The irritable bowel syndrome care process from the patients´ and professionals´ views.

BACKGROUND AND PURPOSE OF THE STUDY: This study assessed the experiences of irritable bowel syndrome patients with the healthcare system. Specifically, this study focused on the barriers that patients found. METHODS: Three focus groups were conducted with the participation of 19 patients and 10 healthcare professionals. From this information a script of questions was designed and 33 structured interviews were conducted. Finally, a scale for evaluation of the perception of patients was designed for primary care (14 items) and gastroenterology (13 items). Internal consistency and construct validity were calculated. RESULTS: The difficulties of accessibility, to clarify doubts, concerns regarding uncertainty, reduced information about prognosis and its social and labour effects were the most cited by patients. Low adherence and persistence in the treatment plan were the problems cited most often by professionals. The items of the scale for primary care were grouped into 4 factors (explained variance, 73%), while those for gastroenterology were grouped into 3 factors (explained variance, 67%). The internal consistency was 0.84 and 0.82, respectively. A total of 29 (88%) patients were satisfied with the care provided in gastroenterology, while 24 (73%) declared themselves satisfied with the primary care physician (Chi-square 2.4, p = 0.21). This study was carried out from November 2013 to July 2014. CONCLUSIONS: This study describes the most relevant problems in the assistance received by these patients.

Opiniones sobre el proceso asistencial de los pacientes con síndrome de intestino irritable / No disponible

ANTECEDENTES Y PROPÓSITO DEL ESTUDIO: en este estudio se evaluó la experiencia de los pacientes con síndrome de intestino irritable (SII) con el sistema sanitario analizando específicamente las dificultades con las que se encuentran estos pacientes. Métodos: para identificar cuestiones clave se condujeron 3 grupos focales con participación de 19 pacientes y 10 profesionales sanitarios. A partir de estas informaciones se diseñó un guion de preguntas y se realizaron 33 entrevistas estructuradas a pacientes con SII. El estudio de campo se realizó entre noviembre de 2013 y julio de 2014. Finalmente con esta información se diseñó una escala de valoración de la percepción de los pacientes de las atenciones que reciben en atención primaria (14 ítems) y digestivo (13 ítems), analizando validez de constructo y consistencia interna. Resultados: las dificultades de accesibilidad, para resolver dudas, preocupación derivada de la incertidumbre, reducida información sobre pronóstico y sus afectaciones sociales y laborales fueron las más citadas por los pacientes. Bajo cumplimiento y baja persistencia en el plan terapéutico fueron los problemas citados con mayor frecuencia por los profesionales. Los ítems de la escala para atención primaria confluyeron en 4 factores (varianza explicada, 73%), mientras que para digestivo confluyó en 3 factores (varianza explicada, 67%). La consistencia interna fue de 0,84 y 0,82, respectivamente. Un total de 29 (88%) pacientes se manifestaron satisfechos con la atención prestada en digestivo, mientras 24 (73%) se declararon satisfechos con el médico de atención primaria (Chi Cuadrado 2,4, p = 0,21). Conclusiones: este estudio describe los principales problemas asistenciales desde la perspectiva del paciente

BACKGROUND AND PURPOSE OF THE STUDY: This study assessed the experiences of irritable bowel syndrome patients with the healthcare system. Specifically, this study focused on the barriers that patients found

[Work environment and patient safety: data comparison between Seneca and RN4CAST projects]. / Entorno laboral y seguridad del paciente: comparación de datos entre los estudios SENECA y RN4CAST.

OBJECTIVE: To analyze the relationship between the work environment and burnout of nurses and the quality of care for patient safety at the Spanish National Health System Hospitals included in SENECA and RN4CAST studies. METHOD: Descriptive study with a secondary analysis that compares data of 984 patient records, 1469 patient, and 1886 professional surveys from SENECA project, with 2139 nurses' surveys from RN4CAST study, in 24 hospitals. Adverse events data related to care, and patient's and professional's perception of safety were compared with work environment (measured by the Nursing Work Index) and burnout (measured by Maslach Burnout Inventory). RESULTS: There was a statistically significant relation of pain with «Staffing and resource adequacy¼ (r=-0,435, p=0,03) and nosocomial infection with «Nursing foundations for quality of care¼ (r=-0,424; p=0,04) and «Nurse participation in hospital affairs¼ (r=-0,516, p=0,01) of the Nursing Work Index. The hospital classification obtained from the Nursing Work Index was associated with the patients' perception of safety (r=0,66, p<0,01). Professionals' perception of participation in patient safety issues was associated with the five factors of the Nursing Work Index (r ∈ [|0,41|-|0,78 |], p<0,046) and with Maslach emotional exhaustion (r=-0,518, p=0,01). CONCLUSIONS: The organizations that foster a supportive work environment will have patients that perceive safer care. In addition, proper resource management could decrease the occurrence of adverse events such as pain.

Que hacen y que deben hacer los pacientes diabeticos para evitar errores con el tratamiento ? / What do diabetic patients and what should they do to avoid errors in the course of treatment?

Objetivo: Describir que hacen los pacientes diabeticos para evitar errores con el tratamiento y presentar consejos para incrementar la seguridad. Metodos Estudio descriptivo de conductas de pacientes diabeticos tratados con insulina para minimizar errores y de consejos de los profesionales para mejorar la seguridad. Se reclutaron aleatoriamente 99 pacientes de 3 centros de salud y 2 hospitales. Adicionalmente, se conto con una muestra de oportunidad de 33 medicos y enfermeros. Resultados Informar de todas las prescripciones (p=0,005), revisar dudas antes de la consulta (p=0,009) y el cumplimiento de la dieta (p=0,02) fueron las unicas precauciones informadas por los pacientes que se relacionaron con un menor numero de errores de los propios pacientes. Las mujeres siguen mejor en casa las indicaciones sobre los controles de glucemia (odds ratio 0,07, intervalo de confianza [IC] del 95%: 0,1-0,6) y recurren a pastilleros para evitar errores (odds ratio: 0,23; IC 95%: 0,1-0,6) con mas frecuencia que los hombres. La informacion de alergias es mas frecuente entre varones (odds ratio: 5,03; IC 95%: 1,4-17,5). Los pacientes con un curso mas prolongado tienden a no proporcionar informacion a su medico sobre otros (..) (AU)

Objective: To report the precautions taken by diabetic patients to avoid treatment errors and to provide advice to increase their safety. Methods: A descriptive study of patients' behaviors to minimize errors and tips by professionals to improve safety. Ninety-nine insulin-treated patients were randomly recruited from 3 primary healthcare centers and 2 hospitals. An opportunity sample of 33 doctors and nurses was also surveyed. Results: Information of all prescriptions (p = 0.005),review of doubts before the visit(p = 0,009),and diet adherence (p = 0.02) were the only precautions reported by patients that related to a lower number of patient errors. Female patients better follow at home instructions for blood glucose monitoring (odds ratio 0.07; 95% confidence interval (CI) 0.1-0.6) and use pillboxes to avoid errors (odds ratio 0.23; 95% CI 0.1-0.6) more frequently than male patients. Male patients more commonly carry with them a card with information about allergies (odds ratio 5.03; 95%CI 1.4-17.5). Patients with a longer course of disease tend to withhold information about other treatments from their doctors ( -15.8; 95% CI -23.2-8.4). For healthcare professionals, safety may increase if patients: play a more active role in their treatment (91%), and inform their doctors about their different treatments (88%).Conclusions: Promotion of patient autonomy, improved communication to patients, and systematic information about the most common medication errors may contribute to patient safety (AU)

[What do diabetic patients and what should they do to avoid errors in the course of treatment?]. / ¿Qué hacen y qué deben hacer los pacientes diabéticos para evitar errores con el tratamiento?

OBJECTIVE: To report the precautions taken by diabetic patients to avoid treatment errors and to provide advice to increase their safety. METHODS: A descriptive study of patients' behaviors to minimize errors and tips by professionals to improve safety. Ninety-nine insulin-treated patients were randomly recruited from 3 primary healthcare centers and 2 hospitals. An opportunity sample of 33 doctors and nurses was also surveyed. RESULTS: Information of all prescriptions (p = 0.005), review of doubts before the visit (p = 0,009), and diet adherence (p = 0.02) were the only precautions reported by patients that related to a lower number of patient errors. Female patients better follow at home instructions for blood glucose monitoring (odds ratio 0.07; 95% confidence interval (CI) 0.1-0.6) and use pillboxes to avoid errors (odds ratio 0.23; 95% CI 0.1-0.6) more frequently than male patients. Male patients more commonly carry with them a card with information about allergies (odds ratio 5.03; 95% CI 1.4-17.5). Patients with a longer course of disease tend to withhold information about other treatments from their doctors (ß -15.8; 95% CI -23.2-8.4). For healthcare professionals, safety may increase if patients: play a more active role in their treatment (91%), and inform their doctors about their different treatments (88%). CONCLUSIONS: Promotion of patient autonomy, improved communication to patients, and systematic information about the most common medication errors may contribute to patient safety.

Política sanitaria para la excelencia clínicay cuidados seguros. El proyecto SÉNECA / Healthcare policy for clinical excellence and safety of care. The SENECA project

El Ministerio de Sanidad y Política Social, en su papel de coordinación del SistemaNacional de Salud (SNS), ha puesto en marcha desde el 2006 un Plan de Calidadcon el objetivo de conseguir una práctica clínica basada en el mejor conocimientocientífico disponible.Este plan consta de 12 estrategias y 39 objetivos. Una de las estrategias prioritariases fomentar la excelencia clínica, que incluye el objetivo 8 del plan: mejorarla seguridad de los pacientes atendidos en los centros sanitarios del SNS. Laimplicación de la Enfermería es fundamental para su consecución.En España, según el estudio ENEAS, la incidencia de efectos adversos relacionadoscon la asistencia hospitalaria es del 9,3%, de los que casi el 43% serían evitables,cifras similares a la de otros estudios internacionales.El artículo repasa las acciones emprendidas en esta estrategia entre los años2005-2007 y, entre ellos, el proyecto ligado a los cuidados enfermeros, denominadoproyecto SÉNECA.Este proyecto tiene como objetivo construir un modelo global de calidad de cuidadosseguros de Enfermería hospitalarios, validarlo y medirlo en el conjunto delos hospitales del Sistema Nacional de Salud (SNS). El modelo se ha construidocon la participación de numerosas sociedades de Enfermería, de pacientes y expertosde varias disciplinas, fundamentalmente enfermeros. En total han participado170 personas.En estos momentos se han concluido las dos primeras fases. Contamos con un instrumentopara medir 100 criterios de calidad ligados a la seguridad de los cuidadoshospitalarios. Esta medición puede ser mediante autoevaluación o auditoríaexterna y el modelo cuenta con indicadores que especifican la fuente de (..) (AU)

Since 2006, the Ministry of Health and Social Policy, as coordinator of the NationalHealth System (NHS), has implemented a Quality Plan with the aim of achievingclinical practice based on the best scientific knowledge available.This plan consists of 12 strategies and 39 objectives. One the most important strategiesin Promoting Clinical Excellence, which includes the Plan’s 8th objective: toimprove the safety of patients who receive care in healthcare centres of the NHS.Nursing involvement is essential for its achievement.In Spain, according to the ENEAS study, the incidence of side effects related withhospital care is 9.3%, of which 43% could be avoidable. These numbers mirrorthose of other international studies.The article reviews the actions carried out in this strategy between 2005 and2007 and, amongst them, the project linked with nursing care, known as the SENECAproject.This project aims to create a general quality model of safe hospital nursing care,validate it and measure it in the hospitals of the National Health System (NHS).The model has been developed with the participation of several Nursing and patientsocieties and experts from different fields, mainly nurses. A total number of170 people have taken part in this project.At present, the first two phases have been carried out. We have an instrumentto measure 100 quality criteria associated with the safety of hospital care. Thismeasurement can be carried out via self-evaluation or external auditing and themodel has indicators that specify the data source and the method used to obtainthis data. The instrument has been validated in five hospitals of the NHS.When the third phase is finalized, we will also have quantitative information onthe level of safety of care in the Spanish NHS.We hope the model becomes a useful tool for measuring and improving hospitalnursing care (..) (AU)