Cross-cultural adaptation and psychometric validation of a Spanish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire.

OBJECTIVES: Successful deprescribing depends largely on factors related to the patient. The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was developed with the objective of evaluating the beliefs and attitudes of older adults and caregivers towards deprescribing. The present study was designed to validate a Spanish version of the rPATD questionnaire, both the versions for older adults and for caregivers, through a qualitative validation phase and the analysis of its psychometric properties. DESIGN: Cross-sectional validation study. SETTING: Primary care settings in Málaga (Spain). PARTICIPANTS: A sample of 120 subjects (60 patients with polypharmacy and 60 caregivers of patients with polypharmacy) were enrolled in the study. MAIN OUTCOME MEASURES: In the qualitative validation stage, the rPATD questionnaire was translated/back-translated and subjected to a cross-cultural adaptation to evaluate its face validity and feasibility. Next, its psychometric properties were assessed. Confirmatory factor analysis was used to evaluate construct validity. Internal consistency was determined using Cronbach's alpha test. Criterion validity through pre-established hypotheses from the Beliefs about Medicines Questionnaire (BMQ) Specific-Concerns Scale, and test-retest reliability were analysed. RESULTS: Confirmatory factor analysis verified the four-factor structure of the original rPATD questionnaire, with items loading into four factors: involvement, burden, appropriateness and concerns about stopping. The Cronbach's alpha coefficient of the factors ranged from 0.683 to 0.879. The burden, appropriateness and concerns about stopping factors were significantly correlated with the BMQ Specific-Concerns Score, except for the concerns about stopping factor in the older adults' version. The consistency of the items between administration times (test-retest reliability) showed weighted Cohen's kappa values ranging from moderate (>0.4) to very good (>0.8). CONCLUSIONS: The Spanish version of the rPATD questionnaire is a feasible, valid and reliable instrument to evaluate attitudes towards deprescribing in Spanish-speaking patients and caregivers.

[Validation into Spanish of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire to assess patients' attitudes towards deprescribing. Research protocol]. / Validación al castellano del cuestionario revised Patients' Attitudes Towards Deprescribing (rPATD) para evaluar las actitudes de los pacientes hacia la deprescripción. Protocolo de investigación.

INTRODUCTION AND OBJECTIVE: Polypharmacy has become a priority public health problem in developed countries. In response to its approach, deprescription stands out. Its success will depend largely on the attitudes and beliefs of patients towards the number of drugs they are taking and their willingness to initiate a process of deprescription. To explore these factors, researchers have developed the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire, originally in English. The objective of this study is the validation into Spanish of rPATD questionnaire, both older adults and caregivers versions. MATERIAL AND METHODS: A first qualitative validation phase and a second phase of analysis of its psychometric characteristics will be carried out through an observational descriptive study of validation of a measurement instrument. One hundred and twenty subjects (polymedicated older adults and caregivers) from three health centers will be selected by consecutive sampling. The questionnaire will be provided and clinical and sociodemographic data will be collected. Feasibility, reliability (through internal consistency and intraobserver reliability) and validity (apparent, construct and criterion) of the questionnaire will be evaluated. EXPECTED RESULTS: It is expected to obtain a questionnaire that will serve as a tool for the clinician to identify patients with a favorable predisposition to deprescription and that will allow to contribute the patient's perspective to this process. CONCLUSION: The use of the rPATD questionnaire, alone or integrated into other more complex interventions, may lead to an improvement in the quality of care for the polymedicated patients.

[Content of official addressed to women informative documents about breast cancer screening in Spain]. / Contenido de los documentos informativos dirigidos a las mujeres sobre el cribado de cáncer de mama en España.

OBJECTIVE: There are several methods to promote informed decision making before undergoing a screening program. This research aimed to analyze the contents of official documents about breast cancer screening programs. METHODS: A descriptive research was performed. After a literature review an agreed checklist was performed with the information needed to make decisions about participation in mammography screening programs. Informative documents about mammography screening valid in Spain in 2016 were analyzed by two independent researchers. The inter-rater agreement was verified and the discrepancies were solved by consensus. Absolute and relative frequencies of each item were calculated. RESULTS: 8 invitations and 14 citation letters, 12 leaflets, 8 brochures and 14 websites, from 18 screening programs, were reviewed. The information turned out to be very different according to each program. Only a third warned that participation is voluntary. 8 programs (44.4%) offered information on what is breast cancer and 7 (38.9%) on the cumulative risk of developing the disease. 15 (83.3%) explained the objectives of the program and 14 (77.8%) explained what mammography is. 14 programs (77.8%) presented as screening benefits the least invasive treatments, 12 the increase in survival (66.7%) and 10 the decrease in specific mortality (55.6%). Most of the programs did not report the possibility of false positives (27.8%) or false negatives (38.9%). Only 7 (38.9%) mentioned the possibility of overdiagnosis and 6 (33.3%) of overtreatment. CONCLUSIONS: The information provided by the different breast cancer screening programs is variable and does not contain sufficient information for informed decision-making.

OBJETIVO: Existen diversos métodos para facilitar la toma de decisiones informada antes de acudir a un programa de cribado. El objetivo de este trabajo fue analizar la información de los documentos oficiales sobre los programas de cribado de cáncer de mama (PCCM). METODOS: Estudio descriptivo. Análisis del contenido de los documentos informativos de los PCCM vigentes en España en 2016. Se elaboró una lista de comprobación con la información necesaria para la toma de decisiones. Dos investigadores revisaron independientemente los documentos. Se comprobó la concordancia interinvestigador y se resolvieron por consenso las discrepancias. Se calcularon las frecuencias absolutas y relativas de cada ítem. RESULTADOS: Se revisaron 8 cartas de invitación a participar y 14 de citación, 12 dípticos o trípticos, 8 folletos y 14 webs, procedentes de 18 PCCM. La información resultó ser muy dispar según cada programa. 8 programas (44,4%) informaban sobre qué es el cáncer de mama y 7 (38,9%) sobre el riesgo acumulado de desarrollarlo. 15 (83,3%) explicaban los objetivos del PCCM y 14 (77,8%) en qué consiste una mamografía. 14 programas (77,8%) presentaban como beneficios el cribado los tratamientos menos invasivos, 12 el aumento de la supervivencia (66,7%) y 10 la disminución de la mortalidad específica (55,6%). La mayoría de los programas no informaban sobre la posibilidad de falsos positivos (27,8%) o falsos negativos (38,9%). Sólo 7 (38,9%) mencionaban la posibilidad de sobrediagnóstico y 6 (33,3%) de sobretratamiento. CONCLUSIONES: La información que facilitan los diferentes PCCM es variable y no contiene información suficiente para la toma de decisiones informada.

Contenido de los documentos informativos dirigidos a las mujeres sobre el cribado de cáncer de mama en España / Content of official addressed to women informative documents about breast cancer screening in Spain

Fundamentos: Existen diversos métodos para facilitar la toma de decisiones informada antes de acudir a un programa de cribado. El objetivo de este trabajo fue analizar la información de los documentos oficiales sobre los programas de cribado de cáncer de mama (PCCM). Métodos: Estudio descriptivo. Análisis del contenido de los documentos informativos de los PCCM vigentes en España en 2016. Se elaboró una lista de comprobación con la información necesaria para la toma de decisiones. Dos investigadores revisaron independientemente los documentos. Se comprobó la concordancia interinvestigador y se resolvieron por consenso las discrepancias. Se calcularon las frecuencias absolutas y relativas de cada ítem. Resultados: Se revisaron 8 cartas de invitación a participar y 14 de citación, 12 dípticos o trípticos, 8 folletos y 14 webs, procedentes de 18 PCCM. La información resultó ser muy dispar según cada programa. 8 programas (44,4%) informaban sobre qué es el cáncer de mama y 7 (38,9%) sobre el riesgo acumulado de desarrollarlo. 15 (83,3%) explicaban los objetivos del PCCM y 14 (77,8%) en qué consiste una mamografía. 14 programas (77,8%) presentaban como beneficios el cribado los tratamientos menos invasivos, 12 el aumento de la supervivencia (66,7%) y 10 la disminución de la mortalidad específica (55,6%). La mayoría de los programas no informaban sobre la posibilidad de falsos positivos (27,8%) o falsos negativos (38,9%). Sólo 7 (38,9%) mencionaban la posibilidad de sobrediagnóstico y 6 (33,3%) de sobretratamiento. Conclusiones: La información que facilitan los diferentes PCCM es variable y no contiene información suficiente para la toma de decisiones informada

Background: There are several methods to promote informed decision making before undergoing a screening program. This research aimed to analyze the contents of official documents about breast cancer screening programs. Methods: A descriptive research was performed. After a literature review an agreed checklist was performed with the information needed to make decisions about participation in mammography screening programs. Informative documents about mammography screening valid in Spain in 2016 were analyzed by two independent researchers. The inter-rater agreement was verified and the discrepancies were solved by consensus. Absolute and relative frequencies of each item were calculated. Results: 8 invitations and 14 citation letters, 12 leaflets, 8 brochures and 14 websites, from 18 screening programs, were reviewed. The information turned out to be very different according to each program. Only a third warned that participation is voluntary. 8 programs (44.4%) offered information on what is breast cancer and 7 (38.9%) on the cumulative risk of developing the disease. 15 (83.3%) explained the objectives of the program and 14 (77.8%) explained what mammography is. 14 programs (77.8%) presented as screening benefits the least invasive treatments, 12 the increase in survival (66.7%) and 10 the decrease in specific mortality (55.6%). Most of the programs did not report the possibility of false positives (27.8%) or false negatives (38.9%). Only 7 (38.9%) mentioned the possibility of overdiagnosis and 6 (33.3%) of overtreatment. Conclusions: The information provided by the different breast cancer screening programs is variable and does not contain sufficient information for informed decision-making

Prescripción prudente y deprescripción de fármacos como herramientas para la prevención cuaternaria / Prudent prescribing and deprescribing drugs as tools for quaternary prevention / Prescrição prudente e desprescrição de fármacos como ferramentas para a prevenção quaternária / Prudent prescribing and deprescribing drugs as tools for quaternary prevention

Las consecuencias de una medicación inadecuada son diversas y con gran repercusión a nivel clínico: desde efectos adversos e interacciones medicamentosas a fracturas por caídas y aumento de morbi-mortalidad. Para evitar o mejorar dichas consecuencias, así como para abordar sus causas y con la seguridad del paciente en mente, nace la deprescripción para conseguir una prescripción más segura, más prudente y más humana. La atención primaria se sitúa en un lugar privilegiado para hacer frente a este reto que debería formar parte de cualquier estrategia de prevención cuaternaria.

As consequências de uma medicação inadequada são diversas e com grande repercussão clínica: desde efeitos adversos e interações medicamentosas até fraturas por quedas e aumento da morbidade e mortalidade. Para se evitar ou amenizar essas consequências, bem como abordar as suas causas, levando-se em conta a segurança dos pacientes, surge a desprescrição para se obter uma prescrição mais segura, mais prudente e mais humana. A atenção primária está em uma posição privilegiada para enfrentar o desafio da desprescrição e esta deveria fazer parte de qualquer estratégia de prevenção quaternária.

The consequences of inappropriate medication are diverse and have great clinical impact: from adverse effects and medication interactions to fractures from falls and increased morbidity and mortality. To avoid or ameliorate such consequences, as well as to address its causes, bearing in mind patients' safety, deprescription has emerged as a safer, more prudent and humane practice. Primary care is in a privileged position to address this challenge of deprescription and it should be part of any strategy of quaternary prevention.

Ancianos frágiles polimedicados: ¿es la deprescripción de medicamentos la salida? / Polypharmacy in frail elderly patients: is deprescribing the answer?

La deprescripción es el proceso de desmontaje de la prescripción de medicamentos por medio de su revisión, que concluye con la modificación de dosis, sustitución o eliminación de unos fármacos y adición de otros. Su desarrollo pretende resolver tensiones y contradicciones entre 2 pares de interrogantes: 1) ¿es la expectativa de vida menor que el tiempo que tarda el medicamento en obtener beneficios?, y 2) ¿ son congruentes las metas de la atención sanitaria con los objetivos de la prescripción-deprescripción? La validez de la deprescripción está fundamentada en argumentos científicos y éticos. Desconocemos la utilidad y seguridad de muchos medicamentos que siguen los ancianos frágiles o enfermos terminales; otros producen efectos adversos molestos o graves. Por tanto, en determinadas ocasiones su retirada pudiera estar justificada, siendo de una manera sustancial seguro hacerlo(AU)

Deprescribing is the process of reconstructing multiple medication use by review and analysis and which concludes with dose modification, replacement or elimination of some drugs or adding others. Its development is intended to resolve tensions and contradictions between two sets of questions: 1/is life expectancy shorter than the time the drug takes to obtain a benefit?, and 2/are the goals of prescribingdeprescribing consistent with those of care? The validity of the rationale on deprescribing is based on scientific and ethical reasons. The usefulness and safety of many drugs that frail elderly or terminally ill takes is unknown, and other drugs may cause troublesome or severe side effects. Thus, in some cases their removal could be justified, being substantially safe doing so(AU)

Opiniones de los médicos de familia acerca de la implicación de los pacientes en la toma de decisiones: un estudio con grupos focales / Opinions of Family Doctor son the involvement of patients in the taking of decisions: a study with focus groups

Objetivo: Conocer qué opinan los médicos de familia de nuestro entorno sobre distintos aspectos relacionados con la implicación de los pacientes en la toma de decisiones clínicas en atención primaria. Diseño: Estudio cualitativo mediante grupos focales. Emplazamiento: Atención primaria. Participantes: Médicos de familia expertos y no expertos en comunicación clínica. Métodos: Se formaron 3 grupos focales de 6-8 profesionales que participaron en 2 reuniones. Las conversaciones fueron registradas y transcritas literalmente. El discurso se analizó sobre categorías basadas en la bibliografía y otras emergentes del texto, codificando la información y realizando una interpretación inductiva. Resultados: Los médicos de familia refieren mayoritariamente que implicarían al paciente en las decisiones proponiéndole un plan adaptado al conocimiento que de él y su problema tienen y posteriormente comprobando su aprobación o rechazo. Sin embargo, algunos profesionales reflexionan si esto podría ser calificado como implicación del paciente, cuestionando el protagonismo real que adoptarían ambos actores a la hora de decidir. Conclusiones: La explicación de los médicos de familia sobre cómo involucrarían al paciente en las decisiones se enfrenta a las teorías más divulgadas sobre el tema e, igualmente, se opone a la visión de los pacientes, que desearían ser involucrados más activamente. Observando algunas reflexiones disonantes sobre la pertinencia de considerar el proceso así expuesto como verdadera implicación del paciente, se hace necesario describir para nuestro medio un modelo teórico realista que permita desarrollar posteriormente estrategias para mejorar la actitud y formación de los profesionales hacia la implicación del paciente en las decisiones clínicas(AU)

Objective: To determine what family doctors think about various aspects of patient involvement in clinical decision making in Primary Care. Design: Qualitative study using focus groups. Location: Primary Care. Participants: Family physicians with and without expertise in clinical communication. Methods: Three focus groups were developed, involving 6-8 professionals per group, and took part in two meetings. The conversations were recorded and transcribed verbatim. The discussion was analysed using literature-based categories and other emerging from the text, encoding the information and making an inductive interpretation. Results: Family physicians refer mainly to involving the patient in decisions by proposing a plan tailored to the knowledge of patient problems and then verifying their approval or rejection. However, some professionals ponder whether this could be classified as patient involvement, questioning the real role that both players would take at the time of deciding. Conclusions: The explanation of how family physicians would involve the patient in decisions clashes with the most widespread theories on the subject and, also opposes the view of patients who would like to be involved more actively. Taking into account discordant reflections on the relevance of considering this process as real patient involvement, it is necessary to describe a realistic theoretical model that allows further development of strategies to improve the attitude and training of professionals to patient involvement in clinical decisions(AU)

[Polypharmacy in frail elderly patients: is deprescribing the answer?]. / Ancianos frágiles polimedicados: ¿es la deprescripción de medicamentos la salida?

Deprescribing is the process of reconstructing multiple medication use by review and analysis and which concludes with dose modification, replacement or elimination of some drugs or adding others. Its development is intended to resolve tensions and contradictions between two sets of questions: 1/is life expectancy shorter than the time the drug takes to obtain a benefit?, and 2/are the goals of prescribing-deprescribing consistent with those of care? The validity of the rationale on deprescribing is based on scientific and ethical reasons. The usefulness and safety of many drugs that frail elderly or terminally ill takes is unknown, and other drugs may cause troublesome or severe side effects. Thus, in some cases their removal could be justified, being substantially safe doing so.

[Opinions of family doctors on the involvement of patients in the taking of decisions: a study with focus groups]. / Opiniones de los médicos de familia acerca de la implicación de los pacientes en la toma de decisiones: un estudio con grupos focales.

OBJECTIVE: To determine what family doctors think about various aspects of patient involvement in clinical decision making in Primary Care. DESIGN: Qualitative study using focus groups. LOCATION: Primary Care. PARTICIPANTS: Family physicians with and without expertise in clinical communication. METHODS: Three focus groups were developed, involving 6-8 professionals per group, and took part in two meetings. The conversations were recorded and transcribed verbatim. The discussion was analysed using literature-based categories and other emerging from the text, encoding the information and making an inductive interpretation. RESULTS: Family physicians refer mainly to involving the patient in decisions by proposing a plan tailored to the knowledge of patient problems and then verifying their approval or rejection. However, some professionals ponder whether this could be classified as patient involvement, questioning the real role that both players would take at the time of deciding. CONCLUSIONS: The explanation of how family physicians would involve the patient in decisions clashes with the most widespread theories on the subject and, also opposes the view of patients who would like to be involved more actively. Taking into account discordant reflections on the relevance of considering this process as real patient involvement, it is necessary to describe a realistic theoretical model that allows further development of strategies to improve the attitude and training of professionals to patient involvement in clinical decisions.

[Research in primary care as an area of knowledge. SESPAS Report 2012]. / La investigación en atención primaria como área de conocimiento. Informe SESPAS 2012.

Primary care offers huge potential for research. This setting is an area of knowledge that must expand to improve the quality of its services and patients' health. Population-based clinical studies with a focus on health promotion and primary, secondary and tertiary disease prevention offer unique research opportunities. Developing research in the biopsychosocial model of clinical practice and new models of integrated healthcare and community care is therefore a priority. The framework and activities carried out by the Research Network in Preventive Activities and Health Promotion have been instrumental in the development of research in primary care in Spain. Despite the efforts invested by various institutions, foundations, teaching and research departments in primary care research, the projected outputs in terms of volume, quality and impact have not been achieved. The involvement of primary care professionals in research platforms is insufficient, with scarce contribution toward investment in specific primary care research projects. To change the current status of research in primary care, a number of measures are required, namely, the consolidation of research organisms specific to primary care with adequate allocation of funding and staff, and the allocation of specific time for research to primary care professionals to enable them to produce significant projects and consolidate established research lines in their areas of expertise, with applications mainly in quality improvement and innovation of primary care services.

Grado de implementación de actividades preventivas por parte de los médicos residentes de Medicina Familiar y Comunitaria en las consultas de Atención Primaria / Implementation of preventive activities by family and community medicine residents in primary care clinics

ObjetivoDeterminar el grado en que los médicos residentes de medicina familiar y comunitaria realizan actividades preventivas durante su estancia en el centro de salud, así como estimar el tiempo empleado en llevarlas a cabo.DiseñoEstudio observacional, descriptivo y transversal.EmplazamientoCentros de salud docentes de los distritos de atención primaria de Córdoba (centro) y Guadalquivir.ParticipantesCuarenta médicos residentes y 384 entrevistas clínicas realizadas con pacientes que acuden a la consulta.Mediciones principalesTres médicos residentes videograban y visualizan las consultas que registran las actividades preventivas efectuadas según las recomendaciones del Programa de Actividades Preventivas y de Promoción de la Salud del año 2005 y el tiempo empleado en cada entrevista en llevar a cabo estas actividades.ResultadosEn el 72,1% de las consultas (IC del 95%: de 67,6 a 76,5) no se realiza ninguna actividad preventiva. Las actividades más frecuentes son las de prevención secundaria (70,1%), destaca en primer lugar la toma de la presión arterial (8,1%). El tiempo medio por consulta en aquéllas en las que no se realizan actividades preventivas es de 5,6min (DE=3,1), mientras que en las que sí se realizan es de 7,04 (DE=3,05) (p<0,0001).ConclusionesLa realización de actividades preventivas por parte de los médicos residentes en las consultas de atención primaria es muy escasa. Una consulta que incluya actividades preventivas requiere de un tiempo significativamente mayor que una que no las incluya(AU)

ObjectiveTo determine the level of preventive activities carried out by Family and Community Medicine medical residents during their stay in the Health Centre, as well as to estimate the time involved in carrying them out.DesignCross-sectional, descriptive, observational study.SettingTeaching Health Centres in the Central- Cordoba and Guadalquivir Primary Care Districts.ParticipantsForty medical residents and 384 clinical interviews with patients who were seen at the clinic.Main measurementsThe consultations were video recorded and looked at by three medical residents who recorded the preventive activities carried out according to the 2005 PAPPS (Health Promotion and Disease Prevention Activities) recommendations, as well as the time employed in performing these activities.ResultsNo preventive activities were performed in 72.1% (95% CI: 67.6 to 76.5%) of the consultations. The most frequent activities were secondary prevention (70.1%), mainly the taking of blood pressure (8.1%). The mean consultation time when there were no preventive activities carried out was 5.6min (SD=3.1), whilst in those that did perform them it was 7.04min (SD=3.05) (P<0.0001).ConclusionsThe performing of preventive activities by medical residents in Primary Care clinics is very limited. A consultation that includes preventive activities requires a significantly longer time than in those that do not include them(AU)

Participación del paciente en la toma de decisiones en atención primaria: una herramienta para su medición / Patient involvement in decision making in primary care clinics: Development of a measuring tool

ObjetivosExplorar el involucramiento de los pacientes en la toma de decisiones (IPTD) que hacen médicos de familia españoles y describir el desarrollo de un instrumento para su valoración.DiseñoDescriptivo, desarrollo de un instrumento de medida.EmplazamientoConsultas de atención primaria.ParticipantesMédicos y residentes de familia.IntervencionesRevisión de la literatura médica sobre el tema y opiniones de médicos, selección de ítems de una escala previa utilizada para medir capacidades comunicativas genéricas (CICAA-CP), inclusión de otros específicos del proceso de participación.Mediciones principalesEl IPTD se valoró en 31 entrevistas con este primer instrumento, tras lo cual se reformuló la escala. Posteriormente se completó el proceso con un pool de 161 entrevistas. Se estimaron algunas propiedades psicométricas (fiabilidad y consistencia interna) en diferentes muestras y estadios del proceso.ResultadosEn 31 encuentros se encontró algún grado de participación del paciente. A pesar de eso, en sólo 18 de estos encuentros (58%) hubo discusión sobre más de una opción de tratamiento. Los valores κ de Cohen de la escala CICAA-Decisión estuvieron entre 0,48 y 0,94. El α de Cronbach fue de 0,60/0,51. El coeficiente de correlación intraclase global fue de 0,96.ConclusionesLos niveles de participación de los pacientes en las consultas de atención primaria pueden considerarse bajos. Una simple pregunta como la definida en un ítem y la escala CICAA-Decisión, en general podría ser útil para valorar el IPTD en estas consultas(AU)

ObjectivesThis work aims to explore to what extent Spanish primary care providers involve patients in decisions and describe the development of a suggested tool for assessing patient involvement in these settings.DesignCross-sectional, development of a measurement tool.SettingPrimary care clinics.ParticipantsFamily doctors and residents.InterventionsBased on a review of the literature and the opinions of primary care doctors, a selection was made of items from a previous scale used to measure general communication skills (CICAA-Patient Centred) and new specific items were added to this to measure involvement.Main measurementsThe involvement of patients in decision-making was evaluated initially with this tool in 31 different clinical visits and the scale was then reformulated. A pool of 161 interviews was used to complete the process. Some psychometric properties (reliability and internal consistency) were estimated for the different samples and stages of the process.ResultsSome degree of patient involvement was found in just 31 visits. Despite this, only in 18 of these (58%) was there some involvement in a discussion about more than one treatment option. The Cohen's kappa values of the CICAA-Decision scale were between 0.48 and 0.94. Cronbach's alpha was 0.60/0.51. The global Intra-class correlation coefficient was 0.96.ConclusionsThe levels of patient involvement were lower than expected. A simple question, such as that defined by one item in particular, and the CICAA-D scale, in general, could be useful to assess patient involvement in decision making in primary care(AU)

Valoración de la relación clínica centrada en el paciente: análisis de las propiedades psicométricas de la escala CICAA / Evaluation of the patient centered clinical relationship: analysis of psychometric properties using the CICAA scale

Objetivo: Analizar las propiedades psicométricas de una escala de valoración de la comunicación clínica centrada en el paciente. Diseño: Estudio observacional de validación de un instrumento de medida. Emplazamiento: Centros de salud y consultas externas hospitalarias. Participantes: Tres investigadores valoraron independientemente entrevistas videograbadas de diferentes submuestras: profesionales sanitarios (médicos residentes de medicina de familia, médicos de familia, médicos de atención especializada, enfermeras de atención primaria), pacientes reales que consultan por problemas de salud crónicos y agudos, y pacientes estandarizados. Mediciones principales: Dimensionalidad (análisis factorial exploratorio), consistencia interna (alfa de Cronbach), concordancia intraobservador e interobservador (índice kappa, coeficiente de correlación intraclase [CCI] y generalizabilidad), sensibilidad al cambio (prueba de la t de Student) y validez convergente con el cuestionario GATHA (coeficiente de correlación de Pearson). Resultados: Se han identificado 6 factores que explican el 66,0% de la varianza. La consistencia interna global del test fue α=0,94. La concordancia global intraobservador, medida con el CCI, osciló entre 0,94 y 0,97, mientras que la concordancia global interobservador estuvo entre 0,82 y 0,90. El número de cuestionarios a cumplimentar por evaluador para obtener una reproducibilidad adecuada (generalizabilidad) osciló entre 6 y 12. No se alcanzó significación estadística al comprobar la sensibilidad al cambio. La escala CICAA y el cuestionario GATHA presentaron una correlación de 0,67.ConclusionesLa escala CICAA es una herramienta genérica de valoración de la comunicación clínica centrada en el paciente que puede utilizarse en diferentes contextos y situaciones clínicas, ya que demuestra ser fiable, válida y eficiente (AU)

Objective: To analyse the psychometric properties by a scale for evaluating patient centered clinical communication. Design: Validation and observational study of a measurement tool.SettingHealth centres and hospital outpatient clinics.ParticipantsThree researchers independently evaluated video recorded interviews of different sub-samples: health professionals (family medicine medical residents, family doctors, specialist care physicians, and primary care nurses), actual patients who consulted for chronic or acute health problems, and standardised patients. Primary measurements Dimensionality (exploratory factor analysis), internal consistency (alpha de Cronbach), intra- and inter-observer agreement (Kappa index, intraclass correlation coefficient [ICC], generalisability), sensitivity to change (Student t test) and convergent validity with the GATHA questionnaire (Pearson correlation coefficient). Results: Six factors have been identified that explain 66.0% of the variance. The overall internal consistency of the test was α=0.94. The overall intra-observer agreement, measured with the ICC, varied between 0.94 and 0.97, whilst the inter-observer was between 0.82–0.90. The number of completed questionnaires required for the evaluator to obtain adequate reproducibility (generalisability) varied between 6 and 12. Statistical significance was not obtained when testing the sensitivity to change. The CICAA scale and the GATHA questionnaire had a correlation of 0.67.ConclusionsThe CICAA scale is a generic patient centered clinical communication evaluation tool that may be used in different clinical contexts and situations, since it has shown to be reliable, valid and efficient (AU)

[Patient involvement in decision making in primary care clinics: development of a measuring tool]. / Participación del paciente en la toma de decisiones en atención primaria: una herramienta para su medición.

OBJECTIVES: This work aims to explore to what extent Spanish primary care providers involve patients in decisions and describe the development of a suggested tool for assessing patient involvement in these settings. DESIGN: Cross-sectional, development of a measurement tool. SETTING: Primary care clinics. PARTICIPANTS: Family doctors and residents. INTERVENTIONS: Based on a review of the literature and the opinions of primary care doctors, a selection was made of items from a previous scale used to measure general communication skills (CICAA-Patient Centred) and new specific items were added to this to measure involvement. MAIN MEASUREMENTS: The involvement of patients in decision-making was evaluated initially with this tool in 31 different clinical visits and the scale was then reformulated. A pool of 161 interviews was used to complete the process. Some psychometric properties (reliability and internal consistency) were estimated for the different samples and stages of the process. RESULTS: Some degree of patient involvement was found in just 31 visits. Despite this, only in 18 of these (58%) was there some involvement in a discussion about more than one treatment option. The Cohen's kappa values of the CICAA-Decision scale were between 0.48 and 0.94. Cronbach's alpha was 0.60/0.51. The global Intra-class correlation coefficient was 0.96. CONCLUSIONS: The levels of patient involvement were lower than expected. A simple question, such as that defined by one item in particular, and the CICAA-D scale, in general, could be useful to assess patient involvement in decision making in primary care.

[Evaluation of the patient centered clinical relationship: analysis of psychometric properties using the CICAA scale]. / Valoración de la relación clínica centrada en el paciente: análisis de las propiedades psicométricas de la escala CICAA.

OBJECTIVE: To analyse the psychometric properties by a scale for evaluating patient centered clinical communication. DESIGN: Validation and observational study of a measurement tool. SETTING: Health centres and hospital outpatient clinics. PARTICIPANTS: Three researchers independently evaluated video recorded interviews of different sub-samples: health professionals (family medicine medical residents, family doctors, specialist care physicians, and primary care nurses), actual patients who consulted for chronic or acute health problems, and standardised patients. PRIMARY MEASUREMENTS: Dimensionality (exploratory factor analysis), internal consistency (alpha de Cronbach), intra- and inter-observer agreement (Kappa index, intraclass correlation coefficient [ICC], generalisability), sensitivity to change (Student t test) and convergent validity with the GATHA questionnaire (Pearson correlation coefficient). RESULTS: Six factors have been identified that explain 66.0% of the variance. The overall internal consistency of the test was alpha=0.94. The overall intra-observer agreement, measured with the ICC, varied between 0.94 and 0.97, whilst the inter-observer was between 0.82-0.90. The number of completed questionnaires required for the evaluator to obtain adequate reproducibility (generalisability) varied between 6 and 12. Statistical significance was not obtained when testing the sensitivity to change. The CICAA scale and the GATHA questionnaire had a correlation of 0.67. CONCLUSIONS: The CICAA scale is a generic patient centered clinical communication evaluation tool that may be used in different clinical contexts and situations, since it has shown to be reliable, valid and efficient.

¿Cuáles son las expectativas de los pacientes cuando acuden a una consulta de atención primaria y qué piensan los médicos sobre ellas? / Which are the patients’ expectations at general practitioner visit and what do doctors known about these?

Objetivos: Conocer qué expectativas valoran más los pacientes cuando acuden a las consultas de atención primaria y la opinión de los médicos de familia sobre ellas. Material y metodo: Estudio observacional, descriptivo. Se estudiaron 2 muestras: a) pacientes seleccionados aleatoriamente de entre los que acudieron a las consultas médicas de 10 centros de salud; antes de entrar a la consulta se pidió a los pacientes que de un listado de 10 expectativas valoraran y priorizaran las más importantes y las menos importantes para esa consulta, y b) a una muestra de médicos de familia se les envió el mismo listado de expectativas para que señalasen y priorizasen aquellas que consideraran eran las más importantes para los pacientes cuando acudían a la consulta. Resultados: Se incluyó a 805 pacientes y 140 médicos. El promedio de expectativas consideradas como importantes por los pacientes para esa consulta fue de 7,7 sobre un total de 10 posibles. Un 99% de los pacientes señalaron 3 o más expectativas. De las 3 expectativas más resaltadas como importantes por médicos y pacientes, éstos coincidieron en 2; la primera fue "ser escuchados". Igualmente, coincidieron con los pacientes en las 2 expectativas menos deseadas: "ser derivados al especialista" y "recibir una prescripción". Los médicos valoraron muy significativamente el deseo de los pacientes de "recibir un diagnóstico" (43%), "consejo" (40%), "derivación" (35%), "prescripción" (25%), "solicitud de una prueba" (17%) y "ser explorados" (15%). Conclusiones: Para los pacientes, las expectativas relacionadas con aspectos comunicativos son las más importantes. En general, los médicos coinciden en esta valoración; sin embargo, sobrestiman los deseos de los pacientes de recibir ciertos servicios relacionados con la atención, como recetas, derivaciones y pruebas complementarias

Aims: To assess patient expectations at general practitioner (GP) visits, and compare them with what GPs think about them. Material and method: Cross sectional study of patients attending GPs consultations. Physicians sample from Andalusia. Before the consultation patients were asked to select, from a list of 10 expectations, the most important they had for that particular visit. They were then asked to prioritise them into the 3 most and least important. Doctors received the list of 10 expectations and were asked to select which expectations they considered as the most important for a patient when consulting; doctors had also to prioritise the 3 most and least important expectations. Results: The study included 805 patients, 140 physicians. Out of the list of ten expectations, patients marked as important for that particular visit an average of 7.7. 797 (99%) patients claimed the important ones for them were three or more, but 207 (30%) were not able to prioritise more than two. When doctors prioritised the most important expectation, within the first three, they coincided with patients in two of them: the first, (listening) and the third (explaining). Similarly, doctors coincided with patients in the two least important expectations: to be referred and to receive a prescription. Out of the list of ten expectations, doctors over-scored significantly the patients wishes for receiving a diagnosis (43%), advice (40%), to be referred (35%), to receive a prescription (25%), a test (17%) and be examined (15%). Conclusions: General expectations as regards physician-patient communication are more important for patients than other more specific ones. Generally, physicians agree with patients in this assessment, but they over-estimated patient wishes of receiving prescriptions, tests or to be referred