ABSTRACT
OBJECTIVE: To analyse barriers limiting an integral approach in the care process of patients with actinic keratosis, and to validate a questionnaire of their perception in order to assess this approach. METHOD: A qualitative study (Focus Group) was conducted to assess the perception of the healthcare process of professionals (dermatologists, family doctors, nurses, pharmacists and managers), and patients. A validation study of a new tool was conducted, defining the scope and contents of a questionnaire of perceived quality. Reliability, consistency and validity were analysed after inviting a convenience sample of 225 patients to respond. RESULTS: Underdiagnosis in primary care, a higher variability in resources, and access to the health care circuit, together with gaps in patient information about actinic keratosis, are relevant barriers to achieve comprehensive care in this disease condition. The result of the focus groups advised to elaborate 14 reactive items. A total of 224 patients responded (mean age 71.6, SD 11.1), of which 153 (68%) were men. Two factors were isolated including 12 items (explained variance of 58%). The consistency of this factorial solution was .87, the split-half reliability being .76, with the scores in the factors showing an adequate predictive capacity. CONCLUSIONS: The coordination between levels and to reduce to variability in equipment and clinical decision making in Primary Care are the most prominent barriers. The questionnaire has appropriate metric properties and it explores the information and care by the medical staff and the information and advice provided by the pharmacist.
Subject(s)
Health Care Surveys , Keratosis, Actinic/diagnosis , Keratosis, Actinic/therapy , Quality of Health Care , Aged , Clinical Decision-Making , Dermatologists , Female , Focus Groups , Humans , Male , Middle Aged , Nurses , Pharmacists , Physicians, Family , Qualitative Research , Reproducibility of ResultsABSTRACT
Benign skin lesions are a common reason for visits to primary care physicians and dermatologists. However, access to diagnosis and treatment for these lesions varies considerably between users, primarily because no explicit or standardized criteria for dealing with these patients have been defined. Principally with a view to reducing this variability in the care of patients with benign cysts or tumors, the Andalusian Regional Section of the Spanish Academy of Dermatology and Venereology (AEDV) has created a Process of Care document that describes a clinical pathway and quality-of-care characteristics for each action. This report also makes recommendations for decision-making with respect to lesions of this type.
Subject(s)
Critical Pathways , Cysts/diagnosis , Cysts/therapy , Skin Diseases/diagnosis , Skin Diseases/therapy , Skin Neoplasms/diagnosis , Skin Neoplasms/therapy , HumansABSTRACT
Attention has been focused on new ways to understand and manage urticaria ever since the recent addition of novel drugs to the therapeutic arsenal, the updating of clinical practice guidelines, and the publication of pathophysiologic insights. The Andalusian Section of the Spanish Academy of Dermatology and Venereology (AEDV) has developed a clinical pathway that defines quality-of-care characteristics and makes recommendations on decision-making affecting patients with urticaria. We present a patient-centered approach to care, in which the patient's clinical pathway through the health care system includes links between primary and hospital care to ensure continuity-a key feature of quality.
Subject(s)
Critical Pathways , Urticaria/diagnosis , Urticaria/therapy , Acute Disease , Chronic Disease , HumansABSTRACT
OBJECTIVE: Identifying a minimum set of efficiency indicators calculated from current information sources. Interventions adopted from the analysis of these indicators could contribute to health services sustainability. METHOD: We applied the discussion group technique. A total of 23 quality coordinators from around the country and the representatives of the regional quality societies in SECA (Spanish Society for Quality in Healthcare) participated. RESULTS: Ten efficiency indicators useful for integrated management areas were identified and accepted, 5 in the area of primary care and 5 for hospital management. CONCLUSION: The efficiency indicators agreed upon could contribute to the sustainability of the health system without this affecting the quality of care.
Subject(s)
National Health Programs , Program Evaluation , Quality Assurance, Health Care , Quality Indicators, Health Care , Cesarean Section/statistics & numerical data , Drug Utilization , Health Care Costs , Hospitalization/statistics & numerical data , Hospitals, Public/standards , Humans , Patient Readmission/statistics & numerical data , Primary Health Care/standards , Qualitative Research , Spain , Surveys and QuestionnairesABSTRACT
Objetivo. Identificar un conjunto mínimo de indicadores de eficiencia que puedan ser calculados a partir de las fuentes de información actuales a partir de los cuales puedan adoptarse medidas que contribuyan a la sostenibilidad de los servicios de salud. Método. Grupos de discusión con participación de 23 coordinadores de calidad de centros e institucionales sanitarias de todo el país y los representantes de las sociedades autonómicas de calidad en Sociedad Española de Calidad Asistencial (SECA). Resultados. Se identificaron y priorizaron por consenso 10 indicadores de eficiencia útiles para áreas integradas de gestión, 5 en el ámbito de la atención primaria y 5 en el ámbito de la gestión hospitalaria. Conclusión. Los indicadores de eficiencia consensuados pueden contribuir a la sostenibilidad del sistema de salud sin por ello mermar la calidad de la atención prestada (AU)
Objective. Identifying a minimum set of efficiency indicators calculated from current information sources. Interventions adopted from the analysis of these indicators could contribute to health services sustainability. Method. We applied the discussion group technique. A total of 23 quality coordinators from around the country and the representatives of the regional quality societies in SECA (Spanish Society for Quality in Healthcare) participated. Results. Ten efficiency indicators useful for integrated management areas were identified and accepted, 5 in the area of primary care and 5 for hospital management. Conclusion. The efficiency indicators agreed upon could contribute to the sustainability of the health system without this affecting the quality of care (AU)
