[The patient and the crossing between Primary and Hospital care. Systematic review of trials for the implementation of tools for integration in Spain]. / El paciente y su travesía entre la atención primaria y la hospitalaria. Revisión sistemática de ensayos clínicos para la implementación de herramientas para la integración en España.

BACKGROUND: Health services are moving towards a complete integration to try and reduce fragmentation, increase efficiencies and improve health outcomes. Estimates the effectiveness in of different tools for integrated care in Spain. METHODS: We performed a systematic review of articles using MEDLINE (last search July31st, 2017). Randomized clinical trials reporting health outcomes of tools for integrated care used in Spain were included. Studies were appraised for quality using the Cochrane Risk of Bias assessment. RESULTS: Twenty studies met the criteria for the systematic review. Interventions included were hospital-at home (four studies, 455 patients), outpatient clinic by videoconference (three studies, 2438 patients), nurse navigator (four studies, 1051 patients), self-care improvement (four studies, 1291 patients), at-home health monitoring (three, 162), health apps (two, 225) and medical reconciliation (one, 172). Hospital-at-home, nurse navigator or self-care improvement reduced readmission rate in older patients, heart failure (HF) or chronic obstructive pulmonary disease (COPD). Self-care improvement and nurse navigator reduced mortality rate in HF. Hospital-at-home reduced hospital stay in COPD. Self-care improvement reduced outpatient visits in asthma patients. Outpatient video by videoconference reduced time to diagnosis and treatment in rural areas. The quality of the evidence ranged from low to very low for all the outcomes because it was based in double or triple downgraded randomized trials. CONCLUSION: The implementation of tools for integrated care in Spain improved some outcomes of relevance in patients with chronic conditions, although evidence is low. Self-care improvement stood out due to the improvements made.

Calidad percibida por los usuarios de un servicio de Medicina Interna tras 5 años de aplicación de una encuesta de satisfacción / User's perceived quality in an internal medicine service after a five-year period application of a user's satisfaction survey

ObjetivoValorar la calidad percibida por los usuarios del Servicio de Medicina Interna de Los Montalvos (Salamanca) durante los 5 primeros años de funcionamiento de este.Material y métodosEstudio transversal, realizado desde febrero de 2004 hasta enero de 2009. A todos los pacientes hospitalizados (6.997) se les entregó al alta una encuesta modelo SERVQHOS de cumplimentación anónima y voluntaria.ResultadosSe recogieron 2.435 encuestas. La participación fue del 34,8%. Excepto en lo relativo a la accesibilidad, las cuestiones planteadas en la encuesta se percibieron como se esperaba o por encima de las expectativas por parte de más del 85% de los encuestados. El 90,6% de los pacientes estuvo satisfecho con la atención recibida y el 83,9% recomendaría el hospital a otras personas. Las variables con mayor capacidad predictiva, en relación con la satisfacción global, fueron el trato personalizado y el interés del personal por solucionar problemas. El 33,6% valoró la facilidad para llegar al hospital por debajo de lo esperado. Tras implantar medidas de mejora, el porcentaje de insatisfacción respecto a la accesibilidad se situó en el 24,8% (p=0,02).ConclusionesNueve de cada 10 pacientes encuestados estaban satisfechos o muy satisfechos con la atención recibida y recomendarían el hospital a otras personas. Las variables más vinculadas con la satisfacción global fueron las relacionadas con el personal del servicio. Tras detectar deficiencias e implantar medidas de mejora, la encuesta detectó mejoría en el nivel de satisfacción(AU9

ObjectiveTo evaluate the quality perceived by users of the ‘Los Montalvos’ Internal Medicine Service (Salamanca, Spain), over its first five years of operation.MethodsA cross-sectional study was carried out from February 2004 to January 2009. All in-patients (6,997) were given a survey model SERVQHOS at the time of discharge, which was anonymous and voluntary.ResultsWe collected 2,435 surveys. Participation was 34.8%. Except for the item regarding accessibility, the other questions of the survey were perceived “as expected” or above expectations by over 85% of the users. A total of 90.6% of patients who completed the survey were satisfied with the care received, and 83.9% would recommend the hospital to others. The variables with higher predictive capability, in relation to overall satisfaction, were “personalised care’, and the interests of staff to solve problems. The easy access to the hospital’ was seen by 33.6% as below expectations. After introducing several improvement measures, the percentage of dissatisfaction regarding accessibility was 24.8% (p=0.02).ConclusionsNine out of ten patients surveyed were satisfied or very satisfied with the care received, and would recommend the hospital to others. The variables more strongly associated with overall satisfaction were those related to service personnel. After identifying deficiencies and implementing measures to improve, the survey detected an increase in the level of satisfaction(AU)

[User's perceived quality in an internal medicine service after a five-year period application of a user's satisfaction survey]. / Calidad percibida por los usuarios de un servicio de Medicina Interna tras 5 años de aplicación de una encuesta de satisfacción.

OBJECTIVE: To evaluate the quality perceived by users of the 'Los Montalvos' Internal Medicine Service (Salamanca, Spain), over its first five years of operation. METHODS: A cross-sectional study was carried out from February 2004 to January 2009. All in-patients (6,997) were given a survey model SERVQHOS at the time of discharge, which was anonymous and voluntary. RESULTS: We collected 2,435 surveys. Participation was 34.8%. Except for the item regarding accessibility, the other questions of the survey were perceived "as expected" or above expectations by over 85% of the users. A total of 90.6% of patients who completed the survey were satisfied with the care received, and 83.9% would recommend the hospital to others. The variables with higher predictive capability, in relation to overall satisfaction, were "personalised care', and the interests of staff to solve problems. The easy access to the hospital' was seen by 33.6% as below expectations. After introducing several improvement measures, the percentage of dissatisfaction regarding accessibility was 24.8% (p=0.02). CONCLUSIONS: Nine out of ten patients surveyed were satisfied or very satisfied with the care received, and would recommend the hospital to others. The variables more strongly associated with overall satisfaction were those related to service personnel. After identifying deficiencies and implementing measures to improve, the survey detected an increase in the level of satisfaction.