Economic Analysis of Cochlear Implants in Adults With Bilateral Severe-to-Profound Hearing Loss. A Systematic Review of the Literature.

OBJECTIVE: To determine the cost-effectiveness or cost-utility of cochlear implants (CI) in adults with severe to profound bilateral hearing loss. DATABASES REVIEWED: PubMed (Medline), The Cochrane Library, Embase via Elsevier, EBSCOhost CINAHL, and Scopus. METHODS: The study included adult participants with severe to profound bilateral neurosensory hearing loss. The analysis encompassed quality of life improvements, costs, cost-effectiveness, cost-utility, cost-benefit, quality-adjusted life year (QALY), incremental cost-effectiveness ratio (ICER), and incremental cost-utility ratio (ICUR). Systematic reviews, meta-analyses, case series, and prospective or retrospective cohort studies published in English between 2010 and 2023 were retrieved. Exclusion criteria included incomplete studies, abstracts, clinical cases, editorials, letters, studies involving pediatric populations, single-side deafness, methodology research, noneconomic aspects of CI, mixed child and adult data, and studies published before 2010. The risk of bias was assessed following the criteria outlined in Appendix I of the economic evaluation's quality assessment as per the NICE Guideline Development Method. RESULTS: Ten articles met the criteria and were included in the qualitative synthesis. One study conducted a prospective cost-utility analyses, one carried out a cost-benefit analyses, one was a randomized controlled clinical trial focusing on cost-utility, and another was a clinical trial addressing cost-effectiveness. Six studies employed Markov models, and one study utilized uniquely the Monte Carlo method. None quantified the economic impact of improved hearing on cognitive function. CONCLUSIONS: The heterogeneity of sources impacted data quality. Unilateral and sequential bilateral CI appeared to be cost-effective when compared with bilateral hearing aids or nontechnological support. When properly indicated, simultaneous bilateral CIs are cost-effective compared to no interventions and to unilateral cochlear implantation through differential discounting or variations from the base cases, especially with a life expectancy of 5-10 years or longer.

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.

Repercusiones del confinamiento por COVID-19 en pacientes crónicos de Andalucía / Consequences of the COVID-19 lockdown in patients with chronic diseases in Andalusia

Objetivo: Conocer las repercusiones del confinamiento por la pandemia de COVID-19 en los autocuidados de personas con enfermedades crónicas y en su salud percibida, e identificar factores para el manejo y la gestión de su enfermedad en situaciones de emergencia. Método: Estudio cualitativo realizado en marzo-abril de 2020, durante el confinamiento por la pandemia de COVID-19, en Andalucía (España), mediante grupos focales virtuales usando la herramienta telemática Zoom. Se realizaron tres grupos con 34 pacientes (17 hombres y 17 mujeres) con enfermedades crónicas: artritis, diabetes, enfermedad cardiovascular, enfermedad inflamatoria intestinal, cáncer de mama y fibromialgia. Resultados: Las personas con enfermedades crónicas refirieron repercusiones del confinamiento en relación con su vivencia emocional, sus recursos de afrontamiento, la información recibida, las dificultades para el autocuidado y el contacto/acceso a los servicios sanitarios, además de sugerir aprendizajes para el futuro. Más y mejor información, formación de pacientes, colaboración directa con asociaciones de pacientes por parte de los gestores y una mejora de la accesibilidad telemática a los servicios sanitarios destacan como las principales líneas de mejora para minimizar el impacto de futuros confinamientos en el autocuidado y en la salud de las personas con enfermedades crónicas. Conclusiones: Durante el confinamiento, las personas con enfermedades crónicas experimentaron dificultades más allá del riesgo de contagio: interferencias en el cuidado y en la atención sanitaria recibida. Es necesaria mayor información y más formación a los/las pacientes y mejoras en la accesibilidad a los servicios sanitarios en situaciones de crisis sanitaria. (AU)

Objective: To understand the consequences of the COVID-19 pandemic lockdown on the self-care of people living with chronic diseases and on their self-perceived health, and to identify factors that may influence the management of their disease in emergency situations. Method: A qualitative study conducted in 2020 (March and April) in Andalusia (Spain) during the COVID-19 pandemic lockdown, through virtual focus groups, using the Zoom telematics tool. Three virtual focus groups were conducted, including 34 patients from Andalusia with different chronic conditions such as arthritis, diabetes, cardiovascular disease, inflammatory bowel disease, breast cancer and fibromyalgia. Results: People with chronic diseases reported effects of the lockdown in relation to their emotional experience, their coping resources, the information they received, the difficulties to manage self-care, and the contact or access to health services. They also suggested some lessons learned for the future. The need for more and better information, patient training, involving patient associations, and improving telematics access to health services are the main areas for improvement to minimize the impact of future quarantines on the self-care and the health of people with chronic diseases. Conclusions: Besides the risk of contracting COVID-19, the difficulties encountered by people with chronic diseases during the lockdown include interferences in the self-care and the health care received. Health crisis situations demand more information, training for patients and improvements in the health services accessibility for patients with chronic conditions. (AU)

[Consequences of the COVID-19 lockdown in patients with chronic diseases in Andalusia]. / Repercusiones del confinamiento por COVID-19 en pacientes crónicos de Andalucía.

OBJECTIVE: To understand the consequences of the COVID-19 pandemic lockdown on the self-care of people living with chronic diseases and on their self-perceived health, and to identify factors that may influence the management of their disease in emergency situations. METHOD: A qualitative study conducted in 2020 (March and April) in Andalusia (Spain) during the COVID-19 pandemic lockdown, through virtual focus groups, using the Zoom telematics tool. Three virtual focus groups were conducted, including 34 patients from Andalusia with different chronic conditions such as arthritis, diabetes, cardiovascular disease, inflammatory bowel disease, breast cancer and fibromyalgia. RESULTS: People with chronic diseases reported effects of the lockdown in relation to their emotional experience, their coping resources, the information they received, the difficulties to manage self-care, and the contact or access to health services. They also suggested some lessons learned for the future. The need for more and better information, patient training, involving patient associations, and improving telematics access to health services are the main areas for improvement to minimize the impact of future quarantines on the self-care and the health of people with chronic diseases. CONCLUSIONS: Besides the risk of contracting COVID-19, the difficulties encountered by people with chronic diseases during the lockdown include interferences in the self-care and the health care received. Health crisis situations demand more information, training for patients and improvements in the health services accessibility for patients with chronic conditions.

Repercusiones del confinamiento por COVID-19 en pacientes crónicos de Andalucía / Consequences of the COVID-19 lockdown in patients with chronic diseases in Andalusia

OBJETIVO: Conocer las repercusiones del confinamiento por la pandemia de COVID-19 en los autocuidados de personas con enfermedades crónicas y en su salud percibida, e identificar factores para el manejo y la gestión de su enfermedad en situaciones de emergencia. MÉTODO: Estudio cualitativo realizado en marzo-abril de 2020, durante el confinamiento por la pandemia de COVID-19, en Andalucía (España), mediante grupos focales virtuales usando la herramienta telemática Zoom. Se realizaron tres grupos con 34 pacientes (17 hombres y 17 mujeres) con enfermedades crónicas: artritis, diabetes, enfermedad cardiovascular, enfermedad inflamatoria intestinal, cáncer de mama y fibromialgia. RESULTADOS: Las personas con enfermedades crónicas refirieron repercusiones del confinamiento en relación con su vivencia emocional, sus recursos de afrontamiento, la información recibida, las dificultades para el autocuidado y el contacto/acceso a los servicios sanitarios, además de sugerir aprendizajes para el futuro. Más y mejor información, formación de pacientes, colaboración directa con asociaciones de pacientes por parte de los gestores y una mejora de la accesibilidad telemática a los servicios sanitarios destacan como las principales líneas de mejora para minimizar el impacto de futuros confinamientos en el autocuidado y en la salud de las personas con enfermedades crónicas. CONCLUSIONES: Durante el confinamiento, las personas con enfermedades crónicas experimentaron dificultades más allá del riesgo de contagio: interferencias en el cuidado y en la atención sanitaria recibida. Es necesaria mayor información y más formación a los/las pacientes y mejoras en la accesibilidad a los servicios sanitarios en situaciones de crisis sanitaria

OBJECTIVE: To understand the consequences of the COVID-19 pandemic lockdown on the self-care of people living with chronic diseases and on their self-perceived health, and to identify factors that may influence the management of their disease in emergency situations. METHOD: A qualitative study conducted in 2020 (March and April) in Andalusia (Spain) during the COVID-19 pandemic lockdown, through virtual focus groups, using the Zoom telematics tool. Three virtual focus groups were conducted, including 34 patients from Andalusia with different chronic conditions such as arthritis, diabetes, cardiovascular disease, inflammatory bowel disease, breast cancer and fibromyalgia. RESULTS: People with chronic diseases reported effects of the lockdown in relation to their emotional experience, their coping resources, the information they received, the difficulties to manage self-care, and the contact or access to health services. They also suggested some lessons learned for the future. The need for more and better information, patient training, involving patient associations, and improving telematics access to health services are the main areas for improvement to minimize the impact of future quarantines on the self-care and the health of people with chronic diseases. CONCLUSIONS: Besides the risk of contracting COVID-19, the difficulties encountered by people with chronic diseases during the lockdown include interferences in the self-care and the health care received. Health crisis situations demand more information, training for patients and improvements in the health services accessibility for patients with chronic conditions

La perspectiva de personas migrantes sobre el acceso a la atención sanitaria en el contexto de políticas de austeridad en Andalucía / The perspective of migrants on access to health care in the context of austerity policies in Andalusia (Spain)

OBJETIVO: Conocer la valoración de personas migrantes sobre su acceso al sistema sanitario tras la entrada en vigor del Real Decreto-Ley16/2012 y sobre el efecto que han podido producir los recortes económicos en dicho acceso. MÉTODO: Estudio cualitativo fenomenológico con entrevistas semiestructuradas, realizado en Andalucía, en dos fases (2009-2010 y 2012-2013), con 36 participantes. Se segmentó la muestra por tiempo de estancia, nacionalidad y ámbito de residencia. Las nacionalidades de las personas migrantes son Bolivia, Marruecos y Rumanía. RESULTADOS: Como elementos facilitadores del acceso en ambas fases se identifican la situación administrativa regular, la posesión de tarjeta sanitaria individual, el conocimiento del idioma, las redes sociales y la información. Los resultados muestran diferencias en el acceso a la atención sanitaria de las personas migrantes antes y después de la aplicación del RDL 16/2012, en el marco de las políticas de austeridad. En la segunda fase se agravan algunas barreras de acceso, como los tiempos de espera y la incompatibilidad de horarios, y empeoran las condiciones socioeconómicas y administrativas de las personas participantes. CONCLUSIONES: El diseño de políticas económicas y de regulación de la atención sanitaria debería tener en cuenta las barreras y los facilitadores de acceso como ejes fundamentales de la protección de la salud de las personas migrantes y, por ende, de la población general

OBJECTIVE: To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. METHOD: Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. RESULTS: Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. CONCLUSIONS: The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population

Impacto diferencial, necesidades heterogéneas. La formación entre iguales para mejorar la salud y los hábitos de vida de los pacientes crónicos / Differential impact and heterogeneous needs. A peer-led training program for improving chronic patients' health status and health behaviors

OBJETIVO: Evaluar el impacto de la formación entre iguales de la Escuela de Pacientes sobre la salud autopercibida y los hábitos de vida de las personas con enfermedades crónicas. DISEÑO: Descriptivo, transversal de evaluación cuantitativa pretest/postest. EMPLAZAMIENTO: Andalucía. PARTICIPANTES: Novecientos sesenta y cuatro pacientes con diabetes, fibromialgia e insuficiencia cardíaca participantes en la Escuela de Pacientes entre 2013 y 2015. INTERVENCIONES: Sesión de formación para formadores en autocuidados para personas con enfermedades crónicas. Mediciones principales: Se usó un cuestionario que midió salud autopercibida, limitaciones, dieta y actividad física. El análisis estadístico fue descriptivo, bivariante, de correlaciones y de ganancias netas. RESULTADOS: Tras realizar la formación se observó una mejoría de la salud, con menos limitaciones y mejor dieta y ejercicio físico, con diferencias estadísticamente significativas en función del sexo, enfermedad, nivel de estudios y estado civil. Se plantean propuestas de mejora de la estrategia formativa, con atención a las necesidades específicas de los colectivos más vulnerables: mujeres y personas con menor nivel educativo. CONCLUSIONES: El impacto de la formación fue positivo y diferencial en función de los perfiles de participantes. Se recomienda profundizar en los resultados, a través de metodología cualitativa, realizar mediciones postest posteriores y adaptar la estrategia formativa a la heterogeneidad de las necesidades de la población formada

OBJECTIVE: To measure the impact of the peer-led training for chronic patients on their health status and behaviors. DESIGN: Descriptive, transversal pretest and posttest quantitative approach. PLACEMENT: Andalusia. PARTICIPANTS: Nine hundred sixty-four patients with Diabetes, fibromyalgia and heart failure, trained at the School of Patients between 2013 and 2015. INTERVENTIONS: Peer-training intervention for self-efficacy for chronic patients. Main measurement: Self-reported health status, activity limitation, diet and physical activity. Statistical analysis included descriptive and bivariate statistics, correlation coefficient and net gains for paired variables. RESULTS: Health status improved after the training, with less limitations and better diet and physical activity, with significant differences by sex, chronic illness, education level and marriage status. Improvement areas where identified for the training strategy, with special attention on the needs of more vulnerable groups (women, people with less education level). CONCLUSIONS: The peer training had a positive impact, with differences depending on social profiles. 1-year and 2-years posttest measurements are needed and a qualitative study is required in order to better evaluate the peer-led strategy and to adapt it to participants' needs and expectations

[The perspective of migrants on access to health care in the context of austerity policies in Andalusia (Spain)]. / La perspectiva de personas migrantes sobre el acceso a la atención sanitaria en el contexto de políticas de austeridad en Andalucía.

OBJECTIVE: To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access. METHOD: Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania. RESULTS: Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen. CONCLUSIONS: The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population.

[Differential impact and heterogeneous needs. A peer-led training program for improving chronic patients' health status and health behaviors]. / Impacto diferencial, necesidades heterogéneas. La formación entre iguales para mejorar la salud y los hábitos de vida de los pacientes crónicos.

OBJECTIVE: To measure the impact of the peer-led training for chronic patients on their health status and behaviors. DESIGN: Descriptive, transversal pretest and posttest quantitative approach. PLACEMENT: Andalusia. PARTICIPANTS: Nine hundred sixty-four patients with Diabetes, fibromyalgia and heart failure, trained at the School of Patients between 2013 and 2015. INTERVENTIONS: Peer-training intervention for self-efficacy for chronic patients. MAIN MEASUREMENT: Self-reported health status, activity limitation, diet and physical activity. Statistical analysis included descriptive and bivariate statistics, correlation coefficient and net gains for paired variables. RESULTS: Health status improved after the training, with less limitations and better diet and physical activity, with significant differences by sex, chronic illness, education level and marriage status. Improvement areas where identified for the training strategy, with special attention on the needs of more vulnerable groups (women, people with less education level). CONCLUSIONS: The peer training had a positive impact, with differences depending on social profiles. 1-year and 2-years posttest measurements are needed and a qualitative study is required in order to better evaluate the peer-led strategy and to adapt it to participants' needs and expectations.

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.

Fibromialgia: percepción de pacientes sobre su enfermedad y el sistema de salud. Estudio de investigación cualitativa / Fibromyalgia: Patient perception on their disease and health system. Qualitative research study

Objetivo Conocer la experiencia y vivencia de personas con fibromialgia y sus expectativas sobre el sistema sanitario y sus profesionales. Métodos Diseño cualitativo a través de grupos focales. Se realizaron tres grupos, uno con pacientes que pertenecían a asociaciones de fibromialgia. Participaron 20 mujeres y 1 varón. Se incluyeron personas que recibían atención en el sistema sanitario público, con distintas trayectorias asistenciales y evolución. Se pidió consentimiento informado. Análisis de contenido. Resultados Describen una vivencia difícil con una sintomatología que puede ser incapacitante para las actividades cotidianas. Hasta que reciben el diagnóstico, perciben incomprensión y soledad. Desarrollan distintas estrategias de afrontamiento, como buscar información o asociarse. Esperan del sistema sanitario: atención y diagnósticos ágiles, acceso a consultas, pruebas que necesiten y terapias beneficiosas o impulso a la investigación. Quieren profesionales con formación para abordar la fibromialgia, una actitud proactiva, interés, empatía e información. Discusión La metodología cualitativa fue idónea para profundizar en la experiencia de pacientes. La atención sanitaria debe dirigirse a mejorar su calidad de vida facilitando su proceso asistencial y ofreciendo acompañamiento, interés, comprensión y apoyo(AU)

Objective To know the experiences and expectations of persons with fibromyalgia towards the health system and its professionals. Methods Qualitative study with three focal groups. The first focal group included patients with fibromyalgia, 20 women and 1 man, receiving care in the public health system, with different assistance paths and progression. Informed Consent was required. Content analysis was done. Results Patients describe a difficult experience, with symptoms that may involve incapacity for daily activities. Until knowing their diagnosis, they feel a lack of understanding and also loneliness. They develop different coping strategies, as looking for information or association. From the health system they expect: attention and a fast diagnosis, accessibility to consultations, medical exams and therapies or an impulse for research. They want trained professionals, proactive attitudes, interest, empathy and information. Discussion Qualitative methods seem suitable for delving into patient experience. Health assistance must improve patients’ quality of life, facilitating their assistance process and offering companionship, interest, comprehension and support(AU)

[Fibromyalgia: Patient perception on their disease and health system. Qualitative research study]. / Fibromialgia: percepción de pacientes sobre su enfermedad y el sistema de salud. Estudio de investigación cualitativa.

OBJECTIVE: To know the experiences and expectations of persons with fibromyalgia towards the health system and its professionals. METHODS: Qualitative study with three focal groups. The first focal group included patients with fibromyalgia, 20 women and 1 man, receiving care in the public health system, with different assistance paths and progression. Informed Consent was required. Content analysis was done. RESULTS: Patients describe a difficult experience, with symptoms that may involve incapacity for daily activities. Until knowing their diagnosis, they feel a lack of understanding and also loneliness. They develop different coping strategies, as looking for information or association. From the health system they expect: attention and a fast diagnosis, accessibility to consultations, medical exams and therapies or an impulse for research. They want trained professionals, proactive attitudes, interest, empathy and information. DISCUSSION: Qualitative methods seem suitable for delving into patient experience. Health assistance must improve patients' quality of life, facilitating their assistance process and offering companionship, interest, comprehension and support.

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.

Proceso Adeno Amigdalectomía

Guía de información dirigida a personas que vayan a ser operadas de adeno-amigdalectomía y a sus cuidadoras o cuidadores. Contiene respuestas sencillas a las preguntas más frecuentes sobre la intervención.

Proceso Adenoidectomía

Guía de información dirigida a personas que vayan a ser operadas de adenoidectomía y a sus cuidadoras o cuidadores. Contiene respuestas sencillas a las preguntas más frecuentes sobre la intervención.

Proceso Amigdalectomía

Guía de información dirigida a personas que vayan a ser operadas de amigdalectomía y a sus cuidadoras o cuidadores. Contiene respuestas sencillas a las preguntas más frecuentes sobre la intervención.

[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.