Systematic review of healthcare interventions for reducing gender-based violence impact on the mental health of women with disabilities.

PURPOSE: Women with disabilities are more exposed to violence. The health sector has a key role in all three levels of prevention of violence against women. The objective of this paper was to review the interventions for preventing gender-based violence and reducing its impact on the mental health of women with any form of disability. METHOD: Relevant studies were identified through conducting searches in PubMed, Scopus, CINAHL, PsyInfo, Social Services Abstracts, and PILOTS. Two reviewers analyzed and selected studies. A qualitative synthesis was made. RESULTS: 3149 references were obtained, among which eight articles describing nine interventions from the USA and the UK. Most were intended for women with mental/intellectual disability and assessed intimate partner or sexual violence. Only one study showed high methodological quality. They were found to be particularly effective as regards improvement of the skills acquired by participants, but the results as regards improved mental health are not consistent. CONCLUSION: Our review shows very little evidence of effective interventions. Further studies are required with higher internal validity and female sample groups with diverse disabilities. CLINICAL RELEVANCE: Gender-based violence is a highly prevalent problem for women with disabilities, and in addition to being a public health challenge is a violation of human rights. Health care systems and policymakers should take a key role in all three levels of prevention of violence against women with disabilities. Interventions with longer follow-up times are required. It is also important for interventions to be designed in consultation with people with disabilities.

Valoración de los servicios de cuidados paliativos desde la perspectiva de los profesionales sanitarios de Andalucía / Evaluation of Palliative Care services from the perspective of the health professionals of Andalusia

OBJETIVO: Conocer la opinión de profesionales sanitarios sobre los servicios en cuidados paliativos (CP), así como identificar barreras y facilitadores en la implementación del Plan Andaluz de CP. MÉTODO: Diseño observacional transversal. Muestreo aleatorizado estratificado por perfiles de profesionales sanitarios de Andalucía (500 personas, error global ± 0,044, tasa de respuesta del 78%). Entrevista telefónica. Análisis univariante y bivariante. RESULTADO: El 72,8% valoraron como buena o muy buena la situación de CP y el 91,9% consideraron que es mejor o mucho mejor que 5 años atrás. Las 3 razones de calificación positiva de CP más frecuentemente identificadas coincidieron con las 3 primeras fortalezas identificadas en su ejercicio de CP: «mejor atención, trato, accesibilidad del paciente», «organización y coordinación» y «creación de unidades de CP». Por el contrario, identificaron como lo más negativo: la falta de «medios»; la de «personal», y la de «formación/información». Estas 2 últimas razones coincidieron también con las 2 principales carencias o dificultades en el ejercicio de CP, situando como tercera carencia la «falta de organización/coordinación de profesionales». Los profesionales de atención primaria presentaron valoraciones más altas, mientras que los de recursos avanzados de CP presentaron las mayores diferencias entre todos los perfiles, sin que se observaran diferencias destacables según sexo o la experiencia en CP. CONCLUSIONES: Evaluar las opiniones de los diferentes profesionales que intervienen en CP proporciona información valiosa para orientar las decisiones sobre la mejora de la atención al paciente y la organización del sistema de salud en general

OBJECTIVE: To evaluate the opinions of healthcare professionals on Palliative Care (PC) services and the implementation of a PC Strategy. METHOD: A cross-sectional study was conducted by interview on a random sample of 500 Andalusian healthcare professionals with stratification by work profiles (Overall error of ± 0.044). Univariate and bivariate analysis were used to analyse the RESULTS: RESULT: A total of 72.8% of the health professionals assessed PC in the region as good or very good, and 91.9% considered it to be better or much better than 5 years before. The most frequent reasons identified for a positive assessment of PC were: increased patient access to better quality personalised services; better organization and coordination of the system; and the creation of PC units in the region. On the other hand, professionals identified the following as three important negative aspects of regional PC: lack of resources; insufficient staff; and lack of adequate training and information support. Primary care practitioners had the highest levels of satisfaction with PC, while specialists had the greatest differences in opinion when compared with other professionals. There were no differences by gender or level of expertise in PC. CONCLUSIONS: Assessing the opinions of different professionals involved in PC provides valuable insights to guide decisions on the improvement of patient care and the organization of the healthcare system in general

Preferences of caregivers and patients regarding opioid analgesic use in terminal care.

CONTEXT: Patients and caregivers participate in decision-taking, and their views should be considered in the preparation of Clinical Practice Guidelines (CPGs). We involved them in the development of a CPG on the safe use of major opioids. OBJECTIVE: To identify the values and preferences of patients and caregivers on the use of opioids and the desired outcomes, to investigate motives for the acceptance/rejection of opioid therapy, and to evaluate their beliefs and information about these drugs. METHODS: A qualitative study was conducted using semi-structured interviews in an Andalusian population of terminal patients and caregivers (N = 42). Study variables included the role, diagnosis, and adherence to treatment. Content and validity analyses were performed. RESULTS: Less than one-third of participants recognized the term opioid. Among these, false beliefs were held related to the addictive nature of these drugs, their exclusive use in terminal cases and at the end of life, and their association with premature death. The information received was very general: it was known that they are "useful for pain," and some were informed about the administration route, composition, and habituation. Participation in decision making was usually limited to reporting symptoms to the physician. CONCLUSION: These patients and caregivers demonstrated a preference for pain alleviation by opioid treatment and gave negative assessments on adverse digestive effects that can cause this treatment to be abandoned. They expressed interest in receiving more information and in participating in therapeutic decision making, and they reported erroneous beliefs and a lack of information about the effects of these drugs.

Definición de competencia médica según pacientes crónicos del sistema sanitario público de Andalucía / Definition of medical competence. The point of view of chronically-ill patients in the Andalusian public healthcare system (Spain)

Objetivo Identificar los atributos con los cuales los/las pacientes crónicos/as atendidos/as en el Sistema Sanitario Público de Andalucía (SSPA) describen la competencia profesional del personal facultativo que les atiende a lo largo de su proceso asistencial. Métodos 147 pacientes crónicos de diferentes procesos asistenciales y sus familiares. Investigación cualitativa con grupos focales y entrevistas en profundidad, realizadas en centros de salud y consultas externas de Granada, Málaga, Sevilla, Cádiz y Córdoba, entre 2007 y 2008. Análisis de contenido con Nudist Vivo. Resultados Las personas participantes definen la competencia médica enlazando elementos de habilidad y conocimientos técnicos (tener conocimientos e interés por la enfermedad, mantener una continuidad en la atención mediante seguimientos correctos o solicitar las pruebas precisas) con otros relacionales, tanto sobre comunicación e información (informar, escuchar, confiar, estimular las preguntas) como sobre trato (humanidad, amabilidad, respeto, interés, cercanía). En la valoración de la asistencia en atención primaria, las expectativas incluyen relación cercana, trato personalizado, información, gestión de recetas y baja laboral, y derivación al/a la especialista. Sobre las consultas de especialidad destaca acertar diagnóstico y tratamiento, informar y hacer un seguimiento del/de la paciente. En el servicio de urgencias se valoran especialmente el alivio de los síntomas, acertar el diagnóstico, ser derivado al/a la especialista y recibir un trato humano. Conclusiones Las necesidades y las expectativas de los/as pacientes crónicos/as hacia la competencia médica se organizan en torno a habilidades técnicas y relacionales (AU)

Objective To identify the attributes used by chronically-ill patients to describe physicians’ competence in the public healthcare system in Andalucia. Methods A total of 147 chronically-ill patients and their relatives were included in this qualitative study. Focal groups and in-depth interviews were performed in health centers and outpatient centers in Granada, Malaga, Seville, Cadiz and Cordoba between 2007 and 2008. Content analysis was carried out using Nudist Vivo. Results The participants defined medical competence as combining elements of technical ability and knowledge (awareness of and interest in the disease, continuity of follow-up and requesting specific tests) with interpersonal skills related to communication, information (informing, listening, trust, prompting questions) and attention (courtesy, cordiality, respect, interest and approachability). Primary care was expected to provide a close relationship, personalized treatment, information, drug prescription, and referral to specialized care. Specialized care was expected to provide an accurate diagnosis and appropriate treatment, information and follow-up. Highly valued aspects of emergency care were symptom relief, accurate diagnosis, referral to specialists and courtesy. Conclusions Chronically-ill patients based their evaluation of medical competence on technical and interpersonal skills (AU)

[Definition of medical competence. The point of view of chronically-ill patients in the Andalusian public healthcare system (Spain)]. / Definición de competencia médica según pacientes crónicos del sistema sanitario público de Andalucía.

OBJECTIVE: To identify the attributes used by chronically-ill patients to describe physicians' competence in the public healthcare system in Andalucia. METHODS: A total of 147 chronically-ill patients and their relatives were included in this qualitative study. Focal groups and in-depth interviews were performed in health centers and outpatient centers in Granada, Malaga, Seville, Cadiz and Cordoba between 2007 and 2008. Content analysis was carried out using Nudist Vivo. RESULTS: The participants defined medical competence as combining elements of technical ability and knowledge (awareness of and interest in the disease, continuity of follow-up and requesting specific tests) with interpersonal skills related to communication, information (informing, listening, trust, prompting questions) and attention (courtesy, cordiality, respect, interest and approachability). Primary care was expected to provide a close relationship, personalized treatment, information, drug prescription, and referral to specialized care. Specialized care was expected to provide an accurate diagnosis and appropriate treatment, information and follow-up. Highly valued aspects of emergency care were symptom relief, accurate diagnosis, referral to specialists and courtesy. CONCLUSIONS: Chronically-ill patients based their evaluation of medical competence on technical and interpersonal skills.

Expectations held by type 1 and 2 diabetes mellitus patients and their relatives: the importance of facilitating the health-care process.

AIM: To understand the expectations held by type 1 and 2 diabetes mellitus (DM 1 & 2) patients and their relatives regarding the health-care provided to them. DESIGN: qualitative. Focus groups. SETTING AND PARTICIPANTS: Andalusia. A theoretical sample that includes the most characteristic profiles. Thirty-one subjects with DM. segmentation characteristics receiving health-care for DM in Primary or Specialized care, living in urban and rural areas, men and women, age, varying diagnosis times, DM course and consequences. Subjects were recruited by health-care professionals at reference care centres. RESULTS: Patients expect their health-care professionals to be understanding, to treat them with kindness and respect, to have good communication skills, to provide information in a non-authoritarian manner while fully acknowledging patients' know-how. Regarding the health-care system, their expectations focus on the system's ability to respond when required to do so, through a relevant professional, along with readily available equipment for treatment. The expectations of people affected by DM1 focus on leading a normal life and not having their educational, labour, social and family opportunities limited by the disease. Expectations in people with DM2 tend towards avoiding what they know has happened to other patients. CONCLUSIONS: 'Facilitating', is a key word. Both the health-care system and its professionals must pay keener attention to the emotional aspects of the disease and its process, adopting a comprehensive approach to care. It is vital that health-care professionals take an active interest in the course of their patient's disease, promoting accessibility and an atmosphere of trust and flexibility.

[Physician/patient relationship in diabetes mellitus type 1 treatment. A qualitative study]. / La relación médico-paciente en el tratamiento de la diabetes tipo 1. Un estudio cualitativo.

OBJECTIVES: To know the experiences and expectations of diabetes mellitus type 1 (DM1) patients and their relatives as regards the relationships established with doctors, and the impact of such relationships on their strategies to cope with the disease and treatment. DESIGN: Qualitative design based on focus groups conducted in 2001. LOCATION: Several health care centres in Granada and Seville, Spain. PARTICIPANTS: DM1 patients and their relatives and/or carers. METHOD: Theory-based sampling including the most representative profiles. Qualitative analysis procedure: text coding, triangulation and interpretation of results. RESULTS: Doctor/patient relationship highly influences the emotional experience of disease and the way patients gain control over it. Interviewed patients said that the relationship with doctors is focused on disease signs and symptoms, leaving emotional aspects aside. Very often, provider communication is built on recrimination and threat. Treatment is imposed rather than agreed, with scarce opportunities for participating in clinical decisions. Patients develop strategies to take their own decisions and adapting treatment to their daily life. CONCLUSIONS: Patients value a relationship model whereby providers listen and empathise with their situation, understand their difficulties in treatment compliance, encourage them, and adapt recommendations to the personal and emotional circumstances of each patient. They prefer doctors combining professional competence-including relational skills-with humanity and kindness, as well as being capable of assuming their co-responsibility in treatment success.

La relación médico-paciente en el tratamiento de la diabetes tipo 1. Un estudio cualitativo / Physician/patient relationship in Diabetes Mellitus type 1 treatment. A qualitative study

Objetivos. Conocer las experiencias y las expectativas de pacientes con diabetes tipo 1 (DM1) y sus familiares sobre la relación que establecen con sus médicos y su influencia en la forma de afrontar la enfermedad y el tratamiento. Diseño. Diseño cualitativo a través de grupos focales realizado en 2001. Emplazamiento. Distintos centros sanitarios de Granada y Sevilla. Participantes. Pacientes con DM1, familiares y/o cuidadores. Método. Muestreo teórico con representación de los perfiles más característicos. Procedimiento de análisis cualitativo: asignación de códigos al texto, triangulación e interpretación de resultados. Resultados. La relación médico-paciente influye decisivamente en la vivencia emocional de la enfermedad y en la manera en que los pacientes asumen el control. Los pacientes entrevistados aseguran que la relación con sus médicos está centrada en los signos y los síntomas de la enfermedad, y que el aspecto emocional se deja de lado. Es frecuente que los profesionales basen su comunicación en la reprimenda y en la amenaza. Los tratamientos se imponen más que se consensúan, y las posibilidades de participación en las decisiones clínicas son escasas. En consecuencia, los pacientes desarrollan estrategias para tomar sus propias decisiones sobre el tratamiento adaptándolo a su vida. Conclusiones. Desean un modelo de relación con sus médicos en el que les escuchen, empaticen con su situación, comprendan los problemas que enfrentan para seguir el tratamiento, les transmitan ánimos y adapten sus recomendaciones a las circunstancias vitales y emocionales de cada paciente. Se prefiere a los profesionales que combinan la competencia técnica (incluida la dimensión relacional) con la humanidad y la amabilidad, y que asumen su corresponsabilidad en el éxito del tratamiento

Objectives. To know the experiences and expectations of diabetes mellitus type 1 (DM1) patients and their relatives as regards the relationships established with doctors, and the impact of such relationships on their strategies to cope with the disease and treatment. Design. Qualitative design based on focus groups conducted in 2001. Location. Several health care centres in Granada and Seville, Spain. Participants. DM1 patients and their relatives and/or carers. Method. Theory-based sampling including the most representative profiles. Qualitative analysis procedure: text coding, triangulation and interpretation of results. Results. Doctor/patient relationship highly influences the emotional experience of disease and the way patients gain control over it. Interviewed patients said that the relationship with doctors is focused on disease signs and symptoms, leaving emotional aspects aside. Very often, provider communication is built on recrimination and threat. Treatment is imposed rather than agreed, with scarce opportunities for participating in clinical decisions. Patients develop strategies to take their own decisions and adapting treatment to their daily life. Conclusions. Patients value a relationship model whereby providers listen and empathise with their situation, understand their difficulties in treatment compliance, encourage them, and adapt recommendations to the personal and emotional circumstances of each patient. They prefer doctors combining professional competence­including relational skills­with humanity and kindness, as well as being capable of assuming their co-responsibility in treatment success