Prevalencia del miedo a caer y factores asociados en personas mayores que viven en la comunidad / Prevalence of fear of falling and related factors in community-dwelling older people

OBJETIVO: El objetivo general del estudio es conocer la prevalencia de la preocupación a caer en personas mayores, independientes para la deambulación, que viven en la comunidad, según la versión reducida del FES-I y los factores asociados que influyen en esta preocupación. DISEÑO: Estudio descriptivo transversal. Emplazamiento: Centro de Salud El Greco (Getafe), Gerencia Asistencial de Atención Primaria de Madrid. PARTICIPANTES: Ciento ochenta y nueve pacientes ≥ 70 años independientes o con dependencia funcional leve-moderada (índice de Barthel ≥ 60) e independientes para la deambulación (camina 45 min sin ayuda o con bastón). El estudio se ofreció a 328 personas: 217 aceptaron y rechazaron 111. Mediciones principales: La variable dependiente, miedo a caerse (MC), fue evaluada mediante el cuestionario Short FES-I, considerando como punto de corte para el cribado positivo del MC una puntuación ≥ 11. Como variables independientes se consideraron: índice de Barthel, escala Downton, prueba de fragilidad Short Physical Performance Battery (SPPB), caídas en el último año, lesiones asociadas a las caídas, tiempo desde la última caída, déficit sensorial, uso de dispositivos de la marcha, comorbilidad y tratamiento farmacológico. RESULTADOS: La prevalencia del MC fue del 42,9% (IC 95%: 35,5-50,2). Los factores asociados al MC en el análisis multivariante final fueron: sexo femenino, vivir solo, alto riesgo de caídas, presencia de fragilidad, uso de hipotensores y lesiones asociadas a caídas previas. CONCLUSIONES: La prevalencia del miedo a caer en personas mayores es elevada. Los profesionales de atención primaria deben sistematizar el cribado de este problema de salud, priorizando especialmente en las personas que presentan los siguientes factores de riesgo: ser mujer, vivir solo, tener una puntuación baja en el SPPB (como indicador de fragilidad) o presentar un elevado riesgo de caídas

AIM: To know, in the population over 70, independent for walking, the prevalence of the concern to fall according to the short version of the Short Falls Efficacy Scale-International (FES-I) questionnaire, in old people living in the community and their associated factors. DESIGN: Cross-sectional study. LOCATION: Centro de Salud El Greco, Getafe, Madrid, Spain. PARTICIPANTS: 189 patients ≥ 70 years with a Barthel ≥ 60, independent for walking (walk 45minutes without help or with a cane). The study was offered to a total of 328 people, of these accepted 217 and rejected 111. MAIN MEASUREMENTS: The dependent variable, fear of falling (FOF), was evaluated by means of the short FES-I questionnaire, considering as a cut-off point for the positive screening of the MC a score ≥ 11. As independent variables we considered: Barthel index, Downton scale, the Short Physical Performance Battery (SPPB) fragility test, falls in the last year, injuries associated with falls, time since the last fall, sensory deficit, use of gait devices, comorbidity and pharmacological treatment. RESULTS: The prevalence of FOF was 42.9% (95% CI: 35.5-50.2). The factors associated with FOF in the final multivariate analysis were: female sex, living alone, high risk of falls, presence of frailty (SPPB ≤ 9), use of hypotensive drugs, and injuries associated with previous falls. CONCLUSIONS: The prevalence of FOF in older people is high. Primary Care professionals should systematize the screening of this health problem, prioritizing especially in people who present the following risk factors: being a woman, living alone, having a low score on the SPPB (as an indicator of frailty) or presenting a high risk of falls

[Prevalence of fear of falling and related factors in community-dwelling older people]. / Prevalencia del miedo a caer y factores asociados en personas mayores que viven en la comunidad.

AIM: To know, in the population over 70, independent for walking, the prevalence of the concern to fall according to the short version of the Short Falls Efficacy Scale-International (FES-I) questionnaire, in old people living in the community and their associated factors. DESIGN: Cross-sectional study. LOCATION: Centro de Salud El Greco, Getafe, Madrid, Spain. PARTICIPANTS: 189 patients ≥70years with a Barthel ≥60, independent for walking (walk 45minutes without help or with a cane). The study was offered to a total of 328 people, of these accepted 217 and rejected 111. MAIN MEASUREMENTS: The dependent variable, fear of falling (FOF), was evaluated by means of the short FES-I questionnaire, considering as a cut-off point for the positive screening of the MC a score ≥11. As independent variables we considered: Barthel index, Downton scale, the Short Physical Performance Battery (SPPB) fragility test, falls in the last year, injuries associated with falls, time since the last fall, sensory deficit, use of gait devices, comorbidity and pharmacological treatment. RESULTS: The prevalence of FOF was 42.9% (95%CI: 35.5-50.2). The factors associated with FOF in the final multivariate analysis were: female sex, living alone, high risk of falls, presence of frailty (SPPB≤9), use of hypotensive drugs, and injuries associated with previous falls. CONCLUSIONS: The prevalence of FOF in older people is high. Primary Care professionals should systematize the screening of this health problem, prioritizing especially in people who present the following risk factors: being a woman, living alone, having a low score on the SPPB (as an indicator of frailty) or presenting a high risk of falls.

Effectiveness of Nursing Process Use in Primary Care.

PURPOSE: To determine whether patients assigned to primary care nurses who use the nursing process (use of NANDA-I, NIC, and NOC) achieve better intermediate health outcomes than the population assigned to nurses who do not use the nursing process. METHODS: This is a retrospective cross-sectional study conducted in 34 primary healthcare centers of Area 11 of the Community of Madrid (Spain) based on electronic health records. FINDINGS: The extension of health care provided was greater in nurses who used the nursing process. Patients assigned to these nurses have better control of their chronic diseases and incur lower drug costs. CONCLUSIONS: The use of the nursing process can lead to improved health of populations. IMPLICATIONS: The development of strategies is necessary to ensure greater use of the nursing process among nurses in primary care.

Effectiveness of an intervention for prevention and treatment of burnout in primary health care professionals.

BACKGROUND: Burnout syndrome is an important health problem that affects many professionals and must be addressed globally, with both organizational measures and personal interventions. Burnout of health professionals can be prevented in order to avoid personal, familial, and social consequences, as well as repercussions for patients. METHODS/DESIGN: This work describes a protocol for a controlled, pragmatic, randomized clinical trial in 2 parallel groups: intervention and control. All health professionals from 7 health care centers will form the intervention group, and all health professionals from 7 different health care centers will form the control group. The intervention group will receive 16 hours of training at their work place. The Maslach's burnout inventory, the Cuestionario de Desgaste Profesional Médico or the Cuestionario de Desgaste Profesional de Enfermería, and the 28-item Goldberg's General Health Questionnaire, validated for our setting, will be used as measurement tools. Change in the average scores from the Maslach's burnout inventory emotional exhaustion scale will be compared between the intervention and control groups, measured as intention-to-treat, and the intervention will be considered effective if a minimum decrease of 20% is achieved. DISCUSSION: Due to the deleterious consequences of burnout syndrome for people suffering from it and for the organization where they work, it is necessary to evaluate the effectiveness of certain interventions for its prevention. Organizational measures are important for preventing burnout syndrome, but so is providing professionals with coping strategies, as this group intervention intends to do. TRIAL REGISTRATION: ClinicalTrials.gov processed this record on June 10, 2013. ClinicalTrials.gov Identifier: NCT01870154.

Economic valuation of health care services in public health systems: a study about Willingness to Pay (WTP) for nursing consultations.

BACKGROUND: Identifying the economic value assigned by users to a particular health service is of principal interest in planning the service. The aim of this study was to evaluate the perception of economic value of nursing consultation in primary care (PC) by its users. METHODS AND RESULTS: Economic study using contingent valuation methodology. A total of 662 users of nursing consultation from 23 health centers were included. Data on demographic and socioeconomic characteristics, health needs, pattern of usage, and satisfaction with provided service were compiled. The validity of the response was evaluated by an explanatory mixed-effects multilevel model in order to assess the factors associated with the response according to the welfare theory. Response reliability was also evaluated. Subjects included in the study indicated an average Willingness to Pay (WTP) of €14.4 (CI 95%: €13.2-15.5; median €10) and an average Willingness to Accept [Compensation] (WTA) of €20.9 (CI 95%: €19.6-22.2; median €20). Average area income, personal income, consultation duration, home visit, and education level correlated with greater WTP. Women and older subjects showed lower WTP. Fixed parameters explained 8.41% of the residual variability, and response clustering in different health centers explained 4-6% of the total variability. The influence of income on WTP was different in each center. The responses for WTP and WTA in a subgroup of subjects were consistent when reassessed after 2 weeks (intraclass correlation coefficients 0.952 and 0.893, respectively). CONCLUSIONS: The economic value of nursing services provided within PC in a public health system is clearly perceived by its user. The perception of this value is influenced by socioeconomic and demographic characteristics of the subjects and their environment, and by the unique characteristics of the evaluated service. The method of contingent valuation is useful for making explicit this perception of value of health services.

Implementation and evaluation of the nursing process in primary health care.

PURPOSE: The purpose of this study is to publicize the experience of implementing and developing the nursing process in a sanitary area of primary health care (PHC), and to assess the outcomes reached during the past 9 years. METHODS: This descriptive longitudinal study was carried out in the 42 PHC centers in the 11th Primary Care Area of Madrid, Spain. FINDINGS: Between 2001 and 2009, 243,838 new nursing diagnoses were performed. The indicator of resolution capacity ranged from 75% to 80% for the attended problems. CONCLUSIONS: Nurses in the 11th PHC Area have effectively incorporated the nursing process as a work methodology in their caregiving practices. IMPLICATIONS FOR NURSING PRACTICE: The nursing process can be used to identify nursing care issues and assess the capacity for resolution.

A study of the user's perception of economic value in nursing visits to primary care by the method of contingent valuation.

BACKGROUND: The identification of the attribution of economic value that users of a health system assign to a health service could be useful in planning these services. The method of contingent valuation can provide information about the user's perception of value in monetary terms, and therefore comparable between services of a very different nature. This study attempts to extract the economic value that the subject, user of primary care nursing services in a public health system, attributes to this service by the method of contingent valuation, based on the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA). METHODS/DESIGN: This is an economic study with a transversal design. The contingent valuation method will be used to estimate the user's willingness to pay (WTP) for the care received from the primary care nurse and the willingness to accept [compensation] (WTA), were this service eliminated. A survey that meets the requisites of the contingent valuation method will be constructed and pilot-tested. Subsequently, 600 interviews will be performed with subjects chosen by systematic randomized sampling from among those who visit nursing at twenty health centers with different socioeconomic characteristics in the Community of Madrid. The characteristics of the subject and of the care received that can explain the variations in WTP, WTA and in the WTP/WTA ratio expressed will be studied. A theoretical validation of contingent valuation will be performed constructing two explanatory multivariate mixed models in which the dependent variable will be WTP, and the WTP/WTA relationship, respectively. DISCUSSION: The identification of the attribution of economic value to a health service that does not have a direct price at the time of use, such as a visit to primary care nursing, and the definition of a profile of "loss aversion" in reference to the service evaluated, can be relevant elements in planning, enabling incorporating patient preferences to health policy decision-making.

Differences between willingness to pay and willingness to accept for visits by a family physician: a contingent valuation study.

BACKGROUND: The economic value attributed by users of health services in public health systems can be useful in planning and evaluation. This value can differ from the perspectives of Willingness to Pay (WTP) and Willingness to Accept [Compensation] (WTA).Our objective was to study the perceptions of the patient about the service provided by the family physician by means of the WTA/WTP ratio. METHODS: An economic evaluation study by the Contingent Valuation Method was designed. Interviews were conducted with 451 subjects at six health centres (four urban and two rural) in areas with different socioeconomic characteristics. A payment card was used to measure the WTP and WTA. Other characteristics of the subject or service that could influence these responses were collected. An explicative model was constructed to study the WTA/WTP relationship. RESULTS: Four hundred and four subjects (89.6%) expressed a WTP and WTA different from zero. The WTA/WTP quotient showed a median of 1.55 (interquartile range 1-3.08) and a mean of 3.30 (IC 95%: 2.84-3.75). The WTA/WTP ratio increases with age and in low-income areas. It decreases in professional groups with more specialized activities, with growing family income, and in the chronically ill. Other characteristics related to the perception of state of health, accessibility to the service, satisfaction, or perception of risk were not explicative. CONCLUSIONS: Subjects who were older and had a less favourable socioeconomic situation expressed a higher WTA/WTP ratio when valuing the visit to the family physician. These characteristics could identify a profile of "aversion to loss" with respect to this service.

Perception of the economic value of primary care services: a Willingness to Pay study.

OBJECTIVE: Identify the economic value the user attributes to the visit to the family physician, in a setting of a National Health System, by the Willingness to Pay (WTP) expressed. METHODS: Economic evaluation study, by the contingent valuation method. Questions were asked about WTP using a payment card format. Interviews were conducted with 451 subjects, in areas with different socioeconomic characteristics. An ordered probit was used to evaluate model's validity. RESULTS: Median WTP expressed was euro18 (interquartile range euro8-28), not including "zero-answers" of thirty-four subjects (7.5%). This value represents 2% of average adjusted family incomes. Patients with higher incomes or with chronic illnesses presented a probability of 5-14 percentage points of expressing a high WTP. For every point of increase of patient satisfaction, the probability of presenting a WTP in the lowest range decreases 7.0 percentage points. Subjects with a low education level and those older than 65 expressed a lower WTP. Accessibility, risk perception, nationality and having private insurance were not related to the WTP expressed. CONCLUSIONS: Users of primary care have a clear perception of the economic value of care received from the family physician, even in a framework of providing services financed by taxes and without cost at the moment of use. This value increases in subjects with higher incomes, with greater need for care, or more satisfied.

Professional quality of life and organizational changes: a five-year observational study in Primary Care.

BACKGROUND: The satisfaction and the quality of life perceived by professionals have implications for the performance of health organizations. We have assessed the variations in professional quality of life (PQL) and their explanatory factors during a services management decentralization process. METHODS: It was designed as a longitudinal analytical observational study in a Health Area in Madrid, Spain. Three surveys were sent out during an ongoing management decentralization process between 2001 and 2005. The professionals surveyed were divided into three groups: Group I (97.3% physicians), group II (92.5% nurses) and group III (auxiliary personnel). Analysis of the tendency and elaboration of an explanatory multivariate model was made. The PQL -35 questionnaire, based on Karasek's demand-control theory, was used to measure PQL. This questionnaire recognizes three PQL dimensions: management support (MS), workload (WL) and intrinsic motivation (IM). RESULTS: 1444 responses were analyzed. PQL increased 0.16 (CI 95% 0.04-0.28) points in each survey. Group II presents over time a higher PQL score than group I of 0.38 (IC 95% 0.18-0.59) points. There is no difference between groups I and III.For each point that MS increases, PQL increases between 0.44 and 0.59 points. PQL decreases an average of between 0.35 and 0.49 point, for each point that WL increases. Age appears to have a marginal association with PQL (CI 95% 0.00-0.02), as it occurs with being single or not having a stable relationship (CI 95% 0.01-0.41). Performing management tasks currently or in the past is related to poorer PQL perception (CI 95% -0.45 - -0.06), and the same occurs with working other than morning shifts (CI 95% -0.03 - -0.40 points).PQL is not related to sex, location of the centre (rural/urban), time spent working in the organization or contractual situation. CONCLUSION: With the improvement in work control and avoiding increases in workloads, PQL perception can be maintained despite deep organizational changes at the macro-management level. Different professional groups experience different perceptions depending on how the changes impact their position in the organization.

Aplicación de la metodología enfermera en atención primaria / Application of the nursing process in primary care

Fundamento: Las enfermeras de atención primaria (AP) han adquirido en los últimos años una mayor responsabilidad en la provisión de servicios sanitarios, y se han convertido en auténticos gestores de cuidados. La utilización de la metodología de enfermería ha facilitado esta nueva concepción integral de la atención. El objetivo de este estudio es dar a conocer la experiencia de implantación y desarrollo de la metodología de enfermería en un área sanitaria de AP de la Comunidad de Madrid. Métodos: Estudio descriptivo longitudinal, realizado en los 42 equipos de AP del Área 11 de Madrid, acerca de las estrategias de implantación de la metodología y la evaluación de los indicadores clave definidos para la monitorización del proceso del cuidado en el período 2001-2004. Resultados: El número de enfermeras que utiliza la metodología y los diagnósticos de enfermería ha aumentado un 167%. La frecuencia de diagnósticos de enfermería identificados desde el año 2001 ha sido de 50.815. El indicador de calidad global mantiene desde el año 2001 un incremento continuado, y en 2004 se situó en el 90,5%. El indicador de capacidad de resolución se ha situado en los 2 últimos años en torno al 75% de los problemas atendidos. El ICE (indicador sintético de cuidados enfermeros) se ha incrementado un 350%. Conclusiones: Las enfermeras/os de AP del Área 11 de Madrid han integrado el proceso de atención de enfermería como metodología de trabajo en su práctica asistencial, participando del modelo de excelencia de la organización con su aportación disciplinar específica e integrando como proceso clave de la organización el cuidado de la población

Background: In recent years, primary care nurses have acquired grea ter responsibility in providing health services, becoming authentic nursing care managers. This new integral concept of care has been aided by the use of the nursing process. The present study aims to describe the implantation and development of the nursing process in a primary care area in the Autonomous Community of Madrid. Methods: We performed a longitudinal descriptive study to analyze the strategies employed to introduce utilization of the nursing process and to evaluate the key indicators defined to monitor nursing care in 42 primary care teams of Area 11 in Madrid between 2001 and 2004. Results: The number of nurses using the nursing process and nursing diagnoses increased by 167%. The frequency of nursing diagnoses made since 2001 was 50,815. The indicator of overall quality showed a continuous increase since 2001 and was 90.5% in 2004. In the last two years of the study, the indicator of resolution of nursing diagnosis was achieved in approximately 75% of the problems attended. The synthetic indicator of nursing care increased by 350%. Conclusions: Primary care nurses in Area 11 of Madrid have integrated the nursing process as a working methodology into their clinical practice, thus contributing to the organization's model of excellence through their specific discipline and integrating the nursing care of the population as a key process in the organization

Mejora de la calidad del proceso asistencial mediante una actividad de formación continuada: a propósito de la espirometría / Quality improvement through continuing education: apropos of spirometry

Objetivo. Evaluar el impacto de una actividad formativa en la calidad de la realización de la técnica espirométrica entre las enfermeras de un área de salud.Diseño. Estudio cuasiexperimental antes-después.Emplazamiento. Diez equipos de atención primaria.Participantes. Veinte enfermeras del equipo de atención primaria (EAP).Intervención. Realización de una actividad de formación de 5 h de duración basada en los principios del aprendizaje de adultos.Mediciones principales. Se evaluó la fiabilidad de las medidas de 2 observadores sobre el mismo paciente para la capacidad vital forzada (CVF), el flujo espiratorio máximo en el primer segundo (FEV1), el flujo espiratorio máximo o peak expiratory flow (FEM o PEF) y la calidad de la curva espirométrica.Resultados. El coeficiente de correlación intraclase (CCI) entre las medidas de los observadores aumentó de manera significativa para el PEF: preformación, 0,941; intervalo de confianza (IC) del 95 por ciento, 0,897-0,967; posformación, 0,993; IC del 95 por ciento, 0,987-0,997. El CCI no se modificó para la CVF y el FEV1. La calidad de la curva de flujo espiratorio se consideró buena en el 32,0 por ciento de los casos antes de la formación y en el 88,9 por ciento tras ella (p < 0,001).Conclusiones. La formación continuada realizada sobre actividades que ya están implantadas en los equipos y que permite la participación activa puede ser útil para mejorar la calidad de determinados procesos asistenciales (AU)

Nuevos indicadores en la provisión de servicios: diagnósticos enfermeros en atención primaria / New service provision indicators: nursing diagnosis in primary health care

La identificación de diagnósticos de enfermería (DdE) y la planificación de cuidados adquieren cada día una mayor relevancia en el trabajo que la enfermera realiza en atención primaria (AP).Objetivo. Conocer la utilización de los DdE en particular y del proceso enfermero en general por parte de las enfermeras del área, y definir los DdE que con mayor frecuencia se utilizan en AP. Material y métodos. Estudio descriptivo transversal, realizado en los 39 equipos de atención primaria del Área 11 de Madrid durante el año 2001.Se diseñaron indicadores de evaluación tanto cuantitativos como cualitativos y se revisaron los registros específicos de diagnósticos de enfermería de todos los profesionales para la evaluación cuantitativa y una muestra de 1.918 historias para la evaluación cualitativa. Resultados. El 75,5 por ciento de las enfermeras han realizado algún DdE. El total de DdE identificados ha sido de 5.129, lo que supone una media de 13,8 por profesional, y un elevado porcentaje pertenece a la esfera biológica del individuo. Se ha alcanzado un cumplimiento del 78,6 por ciento en el indicador "calidad global", que evalúa la utilización de las distintas etapas del proceso enfermero. Conclusiones. Las/os enfermeras/os de AP del Área 11 de Madrid están integrando el proceso de atención de enfermería como metodología de trabajo en su práctica asistencial. Es fundamental disponer de un sistema de información específico de planes de cuidados de enfermería que nos informe de una parte fundamental de los servicios que prestan los profesionales de enfermería en AP (AU)