ABSTRACT
Las guías de práctica clínica pretenden servir de puente entre los niveles de decisión y las fuentes de conocimiento, ofreciendo a los decisores la mejor síntesis de la evidencia científica y un análisis del contexto, para proporcionar elementos de juicio y poder trasladar el conocimiento científico a la práctica clínica. Sin embargo, su impacto real en la asistencia sanitaria es variable y la efectividad a la hora de cambiar la práctica médica moderada. Estudios cualitativos y cuantitativos nos muestran que para la mayoría de los médicos de atención primaria las guías son una valiosa fuente de asesoramiento y formación, y creen que mejoran la calidad de la atención sanitaria. No obstante, subrayan su rigidez, la dificultad para aplicar a pacientes individuales y que su objetivo es reducir costes sanitarios. En España existen diversas experiencias en la elaboración de guías de práctica clínica, muchas de ellas dirigidas específicamente a atención primaria, siendo destacable el papel que en este sentido está jugando GuíaSalud. Pero la adecuada implementación de una guía de práctica clínica incluye no solamente la calidad y la rigurosidad de las evidencias utilizadas para desarrollarla, sino también la credibilidad de los profesionales y las organizaciones que la elaboran y otros factores contextuales, como características de los pacientes, de los proveedores y de las organizaciones o sistemas. Un importante paso en la investigación futura será desarrollar una mejor comprensión teórica sobre el cambio organizativo que se requiere para que los sistemas de gestión y los profesionales den la orientación adecuada a la implementación de las guías de práctica clínica (AU)
Clinical practice guidelines are intended to serve as a bridge between the decision levels and the sources of knowledge, giving decision makers the best synthesis of scientific evidence and an analysis of context, to provide elements of judgement and to transfer scientific knowledge into clinical practice. However, the actual impact on health care is variable and effectiveness in changing medical practice, moderate. Qualitative and quantitative studies show that most primary care physicians consider that the guides are a valuable source of advice and training and a kind of improving the quality of healthcare. However, they underline its rigidity, the difficulty to apply to individual patients and that their main goal is to reduce healthcare costs. In Spain, there are several experiences as GuíaSalud in developing clinical practice guidelines aimed specifically at primary care. However, the proper implementation of a clinical practice guideline includes not only the quality and thoroughness of the evidence, but the credibility of professionals and organizations and other contextual factors such as characteristics of patients, providers and organizations or systems. An important step in future research is to develop a better theoretical understanding of organizational change that is required for management and professionals to give appropriate guidance to the implementation of the clinical practice guidelines (AU)
Subject(s)
Humans , Practice Patterns, Physicians' , Technology Assessment, Biomedical/trends , Decision Support Systems, Clinical , Primary Health Care/trends , Outcome and Process Assessment, Health Care/trendsABSTRACT
Clinical practice guidelines are intended to serve as a bridge between the decision levels and the sources of knowledge, giving decision makers the best synthesis of scientific evidence and an analysis of context, to provide elements of judgement and to transfer scientific knowledge into clinical practice. However, the actual impact on health care is variable and effectiveness in changing medical practice, moderate. Qualitative and quantitative studies show that most primary care physicians consider that the guides are a valuable source of advice and training and a kind of improving the quality of healthcare. However, they underline its rigidity, the difficulty to apply to individual patients and that their main goal is to reduce healthcare costs. In Spain, there are several experiences as GuíaSalud in developing clinical practice guidelines aimed specifically at primary care. However, the proper implementation of a clinical practice guideline includes not only the quality and thoroughness of the evidence, but the credibility of professionals and organizations and other contextual factors such as characteristics of patients, providers and organizations or systems. An important step in future research is to develop a better theoretical understanding of organizational change that is required for management and professionals to give appropriate guidance to the implementation of the clinical practice guidelines.
Subject(s)
Practice Guidelines as Topic , Primary Health Care/standards , Bias , Forecasting , Guideline Adherence , Health Priorities , Humans , Organizational Innovation , Physician-Patient Relations , Quality Improvement , Spain , Technology Assessment, BiomedicalABSTRACT
BACKGROUND: Clinical practice guidelines (CPGs) have become a very popular tool for decision making in healthcare. While there is some evidence that CPGs improve outcomes, there are numerous factors that influence their acceptability and use by healthcare providers. While evidence of clinicians' knowledge, perceptions and attitudes toward CPGs is extensive, results are still disperse and not conclusive. Our study will evaluate these issues in a large and representative sample of clinicians in Spain. METHODS/DESIGN: A mixed-method design combining qualitative and quantitative research techniques will evaluate general practitioners (GPs) and hospital-based specialists in Spain with the objective of exploring attitudes and perceptions about CPGs and evidence grading systems. The project will consist of two phases: during the first phase, group discussions will be carried out to gain insight into perceptions and attitudes of the participants, and during the second phase, this information will be completed by means of a survey, reaching a greater number of clinicians. We will explore these issues in GPs and hospital-based practitioners, with or without previous experience in guideline development. DISCUSSION: Our study will identify and gain insight into the perceived problems and barriers of Spanish practitioners in relation to guideline knowledge and use. The study will also explore beliefs and attitudes of clinicians towards CPGs and evidence grading systems used to rate the quality of the evidence and the strength of recommendations. Our results will provide guidance to healthcare researchers and healthcare decision makers to improve the use of guidelines in Spain and elsewhere.
Subject(s)
Health Services Research , Medical Staff, Hospital/psychology , Physicians, Family/psychology , Practice Guidelines as Topic , Qualitative Research , Clinical Competence , Clinical Protocols , Diffusion of Innovation , Female , Health Knowledge, Attitudes, Practice , Humans , Male , Medical Staff, Hospital/classification , Medical Staff, Hospital/statistics & numerical data , Physicians, Family/classification , Physicians, Family/statistics & numerical data , Spain , Surveys and QuestionnairesABSTRACT
OBJECTIVES: The aim of this study was to explore the needs and requirements of decision makers in our regional healthcare system for health technology assessment (HTA) products to support portfolio development planning for a new HTA agency in Madrid, Spain. METHODS: A Delphi study was conducted during 2003. Questionnaires were developed based on a review of products and services offered by other agency members of the International Network of Agencies for Health Technology Assessment, and included preference and prioritization questions to evaluate twenty-two different products and services. The initial Delphi panel involved eighty-seven experts from twenty-one public hospitals, eleven primary healthcare centers, six private hospitals, and eight departments of the Regional Ministry of Health of the Community of Madrid. RESULTS: The global participation rate was 83.9 percent. Ten of the twenty-two possible products were rated of high interest by more than 80 percent of respondents. Important differences in preferences and priorities were detected across different settings. Public hospitals and primary healthcare centers shared a more "micro" perspective, preferring classic technology-centered HTA products, whereas private hospitals and Ministry representatives demanded more "macro" products and services such as organizational model and information system assessments. CONCLUSIONS: The high participation rate supports the representativeness of the results for our regional context. The strategic development of an HTA portfolio based on decision makers' needs and requirements as identified in this type of exercise should help achieve a better impact on policy development and decision making.
Subject(s)
Decision Making , Government Agencies , Technology Assessment, Biomedical , Delphi Technique , National Health Programs , Needs Assessment , Spain , Surveys and QuestionnairesABSTRACT
El presente trabajo estudia el papel del estado del contrato psicológico para predecir resultados de salud psicológica en una muestra de 385 empleados de distintas empresas españolas. Los resultados indican que el estado del contrato psicológico predice la satisfacción con la vida, el conflicto trabajo-familia y el bienestar psicológico más allá de la predicción alcanzada por el propio contenido del contrato psicológico, y que la confianza y la justicia, dos de las dimensiones del estado del contrato psicológico, consideradas conjuntamente contribuyen a explicar dichas variables añadiendo valor al rol que como predictor desempeña el cumplimiento del contrato. Estos resultados suponen un apoyo a los planteamientos de Guest y colaboradores
In the present paper the role of the state of the psychological contract to predict psychological health results is studied in a sample of 385 employees of different Spanish companies. Results indicate that the state of the psychological contract significantly predicts life satisfaction, work-family conflict and well-being beyond the prediction produced by the content of the psychological contract. In addition, trust and fairness, two dimensions of the state of psychological contract, all together contribute to explain these psychological health variables adding value to the role as predictor of fulfillment of the psychological contract. The results support the approach argued by Guest and colleagues
Subject(s)
Male , Female , Humans , Mental Status Schedule/statistics & numerical data , Mental Health/statistics & numerical data , 16360 , Job Satisfaction , Trust , Social Justice , Surveys and QuestionnairesABSTRACT
In the present paper the role of the state of the psychological contract to predict psychological health results is studied in a sample of 385 employees of different Spanish companies. Results indicate that the state of the psychological contract significantly predicts life satisfaction, work-family conflict and well-being beyond the prediction produced by the content of the psychological contract. In addition, trust and fairness, two dimensions of the state of psychological contract, all together contribute to explain these psychological health variables adding value to the role as predictor of fulfillment of the psychological contract. The results support the approach argued by Guest and colleagues.
Subject(s)
Contracts , Mental Health , Occupational Health , Work/psychology , Adult , Contracts/ethics , Family , Female , Humans , Industry , Interprofessional Relations , Male , Personal Satisfaction , Social Justice , Spain , TrustABSTRACT
En este trabajo se pretenden estudiar los efectos de la presión temporal sobre la cohesión grupal en grupos que trabajan en la realización de tareas de distinta naturaleza y a través de diversos canales de comunicación. Para ello se llevó a cabo un experimento con 124 sujetos, que fueron distribuidos aleatoriamente en grupos de 4 personas en las seis condiciones creadas (3*2 canal de comunicación*presión temporal). Los resultados muestran la importancia del tipo de tarea y el canal de comunicación para comprender la relación entre presión temporal y cohesión grupal. Concretamente, la presión temporal disminuye la cohesión grupal cuanto mayor es la interdependencia entre los miembros requerida por la tarea, y en condiciones de comunicación cara a cara, pero no en comunicación mediada. Se sugiere que futuros trabajos deberán incluir variables del ambiente o individuales para comprender la relación entre presión temporal y resultados del trabajo en grupo (AU)
The aim of this paper is to study the effects of time pressure on group cohesiveness in different tasks types (creativity, intellective and mixed-motive) and communication media (face-to-face, videoconference and e-mail). It was carried out an experiment using a sample of 124 subjects, randomly assigned into six different experimental conditions (3*2 communication media*time pressure) in four-person work groups. The results showed the relevance of task type and communication media to understand the relation between time pressure and group cohesiveness. Specifically, time pressure influenced negatively on group cohesiveness, when interdependence task requirements were high or middle, and groups worked face-to-face. It is suggested that future research should include other environmental or individual variables to reach a better understanding of the relation between time pressure and group work outcomes (AU)
Subject(s)
Adult , Female , Male , Humans , Task Performance and Analysis , Workload/psychology , Adaptation, Psychological/classification , Group Processes , CommunicationABSTRACT
En el presente trabajo se analiza la evolución que experimenta el significado del trabajo que poseen los jóvenes durante sus primeros tres años de empleo a partir del estudio de sus componentes. La muestra estaba formada por 238 jóvenes de primer empleo pertenecientes a dos grupos ocupacionales (administrativos y trabajadores del metal). Estos jóvenes fueron encuestados en tres momentos a lo largo de un período aproximado de tres años. Los resultados indican que los diferentes componentes del significado del trabajo varían en diferente grado a lo largo del tiempo. La direccción de los resultados apunta que las primeras experiencias de empleo les está afectando negativamente. En general, los resultados suponen un apoyo a la tesis interaccionista en la controversia respecto a la estabilidad de dicho constructo. (AU)
