Subject(s)
Office Visits/statistics & numerical data , Humans , Models, Statistical , Spain , Time FactorsABSTRACT
OBJECTIVE: To analyse the compliance with the primary health care quality criteria of the Committee for Quality Improvement of the Catalan Society of Family and Community Medicine. DESIGN: Cross-sectional descriptive study. SETTING: Reformed primary care centres (PCC) in Catalonia (186), of which 73 (39.2%) filled out the disk with the results. MEASUREMENTS AND MAIN RESULTS: A total of 202 criteria, divided into five sections (structure and material resources, human resources, work organisation, systems of recording and access, and continuity, confidentiality and participation), were self-evaluated in each PCC. These criteria were defined as basic or optimal and compliance with them was graded from 1 to 4. 72.8% of the criteria were fully complied with. In 7.4% there was partial compliance, and in 19.7% non-compliance. The basic criteria had 74% total compliance, whereas the optimal criteria had 51.9%. The groups with least compliance (sum of the total plus the partial) were records systems (68.6%) and human resources (73.5%). The organisation group had the best compliance (85.5%). By sub-groups, the greatest compliance was found in privacy (93.7%), direct care (89.2%) and recording actions (89.1%). Sub-groups with least compliance were long-term treatments (61.8%), vaccinations (46.4%) and storage (42%). Eight of the 18 criteria not complied with by 50% or more were considered responsibility of the team. There was 37.8% total compliance and 24% partial in the criteria referring to the specific training of primary care professionals. Up to 80% non-compliance was found in quality of long-term prescription records, vaccinations and storage. CONCLUSIONS: The high level of compliance in the sections which depend most on professionals should be noted (accessibility-continuity and organisation). This study is a first approach towards understanding the quality of the structure of PC in Catalonia, and enables proposals for improvement to be set up.
Subject(s)
Patient Care Team/standards , Primary Health Care/standards , Quality of Health Care/standards , Community Medicine , Cross-Sectional Studies , Family Practice , Humans , Patient Care Team/organization & administration , Patient Care Team/statistics & numerical data , Primary Health Care/organization & administration , Primary Health Care/statistics & numerical data , Quality of Health Care/organization & administration , Quality of Health Care/statistics & numerical data , Societies, Medical , Spain , WorkforceABSTRACT
Objetivo. Analizar el nivel de cumplimiento de los criterios de calidad en atención primaria de salud de la Comissió de Millora de la Qualitat de la Societat Catalana de Medicina Familiar i Comunitària (SCMFiC). Diseño. Estudio descriptivo tranversal. Emplazamiento. Centros de Atención Primaria (CAP) reformados de Cataluña (186), de los cuales cumplimentaron el disquete con los resultados 73 (39,2 por ciento). Mediciones y resultados principales. Un total de 202 criterios -distribuidos en 5 apartados (estructura y recursos materiales, recursos humanos, organización del trabajo, sistemas de registro y accesibilidad, continuidad, confidencialidad y participación)- fueron autoevaluados en cada CAP. Estos criterios están definidos como básicos u óptimos y se valora su grado de cumplimiento de 1 a 4. El 72,8 por ciento de los criterios se cumplían totalmente, el cumplimiento parcial fue del 7,4 por ciento y un 19,7 por ciento se incumplían. Los criterios básicos presentaron un cumplimiento total del 74 por ciento, mientras que el de los óptimos fue del 51,9 por ciento. Los grupos con menor cumplimiento (suma del total más el parcial) fueron sistemas de registro (68,6 por ciento) y recursos humanos (73,5 por ciento). El mejor cumplimiento lo presenta el grupo de organización (85,5 por ciento). Por subgrupos el mayor cumplimiento se detecta en intimidad (93,7 por ciento), atención directa (89,2 por ciento) y registro de actividad (89,1 por ciento). Los subgrupos con mayor incumplimiento fueron tratamientos de larga duración (61,8 por ciento), vacunas (46,4 por ciento) y almacén (42 por ciento). De los 18 criterios que se incumplen en la mitad o más, 8 se consideran responsabilidad del equipo. Se observa un cumplimiento total del 37,8 por ciento y parcial en el 24 por ciento de los criterios que hacen referencia a la formación específica de los profesionales de AP. Se han obtenido incumplimientos de hasta el 80 por ciento en cuanto a calidad de registros de prescripción crónica, vacunas y almacén. Conclusiones. Cabe destacar el alto grado de cumplimiento de los apartados que más dependen de los profesionales (accesibilidad-continuidad y organización). Este estudio supone una aproximación al conocimiento de la situación de calidad de la estructura de la AP en Cataluña y permite establecer propuestas de mejora (AU)
Subject(s)
Humans , Societies, Medical , Spain , Patient Care Team , Quality of Health Care , Primary Health Care , Community Medicine , Cross-Sectional Studies , Family PracticeABSTRACT
OBJECTIVE: Application of computerized program for detection of potential drug interactions (PDI) in chronic prescriptions in four primary care centers. To evaluate the clinical significance of PDI identified according to clinical criterions. DESIGN: An observational crossover study. SETTING: Clutat Vella health district (City of Barcelona). MEASUREMENTS AND RESULTS: Using information of Consejo General de Colegios Oficiales de Farmaceuticos databases and the chronic prescriptions database of the primary care centers, computerized drug-interaction system have been developed for detection of PDI in patients. A panel of primary care physicians and clinical pharmacists developed criteria that were used to evaluate the clinical significance of PDI. 9840 Cards of Authorized Prescription (CAP) were analyzed, 36108 medicaments and 42877 drugs. A total of 2140 patients were involved for a total of 3406 PDI, 21.75% of patients with CAP. Clinical signification for the panel was found in 40.07% of these 3406 PIF; 3.78% were suggest to avoid the association drugs. CONCLUSIONS: The incidence of PDI with clinical signification are lower than other studies of the literature; it suggest a appropriate knowledge of drug prescription. The application of computerized program make much more easy the detection of adverse drug interactions in chronic prescription.
Subject(s)
Drug Interactions , Drug Prescriptions , Cross-Over Studies , Humans , Information Systems , Pharmacists , Physicians, Family , Software , SpainABSTRACT
OBJECTIVES: 1) To make an integrated evaluation of the cognitive status, functional capacity, chronic disorders and social situation of the over-75 age group. 2) To find this group's self-perception of their health. DESIGN: A descriptive crossover study. SETTING: The Gòtic Health District in Barcelona. PARTICIPANTS: 316 people were included in the study. They were chosen by simple randomised sampling from the over-75s seen at the centre (n = 1,625). MEASUREMENTS AND MAIN RESULTS: To assess cognitive status, the Pfeiffer Short Portable Mental Status Questionnaire was used; for functional capacity, the Katz Index; and for chronic disorders, the medical records were reviewed. A questionnaire was used to find patients' social situation and assessed social relationships, social resources used and architectonic barriers. Self-perception of health status was evaluated using the Nottingham Health Profile. Prevalence of cognitive deterioration was 29.7%. 39.4% of patients were dependent in one or more basic activities of their daily life. 90.8% had a chronic disorder, the most frequent being AHT, arthrosis, obesity and dyslipemias. 28.3% lived alone and 26.7% used social services. CONCLUSIONS: We think this kind of assessment is useful in primary care. It would provide an integrated diagnosis (clinical, functional, medical and social) of elderly patients.
Subject(s)
Health Status , Self Concept , Activities of Daily Living , Aged , Aged, 80 and over , Chronic Disease , Cognition Disorders/diagnosis , Female , Humans , Male , Medical Records , Mental Status Schedule , Physical Examination , Primary Health Care , Psychiatric Status Rating Scales , Surveys and QuestionnairesABSTRACT
Appropriate access to health care is one of the components of Primary Health Care (PHC) and it can be a good quality indicator. We present in this paper the results of 1 year of follow-up of an appointment system applied in 29 PHC centers in the Balearic Islands, Spain; the program was set up by the National Institute of Health. Telephonic appointment proportion increased from the first weeks, stabilizing at about 70%. The number of calls that it is necessary to make in order to get an appointment at peak time is now 1.5 and only 1 throughout the rest of the day. To determine changes in the waiting time and visit time, and the user opinion of the system, an enquiry was made to a sample of patients 1 month before, and 1 month, 6 months and 1 year after the program started. The waiting time is now less than 15 min for most of the people interviewed, in contrast with the previous situation when the waiting time was more than 30 min. The visit time is longer now and more than two thirds of the people think that care is better or much better than prior to the start of the program. These results have been verified in the waiting room (11.2 min mean waiting time and 7.2 min mean visit time). We conclude that we have achieved the goals of the appointment system program in all the centers covered by our department.
