ABSTRACT
BACKGROUND: Medical non-compliance has been identified as a major public health problem in the treatment of hypertension. There is a large research record focusing on the understanding of this phenomenon. However, to date, the majority of studies in this field have been focused from the medical care perspective, but few studies have focused on the patients' point of view. OBJECTIVE: Our aim was to identify factors related to non-compliance with the treatment of patients with hypertension. METHODS: We use a qualitative study in which data were gathered from seven focus group discussions conducted in March-May 2001. Patients were identified as non-compliant, using the Morisky-Green test, at two primary health care centres of the Spanish National Health Service. RESULTS: A complex web of factors was identified that influenced non-compliance. Patients had fears and negative images of antihypertensive drugs. The data also revealed a lack of basic background knowledge about hypertension. The clinical encounter was viewed as unsatisfactory because of its length, few explanations given by the physician and low physician-patient interaction. CONCLUSIONS: Most of the factors related to poor compliance have implications for patient management. Knowing patients' priorities regarding the most important aspects of care that have high potential for low compliance may be helpful in improvement of the quality of hypertensive patient care.
Subject(s)
Health Knowledge, Attitudes, Practice , Hypertension/drug therapy , Treatment Refusal/statistics & numerical data , Adolescent , Adult , Aged , Aged, 80 and over , Antihypertensive Agents/therapeutic use , Focus Groups , Humans , Middle Aged , Patient Education as Topic/statistics & numerical data , Patient Participation/statistics & numerical data , Patient Satisfaction/statistics & numerical data , Physician-Patient Relations , Qualitative Research , SpainABSTRACT
OBJECTIVES: To assess the reliability and validity of existing clinical guidelines on neck-pain physiotherapy treatment and follow-up in Spain. DESIGN: We identified existing guidelines through a nationwide census and listed their recommendations, grouped according to the main steps of the process flow-chart. To assess reliability we analysed the variability of statements. To analyse validity we assessed the type of scientific evidence supporting the recommendations, and we compared them with a list of evidence-based recommendations that was elaborated for this study. SETTING AND PARTICIPANTS: Primary health care centres (n = 24) with guidelines for neck-pain treatment and follow-up. MAIN OUTCOME MEASURES: We quantified the number of recommendations, the proportion of valid statements, the frequencies of non-evidence-based recommendations, and the absence of the evidence-based recommendations we had identified. RESULTS: The 34 identified guidelines contained 325 recommendations, with great variation between guidelines with respect to the number, type (for up to 26 different clinical decisions), and content of the recommendations they provided. Direct assessment of the scientific evidence was not possible because no specific reference was given to support any recommendation. When compared with our list, only 20.9% of the recommendations could be considered evidence-based. No guideline contained all the eight evidence-based recommendations we identified. CONCLUSIONS: The results question the guidelines' reliability and validity, and their usefulness in ensuring quality. We conclude that guidelines should be reviewed and re-designed with greater scientific rigour.
Subject(s)
Evidence-Based Medicine , Neck Pain/rehabilitation , Pain Clinics/standards , Physical Therapy Modalities/standards , Practice Guidelines as Topic/standards , Primary Health Care/standards , Continuity of Patient Care/standards , Decision Making , Follow-Up Studies , Humans , Office Visits , Outcome and Process Assessment, Health Care , Patient Education as Topic/standards , Physical Therapy Modalities/statistics & numerical dataABSTRACT
Objetivo: Determinar la calidad estructural de los protocolos de enfermería en el ámbito de la atención primaria de salud de la región de Murcia y analizar los factores asociados. Diseño: Evaluación retrospectiva. Emplazamiento: Centros de salud de la región de Murcia. Pacientes u otros participantes: Conjunto de protocolos accesibles de enfermería elaborados entre 1985 y 1993 (147 en total).Mediciones y resultados principales: se evalúa el grado de cumplimiento de 9 criterios de calidad estructural que han sido definidos a partir del esquema propuesto por el Institute of Medicine. Aproximadamente la mitad de los documentos evaluados no se ajusta al concepto de protocolo y ninguno reúne de forma simultánea todos los requisitos evaluados. De hecho, solamente 2 criterios se cumplen en más del 60 por ciento de los protocolos. Además, la observancia es inferior al 25 por ciento en 4 criterios (C3: "existencia de un mecanismo de evaluación"; C4: "incluye algún algoritmo"; C7: "incluye un índice paginado", y C9: "adjunta las referencias bibliográficas"). Por otra parte, la calidad es ligeramente superior en los protocolos de actividades preventivas y en los que se refieren a la mujer. Sin embargo, los que forman parte de un programa de salud o los que están acreditados presentan más defectos de calidad. Conclusiones: Existe un amplio margen de mejora en la calidad estructural de los protocolos de enfermería. La elaboración de estas herramientas requiere del seguimiento y aplicación de esquemas de referencia o de "protocolos de diseño de los protocolos clínicos" para prevenir los numerosos defectos estructurales que se pueden producir (AU)
