[Synthetic indicator of compliance with standards for Quality Units of health centers and multicenter prospective pilot study]. / Indicador sintético de cumplimiento de estándares para Unidades de Calidad de centros sanitarios y estudio de pilotaje prospectivo multicéntrico.

BACKGROUND AND OBJECTIVE: In Spain, Quality Units play a key and unique role in advising healthcare centers on the methodology of healthcare quality. The objectives of the study were to develop computer algorithms to obtain a synthetic indicator of standard compliance for Quality Units and to pilot its functioning in these units. MATERIALS AND METHODS: The Excel program was used to establish evaluation algorithms, and quantitatively interrelate and weight various categories of standards, as a computer evaluation tool, to build a continuous improvement cycle system, and offer a global synthetic indicator of compliance. The tool was tested in a prospective multicenter pilot study, in which coordinators of Quality Units from different health centers and care settings participated, to evaluate the usefulness of the tool and compliance with the standards, in addition to analyzing the content validity of each standard. RESULTS: The formulas for the structured computer algorithms were developed, consecutively, in a «PLAN-DO-CHECK-ACT¼ improvement cycle for the 9 categories of standards, resulting in a single synthetic indicator of compliance. Twenty-one Quality Units participated in the piloting. The overall average compliance rate for the synthetic indicator was 55.63% with differences between centers (P=.002) and between categories (P<.0001), but not by autonomous communities (P=.86) or by areas (P=.97). Content validity was ensured through the variable of «understanding¼ of the standards (P<.001), and through their «justification¼ with documentary evidence (P<.001). CONCLUSIONS: The computer tool with the synthetic indicator have allowed for the evaluation of standard compliance in Quality Units of healthcare centers.

Assessment of the quality, diagnosis, and therapeutic recommendations of clinical practice guidelines on patients with Helicobacter pylori infection: A systematic review.

We conducted this study to systematically review and assess the current clinical practice guidelines (CPGs) related to the diagnosis and treatment of Helicobacter pylori (H. pylori) infection. The aim was to evaluate the quality of these included CPGs and provide clinicians with a convenient and comprehensive reference for updating their own CPGs. We searched four databases to identify eligible CPGs focusing on H. pylori diagnosis and treatment recommendations. The results were presented using evidence mappings. Quality and clinical applicability were assessed comprehensively using AGREE-II and AGREE-REX. Statistical tests, specifically Bonferroni tests, were employed to compare the quality between evidence-based guidelines and consensus. A total of 30 eligible CPGs were included, comprising 17 consensuses and 13 guidelines. The quality showed no statistical significance between consensuses and guidelines, mainly within the moderate to low range. Notably, recommendations across CPGs exhibited inconsistency. Nevertheless, concerning diagnosis, the urea breath test emerged as the most frequently recommended method for testing H. pylori. Regarding treatment, bismuth quadruple therapy stood out as the predominantly recommended eradication strategy, with high-dose dual therapy being a newly recommended option. Our findings suggest the need for specific organizations to update their CPGs on H. pylori or refer to recently published CPGs. Specifically, CPGs for pediatric cases require improvement and updating, while a notable absence of CPGs for the elderly was observed. Furthermore, there is a pressing need to improve the overall quality of CPGs related to H. pylori. Regarding recommendations, additional evidence is essential to elucidate the relationship between H. pylori infection and other diseases and refine test indications. Clinicians are encouraged to consider bismuth quadruple or high-dose dual therapy, incorporating locally sensitive antibiotics, as empirical radical therapy. .

Representações sociais de médicos da Atenção Primária sobre a atenção à saúde para pessoas com deficiência / Representaciones sociales de médicos de la atención primaria sobre la atención de la salud para personas con discapacidad / Social representations of primary care physicians about health care for people with disabilities

O presente artigo objetivou analisar as representações sociais de médicos atuantes na Estratégia Saúde da Família sobre atendimento à saúde para pessoas com deficiência (PcD). Utilizou-se a Teoria das Representações Sociais, com abordagem estrutural da Teoria do Núcleo Central, a partir da técnica de evocação de palavras analisadas pelos softwares Evoc® e Iramutec®. Participaram da pesquisa 109 médicos, predominantemente jovens e mulheres. A atenção às PcD se orienta por uma prática incompleta, insegura e permeada pelo receio de médicos que referem lacunas no processo de formação profissional, além de haver dificuldades de comunicação com pacientes identificados como PcD. Poucos médicos apresentam relatos mais inclusivos na assistência de PcD. Predominam as percepções restritas ao corpo, normatizadas pelo modelo biomédico e que ignoram as estruturas sociais. (AU)

El objetivo fue el análisis de las Representaciones Sociales de médicos actuantes en la Estrategia Salud de la Familia sobre atención de la salud para personas con discapacidad (PcD). Se utilizó la Teoría de las Representaciones Sociales, con abordaje estructural de la Teoría del Núcleo Central a partir de la técnica de evocación de palabras analizadas por los softwares EVOC® e IRAMUTEC®. Participaron 109 médicos, predominantemente jóvenes y mujeres. La atención a las PcD se orienta por una práctica incompleta, insegura, atravesada por el recelo de médicos que refieren lagunas en el proceso de formación profesional, además de dificultades de comunicación con pacientes identificados como PcD. Pocos médicos presentan relatos más inclusivos en la asistencia de PcD. Predominan las percepciones restringidas al cuerpo, normalizadas por el modelo biomédico y que ignoran las estructuras sociales.(AU)

The objective was to analyze the Social Representations of physicians working in the Family Health Strategy on health care for people with disabilities (PwD). The Theory of Social Representations was used, with a structural approach of the Central Nucleus Theory based on the technique of evoking words analyzed by the EVOC® and IRAMUTEC® software. 109 physicians participated, predominantly younger individuals and women. Care to PwD is guided by an incomplete, unsafe practice, permeated by the fear of doctors who mention gaps in the professional training process, in addition to communication difficulties with patients identified as PwD. Few physicians have more inclusive reports on PwD care. The predominant perceptions are restricted to the body, standardized by the biomedical model and ignoring social structures.(AU)

[Patient participation through active listening. About the remodeling of an extractions service]. / Participación del paciente a través de la escucha activa. A propósito de la remodelación de un servicio de extracciones.

BACKGROUND AND OBJECTIVE: From listening to patients there arises the possibility of improving both the care and the health infrastructure that users frequent. Our purpose of study was to explore the perception of users about the means and the care received involved in a hospital service through active listening, and to evaluate the satisfaction perceived after the opening of the renovated area. METHODS: A mixed methodology evaluative investigation was carried out within the context of the Extraction Service of the Costa del Sol Hospital, using qualitative methodology to assess the perception of users, and quantitative methodology through a satisfaction survey to identify the change after remodeling of the area. RESULTS: Through a qualitative approach, improvements have been identified in terms of the internal and external infrastructure of the center, highlighting the need to personalize spaces depending on the profile of the patient attended. In evaluating the impact after remodeling the area, patients have a higher overall satisfaction both from the healthcare professionals who attend them and from the healthcare center. CONCLUSIONS: Through the use of a mixed methodology, useful information has been incorporated for a project to improve a hospital infrastructure, and a subsequent evaluation of the positive impact on the satisfaction perceived by users after remodeling.

Evaluación del desempeño del modelo asistencial de una policlínica pública: la mirada de los usuarios / Performance evaluation of the healthcare model of a public polyclinic: the gaze of the users / Avaliação de desempenho do modelo assistencial de uma policlínica pública: o olhar dos usuários

El presente artículo describe los resultados de una investigación desarrollada en el año 2019, en el contexto del sistema sanitario uruguayo, sub sector público perteneciente a una red que brinda atención a usuarios portadores de Diabetes Mellitus tipo 2, referente en el tratamiento de esta patología a nivel nacional. Se realizó una evaluación del desempeño del modelo de atención de la misma, a través de la óptica de los usuarios en relación a la atención de salud recibida. Se estableció como objetivo evaluar el desempeño del modelo de atención de dicha policlínica. La investigación utilizó un diseño descriptivo, transversal, con un muestreo aleatorio simple, siendo el universo de 179 usuarios. Se utilizó el Procedimiento para Evaluar el Desempeño de Redes Integradas de Servicios de Salud abordando el componente Modelo Asistencial. Este componente posee varias dimensiones que analizan aspectos tanto de accesibilidad a los servicios, como aspectos de conocimientos que el usuario posee sobre la patología y sus derechos. Los resultados obtenidos no difieren de los arrojados en otro estudio realizado en otra red sanitaria de Uruguay, en donde aplicando el mismo instrumento se destacan la casi ausencia de análisis de situación de salud de la población adscripta, dificultades para el acceso a consultas médicas en general, y en particular con especialistas, sumándosele la ausencia de mecanismos de monitoreo clínico y desconocimiento de los servicios que brinda la red. Como resultado se evidenció una red con un bajo índice de desempeño (0.49 %).Concluyendo que el servicio dista de los estándares de calidad establecidos tanto por el prestador de salud al cual pertenece, como por organismos internacionales. De este modo se establecieron posibles riesgos en relación a la accesibilidad a la atención sanitaria que los usuarios perciben, así como una posible vulneración de sus derechos.

Este artigo descreve os resultados de uma investigação realizada ao longo de 2019, no contexto do sistema de saúde uruguaio, subsetor público. Neste, foi realizada uma avaliação do desempenho do modelo assistencial de uma prestadora pública, por meio da percepção dos usuários em relação ao atendimento recebido. O serviço de saúde atendido pertence a uma rede de saúde que atende usuários com Diabetes Mellitus tipo 2 e que, por sua vez, é referência no tratamento dessa patologia em todo o país. O objetivo foi avaliar o desempenho do modelo assistencial da referida policlínica. A pesquisa utilizou um delineamento descritivo, transversal, com amostragem aleatória simples, em que o universo foi constituído por 179 usuários. Foi utilizado o Procedimento de Avaliação de Desempenho de Redes Integradas de Serviços de Saúde, abordando o componente Modelo Assistencial. Este componente possui várias dimensões que analisam aspectos tanto da acessibilidade aos serviços, quanto aspectos do conhecimento que o usuário possui sobre a patologia e seus direitos. Como resultado, evidenciou-se uma rede com baixo índice de desempenho (0,49 %).

This article describes the results of an investigation carried out throughout 2019, in the context of the Uruguayan health system, sub public sector. In this, an evaluation of the performance of the care model of a public provider was carried out, through the perception of the users in relation to the health care received. The health service addressed belongs to a health network that provides care to users with type 2 Diabetes Mellitus and which, in turn, is a benchmark in the treatment of this pathology at the national level. The objective was to evaluate the performance of the care model of said polyclinic. The research used a descriptive, cross-sectional design, with a simple random sampling, in which the universe consisted of 179 users. The Procedure to Evaluate the Performance of Integrated Health Services Networks was used, addressing the Healthcare Model component. This component has several dimensions that analyze aspects of both accessibility to services, as well as aspects of knowledge that the user has about the pathology and their rights. As a result, a network with a low performance index (0.49 %) was evidenced. It was concluded that the service falls short of the quality standards established both by the health provider to which it belongs, and by international organizations. In this way, possible risks were established in relation to the accessibility to health care that users perceive, as well as a possible violation of their rights as individuals.

Bases teóricas sobre la evaluación de la calidad del servicio en salud / Theoretical bases on health service quality assessment

Exponer las diferentes conceptualizaciones y los modelos de evaluación de la calidad de servicio en salud, respecto a sus características, fundamentos, y diferencias a través del análisis y síntesis de los aspectos más significativos encontrados en la literatura. Se realizó una revisión bibliográfica, bajo el sustento teórico de los siguientes métodos teóricos: Análisis, síntesis, histórico lógico y análisis documental de 19 artículos completos, accesibles en el idioma español e inglés, recolectados de bases de datos académicos como Google Académico, Research Gate, PubMed, Cochrane Library, Scielo Salud pública. Destacar que la búsqueda, recolección y análisis se realizó en los meses de mayo a julio. Tras la revisión bibliográfica pone en manifiesto la falta de consenso entre los expertos en el tema de calidad respecto a su conceptualización, misma que ha evolucionado conforme al contexto, social, tecnológico y científico. En definitiva, las bases teóricas para la evaluación de la calidad de atención en el servicio de salud, el primer modelo específico aplicado a salud fue el modelo de Abedis Donabedian, continuando las bases teóricas con el paradigma de la desconfirmación liderada por el modelo nórdico de Grönroos, el modelo de Parasumaran, Berry y Zeithaml respecto a la brecha que existe entre las expectativas y percepción; y el modelo de Cronin Taylor respecto a la valoración de las percepciones. Así mismo, se concluye, que el constructo de calidad está en evolución y su interpretación depende del observador y sus prioridades en base a la adaptación del instrumento respecto al contexto de aplicabilidad.

To expose the different conceptualizations and models of health service quality evaluation, regarding their characteristics, foundations, extension and differences through the analysis and synthesis of the most significant aspects found in the literature. A bibliographic review was carried out under the theoretical support of the following theoretical methods: analysis, synthesis, logical history and documentary analysis of 18 complete articles, accessible in Spanish and English, collected from academic databases such as Google Scholar, Research Gate, PubMed, Cochrane Library, Scielo Public Health, the search, collection and analysis was carried out from May to July. The bibliographic review reveals the lack of consensus among experts on the subject of quality with respect to its conceptualization, which has evolved according to the social, technological and scientific context. In short, the theoretical bases for the evaluation of the quality of care in the health service, the first specific model applied to health was the Abedis Donabedian model, continuing the theoretical bases with the paradigm of disconfirmation led by the Nordic model of Grönroos, the model of Parasumaran, Berry and Zeithaml regarding the gap that exists between expectations and perception; and the Cronin Taylor model regarding the assessment of perceptions. It is also concluded that the quality construct is evolving and its interpretation depends on the observer and his or her priorities based on the adaptation of the instrument to the context of applicability

Perception of the healthcare accreditation system in Colombia / Percepción del sistema de acreditación sanitaria en Colombia

Abstract Introduction: Accreditation is an external, systematic, periodic, and voluntary evaluation process to which health care institutions submit themselves in order to demonstrate compliance with superior levels of quality of care. The Icontec, through an evaluative model, accredits the quality of health institutions in Colombia. Methods: Descriptive cross-sectional study following the recommendations of the survey study report. Using an electronic format, 22 health institutions with experience in the Icontec accreditation process were surveyed. The instrument evaluated three thematic axes of the process: added value provided by the accreditation process, evaluation process and final report. The measurement was carried out using a Likert-type scale and a descriptive statistical analysis to establish the perception of the phases of the process. Results: the items with the best perception were the humanization of care (86.4%) followed by patient safety and teamwork (81.8%). After accreditation, the quality of the processes improved (77.4%), infection prevention and control (68.1%) and physician commitment (63.6%). 54.6% felt that evaluators use different methods of evaluation. 63.6% of the respondents considered that Icontec does not comply with the times defined for the delivery of the report. Conclusion: the Icontec accreditation system adds value to health institutions in most of the thematic areas evaluated, especially in the humanization of care and patient safety. The lowest perception is presented in the increase of physicians' commitment.

Resumen Introducción: la acreditación es un proceso de evaluación externo, sistemático, periódico y voluntario al que se someten instituciones de salud para demostrar el cumplimiento de niveles superiores de calidad en la atención. El Icontec, Instituto colombiano de normas técnicas, es la organización colombiana no gubernamental designada por el Ministerio de Salud para ser la entidad que acredita la calidad de las instituciones de salud en Colombia. El objetivo del presente estudio fue evaluar la percepción del valor que agrega la acreditación a la calidad de la atención en clínicas y hospitales en Colombia. Métodos: estudio transversal observacional. Se encuestaron 22 profesionales con experiencia en el proceso de acreditación Icontec. El instrumento evaluó tres ejes temáticos del proceso: valor agregado que aporta el proceso de acreditación, proceso de evaluación e informe final. La percepción de las fases del proceso fue medida a través de una escala tipo Likert y un análisis estadístico descriptivo. Resultados: los ítems con mejor percepción fueron la humanización de la atención (86.4%), la seguridad de los pacientes y el trabajo en equipo (81.8%). Laacreditación mejora la calidad de los procesos (77.4%), la prevención y el control de infecciones (68.1%) y el compromiso de los médicos (63.6%). El 54.6% consideró que los evaluadores utilizan métodos diferentes de evaluación. Conclusión: el sistema de acreditación Icontec en Colombia, agrega valor a las instituciones de salud en la mayoría de los ejes temáticos evaluados. La percepción más baja se presenta en el incremento de compromiso de los médicos.

Desarrollo histórico de la evaluación del impacto de la formación de especialidades médicas en Cuba / Develop historical of the evaluation of the impact in the formation of the medical specialties in Cuba

RESUMEN La evaluación en la formación surgió en el siglo XVII, buscando dar juicios de valor a las acciones y actitudes de los estudiantes, a la determinación sistemática del mérito, valor y significado del aspecto a evaluar en función de criterios y normas establecidas en aquella época. Su evolución desde lo conceptual y lo procesual tuvo la influencia de los paradigmas investigativos. Muchos han sido los modelos propuestos en el ámbito internacional para perfeccionar el proceso de evaluación de la calidad en la educación. Actualmente, se asocia el término "evaluación" con el término "impacto", usado con frecuencia como expresión del efecto de una acción determinada, con cambios o transformaciones generadas en las personas, organizaciones, procesos o productos. En Cuba, este proceso ha tenido diferentes etapas, pero no es hasta el siglo XXI que comienza a implementarse en el Sistema Universitario de Programas de Acreditación, actual Sistema de Evaluación y Acreditación de la Educación Superior, con el objetivo de lograr una mejora continua en la formación, acorde a los principios y exigencias de la sociedad socialista. Dentro del mismo, el Sistema de Evaluación y Acreditación de Especialidades de Posgrado desempeña un papel fundamental en el desarrollo de dicha figura del posgrado, teniendo una repercusión notable en el desarrollo de las ciencias médicas. Este artículo expone la evolución histórica de la evaluación de la calidad y su impacto en el proceso de formación de especialidades médicas en el país, como referente para futuras investigaciones (AU).

ABSTRACT Training assessment emerged in the 17 century, in search for giving value judgment to the students' actions and behavior, for systematic determining the worth, value and significance of the aspect to assess according to criteria and norms established at that time. Its evolution, from the point of view of the conceptual and process, received the influence of research paradigms. Many models have been proposed around the world to improve the process of quality assessing in the educational field. Currently, the term 'assessment' is associated to the term 'impact', frequently used as an expression of a determinate action's effect on changes or transformations in people, organizations, processes or products. This process has had different stages in Cuba, but only in the 21 century, the University System of Accreditation Programs (SUPRA by its acronym in Spanish) -currently known as Accreditation and Assessment System of High Education (SEAES by its acronym in Spanish)- has begun to be implemented, with the objective of achieving a better continuous training, according to the principles and demands of the socialist society. Among it, the Accreditation and Assessment System of Post-grade Specialties (SEA-EP by its acronym in Spanish), play an important role in the development of the post-grade figure, having a remarkable repercussion in the medical sciences. This article exposes the historical evolution of the quality assessment and its impact in the medical sciences training process in the country as a referent for subsequent researches (AU).

Categorización de las maternidades privadas de la provincia de Mendoza, Argentina: ¿Una intervención sanitaria reproducible? / Private maternity hospital categorization in the province of Mendoza, Argentina: a reproducible health intervention?

INTRODUCCIÓN: Las instituciones públicas de salud adhieren a los acuerdos federales y a las resoluciones ministeriales sobre políticas en salud perinatal, pero no existe información sobre su cumplimiento en instituciones privadas. La provincia de Mendoza detectó peores resultados de sobrevida de niños prematuros y de mortalidad materna en instituciones privadas, por lo que solicitó la colaboración del Ministerio de Salud de la Nación para efectuar una evaluación categorizante. El objetivo de esta intervención sanitaria fue categorizar las maternidades privadas de la provincia y comparar su impacto en los recién nacidos (RN) prematuros. MÉTODOS: Se categorizaron todas las maternidades y se efectuó una evaluación prospectiva y transversal de la intervención sanitaria. Se analizó el cumplimiento de las resoluciones ministeriales y se evaluó la evolución de los RN de ≤1500 gramos. RESULTADOS: Se pudieron categorizar 10 de las 20 instituciones estudiadas. El resto de las instituciones debieron efectuar cambios para acceder a una categoría. La mayoría no cumplía con estándares de planta física, equipamiento, calidad, seguridad y recurso humano. Los nacimientos de prematuros en maternidades privadas de alta complejidad aumentaron de 74% a 87% (p<0,05), y su mortalidad disminuyó de 35% a 32% (p>0,05 no significativo). DISCUSIÓN: La provincia de Mendoza logró llevar a cabo una intervención novedosa en el sector privado de salud. Esta intervención sanitaria se mostró efectiva, con resultados favorables sobre todo en la atención de los RN más vulnerables.

Evaluación de la calidad del proceso de atención a los diabético tipo 2 / Quality Evaluation of the Care Process for Type 2 Diabetics

RESUMEN Fundamento: la diabetes mellitus es un problema de salud serio con tendencia ascendente. Cada año fallecen un número considerable de personas como consecuencia de sus complicaciones que derivan de un mal control, por lo que el mejoramiento de la calidad de la atención constituye un reto para los sistemas de salud. Objetivo evaluar la calidad de la atención mediante la revisión de las historias clínicas y la indagación en algunos de los indicadores del programa, en un área de salud del municipio Cárdenas durante el año 2016. Método: se realizó una investigación de sistemas y servicios de Salud, utilizando un muestreo por conglomerado bietápico. Las variables estudiadas estaban relacionadas con el cumplimiento de las principales actividades establecidas en el proceso de atención al paciente y otras con los conocimientos, capacitaciones y satisfacción de los proveedores. Se aplicaron instrumentos probados en estudios anteriores. Para el vaciamiento y análisis de los resultados se utilizaron los paquetes estadísticos Access 2000 y SPSS 21.0. Resultados: la evaluación del proceso, nivel de conocimiento, capacitaciones y satisfacción de los proveedores fue no adecuado en el área estudiada, al no alcanzarse los estándares propuestos para ninguno de los criterios. Conclusiones: la atención que recibieron estos pacientes no es adecuada ya que existieron dificultades en el cumplimiento del programa, lo que repercutió en su seguimiento y control.

ABSTRACT Background: diabetes mellitus is a serious health problem with an upward trend. Every year a considerable number of people die as a result of their complications that derive from poor control, so improving the quality of care constitutes a challenge for health systems. Objective: to evaluate the quality of care by reviewing the medical records and investigating some of the program indicators, in a health area of ​​the Cárdenas municipality during 2016. Method: an investigation of health systems and services was carried out, using a two-stage conglomerate sampling. The variables studied were related to the fulfillment of the main activities established in the patient care process and others with the knowledge, training and satisfaction of the providers. Instruments tested in previous studies were applied. The statistical packages Access 2000 and SPSS 21.0 were used to collect and analyze the results. Results: the evaluation of the process, level of knowledge, training and satisfaction of the suppliers was not adequate in the studied area, as the proposed standards were not reached for any of the criteria. Conclusions: the care received by these patients is not adequate since there were difficulties in the fulfillment of the program, which affected on its follow-up and control.

A composite indicator to assess the quality of care in the management of patients with rheumatoid arthritis in outpatient rheumatology clinics. / Indicador compuesto para evaluar la calidad asistencial en el manejo de los pacientes con artritis reumatoide en las consultas externas de Reumatología.

OBJECTIVE: The current guidelines in the treatment of rheumatoid arthritis (RA) include the early diagnosis and early use of disease modifying drugs to achieve remission or low disease activity level, known as "Treat to Target" (T2T). The objective of this study is to develop a composite indicator (CI) to evaluate the quality of care in the management of patients with RA, according to the T2T strategy and other general recommendations concerning the management of these patients. MATERIAL AND METHOD: The phases of the construction of the CI were: 1) selection of quality criteria through expert judgment; 2) prioritization of the criteria, according to relevance and feasibility, applying the Delphi methodology (two rounds) involving 20 experts; 3) design of quality indicators; and 4) calculation of the weighted CI, using the mean value in relevance and feasibility granted by the experts. The source of information for the calculation of the CI are the medical records of patients with RA. RESULTS: Twelve criteria out of 37 required a second Delphi round. Thirty-one criteria were prioritized. These criteria presented a median in relevance and feasibility greater than or equal to 7.5, with an interquartile range of less than 3.5, and a level of agreement (score greater than or equal to 8) greater than or equal to 80%. CONCLUSIONS: The constructed CI allows us to evaluate the quality of care of patients with RA following the T2T strategy in the rheumatology units of Spanish hospitals, offering a valid and easily interpretable summary measure.

Instrumentos para evaluar la calidad percibida por los usuarios en los servicios de salud / Instruments to Evaluate Quality Perceived by Health Service Users / Instrumentos para avaliar a qualidade percebida pelos usuários dos serviços de saúde

Resumen La calidad es considerada un factor clave en la diferenciación y en la excelencia de los servicios de salud, y la percepción de un paciente sobre la prestación del servicio determina en forma definitiva su nivel de calidad. Se han descrito indicadores que ayudan a evaluar la calidad de los servicios de salud, entre estos, indicadores de efectividad, de oportunidad y de adhesión. Sin embargo, la evaluación integral de la calidad percibida en los servicios de salud es aún compleja. Se realizó una búsqueda en Medline, Embase, OVID, Lilacs, Ebsco, Scielo y The Cochrane Library para identificar instrumentos de tipo cualitativo o cuantitativo que permitieran medir la calidad de los servicios de salud percibida por los pacientes. Se encontraron estudios que validaron y aplicaron la escala Servqual y Servqhos en el ámbito hospitalario. Adicionalmente, en nuestro país se intentó validar escalas diferentes a estas, pero no contaron con un rigor estadístico importante.

Abstract Quality is considered as a key factor for the differentiation and excellence of the health services. The way patients perceive the health care service determines conclusively the service quality levels. This work describes some indicators that help to assess the health service quality including effectiveness, opportunity, and adherence indicators. However, the comprehensive evaluation of the quality as perceived in the health services is still a complex matter. A search was conducted in the databases Medline, Embase, OVID, Lilacs, Ebsco, Scielo and The Cochrane Library in order to identify those instruments, either qualitative or quantitative, allowing to measure the health service quality as perceived by the patients. Studies were found that validated and applied the scales Servqual and Servqhos in the hospital environment. Finally, there were some attempts to validate some scales different to these ones, but they were not applied with a significant statistic rigorousness.

Resumo A qualidade é considerada fator chave na diferenciação e excelência dos serviços de saúde e a percepção de um paciente sobre a prestação do serviço determina em forma definitiva seu nível de qualidade. Indicadores que ajudam a avaliar a qualidade dos serviços de saúde já foram descritos, entre estes, indicadores de efetividade, de oportunidade e de adesão. No entanto, a avaliação integral da qualidade percebida nos serviços de saúde é ainda complexa. Realizou-se uma busca em Medline, Embase, OVID, Lilacs, Ebsco, Scielo e The Cochrane Library para identificar instrumentos de tipo qualitativo ou quantitativo que permitiram medir a qualidade dos serviços de saúde percebida pelos pacientes. Encontraram-se estudos que validaram e aplicaram a escala Servqual e Servqhos no âmbito hospitalar. Além disso, em nosso país tentou-se validar escalas diferentes a estas, mas não contamos com rigor estatístico importante.

[Identifying indicators of good practice in clinical and healthcare management]. / Identificación de indicadores de buenas prácticas en gestión clínica y sanitaria.

OBJECTIVE: To identify good practices in order to develop and implement indicators of health outcomes for clinical and healthcare management, as well as the characteristics for an indicator to be considered adequate. METHODOLOGY: A scoping review was performed, with the following phases: 1) Search and identification of bibliography. 2) Selection of relevant documents. Including those studies that discussed issues related to good practices for the use of health indicators in the management field. Those published in a language other than English or Spanish or before 2006 were excluded. 3) Analysis and extraction of information. 4) Consultation with stakeholders, using a qualitative methodology through Concept Mapping, with the participation of 40 experts (decision-makers, scientific societies, and health professionals). The data collection process included an inductive and structured procedure, with prioritisation of ideas grouped into clusters, according to feasibility and importance criteria (0-10 scale). RESULTS: Good practices identified 2 levels: 1) macro-management: Define a framework for the evaluation of indicators and establish a benchmark of indicators. 2) meso-management: Establish indicators according to evidence and expert consensus, taking into account priority areas and topics, testing before final use, and communicate results adequately. The characteristics of a suitable indicator are: 1) Approach of an important issue, 2) Scientific validity, 3) Possibility of measurement with reliable data, 4) Meaning of useful and applicable measurement, and 5) Wide scope. CONCLUSIONS: The best practices for the use of indicators in clinical and healthcare management can make it easier to monitor performance and accountability, as well as to support the decision-making addressed at the development of initiatives for quality improvement.

Estado actual de la evaluación de la calidad en los servicios de Estomatología en Cuba / Present situation of quality assessment of the Dentistry services in Cuba

Evaluar la calidad de los servicios de salud es una tarea compleja, dado el carácter multidimensional de su definición, la diversidad de enfoques teóricos y la variabilidad de los componentes de cada especialidad o servicio. Este trabajo tiene como objetivo exponer las características de la evaluación de la calidad en los servicios de Estomatología en Cuba en la actualidad. Se realizó una revisión de documentos y estudios publicados en los últimos diez años. En un inicio se destacan los antecedentes y enfoques de la calidad de los servicios de salud; luego se exponen los métodos y programas de evaluación y gestión de la calidad en Cuba. La evaluación se lleva a cabo mediante supervisiones o auditorías a los servicios, con interés particular en la estadística de indicadores. Es un elemento fundamental el Programa de mejora continua de la calidad de la atención estomatológica y la satisfacción de los prestadores, incluido en el anexo II del Programa Nacional de Atención Estomatológica a la Población. Diversas fuentes identifican problemas de calidad en los servicios de Estomatología, los cuales deben ser considerados desde el ámbito académico y administrativo. Se concluye que la evaluación de la calidad de los servicios estomatológicos en Cuba, precisa de una actualización o rediseño de la metodología.

Assessing the quality of health services is a complex task, due to the multidimensional character of its definition, diversity of the theoretical approaches and component variability of each specialty and service. This paper is aimed at presenting the characteristics of quality assessment in Dentistry services in Cuba at present. It was carried out a review of documentary and published studies in the last ten years. At the beginning antecedents and health services quality approaches are highlighted; then assessment methods and programs are presented, so as quality management in Cuba. The assessment is carried out by means of supervisions and audits to the services with particular interest in indicators statistics. This a fundamental element in the quality continue improvement program in Dental services and the satisfaction of providers, including annex II of the National Program of Dental Care to the population. Various sources identify quality problems in Dentistry services, which should be considered from the academic and administrative point of view. It is concluded that assessing dental services in Cuba, needs an updating or a methodological redesign.

[Prevalence of oral anticoagulation and quality of its management in primary healthcare: A study by the Health Sentinel Network of the Region of Valencia (Spain)]. / Prevalencia de la anticoagulación oral y calidad de su seguimiento en el ámbito de la atención primaria: estudio de la Red Centinela Sanitaria de la Comunitat Valenciana.

OBJECTIVE: To estimate the prevalence of patients with oral anticoagulant therapy (OAT) in the Region of Valencia and to evaluate the quality of management of OAT with vitaminK antagonists (VKA) carried out in primary healthcare. DESIGN: Observational cross-sectional study conducted through the Health Sentinel Network of the Region of Valencia, which includes a survey and the retrospective analysis of OAT monitoring. SETTING: Primary healthcare, Region of Valencia, Spain. SUBJECTS: All patients aged 18years or older on OAT who consulted during the year 2014. The population covered by the 59 doctors of the Health Sentinel Network constitutes 2.2% of the adult population of the Region of Valencia, and it is representative of it. KEY MEASUREMENTS: Demographic, socioeconomic and health data as well as information concerning OAT. Quality of OAT management with VKA was assessed by means of the percentage of time in therapeutic range (TTR), computed using the Rosendaal method. RESULTS: A total of 1,144 patients were recorded (mean age 74.5±11 years; 49.7% women). Prevalence of OAT in the Region of Valencia is 1.3 cases per 100 population. The characteristic profile of these patients is an old person, with several comorbidities and a low level of education, who lives accompanied. Atrial fibrillation is the most common indication. 82.8% of patients on OAT with VKA were monitored in primary healthcare. The average TTR was 65.0%, and 53.9% of patients had a TTR ≥65%. Among inadequately controlled patients, 74.4% were perceived as well-controlled by their primary care doctor. CONCLUSIONS: Prevalence of OAT is high, and it is expected to increase. The degree of control achieved meets the generally accepted quality standard (mean TTR ≥65%), and it is comparable to that observed in other national and international studies. However, there is wide scope for improvement. It is crucial to optimize the management of this therapy in the most effective and cost-effective way. Among other measures, access of physicians to their patients' clinical information should be improved.

Conocimiento y satisfacción de los trabajadores de la campaña antivectorial contra el Aedes aegypti / Knowledge and satisfaction of the antivectorial campaign workers against Aedes aegypti

Se realizó una investigación cualitativa, de tipo evaluativo, en el Departamento de Control de Vectores del Policlínico Docente Carlos Juan Finlay de Santiago de Cuba, en el período enero-mayo del 2013, con el propósito de evaluar la calidad del trabajo de los operarios A, B y los jefes de brigada, a partir de sus conocimientos para un eficiente desempeño en la lucha contra el Aedes aegypti, y sobre la base de criterios, indicadores y estándares elaborados a los efectos. Se obtuvo que los trabajadores no poseían los conocimientos necesarios ni estaban satisfechos con las condiciones y desempeño laborales, pues los criterios establecidos resultaron inadecuados en la totalidad de ellos; en cuanto a la satisfacción de los moradores, solo 8 criterios fueron adecuados. De esta manera, pudo concluirse que los operarios y jefes de brigada no dominaban las actividades diarias de la campaña antivectorial(AU)

A qualitative evaluative investigation was carried out in the Vectors Control Department of Carlos Juan Finlay Teaching Polyclinic in Santiago de Cuba, during January-May, 2013, with the purpose of evaluating the work quality of A, B operator and brigade chiefs, starting from their knowledge for an efficient performance in the control of Aedes aegypti, and on the base of criteria, indicators and standards elaborated for the purpose. It was concluded that workers didn't possess the necessary knowledge and were not satisfied with the conditions and working performance, because the established criteria were inadequate in all of them; as for the satisfaction of the residents, just 8 criteria were adequate. This way, it could be concluded that the operators and brigade chiefs didn't master the daily activities of the antivectorial campaign(AU)

Conocimiento y satisfacción de los trabajadores de la campaña antivectorial contra el Aedes aegypti / Knowledge and satisfaction of the antivectorial campaign workers against Aedes aegypti

Se realizó una investigación cualitativa, de tipo evaluativo, en el Departamento de Control de Vectores del Policlínico Docente "Carlos Juan Finlay" de Santiago de Cuba, en el período enero-mayo del 2013, con el propósito de evaluar la calidad del trabajo de los operarios A, B y los jefes de brigada, a partir de sus conocimientos para un eficiente desempeño en la lucha contra el Aedes aegypti, y sobre la base de criterios, indicadores y estándares elaborados a los efectos. Se obtuvo que los trabajadores no poseían los conocimientos necesarios ni estaban satisfechos con las condiciones y desempeño laborales, pues los criterios establecidos resultaron inadecuados en la totalidad de ellos; en cuanto a la satisfacción de los moradores, solo 8 criterios fueron adecuados. De esta manera, pudo concluirse que los operarios y jefes de brigada no dominaban las actividades diarias de la campaña antivectorial.

A qualitative evaluative investigation was carried out in the Vectors Control Department of "Carlos Juan Finlay" Teaching Polyclinic in Santiago de Cuba, during January-May, 2013, with the purpose of evaluating the work quality of A, B operator and brigade chiefs, starting from their knowledge for an efficient performance in the control of Aedes aegypti, and on the base of criteria, indicators and standards elaborated for the purpose. It was concluded that workers didn't possess the necessary knowledge and were not satisfied with the conditions and working performance, because the established criteria were inadequate in all of them; as for the satisfaction of the residents, just 8 criteria were adequate. This way, it could be concluded that the operators and brigade chiefs didn't master the daily activities of the antivectorial campaign.

Asistencia sanitaria, certificación de calidad y apoyo institucional: la atención primaria en Brasil / Health care, quality certification and institutional support: a focus on primary health care in Brazil

Resumen: Objetivo: Ofrecer un panorama de la distribución del apoyo institucional a la atención primaria en Brasil e identificar la relación entre actividades de apoyo institucional y los resultados de la certificación del Programa Nacional para Mejorar el Acceso y la Calidad de la Atención Primaria (PMAQ). Material y métodos: Se efectuó un estudio transversal mediante entrevistas con 16 960 equipos en Brasil, en 2012. Para examinar la relación entre apoyo recibido y la calidad de la atención, se efectuó una regresión logística binaria múltiple. Resultados: Se observó una relación positiva entre el alto apoyo y la certificación en las subdimensiones analizadas: atención de la mujer y niños, diabetes mellitus/ hipertensión y salud mental. Las actividades de apoyo que más contribuyeron fueron autoevaluación, evaluación compartida, talleres con objetivos específicos y formación permanente. Conclusiones: Las actividades de apoyo institucional ayudaron a mejorar la calidad y el acceso de la población a la asistencia sanitaria en Brasil.

Abstract: Objective: To provide an overview of the distribution of institutional support in primary care in Brazil and to identify associations between the activities of institutional support and the outcome of the certification of the National Programme for Improving Access and Quality in Primary Health Care (PMAQ). Materials and methods: A cross-sectional study was conducted through interviews with 16 960 professionals in Brazil in 2012.To examine the relationship between the received support and the quality of health care it was made a multiple binary logistic regression. Results: A positive relationship between high-level support and certification in the sub-dimensions analyzed was observed: women and child care, diabetes mellitus/ hypertension and mental health.The support activities which contributed most were: self-assessment, shared assessment, targeted workshops and training. Conclusion: Institutional support activities have helped to improve the quality and access of the population to healthcare in the country.

Instrumento para la evaluación del proceso de atención al adulto mayor en el consultorio del médico y la enfermera de la familia / A tool for assessing senior adult care in the family doctors office

Introducción: el envejecimiento de la población constituye un reto para la salud pública, en tanto incrementa la demanda de atención especializada a adultos mayores aquejados de enfermedades no transmisibles y discapacidades.Objetivo: desarrollar un instrumento para la evaluación de la calidad del proceso de atención al adulto mayor que cumpla con los atributos de validez, fiabilidad, capacidad discriminatoria y factibilidad requeridos.Métodos: se realizó un trabajo de desarrollo tecnológico a partir de la aplicación de un algoritmo metodológico, que permitió la construcción y validación de un formulario para la evaluación de las historias clínicas en un Consultorio del Médico y la Enfermera de la Familia. La validación del instrumento incluyó el análisis de consistencia interna a través del coeficiente de Cronbach global y eliminando ítems, la validación de contenido por expertos, mediante los criterios de Moriyama y el Índice Kappa de Concordancia para la evaluación del poder discriminatorio. La factibilidad se confirmó durante las aplicaciones.Resultados: se obtuvo un instrumento de cinco módulos: datos generales, dispensarización, examen periódico de salud, vacunación e interconsultas.Conclusiones: se diseñó y validó un instrumento, tipo formulario, para la evaluación de la calidad del proceso de atención médica al adulto mayor, que cumple con los requisitos métricos de fiabilidad, validez, poder discriminatorio y factibilidad requeridos para su uso en el Consultorio del Médico y la Enfermera de la Familia

Instrumento para la evaluación del proceso de atención al adulto mayor en el consultorio del médico y la enfermera de la familia / A tool for assessing senior adult care in the family doctor's office

Introducción: el envejecimiento de la población constituye un reto para la salud pública, en tanto incrementa la demanda de atención especializada a adultos mayores aquejados de enfermedades no transmisibles y discapacidades. Objetivo: desarrollar un instrumento para la evaluación de la calidad del proceso de atención al adulto mayor que cumpla con los atributos de validez, fiabilidad, capacidad discriminatoria y factibilidad requeridos. Métodos: se realizó un trabajo de desarrollo tecnológico a partir de la aplicación de un algoritmo metodológico, que permitió la construcción y validación de un formulario para la evaluación de las historias clínicas en un Consultorio del Médico y la Enfermera de la Familia. La validación del instrumento incluyó el análisis de consistencia interna a través del coeficiente de Cronbach global y eliminando ítems, la validación de contenido por expertos, mediante los criterios de Moriyama y el Índice Kappa de Concordancia para la evaluación del poder discriminatorio. La factibilidad se confirmó durante las aplicaciones. Resultados: se obtuvo un instrumento de cinco módulos: datos generales, dispensarización, examen periódico de salud, vacunación e interconsultas. Conclusiones: se diseñó y validó un instrumento, tipo formulario, para la evaluación de la calidad del proceso de atención médica al adulto mayor, que cumple con los requisitos métricos de fiabilidad, validez, poder discriminatorio y factibilidad requeridos para su uso en el Consultorio del Médico y la Enfermera de la Familia(AU)

Introduction: Population ageing is a public health challenge, as it increases the demand of specialized care for senior adults suffering from noncommunicable diseases and disabilities. Objective: To develop a tool for assessing the quality of senior adult care that meets the required attributes of validity, reliability, discriminatory capacity and feasibility. Methods: A work of technological development was carried out beginning with the application of a methodological algorithm, which permitted the construction and validation of a questionnaire for assessing the clinical records in a family doctor's office. The tool validation included the analysis of the internal consistency by global Cronbach rate and eliminating items; the validation of contents by experts, using Moriyama criteria and the Kappa concordance coefficient for assessing the discriminatory power. Results: A tool of five modules was obtained: general information, distribution, followed-up health examination, vaccination and consultations. Conclusions: A questionnaire-type tool was designed and validated for assessing the quality of senior adult care, which meet the metrical requirements of reliability, validity, discriminatory power and feasibility to be used in the family doctor's office(AU)