude and complexity of chronic diseases in women, there is a higher frequency of hospital admissions in men compared to women with the same diseases. This implies an unequal care profile in the field of hospital admissions that the scientific literature associates with gender biases in health care.

Morbilidad por enfermedades crónicas y su atención sanitaria en Asturias: análisis de género / Morbidity due to chronic diseases and their health care in Asturias: a gender analysis

Objetivo: Determinar las diferencias según sexo de la magnitud y la complejidad por enfermedades crónicas, y las desigualdades de género, en la atención sanitaria de la población adulta en Asturias en el año 2022. Método: Estudio transversal poblacional en mayores de 14 años con al menos un diagnóstico de enfermedad crónica (780.566 habitantes). Fuentes de información: programa informático de grupos de morbilidad (Ministerio de Sanidad), Historia clínica electrónica de atención primaria y hospitalaria. Análisis comparativo por sexo y edad: medias de patologías crónicas e índice de complejidad (t de Student y ANOVA de un factor), y probabilidad (odds ratio e intervalo de confianza del 95%) de padecer enfermedades crónicas específicas, realizar una o más visitas a urgencias, e ingresos hospitalarios. Resultados: En atención primaria se registraron un 89,9% de mujeres y un 82,1% de hombres con al menos una enfermedad crónica. La media fue mayor en las mujeres (4,36) que en los hombres (3,22) (p < 0,001). Índice de complejidad: hombres 4,56 y mujeres 5,85 (p < 0,001). Mientras que la probabilidad de acudir a urgencias es superior en las mujeres en el 50% de las patologías (hombres 29%), la probabilidad de ingresar es superior en los hombres en 13 de las 14 patologías estudiadas (85%). Conclusiones: El análisis de género también se puede aplicar en fuentes secundarias del Sistema Nacional de Salud. Pese a la mayor magnitud y complejidad en las mujeres, la mayor frecuencia de hospitalizaciones en los hombres que en las mujeres con las mismas patologías supone un perfil de atención desigual en el ámbito de ingresos hospitalarios que la literatura científica relaciona con sesgos de género en la atención sanitaria.(AU)

Objective: To determine gender differences in the magnitude and complexity of chronic diseases and gender inequalities in health care in the adult population of Asturias in 2022. Method: A cross-sectional population study in people (>14 years) with at least one diagnosis of chronic disease (780,566 inhabitants). Sources of information: computer program for morbidity groups (Ministry of Health), Electronic medical record of primary care and hospital. Comparative analysis by sex and age, the mean values of chronic diseases and complexity index (Student's t test and one-way ANOVA), and probability (odds ratio and 95% CI) of suffering from specific chronic diseases, making one or more visits to the hospital emergency department or one or more admissions to hospital. Results: 89.9% of women and 82.1% of men were registered with at least one chronic disease. The mean was higher in women (4.36) than in men (3.22) (p < 0.001). Complexity index: men 4.56 and women 5.85 (p < 0.001). Results show that women are more likely to attend the hospital emergency department, with an attendance rate of 50% for the diseases cited, compared with men at 29%. The rate of hospital admission is higher in men in 13 of the 14 diseases studied (85%). Conclusions: Gender analysis can also be applied to secondary sources of the National Health System. Despite the greater magnitude and complexity of chronic diseases in women, there is a higher frequency of hospital admissions in men compared to women with the same diseases. This implies an unequal care profile in the field of hospital admissions that the scientific literature associates with gender biases in health care.(AU)

[Impact of the chronic disease care program on social determinants of health in Asturias.] / Impacto de la Estrategia de Salud y Atención a la Población con Enfermedad Crónica sobre los determinantes sociales de la salud en Asturias.

OBJECTIVE: Providing care for people with chronic diseases is a challenge requiring institutional programs and strategies, thus it necessary to evaluate the impact of the same on the social determinants of health (SDH). The aims were: 1) to describe the impact of the structural determinants of the Health Strategy for the Population with Chronic Diseases (EAPEC) in Asturias and 2) to propose actions for improvement regarding social stratification factors. METHODS: Qualitative study of six strategic programs of the Chronic Disease Strategy: Health Observatory, Social and Healthcare Coordination, School for Patients Program, Caregivers Program, Mental Health Services Continuity, and Quality and Safety in Healthcare. A screening tool was used, validated for evaluation of the health impact on the structural determinants (socioeconomic and political context and social stratification factors) of the SDH. A personal semi-structured interview was carried out with the manager of each program in 2016, and a final report was produced that included the impacts found and proposals for improvement. RESULTS: All programs had a positive impact on social values (social justice, equity) and the state of wellbeing (social and educational policies). In terms of social stratification, the principal positive effects included age and functional diversity. Regarding the factors linked to geographic location, gender, origin/ethnicity, and social class the principal effects were negative. CONCLUSIONS: This strategy aimed at people with chronic diseases has positive effects. However, paying attention to social stratification factors during implementation of the same is a priority.

OBJETIVO: La atención a personas con enfermedades crónicas es un reto que precisa de estrategias y programas institucionales, siendo necesario evaluar su impacto en los determinantes sociales de la salud (DSS). Los objetivos de este trabajo fueron tanto describir el impacto en los determinantes estructurales de la Estrategia de Salud y Atención a la Población con Enfermedad Crónica (EAPEC) de Asturias como proponer acciones de mejora en relación con los factores de estratificación social. METODOS: Se realizó un estudio cualitativo de 6 programas estratégicos de la Estrategia de Cronicidad: Observatorio de Salud, Coordinación Sociosanitaria, Escuela de Pacientes, Atención a Personas Cuidadoras, Continuidad Asistencial en Salud Mental, Calidad y Seguridad en Atención Sanitaria. Se utilizó una herramienta de cribado validada para la evaluación del impacto en la salud sobre los determinantes estructurales (contexto socioeconómico y político, factores de estratificación social) de los DSS. Se realizó una entrevista personal semiestructurada con el responsable de cada programa en 2016, elaborando un informe final con los impactos detectados y propuestas de mejora. RESULTADOS: Todos los programas tuvieron un impacto positivo sobre los valores sociales (justicia social, equidad) y el estado de bienestar (políticas sociales, educativas). Dentro de la estratificación social, los principales efectos positivos afectaron a la edad y a la diversidad funcional. En los factores vinculados a la localización geográfica, género, origen/etnia y clase social se concentraron los principales efectos negativos. CONCLUSIONES: Esta estrategia dirigida a personas con enfermedades crónicas tiene efectos positivos. Sin embargo, es prioritario prestar atención a los factores de estratificación social durante su ejecución.

Impacto de la Estrategia de Salud y Atención a la Población con Enfermedad Crónica sobre los determinantes sociales de la salud en Asturias / Impact of the chronic disease care program on social determinants of health in Asturias

OBJETIVO: La atención a personas con enfermedades crónicas es un reto que precisa de estrategias y programas institucionales, siendo necesario evaluar su impacto en los determinantes sociales de la salud (DSS). Los objetivos de este trabajo fueron tanto describir el impacto en los determinantes estructurales de la Estrategia de Salud y Atención a la Población con Enfermedad Crónica (EAPEC) de Asturias como proponer acciones de mejora en relación con los factores de estratificación social. MÉTODOS: Se realizó un estudio cualitativo de 6 programas estratégicos de la Estrategia de Cronicidad: Observatorio de Salud, Coordinación Sociosanitaria, Escuela de Pacientes, Atención a Personas Cuidadoras, Continuidad Asistencial en Salud Mental, Calidad y Seguridad en Atención Sanitaria. Se utilizó una herramienta de cribado validada para la evaluación del impacto en la salud sobre los determinantes estructurales (contexto socioeconómico y político, factores de estratificación social) de los DSS. Se realizó una entrevista personal semiestructurada con el responsable de cada programa en 2016, elaborando un informe final con los impactos detectados y propuestas de mejora. RESULTADOS: Todos los programas tuvieron un impacto positivo sobre los valores sociales (justicia social, equidad) y el estado de bienestar (políticas sociales, educativas). Dentro de la estratificación social, los principales efectos positivos afectaron a la edad y a la diversidad funcional. En los factores vinculados a la localización geográfica, género, origen/etnia y clase social se concentraron los principales efectos negativos. CONCLUSIONES: Esta estrategia dirigida a personas con enfermedades crónicas tiene efectos positivos. Sin embargo, es prioritario prestar atención a los factores de estratificación social durante su ejecución

OBJECTIVE: Providing care for people with chronic diseases is a challenge requiring institutional programs and strategies, thus it necessary to evaluate the impact of the same on the social determinants of health (SDH). The aims were: 1) to describe the impact of the structural determinants of the Health Strategy for the Population with Chronic Diseases (EAPEC) in Asturias and 2) to propose actions for improvement regarding social stratification factors. METHODS: Qualitative study of six strategic programs of the Chronic Disease Strategy: Health Observatory, Social and Healthcare Coordination, School for Patients Program, Caregivers Program, Mental Health Services Continuity, and Quality and Safety in Healthcare. A screening tool was used, validated for evaluation of the health impact on the structural determinants (socioeconomic and political context and social stratification factors) of the SDH. A personal semi-structured interview was carried out with the manager of each program in 2016, and a final report was produced that included the impacts found and proposals for improvement. RESULTS: All programs had a positive impact on social values (social justice, equity) and the state of wellbeing (social and educational policies). In terms of social stratification, the principal positive effects included age and functional diversity. Regarding the factors linked to geographic location, gender, origin/ethnicity, and social class the principal effects were negative. CONCLUSIONS: This strategy aimed at people with chronic diseases has positive effects. However, paying attention to social stratification factors during implementation of the same is a priority

Herramientas para una evaluación del impacto en salud de los programas de salud pública e intervenciones comunitarias con una perspectiva de equidad / Tools to assess the impact on health of public health programmes and community interventions from an equity perspective

Es imprescindible desarrollar un enfoque integral de las intervenciones institucionales que permita realizar la evaluación del impacto en la salud desde la perspectiva de los determinantes sociales de la salud y la equidad. Para realizar dicha evaluación son necesarias herramientas adaptadas y sencillas. El objetivo de este trabajo es describir la metodología empleada en el diseño y la aplicación de dos herramientas para evaluar el impacto en los determinantes sociales de la salud y la equidad en programas de salud e intervenciones comunitarias. En los programas de salud se aplicó una herramienta adaptada mediante entrevista entre el equipo evaluador y la persona responsable del programa. Las intervenciones comunitarias fueron evaluadas mediante una herramienta on line que además permite obtener un informe con recomendaciones de mejora según los ejes de desigualdad. La aplicación de estos instrumentos puede contribuir a disminuir las desigualdades sociales en salud y a mejorar las intervenciones en salud pública

It is essential to develop a comprehensive approach to institutionally promoted interventions to assess their impact on health from the perspective of the social determinants of health and equity. Simple, adapted tools must be developed to carry out these assessments. The aim of this paper is to present two tools to assess the impact of programmes and community-based interventions on the social determinants of health. The first tool is intended to assess health programmes through interviews and analysis of information provided by the assessment team. The second tool, by means of online assessments of community-based interventions, also enables a report on inequality issues that includes recommendations for improvement. In addition to reducing health-related social inequities, the implementation of these tools can also help to improve the efficiency of public health interventions

Claves para el éxito de la participación comunitaria: diálogos sobre participación en el ámbito local. Informe SESPAS 2018 / Keys to the success of community engagement: dialogues on engagement at local level. SESPAS Report 2018

En los últimos años han surgido en el ámbito local diferentes experiencias exitosas en el campo de la participación comunitaria en salud. El presente artículo reproduce un diálogo entre diferentes actores acerca de las claves que pueden facilitar que estas experiencias comunitarias lleguen a ser exitosas. El formato elegido es una conversación semiestructurada articulada a través de diferentes elementos relativos al contexto actual, las dificultades identificadas, las herramientas de trabajo y finalmente los aspectos que podrían facilitar el desarrollo de experiencias exitosas. La mayor parte de las experiencias comunitarias en las que se ha basado la realización de este análisis cualitativo parten de espacios intersectoriales de trabajo, en su mayoría mesas intersectoriales municipales y consejos de salud, en las que participan los autores del trabajo. El desarrollo de un modelo más participativo e inclusivo dentro del campo de acción comunitaria no está exento de dificultades, pero se dispone de instrumentos con los que promover la participación de la ciudadanía en la toma de decisiones relativas a su salud y la de su comunidad. Para facilitar la implementación de experiencias exitosas es necesario articular diferentes herramientas normativas, técnicas y metodológicas, así como orientar nuestras intervenciones a promover la inclusión de la participación en todas las fases del ciclo de intervención, incluyendo una perspectiva de salud en todas las políticas y actuando sobre determinantes desde un enfoque de equidad

In recent years, successful local health interventions have emerged in the field of community engagement in health. This paper presents a dialogue between different local actors about the key aspects which can enhance the success of these community experiences. The format chosen for our work is a semi-structured conversation where authors discuss different aspects related to the current context of community engagement in health, the identified barriers to participating, and the effective tools which might facilitate the development of successful experiences. Most of the community experiences, which are the basis of this analysis, are found in intersectoral workspaces; mainly in local committees and health councils, in which the authors of this paper are involved. Developing an inclusive model of community engagement is challenging, but we rely on different tools that allow us to promote the participation of citizens in the decisions taken concerning their health and that of their community. To facilitate the development of successful experiences, it is necessary to combine different normative, technical and methodological tools. Furthermore, we also need to guide our intervention to promote participation in all phases of the intervention cycle, including a health perspective in all the policies, and acting on determinants from an equity perspective

[Keys to the success of community engagement: dialogues on engagement at local level. SESPAS Report 2018]. / Claves para el éxito de la participación comunitaria: diálogos sobre participación en el ámbito local. Informe SESPAS 2018.

In recent years, successful local health interventions have emerged in the field of community engagement in health. This paper presents a dialogue between different local actors about the key aspects which can enhance the success of these community experiences. The format chosen for our work is a semi-structured conversation where authors discuss different aspects related to the current context of community engagement in health, the identified barriers to participating, and the effective tools which might facilitate the development of successful experiences. Most of the community experiences, which are the basis of this analysis, are found in intersectoral workspaces; mainly in local committees and health councils, in which the authors of this paper are involved. Developing an inclusive model of community engagement is challenging, but we rely on different tools that allow us to promote the participation of citizens in the decisions taken concerning their health and that of their community. To facilitate the development of successful experiences, it is necessary to combine different normative, technical and methodological tools. Furthermore, we also need to guide our intervention to promote participation in all phases of the intervention cycle, including a health perspective in all the policies, and acting on determinants from an equity perspective.

[Tools to assess the impact on health of public health programmes and community interventions from an equity perspective]. / Herramientas para una evaluación del impacto en salud de los programas de salud pública e intervenciones comunitarias con una perspectiva de equidad.

It is essential to develop a comprehensive approach to institutionally promoted interventions to assess their impact on health from the perspective of the social determinants of health and equity. Simple, adapted tools must be developed to carry out these assessments. The aim of this paper is to present two tools to assess the impact of programmes and community-based interventions on the social determinants of health. The first tool is intended to assess health programmes through interviews and analysis of information provided by the assessment team. The second tool, by means of online assessments of community-based interventions, also enables a report on inequality issues that includes recommendations for improvement. In addition to reducing health-related social inequities, the implementation of these tools can also help to improve the efficiency of public health interventions.

Características y factores relacionados con sobrecarga en una muestra de cuidadores principales de pacientes ancianos con demencia / Characteristics and factors associated with dementia caregivers burden

Objetivo. Describir las características y los factores asociados a sobrecarga en los cuidadores principales (CP) de un grupo de pacientes ancianos con demencia no institucionalizados valorados en una unidad de evaluación geriátrica (UEG). Material y métodos. Estudio observacional descriptivo transversal. Se recogieron características basales del paciente y del CP. Para la estimación de carga del CP se utilizaron la escala de ansiedad (EGA) y depresión (EGD) de Goldberg y la escala de sobrecarga de Zarit (EZ). Resultados. Se incluyeron 130 pacientes (8 pérdidas). Ninguna variable del paciente con demencia se relacionó con medidas de sobrecarga. Una peor percepción de salud y calidad de vida se relacionaron con riesgo de ansiedad (EGA > 4), depresión (EGD > 2) y sobrecarga (EZ > 47). Mayor frecuentación a atención primaria y la ausencia de trabajo remunerado fuera de casa se relacionaron con riesgo de ansiedad y depresión. Una mayor edad del CP y menor formación académica se relacionaron con riesgo de depresión. El consumo de antiinflamatorios, ansiolíticos y antidepresivos se relacionó con riesgo de ansiedad y el consumo de antiinflamatorios se relacionó con sobrecarga. Conclusiones. El perfil de los cuidadores de nuestra muestra es comparable al descrito del CP de pacientes con demencia en nuestro país, aunque el tiempo dedicado al cuidado es mayor. Se trata de un grupo difícil de detectar y con necesidades asistenciales no satisfechas. Aunque no exista una demanda sanitaria adecuada se podría intervenir (AU)

Objective: To describe the characteristics and determining factors of carer stress in a group of elderly home care patients with dementia evaluated in a Geriatric Assessment Unit. Material and methods: An observational descriptive cross-sectional study was conducted using an assessment of baseline characteristics of patients and carers. Estimation of caregiver burden was registered by validated scales: Goldberg Anxiety Scale (GAS), Goldberg Depression Scales (GDS), and Zarit Burden Scale (ZS). Results: A total of 130 patients were included. No item related to dementia patients was associated with caregiver burden. A poor perception of health and quality of life by the care- givers were associated with anxiety risk, depression and burden. Attendance rates for primary care and lack of paid work outside the home were associated with both, depression (GDS > 2) and anxiety (GAS > 4). Carer age and a lower education were related to depression. Anti- inflammatory, anxiolytics and antidepressants consumption was associated with anxiety, and anti-inflammatory consumption with caregiver burden (ZS >47). Conclusions: The profile of carers in our sample is comparable to that described in other national studies, but care time is longer. The target population is difficult to identify and in need of help. Although there is not a formal demand for help, we should be encouraged to develop new healthcare methods (AU)

[Characteristics and factors associated with dementia caregivers burden]. / Características y factores relacionados con sobrecarga en una muestra de cuidadores principales de pacientes ancianos con demencia.

OBJECTIVE: To describe the characteristics and determining factors of carer stress in a group of elderly home care patients with dementia evaluated in a Geriatric Assessment Unit. MATERIAL AND METHODS: An observational descriptive cross-sectional study was conducted using an assessment of baseline characteristics of patients and carers. Estimation of caregiver burden was registered by validated scales: Goldberg Anxiety Scale (GAS), Goldberg Depression Scales (GDS), and Zarit Burden Scale (ZS). RESULTS: A total of 130 patients were included. No item related to dementia patients was associated with caregiver burden. A poor perception of health and quality of life by the caregivers were associated with anxiety risk, depression and burden. Attendance rates for primary care and lack of paid work outside the home were associated with both, depression (GDS>2) and anxiety (GAS>4). Carer age and a lower education were related to depression. Anti-inflammatory, anxiolytics and antidepressants consumption was associated with anxiety, and anti-inflammatory consumption with caregiver burden (ZS >47). CONCLUSIONS: The profile of carers in our sample is comparable to that described in other national studies, but care time is longer. The target population is difficult to identify and in need of help. Although there is not a formal demand for help, we should be encouraged to develop new healthcare methods.

Calidad de vida de los profesionales en el modelo de gestión clínica de Asturias / Professional quality of life in the clinical governance model of Asturias (Spain)

Objetivo: Analizar la calidad de vida profesional en el modelo de gestión clínica de Asturias y comprobar si hay diferencias en los centros donde el modelo lleva implantado más tiempo o en función del ámbito asistencial (atención primaria o especializada). Métodos: Se aplicó el CVP-35 (35 preguntas), anónimo y autocumplimentado, con tres preguntas adicionales. Se realizó un análisis descriptivo, univariado y bivariado, de las preguntas por separado y según las subescalas "Apoyo directivo" (AD), "Cargas de trabajo" (CT) y "Motivación intrínseca" (MI), siendo las principales variables independientes el ámbito asistencial y el tiempo como unidad o área de gestión clínica. Resultados: De la población de estudio, 2572 profesionales, respondieron 1395 (54%) (el 67% en primaria y 51% en especializada). El 87% llevaba 5 años o más en su puesto. Para el 33% era su primer año en gestión clínica. El ítem con mayor puntuación fue la capacitación para el trabajo (8,39 ± 1,42) y el más bajo los conflictos con los compañeros (3,23 ± 2,2). Primaria obtiene resultados más altos en AD y calidad de vida en el trabajo, y especializada en CT. Respecto a la gestión clínica, las mejores puntuaciones se obtienen en las de 3 años y las peores en las de primer año. Las diferencias son especialmente favorables a la gestión clínica en especializada: las que más tiempo llevan perciben menos CT y más MI y calidad de vida. Conclusiones: Llevar más tiempo en el modelo de gestión clínica se asocia con mejores percepciones en la calidad de vida profesional, sobre todo en atención especializada (AU)

Objective: To evaluate professional quality of life in our clinical governance model by comparing differences according to the time since the model's implementation (1-3 years) and the setting (primary or hospital care). Methods: A cross-sectional descriptive study was performed. The 35-item, anonymous, self-administered Professional Quality of Life Questionnaire, with three additional questions, was applied. A minimum sample size for each clinical governance unit/area (CGU/CGA) was calculated. Descriptive, univariate and bivariate analyses were performed using the 35 items separately. The subscales of "management support", "workload" and "intrinsic motivation" were used as dependant variables, and the setting and time since implementation of the CGU/CGA as independent variables. Results: Of the study population of 2572 professionals, 1395 (54%) responded (67% in primary care and 51% in hospital care). A total of 87% had been working for 5 years or more in their positions. Thirty-three percent had worked for less than a year in clinical governance. The item with the highest score was job training (8.39 ± 1.42) and that with the lowest was conflicts with peers (3.23 ± 2.2). Primary healthcare professionals showed better results in management support and quality of life at work and hospital professionals in workload. The clinical governance model obtained the best scores at 3 years and the worst at 1 year. These differences were especially favorable for clinical governance in hospitals: professionals working longer perceived a lower workload and more intrinsic motivation and quality of life. Conclusions: A longer time working in the clinical governance model was associated with better perception of professional quality of life, especially in hospital care (AU)

[Professional quality of life in the clinical governance model of Asturias (Spain)]. / Calidad de vida de los profesionales en el modelo de gestión clínica de Asturias.

OBJECTIVE: To evaluate professional quality of life in our clinical governance model by comparing differences according to the time since the model's implementation (1-3 years) and the setting (primary or hospital care). METHODS: A cross-sectional descriptive study was performed. The 35-item, anonymous, self-administered Professional Quality of Life Questionnaire, with three additional questions, was applied. A minimum sample size for each clinical governance unit/area (CGU/CGA) was calculated. Descriptive, univariate and bivariate analyses were performed using the 35 items separately. The subscales of « management support ¼, « workload ¼ and « intrinsic motivation ¼ were used as dependant variables, and the setting and time since implementation of the CGU/CGA as independent variables. RESULTS: Of the study population of 2572 professionals, 1395 (54%) responded (67% in primary care and 51% in hospital care). A total of 87% had been working for 5 years or more in their positions. Thirty-three percent had worked for less than a year in clinical governance. The item with the highest score was job training (8.39 ± 1.42) and that with the lowest was conflicts with peers (3.23 ± 2.2). Primary healthcare professionals showed better results in management support and quality of life at work and hospital professionals in workload. The clinical governance model obtained the best scores at 3 years and the worst at 1 year. These differences were especially favorable for clinical governance in hospitals: professionals working longer perceived a lower workload and more intrinsic motivation and quality of life. CONCLUSIONS: A longer time working in the clinical governance model was associated with better perception of professional quality of life, especially in hospital care.