Prevalence and determinants of home delivery among pregnant women in Somaliland: Insights from SLDHS 2020 data.

OBJECTIVE: This cross-sectional study aimed to identify the determinants of home deliveries among women in Somaliland, with the objective of informing targeted interventions to improve maternal and child health outcomes. DESIGN: A cross-sectional study design was employed, utilizing data from a nationally representative sample of 3250 women in Somaliland. A multivariate logistic regression analysis was conducted to examine the factors influencing the likelihood of home delivery. SITE: The study was conducted in Somaliland, a region where home delivery remains prevalent. PARTICIPANTS: The study included 3250 women of reproductive age in Somaliland who had given birth. INTERVENTIONS: No specific interventions were administered as part of this study. The focus was on understanding the factors associated with home deliveries. MAIN MEASUREMENTS: Sociodemographic, economic, and regional factors were examined as potential determinants of home deliveries. Education levels of women and their husbands, maternal age at first marriage and first birth, and household wealth were among the main measurements analyzed. RESULTS: The analysis revealed that higher education levels were associated with a decreased likelihood of home delivery. Women with secondary (OR: 0.42, 95% CI: 0.32-0.55) or higher (OR: 0.21, 95% CI: 0.12-0.37) education were less likely to deliver at home than those with no education. Similarly, women whose husbands had a secondary (OR: 0.55, 95% CI: 0.41-0.73) or higher (OR: 0.43, 95% CI: 0.28-0.66) education were less likely to deliver at home. Increased maternal age at first marriage (OR: 1.04, 95% CI: 1.02-1.06) and first birth (OR: 1.03, 95% CI: 1.01-1.05) were significant predictors of home delivery. Lower household wealth was also associated with a higher likelihood of home delivery. Significant regional variations were observed, with certain regions showing higher rates of home deliveries compared to others. CONCLUSIONS: The findings highlight the importance of targeted interventions to address sociodemographic and regional disparities in the utilization of institutional delivery services in Somaliland. Strategies should focus on improving access to and quality of maternal healthcare services, empowering women's decision-making, and engaging men to address gender norms within households.

[Blockchain in health: Transforming security and clinical data management]. / Blockchain en salud: transformando la seguridad y la gestión de datos clínicos.

INTRODUCTION: Technological advances continue to transform society, including the health sector. The decentralized and verifiable nature of blockchain technology presents great potential for addressing current challenges in healthcare data management. DISCUSSION: This article reports on how the generalized adoption of blockchain faces important challenges and barriers that must be addressed, such as the lack of regulation, technical complexity, safeguarding privacy, and economic and technological costs. Collaboration between medical professionals, technologists and legislators is essential to establish a solid regulatory framework and adequate training. CONCLUSION: Blockchain technology has the potential to revolutionize data management in the healthcare sector, improving the quality of medical care, empowering users, and promoting the secure sharing of data, but an important cultural change is needed, along with more evidence, to reveal its advantages in front of the existing technological alternative.

Patient journey of individuals tested for HCV in Spain: LiverTAI, a retrospective analysis of EHRs through natural language processing.

OBJECTIVES: Limited screening and delays in diagnosis and linkage-to-care are barriers for hepatitis C virus (HCV) elimination. The LiverTAI study focused on patients tested for HCV using AI technologies to describe their demographic and clinical characteristics and pre-testing patient journeys, reflecting clinical practice in hospitals. PATIENTS AND METHODS: LiverTAI is a retrospective, secondary analysis of electronic health records (EHRs) from 6 tertiary Spanish hospitals, extracting unstructured clinical data using natural language processing (NLP) EHRead® technology. Adult subjects with an HCV testing procedure from January 2014 to December 2018 were grouped according to HCV seropositivity and viremia. RESULTS: From 2,440,358 patients, 16,261 patients were tested for HCV (13,602 [83.6%] HCV seronegative; 2659 [16.4%] seropositive). Active HCV viremia appeared in 37.7% (n=1003) of patients, 18.6% (n=494) had negative viremia, and 43.7% (n=1162) unknown viremia. Patient journeys showed core departments (Gastroenterology, Internal Medicine, and Infectious Disease) and others including Emergency perform ample HCV testing in Spanish hospitals, whereas Medical Oncology lags. Patients were PCR-tested and genotyped significantly faster in core departments (p<.001). CONCLUSIONS: Our results highlight hospital departments responsible for HCV testing. However, further testing was sub-optimal during the study period. Therefore, we underscore the need for HCV screening and reflex testing to accelerate diagnosis and linkage-to-care.

Linkage to HIV care after home-based HIV counselling and testing in sub-Saharan Africa: a systematic review.

BACKGROUND: Home-based HIV counselling and testing (HBHCT) has the potential to increase HIV testing uptake in sub-Saharan Africa (SSA), but data on linkage to HIV care after HBHCT are scarce. We conducted a systematic review of linkage to care after HBHCT in SSA. METHODS: Five databases were searched for studies published between 1st January 2000 and 19th August 2016 that reported on linkage to care among adults newly identified with HIV infection through HBHCT. Eligible studies were reviewed, assessed for risk of bias and findings summarised using the PRISMA guidelines. RESULTS: A total of 14 studies from six countries met the eligibility criteria; nine used specific strategies (point-of-care CD4 count testing, follow-up counselling, provision of transport funds to clinic and counsellor facilitation of HIV clinic visit) in addition to routine referral to facilitate linkage to care. Time intervals for ascertaining linkage ranged from 1 week to 12 months post-HBHCT. Linkage ranged from 8.2% [95% confidence interval (CI), 6.8-9.8%] to 99.1% (95% CI, 96.9-99.9%). Linkage was generally lower (<33%) if HBHCT was followed by referral only, and higher (>80%) if additional strategies were used. Only one study assessed linkage by means of a randomised trial. Five studies had data on cotrimoxazole (CTX) prophylaxis and 12 on ART eligibility and initiation. CTX uptake among those eligible ranged from 0% to 100%. The proportion of persons eligible for ART ranged from 16.5% (95% CI, 12.1-21.8) to 77.8% (95% CI, 40.0-97.2). ART initiation among those eligible ranged from 14.3% (95% CI, 0.36-57.9%) to 94.9% (95% CI, 91.3-97.4%). Additional linkage strategies, whilst seeming to increase linkage, were not associated with higher uptake of CTX and/or ART. Most of the studies were susceptible to risk of outcome ascertainment bias. A pooled analysis was not performed because of heterogeneity across studies with regard to design, setting and the key variable definitions. CONCLUSION: Only few studies from SSA investigated linkage to care among adults newly diagnosed with HIV through HBHCT. Linkage was often low after routine referral but higher if additional interventions were used to facilitate it. The effectiveness of linkage strategies should be confirmed through randomised controlled trials.

Non-communicable diseases and HIV care and treatment: models of integrated service delivery.

OBJECTIVES: Non-communicable diseases (NCD) are a growing cause of morbidity in low-income countries including in people living with human immunodeficiency virus (HIV). Integration of NCD and HIV services can build upon experience with chronic care models from HIV programmes. We describe models of NCD and HIV integration, challenges and lessons learned. METHODS: A literature review of published articles on integrated NCD and HIV programs in low-income countries and key informant interviews were conducted with leaders of identified integrated NCD and HIV programs. Information was synthesised to identify models of NCD and HIV service delivery integration. RESULTS: Three models of integration were identified as follows: NCD services integrated into centres originally providing HIV care; HIV care integrated into primary health care (PHC) already offering NCD services; and simultaneous introduction of integrated HIV and NCD services. Major challenges identified included NCD supply chain, human resources, referral systems, patient education, stigma, patient records and monitoring and evaluation. The range of HIV and NCD services varied widely within and across models. CONCLUSIONS: Regardless of model of integration, leveraging experience from HIV care models and adapting existing systems and tools is a feasible method to provide efficient care and treatment for the growing numbers of patients with NCDs. Operational research should be conducted to further study how successful models of HIV and NCD integration can be expanded in scope and scaled-up by managers and policymakers seeking to address all the chronic care needs of their patients.

Improving quality of care through payment for performance: examining effects on the availability and stock-out of essential medical commodities in Tanzania.

OBJECTIVE: To evaluate the effects of payment for performance (P4P) on the availability and stock-out rate of reproductive, maternal, newborn and child health (RMNCH) medical commodities in Tanzania and assess the distributional effects. METHODS: The availability of RMNCH commodities (medicines, supplies and equipment) on the day of the survey, and stock-outs for at least one day in the 90 days prior to the survey, was measured in 75 intervention and 75 comparison facilities in January 2012 and 13 months later. Composite scores for each subgroup of commodities were generated. A difference-in-differences linear regression was used to estimate the effect of P4P on outcomes and differential effects by facility location, level of care, ownership and socio-economic status of the catchment population. RESULTS: We estimated a significant increase in the availability of medicines by 8.4 percentage points (P = 0.002) and an 8.3 percentage point increase (P = 0.050) in the availability of medical supplies. P4P had no effect on the availability of functioning equipment. Most items with a significant increase in availability also showed a significant reduction in stock-outs. Effects were generally equally distributed across facilities, with effects on stock-outs of many medicines being pro-poor, and greater effects in facilities in rural compared to urban districts. CONCLUSION: P4P can improve the availability of medicines and medical supplies, especially in poor, rural areas, when these commodities are incentivised at both facility and district levels, making services more acceptable, effective and affordable, enhancing progress towards universal health coverage.

[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.

Evaluating facility-based antiretroviral therapy programme effectiveness: a pilot study comparing viral load suppression and retention rates.

OBJECTIVES: Increased demand for antiretroviral therapy (ART) services combined with plateaued levels of development assistance for HIV/AIDS requires that national ART programmes monitor programme effectiveness. In this pilot study, we compared commonly utilised performance metrics of 12- and 24-month retention with rates of viral load (VL) suppression at 15 health facilities in Uganda. METHODS: Retrospective chart review from which 12- and 24-month retention rates were estimated, and parallel HIV RNA VL testing on consecutive adult patients who presented to clinics and had been on ART for a minimum of six months. Rates of VL suppression were then calculated at each facility and compared to retention rates to assess the correlation between performance metrics. Multilevel logistic regression models predicting VL suppression and 12- and 24-month retention were constructed to estimate facility effects. RESULTS: We collected VL samples from 2961 patients and found that 88% had a VL ≤1000 copies/ml. Facility rates of VL suppression varied between 77% and 96%. When controlling for patient mix, a significant variation in facility performance persisted. Retention rates at 12 and 24 months were 91% and 79%, respectively, with a comparable facility-level variation. However, neither 12-month (ρ = 0.16) nor 24-month (ρ = -0.19) retention rates were correlated with facility rates of VL suppression. CONCLUSIONS: Retaining patients in care and suppressing VL are both critical outcomes. Given the lack of correlation noted in this study, the utilisation of VL monitoring may be necessary to truly assess the effectiveness of health facilities delivering ART services.

Factors associated with HIV status awareness and Linkage to Care following home based testing in rural Malawi.

OBJECTIVE: HIV diagnosis and linkage to care are the main barriers in Africa to achieving the UNAIDS 90-90-90 targets. We assessed HIV-positive status awareness and linkage to care among survey participants in Chiradzulu District, Malawi. METHOD: Nested cohort study within a population-based survey of persons aged 15-59 years between February and May 2013. Participants were interviewed and tested for HIV (and CD4 if found HIV-positive) in their homes. Multivariable regression was used to determine factors associated with HIV-positive status awareness prior to the survey and subsequent linkage to care. RESULTS: Of 8277 individuals eligible for the survey, 7270 (87.8%) participated and were tested for HIV. The overall HIV prevalence was 17.0%. Among HIV-positive participants, 77.0% knew their status and 72.8% were in care. Women (adjusted odds ratio [aOR] 6.5, 95% CI 3.2-13.1) and older participants (40-59 vs. 15-29 years, aOR 10.1, 95% CI 4.0-25.9) were more likely to be aware of their positive status. Of those newly diagnosed, 47.5% were linked to care within 3 months. Linkage to care was higher among older participants (40-59 vs. 15-29, adjusted hazard ratio [aHR] 3.39, 95% CI 1.83-6.26), women (aHR 1.73, 95% CI 1.12-2.67) and those eligible for ART (aHR 1.61, 95% CI 1.03-2.52). CONCLUSIONS: In settings with high levels of HIV awareness, home-based testing remains an efficient strategy to diagnose and link to care. Men were less likely to be diagnosed, and when diagnosed to link to care, underscoring the need for a gender focus in order to achieve the 90-90-90 targets.

Criteria-based audit of caesarean section in a referral hospital in rural Tanzania.

OBJECTIVE: WHO uses the Caesarean section (CS) rate to monitor implementation of emergency obstetric care (EmOC). Although CS rates are rising in sub-Saharan Africa, maternal outcome has not improved. We audited indications for CS and related complications among women with severe maternal morbidity and mortality in a referral hospital in rural Tanzania. METHODS: Cross-sectional study was from November 2009 to November 2011. Women with severe maternal morbidity and mortality were identified and those with CS were included in this audit. Audit criteria were developed based on the literature review and (inter)national guidelines. Tanzanian and Dutch doctors reviewed hospital notes. The main outcome measured was prevalence of substandard quality of care leading to unnecessary CS and delay in performing interventions to prevent CS. RESULTS: A total of 216 maternal near misses and 32 pregnancy-related deaths were identified, of which 82 (33.1%) had a CS. Indication for CS was in accordance with audit criteria for 36 of 82 (44.0%) cases without delay. In 20 of 82 (24.4%) cases, the indication was correct; however, there was significant delay in providing standard obstetric care. In 16 of 82 (19.5%) cases, the indication for CS was not in accordance with audit criteria. During office hours, CS was more often correctly indicated than outside office hours (60.0% vs. 36.0%, P < 0.05). DISCUSSION: Caesarean section rate is not an useful indicator to monitor quality of EmOC as a high rate of unnecessary and potentially preventable CS was identified in this audit.

Impacts of a new insurance benefit with capitated provider payment on healthcare utilization, expenditure and quality of medication prescribing in China.

OBJECTIVES: To assess a new Chinese insurance benefit with capitated provider payment for common diseases in outpatients. METHODS: Longitudinal health insurance claims data, health administrative data and primary care facility data were used to assess trajectories in outpatient visits, inpatient admissions, expenditure per common disease outpatient (CD/OP) visit and prescribing indicators over time. We conducted segmented regression analyses of interrupted time series data to measure changes in level and trend overtime, and cross-sectional comparisons against external standards. RESULTS: The number of total outpatient visits at 46 primary care facilities (on the CD/OP benefit as of July 2012) increased by 46 895 visits/month (P = 0.004, 95% CI: 15 795-77 994); the average number of CD/OP visits reached 1.84/year/enrollee in 2012; monthly inpatient admissions dropped from 6.4 (2009) to 4.3 (2012) per 1000 enrollees; the median total expenditure per CD/OP visit dropped by CNY 15.40 (P = 0.16, 95% CI: -36.95~6.15); injectable use dropped by 7.38% (P = 0.03, 95% CI: -14.08%~-0.68%); antibiotic use was not improved. CONCLUSIONS: Zhuhai's new CD/OP benefit with capitated provider payment has expanded access to primary care, which may have led to a reduction in expensive specialist inpatient services for CD/OP benefit enrollees. Cost awareness was likely raised, and rapidly growing expenditures were contained. Although having been partially improved, inappropriate prescribing of antibiotics and injectables was still prevalent. More explicit incentives and specific quality of care targets must be incorporated into the capitated provider payment to promote scientifically sound and cost-effective care and treatment.

Traditional vs. non-traditional healing for minor and major morbidities in India: uses, cost and quality comparisons.

OBJECTIVES: To examine the uses, cost and quality of care of traditional healing for short-term morbidities and major morbidities in India and to compare them with the non-traditional healing. METHODS: We used data from a nationally representative survey, the India Human Development Survey (2004-2005) and descriptive as well as bivariate analyses for the examination. RESULTS: Use of traditional healing is much less common than use of non-traditional healing in both rural and urban areas and across all socio-economic and demographic characteristics; it is slightly more common in rural than urban areas for short-term morbidities. Use of traditional healing is relatively more frequent for cataract (especially in rural areas), leprosy, asthma, polio, paralysis, epilepsy and mental illnesses; its total cost of care and mean waiting time (in the health facility) are substantially lower than for non-traditional healing. Among patients who use both traditional and non-traditional healing, a relatively higher proportion use traditional healing complemented by non-traditional healing for short-term illnesses, but vice versa for major morbidities. CONCLUSION: This is the first study which has investigated at the national level the uses, complementarities, cost and quality aspects of traditional and non-traditional healing in India. Traditional healing is more affordable and pro-poor. Relatively higher use of traditional healing in patients from poorly educated as well as poor households and suffering from diseases, such as, epilepsy and mental illnesses; and higher demand for traditional healing for the above diseases highlight the need for research/policy reorientation in India.

[Co-payment on prescription drugs in the Spanish public health system: Certainty, risk and selection of risks]. / Copago en farmacia de receta en la sanidad pública española: certezas, riesgos y selección de riesgos.

The model of co-payment on prescription drugs in the Spanish National Health System (NHS) changed on 1 July 2012. For more than three decades that it was not modified. This article provides a brief historical reminder of the evolution of this model of co-payment. The basic characteristics of this model are compared with the model of copayment on prescription drugs of the Administrative Mutualism (Civil Servants). The document provides detailed information on the percentage of effective copayment, fundraising effects, the economic participation of the patient, among others, in both models. Finally, listed pending improvements not addressed by 2012 changes such as the concentration of the co-payment in the active patient population and risk selection promoted by the differences in the financial contribution between the two models of co-payment (NHS and Mutualist).

[Case management as a methodology for connecting the health and social care systems in Spain]. / La gestión de casos como metodología para la conexión de los sistemas sanitario y social en España.

OBJECTIVE: The aim of this paper is to present the assessment of a case management project, implemented with chronic patients in Valencia, for the integration of health and social care. This project is linked with the 'Sustainable Socio-Health Model'. LOCATION: Health department 06 in Valencia. PARTICIPANTS: The target groups were chronic patients of 65 years and over. INTERVENTIONS: A non-randomized non-blinded comparative study with an intervention and control group. The intervention consisted in the creation of an interdisciplinary case management team, the use of a common portfolio of resources, and its application to a pilot sample with an intervention period of 6-9 months. MAIN MEASUREMENTS: Diseases (ICD-9), functional capacity, use of health and social resources, satisfaction, unit cost services. RESULTS: There was an increase in the combined use of health and social resources in the intervention group, which included social day centers (21.8% in the intervention group compared to 9.8% in the control group), in coordination with primary care (suggested as the only health resource in 55.4% of cases). There was a decrease in the number of medical visits in the intervention group (43.6% versus 74.5% in the control group). Increased patient satisfaction (55.5% in the intervention group compared to 29.4% in the control group) was observed. At least an extra 4.4% of patients were treated using hospital resources without increasing costs. CONCLUSIONS: Case management using a common unique portfolio of health and social resources can improve the coordination of resources, increases patient satisfaction and increases the capacity of using of hospital resources.

[Economic evaluation of a program of coordination between levels for complex chronic patients' management]. / Evaluación económica de un programa de coordinación entre niveles para el manejo de pacientes crónicos complejos.

OBJECTIVE: The complex chronic patient program (CCP) of the Alt Penedès aims to improve the coordination of care. The objective was to evaluate the relationship between the costs associated with the program, and its results in the form of avoided admissions. DESIGN: Dost-effectiveness analysis from the perspective of the health System based on a before-after study. LOCATION: Alt Penedès. MAIN MEASUREMENTS: Health services utilisation (hospital [admissions, emergency visits, day-care hospital] and primary care visits). CCP Program results were compared with those prior to its implementation. The cost assigned to each resource corresponded to the hospital CatSalut's concert and ICS fees for primary care. A sensitivity analysis using boot strapping was performed. The intervention was considered cost-effective if the incremental cost-effectiveness ratio (ICER) did not exceed the cost of admission (€ 1,742.01). RESULTS: 149 patients were included. Admissions dropped from 212 to 145. The ICER was €1,416.3 (94,892.9€/67). Sensitivity analysis showed that in 95% of cases the cost might vary between €70,847.3 and €121,882.5 and avoided admissions between 30 and 102. In 72.4% of the simulations the program was cost-effective. CONCLUSIONS: Sensitivity analysis showed that in most situations the PCC Program would be cost-effective, although in a percentage of cases the program could raise overall cost of care, despite always reducing the number of admissions.

The relevance of therapeutic positioning in the post-approval evaluation of new medicines. / La importancia del posicionamiento terapéutico en la evaluación posautorización de nuevos medicamentos.

The objective of regulatory authorities is to ensure a favorable risk-benefit balance for medicines in their licensed indication, without seeking to establish their place in the therapeutic armamentarium beyond that. The licensed indication covers heterogeneous subpopulations and often does not sufficiently specify the characteristics of the patients who may benefit. The regulatory information does not always show the benefit over the standard treatments; moreover, it only reacts to the conditions specified in the developer's application, and lacks an assessment of the clinical relevance of the benefit and its uncertainties. Many cases highlight the need to establish a more specific therapeutic benefit scenario than the licensed indication. For example, abemaciclib was approved in the adjuvant setting for high-risk patients with early breast cancer, but the appropriate level of risk and how to assess it needs to be specified. Also, pembrolizumab is approved for neoadjuvant plus adjuvant treatment in lung cancer; but it remains to be analyzed whether it is superior to nivolumab in neoadjuvant treatment alone, which involves less treatment and economic burden. As therapeutic positioning is always a necessary decision, whether made at a national, regional, local or individual level, it must be made in the most appropriate way. The absence of a multidisciplinary discussion and consensus, relying only on individual decisions to determine positioning from the outset, underestimates information gaps, inter-individual variability and the influence of drug promotion. It can be harmful and costly. To properly manage the introduction of new medicines, it is essential to establish their benefit scenario in a multidisciplinary way. This, together with consideration of the clinical benefit provided versus the appropriate alternatives and the uncertainties of the benefit, constitutes the objective of the clinical assessment and the basis for designing a well-focused economic analysis. This allows policy makers to make the most appropriate decisions on pricing and funding new treatments. In an ideal situation, the benefit scenario considered for the new medicine would coincide with the one established for funding, but costs that are difficult to bear may lead to restrictions and affect the final positioning after the economic and budgetary impact assessment.

The FlaQuM-Quickscan: A starting point to include primary care professionals' perspectives in the evaluation of hospital quality priorities.

INTRODUCTION: Today, primary care professionals' (PCPs) perspectives on hospital quality are unknown when evaluating hospital quality priorities. The aims of the present study were to identify key healthcare quality attributes from PCPs' perspective, to validate an instrument that measures PCPs' experiences of healthcare quality multidimensionally and to define hospital quality priorities based on PCPs' experiences. MATERIAL AND METHODS: Focus groups with PCPs were conducted to identify quality attributes through a qualitative in-depth analysis. A multicentre study of 18 hospitals was used to quantitatively assess construct, discriminant and criterion validity of the FlaQuM-Quickscan, an instrument that measures 'Healthcare quality for patients and kin' (part 1) and 'Healthcare quality for professionals' (part 2). To set quality priorities, scores on quality domains were analyzed descriptively and between-hospital variation was examined by evaluating differences in hospitals' mean scores on the quality domains using one-way Analysis of Variance (ANOVA). RESULTS: Identified key attributes largely corresponded with Lachman's multidimensional quality model. Including 'Communication' as a new quality domain was recommended. The FlaQuM-Quickscan was completed by 550 PCPs. Confirmatory factor analyses showed reasonable to good fit, except for the Root Mean Square Error of Approximation (RMSEA) in part 2. The 'Equity' domain scored the highest in parts 1 and 2. Domains 'Kin-centred care' and 'Accessibility and timeliness' scored the lowest in part 1 and 'Resilience' and 'Partnership and co-production' in part 2. Significant variation in hospitals' mean scores was observed for eleven domains in part 1 and sixteen domains in part 2. CONCLUSIONS: The results gained a better understanding of PCPs' perspective on quality. The FlaQuM-Quickscan is a valid instrument to measure PCPs' experiences of hospital quality. Identified priorities indicate that hospital management should focus on multifaceted quality strategies, including technical domains, person-and kin-centredness, core values and catalysts.

The diabetes education material on diabetes for website: Results of a validation process.

OBJECTIVE: To validate an educational material on diabetes through an expert consensus for its implementation into a web site. MATERIAL AND METHODS: An observational study was carried out in a group of health professionals, for which an educational material was developed for patients with diabetes. Topics included nutrition, physical exercise, control indicators, complications, pharmacological treatment, among others. The language, text and figures were focused on easy comprehension, additionally, a section of didactic activities to be answered by the patient with diabetes at the end of each module was included. To evaluate the educational material by health professionals, an instrument was designed and validated. Once all the educational material was available, each of the modules was sent by e-mail to at least three clinical experts in the assigned topic, as well as the instrument for the evaluation of the module. RESULTS: Thirty-seven experts were included in the study, 76% rated the educational modules evaluated as highly adequate, while only 24% rated them as adequate. The instrument used obtained a good level of internal consistency, with a Cronbach's alpha coefficient of 0.92. In the dimensions of the instrument, the lowest Cronbach's alpha score was that of "call-to-action", with a value of 0.71. CONCLUSION: The diabetes educational material was rated as highly appropriate by the clinical experts. The developed instrument has an adequate content validity, as well as a good level of internal consistency.

[How to assess health outcomes in chronic non-cancer pain? Qualitative research]. / ¿Cómo evaluar los resultados en salud en el dolor crónico no oncológico? Investigación cualitativa.

INTRODUCTION AND OBJECTIVES: There is a lack of indicators that evaluate the health results of the non-cancer chronic pain (NCCP). The objective of this study was to agree on how to evaluate health outcomes in NCCP in Spain, as well as to propose lines of action to have an optimal evaluation framework not only for patients, but for healthcare professionals and managers as well. MATERIAL AND METHODS: This was a qualitative research study through directed group interviews which followed a script based on structured questions using the PICO methodology. RESULTS: More than the intensity of pain, the main points to be measured are pain-free time, improved rest/sleep, improved mood, recovery of daily activities and adherence to treatment, in addition to -in the scope of management- resource consumption. The therapeutic objective must be defined individually, based on the adjustment of expectations between the healthcare professional and the patients, taking into account their preferences and involving them in the therapeutic process. Patients and caregivers must be informed and trained with special emphasis on the psycho-emotional sphere of pain. CONCLUSIONS: It is necessary to evaluate the health outcomes in NCCP in Spain. Lines of action are proposed that might provide an adequate assessment framework for the patient, the healthcare professionals and the health managers.

[Translated article] Achieving excellence in the pharmaceutical care of the surgical patient.

The perioperative setting is one of the hospital areas with the highest prevalence of medication errors. Despite the wide experience of hospital pharmacists in developing medication safety programs and improvement initiatives, the perioperative setting has remained one of the areas in which there is less experience. Clinical pharmacist should be integrated into the multidisciplinary care team so that they can be involved in the different surgical phases of care, which include from the preoperative assessment to inpatient stay, and finally discharge from hospital. Their work will consist of coordinating and implementing strategies that have been demonstrated to reduce medication errors during the perioperative process. The aim of this paper is to introduce a specialized pharmaceutical care program to achieve excellence in the pharmaceutical care of surgical patients. This program is especially aimed at promoting the figure of the clinical pharmacist in the perioperative setting to guarantee the highest quality and safety in pharmacotherapeutic care throughout all the surgical phases of care.