ABSTRACT
La satisfacción que los pacientes tienen con respecto a sus tratamientos es un indicador de la calidad de los mismos y un importante predictor de sus posibles resultados. Se analizaron los niveles de tal satisfacción en una muestra de pacientes con problemáticas de abuso de sustancias, tratados en instituciones del Área Metropolitana de Buenos Aires (AMBA). Los grados de satisfacción fueron a su vez analizados en relación con las características diferenciales de las instituciones (tipo de institución, ubicación geográfica, género de los pacientes aceptados, presencia de cualidades atípicas en las instituciones) y la evolución de los tratamientos (duración y cantidad de interrupciones del proceso). A partir de un muestreo aleatorio por conglomerados y estratificado, se convocó una muestra de 216 participantes pertenecientes a 22 centros, que completaron un cuestionario de satisfacción, diseñado para este estudio. Los resultados mostraron niveles elevados de satisfacción en las distintas áreas exploradas, observando características distintivas de las instituciones asociadas a diferentes niveles de satisfacción, como es el caso del tipo de institución y el género de los participantes aceptados. No obstante, no se encontraron diferencias en los grados de satisfacción en función del tiempo de desarrollo del tratamiento y la cantidad de interrupciones del mismo. Los resultados obtenidos son discutidos en relación a los alcances del estudio, a la vez que se presentan sus limitaciones y se proponen futuras investigaciones para avanzar sobre esta temática.
The client satisfaction about his treatments it is an important indicator of its quality, but also a fundamental predictor of treatment outcome. Specifically, in patients with drug abuse disorders, the degrees of satisfaction with their treatments have presented lineal correlations with the amount of therapeutic change and the continuity in treatment (prevention of drop-out). Thus, the analysis of clients' satisfaction with their treatments is presented as an indirect and alternative strategy to analyze the effects of therapy for drug abuse disorders, a main health, social, and political problem in the world wide. In this exploratory study we analyzed the levels of satisfaction about their treatment in a sample of client's with substance abuse disorders, treated in institutions of the Buenos Aires Metropolitan Area (AMBA). Then we explored the relationship among the levels of satisfaction with the specific features of the institutions where the treatments were conducted (type of institution, geographic location, genre of the clients accepted, and the presence of atypical characteristics) and with characteristics of the evolution of those treatments (treatments length and amount of interruptions during the therapeutic process). Based on a stratified cluster random sampling strategy, using the above-described characteristics of the institutions analyzed in this study to create the clusters, we designed a sample of 216 subjects that were treated in 22 institutions with treatments subsidized by the Argentine National Secretary for the Prevention of Drug Abuse and the Fight against Drug Trafficking (SEDRONAR by its acronym in Spanish). All the participants of this research completed a questionnaire developed ad hoc and based on previous developments, to explore patient's levels of satisfaction in six areas: Admission, General environment (divided into the sub-areas Human and physical context and Mistreatment), Satisfaction with food, Staff evaluation (divided into the sub-areas Overall staff assessment and Specific staff assessment), Satisfaction with treatment (divided into the sub-areas Treatment features, Treatments results, and Complementary therapeutic devices), and General treatment evaluation. Results showed that there were same features of the institutions related to different levels of satisfaction in the participants of the study. Regarding the type of institution, patients of the psychiatric clinics presented the lowest degrees of satisfaction while the patients of the day hospitals had the highest levels of satisfaction. Also different levels of satisfactions were observed based on the genre of the patients accepted in the institutions. Patients of the institutions that only accept male clients have greater degrees of satisfaction than patients in mixed institutions. No significant differences were found in patient's satisfaction due to institution geographical location. Also, we have not found a significant association between patient's satisfaction and treatment length or between treatment satisfaction and amount of interruptions in the therapy. The results are discussed in the context of the scopes of the study, while further research is suggested to move forward in the exploration of this issue. The differences in satisfaction due to the type of institution might be explained by the degree of openness and flexibility of the setting, but also by the severity of the patients that are included in eacht type of institutions. As well, the differences in satisfaction based on the genre of the patients accepted by the institution could be explained by the predominance of male patients in the population (85%) and the possible lack of adaptation of treatment characteristics to female specific necessities. However, the results of this research must be interpreted extremely cautious because of limitations of the study related to the sample method and the unknown psychometric properties (in terms of validity and reliability) of the instrument used.
ABSTRACT
Como consecuencia de la epidemia de dengue que afectó a la República de Bolivia y provincias del norte argentino, se produjo por primera vez un brote de dengue autóctono en el Area Metropolitana Buenos Aires. A partir de enero de 2009 asistimos casos de dengue importado hasta la tercera semana de marzo, cuando aparecieron los primeros casos por transmisión local, tendencia que se mantuvo hasta mediados de mayo. La mayor concentración de casos autóctonos atendidos residía en la región oeste de la ciudad de Buenos Aires y en localidades de los partidos de 3 de Febrero y La Matanza, que limitan con ella. Existieron factores concurrentes para que se produjera este brote: alta densidad vectorial, viajeros provenientes de regiones epidémicas concentrados por su domicilio en las áreas donde luego se produjo la transmisión local. El 95% ingresaron en los primeros días de viremia y en un período climático caracterizado por temperaturas medias elevadas que se mantuvieron hasta mediados de otoño. De los nueve pacientes con signos de alarma para el desarrollo de dengue grave, siete fueron casos autóctonos que no tenían antecedentes de haber padecido previamente dengue. Se comunican los hallazgos clínicos y epidemiológicos y se analizan los factores que regularon la transmisión.
As a consequence of the dengue epidemic in the Bolivian Republic and the northern provinces of Argentina, an outbreak of indigenous dengue occurred for the first time in the Buenos Aires Metropolitan Area. Since January 2009 we assisted imported dengue cases coming from epidemic regions; later, around the end of March, and until middle autumn, indigenous cases appeared. The major concentration of these indigenous cases was in the west area of Buenos Aires City and in the neighboring localities 3 de Febrero and La Matanza. There were several factors that made the local transmission possible: a high vector density, people traveling from epidemic areas and clustering in the geographical zone where the indigenous epidemic occurred, during a period with high medium temperatures, entering 95% of the imported cases during the first days of the viremia. Of the nine patients with alarming signs for the development of severe dengue, seven were indigenous cases with no previous history of dengue infections. We report the clinical and epidemiological findings, and we analyze the factors which regulated the transmission.