ABSTRACT
OBJECTIVES: To identify the factors valued by users of health centres; to weigh the relative importance of each factor. DESIGN: Qualitative stage (4 focus groups) to identify the factors valued. Quantitative stage (questionnaire to 225 people) to weigh their relative importance. SETTING: Primary care. PARTICIPANTS: Citizens from middle-high and middle-low social classes, urban, rural and over 65, were chosen through key informants for their interest in the health services. They were recruited with the assistance of various residents' associations and town councils. METHOD: The factors valued were identified through focus groups and classified in categories. Their relative importance was weighed through a questionnaire and a factorial analysis to identify the main components was run. RESULTS: 60 factors that could be valued by patients were identified. Eight of these referred to the centre and concrete assets, nine to organisation and acessibility, 18 to relationship with the health professionals, and 25 to the services available. The most highly valued factor was: "The centre has sufficient material available for cures, minor surgery, bandages, etc." The factorial analysis confirmed the categories established. Organisation and accessibility, and relationship with professionals were the most highly valued dimensions. CONCLUSIONS: The combination of qualitative and quantitative methods seems very fitting for this kind of study. Although many of the factors were to be expected, other little-expected ones emerged. In addition, users seem to value certain factors in a different way from how the professionals do.
Subject(s)
Patient Satisfaction , Primary Health Care/statistics & numerical data , Quality of Health Care/statistics & numerical data , Aged , Attitude to Health , Community Health Centers/statistics & numerical data , Female , Focus Groups , Humans , Male , Surveys and QuestionnairesABSTRACT
Objetivos. Identificar los aspectos que valoran los pacientes en los centros de salud. Ponderar la importancia relativa de cada uno de ellos. Diseño. Fase cualitativa (4 grupos focales) para identificar los aspectos que se valoran. Fase cuantitativa (encuesta a 225 ciudadanos) para ponderar su importancia relativa. Emplazamiento. Atención primaria. Participantes. Ciudadanos de clase social media-alta, media-baja, urbanos, rurales y mayores de 65 años, seleccionados a través de informantes clave por su interés en los servicios sanitarios. Se reclutaron con la colaboración de diferentes asociaciones de vecinos y ayuntamientos. Método. Mediante grupos focales se identificaron los aspectos que se valoran, y se clasificaron en categorías. Mediante encuesta se ponderó la importancia relativa de los mismos y se realizó un análisis factorial para identificar los componentes principales. Resultados. Se identificaron 60 aspectos valorables por los pacientes. De ellos, 8 se referían al centro y eran tangibles, 9 a organización y accesibilidad, 18 a relación con los profesionales y 25 a servicios disponibles. El aspecto más valorado fue: "el centro dispone de suficiente material para curas, pequeña cirugía, vendajes, etc.". El análisis factorial confirmó las categorías que se habían establecido. La organización y accesibilidad y las relaciones con los profesionales parecen ser las dimensiones más valoradas. Conclusiones. La combinación de métodos cualitativos y cuantitativos parece muy adecuada para este tipo de estudios. Aunque muchos de los aspectos eran de esperar, aparecen otros poco previsibles. Además, los clientes parecen valorar ciertos aspectos de manera distinta a como lo harían los profesionales (AU)
Subject(s)
Aged , Male , Female , Humans , Patient Satisfaction , Quality of Health Care , Surveys and Questionnaires , Primary Health Care , Attitude to Health , Community Health CentersABSTRACT
OBJECTIVE: To assess the effectiveness of the quality improvement programme (QIP) at the centre. DESIGN: A retrospective analysis of the "improvable situations" detected between 1988 and 1992, their causes and the methods used for their detection. The present status of the improvable situations (solutions) was then studied. SETTINGS: La Mina Primary Care Centre. PATIENTS AND OTHER PARTICIPANTS: The improvable situations detected from the start of the QIP in March 1989 until December 1992. MEASUREMENTS AND MAIN RESULTS: 172 situations were identified, corresponding to 83 different problems, situations or opportunities of improvement. The method which identified the most different and solvable situations (64.5%) was the use of the improvable situation report sheet (problem report) by the professionals at the centre. The component of quality most often affected was accessibility; and the least, satisfaction. The effectiveness component had the highest percentage of situations solved (64.3%) and external problems, the lowest (30%). 62 out of the 180 causes (34.4%) for the 73 improvable situations, which did not affect external aspects of care, were solved. The commonest and most solvable causes were due to lack of internal organisation (64%). 51.8% of the 83 situations detected were solved. There was 73.2% effectiveness of the QIP, measured as a percentage of solved situations, not including those situations with external causes or depending on the user. CONCLUSIONS: The most useful method of detecting solvable solutions is the use of the improvable situations report sheet by the professional.
Subject(s)
Primary Health Care , Quality of Health Care , Primary Health Care/organization & administration , Primary Health Care/standards , Program Evaluation , Retrospective Studies , SpainABSTRACT
OBJECTIVE: To identify the antibiotic prescriptions and evaluate their suitability for the infectious conditions treated at a Primary Care Centre. DESIGN: A prospective observation study. SETTING: La Mina Primary Care Centre. Sant Adrià de Besòs (Barcelona). PATIENTS AND OTHER PARTICIPANTS: The on-demand visits of patients over 14 to the General Medicine and Emergency clinics between June 1991 and May 1992 provided the data through a simple multi-stage random sample. MEASUREMENTS AND MAIN RESULTS: On the basis of the clinical notes, these variables were recorded: age, gender, diagnosis, the antibiotic prescribed and its manner of administration. The indication and choice of treatment was assessed in line with previously established criteria, as well as whether the antibiotic was first-choice in Primary Care. Infections treated in hospital or by specialists, non-bacterial cutaneous infections and Conjunctivitis were excluded. Out of 2,523 people examined, 474 presented infectious conditions (18.8%); the most common of these were infections of the upper respiratory tract (46.4%) and acute Bronchitis (17.3%). An antibiotic was prescribed in 206 cases (43.3%). The most used antibiotics were: Amoxicillin (41.5%), Penicillin (19.0%), Cloxacillin (11.2%), Erythromycin (10.2%) and Pipemidic Acid (7.8%). They were orally taken in 89.4% of cases. 92.3% of the antibiotics were first-choice. Overall fitness of treatment was 86.3% (56.5% unnecessary and non-prescribed treatment; and 29.7% necessary and using the recommended antibiotic). The least suitable treatment was observed for cases of acute Bronchitis without any risk factors. CONCLUSIONS: Prescriptions are adjusted to the recommendations on antibiotic policy in Primary Care, although less suitable treatment was observed for acute Bronchitis. The importance of applying a methodology based on objective criteria, in order to make a qualitative analysis in studies on the use of medication, is highlighted.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Communicable Diseases/drug therapy , Drug Utilization , Primary Health Care , Adolescent , Adult , Aged , Female , Humans , Male , Middle Aged , Prospective StudiesABSTRACT
In a study of the need for detecting subclinical hypothyroidism in a population aged 60-80 years, the measurement of thyrotropin with the immunofluorometric technique in 446 individuals seeking attention identified 58 with high TSH (greater than 4 microU/ml); only 33 of these were evaluated in a specialized endocrinological unit. The abnormality was confirmed by radioimmunometric technique in 19 patients (4%), and in the remaining 14 individuals disease was ruled out. The prevalence in this group of individuals is comparable to that found in other studies which recommend screening for subclinical hypothyroidism, but the requirement for the implementation of such a screening program in our area should be carefully evaluated before it could be recommended.
Subject(s)
Hypothyroidism/prevention & control , Mass Screening , Thyrotropin/blood , Aged , Aged, 80 and over , Female , Humans , Hypothyroidism/blood , Male , Middle Aged , Primary Health Care , SpainABSTRACT
After having found that the prevalences of hypertension, hypercholesterolemia, obesity and smoking were low in our adult population on care, we developed a study to investigate the causes of the problem and to introduce measures for its solution following the methodology of the medical audit. The indexes showed that the performance of preventive cardiovascular activities (PCVA) was low: blood pressure measurement 45%, blood cholesterol determination 23%, height and weight measurement 8% and questioning on smoking habits 40%. After the implementation of corrective measures, indexes of 79%, 76%, 71% and 56%, respectively, have been achieved. In addition, a defective recording of the detected risk factors was found: 87% in the clinical history record, 72% in the age and sex card; after the corrective measures, the rates were 98% and 91% respectively. The present study demonstrates the effectiveness of quality control measures carried out by the professionals responsible for care to improve its quality.
Subject(s)
Cardiovascular Diseases/epidemiology , Medical Audit , Primary Health Care , Age Factors , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/prevention & control , Humans , Medical Audit/statistics & numerical data , Prevalence , Primary Health Care/statistics & numerical data , Risk Factors , Sex Factors , Spain/epidemiologyABSTRACT
The effectiveness of amoxicillin/clavulanic acid (A/Cl) and trimetoprim (TMP) were compared in two different schedules: 10 days treatment and monodose, in 80 patients with, urinary tract infection (UTI) demonstrated by urine culture. The patients over 65 years, the males and those with underlying risk conditions randomly received A/Cl or TMP during 10 days. The rates of cure were 76.9% for A/Cl and 73.9% for TMP. The difference was not significant. Thirty-one patients without those features randomly received a short A/Cl course or a single dose of TMP. The rates of cure were 92.8% for A/Cl and 58.8% for TMP. The difference was statistically significant. It was concluded that, in our patients, complicated lower UTI have a similar response rate to a ten days course of A/Cl or TMP, whereas A/Cl for three days is more effective than a single TMP dose to treat noncomplicated lower UTI.
