ABSTRACT
BACKGROUND: Patients' opinions are crucial in assessing the effectiveness of the ethical theories which underlie the care relationship between patients and primary health care professionals. OBJECTIVES: To study the ethical behaviour of primary health care professionals with respect to communication issues according to patients' opinions. METHODS: Cross-sectional study using a self-administered questionnaire in patients from a network of 15 urban primary health centres. Participants were patients attended at the centres when the study was conducted. We used a Rasch analysis to verify the structure of the 17 questionnaire items, and to calculate interval level measures for patients and items. We analysed differences according to patient subgroups using analysis of variance tests and differences between the endorsement of each item. RESULTS: We analysed 1013 (70.34%) of questionnaires. Data fit to the Rasch model was achieved after collapsing two categories and eliminating five items. Items with the lowest degree of endorsement were related to the management of differences in conflictive situations between patients and health care professionals. We found significant differences (P < 0.001) in patients' opinions according to the degree of confidence in professionals and their educational level. CONCLUSIONS: Patients opined that empathy and traditional communication skills were respected by family physicians and nurses. However, opinions on endorsement were lower when patients disagreed with health care professionals. The differences found between patient subgroups demonstrated the importance of trust and confidence between patients and professionals.
Subject(s)
Communication , Health Knowledge, Attitudes, Practice , Physician-Patient Relations/ethics , Physicians/ethics , Primary Health Care , Adolescent , Adult , Aged , Aged, 80 and over , Cross-Sectional Studies , Dissent and Disputes , Educational Status , Female , Humans , Male , Middle Aged , Models, Statistical , Surveys and Questionnaires , Trust , Young AdultABSTRACT
BACKGROUND: Assessing ethical endorsement is crucial to the study of professional performance and moral conduct. There are no specific instruments that verify patients and professional experiences of ethical practice in the specific area of primary health care (PHC). OBJECTIVE: To study the psychometric properties of two questionnaires to identify professional and patient endorsement of normative ethics. METHODS: A methodological study conducted in PHC centres from an urban area (Barcelona). A group of items from an ethical code were generated using a qualitative study with focus groups. Items underwent expert validation, item refinement and test-retest reliability. Two groups of items for PHC professionals and patients were validated. The structure of the constructs and the internal consistency were studied after participants completed the questionnaires. Principal component analysis with supplementary variables showed the utility of the validated questionnaires. RESULTS: The patients' questionnaire consisted of 17 general items plus 11 additional items on specific conditions, and the health professional's contained 24 general and 9 specific items. The construct of the questionnaires comprised a three-factor solution for patients and a five-factor solution for professionals. Principal component analysis with supplementary variables showed that patients with higher scores on ethical perception were associated with better opinions on health care quality and more confidence in professionals. In PHC professionals, higher scores were associated with effective knowledge of the code. CONCLUSIONS: Both questionnaires showed good psychometric properties and are valid to screen ethical attitudes. The instrument warrants further testing and use with culturally diverse patients and PHC professionals.
Subject(s)
Ethics, Medical , Primary Health Care/ethics , Quality of Health Care/ethics , Adult , Aged , Aged, 80 and over , Female , Focus Groups , Humans , Male , Middle Aged , Psychometrics , Qualitative Research , Reproducibility of Results , Spain , Surveys and Questionnaires , Young AdultABSTRACT
ObjetivoConocer las opiniones sobre las guías de práctica clínica (GPC) para la depresión de médicos de atención primaria (AP), psiquiatras y psicólogos.DiseñoEstudio cualitativo, descriptivo-exploratorio basado en entrevistas semiestructuradas individuales y grupales.EmplazamientoCentros de AP y centros de salud mental de la red pública de Barcelona, Sabadell, Cornellà y Gavà.Participantes y contextoTreinta y un profesionales (10 médicos de AP, 11 psiquiatras y 10 psicólogos). Las entrevistas se realizaron en su lugar de trabajo o en la unidad de investigación de la institución donde se realizó el estudio entre octubre de 2007 y junio de 2008.MétodosMuestreo teórico y de conveniencia. Para garantizar la heterogeneidad se tuvo en cuenta el sexo, la edad, la experiencia y la pertenencia a diferentes instituciones. Grabación y transcripción de las entrevistas. Análisis de contenido. Triangulación de técnicas y contraste de resultado con los participantes.ResultadosLa principal utilidad de las GPC es que agilizan la toma de decisiones y dan seguridad. Como inconvenientes, se duda sobre la objetividad de las GPC y no se considera que las recomendaciones puedan aplicarse a sus pacientes. Los médicos de AP no conocían, en el momento del estudio, ninguna GPC para la depresión. Los especialistas sí conocen, pero no las utilizan al priorizar su experiencia.ConclusionesSe han detectado ideas erróneas sobre lo que es una GPC. Si se desea implementar una GPC, es necesario informar previamente sobre qué es una GPC, qué no es y para qué puede resultar útil(AU)
AimTo explore the views on clinical practice guidelines (CPG) of general practitioners (GP), psychiatrists, and psychologists.DesignDescriptive-exploratory qualitative study based on semi-structured individual and group interviews.SettingPublic primary health care and mental health centres in Barcelona, Sabadell, Cornellà de Llobregat and Gavà.Participants and contextA total of 31 health professionals (10GPs, 11 psychiatrists, and 10 psychologists) interviewed at their work place or at the research unit between October 2007 and June 2008.MethodConvenience sample. Participants were heterogeneous as regards sex, age, experience and workplace. Interviews were recoded and transcribed. Content analysis. Triangulation between techniques and results comparisons with participants was carried out as quality control.ResultsThe main advantages of CPGs were that they helped in decision making and gave security. On the other hand, participants were sceptical about the objectivity of GPC and considered that recommendations could not be applied to their individual patients. Additionally, they perceived CPG as inflexible. At the time of the study, GPs did not know of any CPG for depression. Specialists knew several CPGs but they did not use them as they prioritise their own experience.ConclusionsThere are some erroneous ideas about what a CPG is. If we want to implement CPGs, it is important to carry out some previous work presenting what a CPG is, what it is not and when it could be useful(AU)
Subject(s)
Humans , Depressive Disorder/epidemiology , Practice Patterns, Physicians'/statistics & numerical data , Primary Health Care/statistics & numerical data , Health Care Surveys/statistics & numerical data , Depressive Disorder/drug therapy , 25783ABSTRACT
AIM: To explore the views on clinical practice guidelines (CPG) of general practitioners (GP), psychiatrists, and psychologists. DESIGN: Descriptive-exploratory qualitative study based on semi-structured individual and group interviews. SETTING: Public primary health care and mental health centres in Barcelona, Sabadell, Cornellà de Llobregat and Gavà. PARTICIPANTS AND CONTEXT: A total of 31 health professionals (10GPs, 11 psychiatrists, and 10 psychologists) interviewed at their work place or at the research unit between October 2007 and June 2008. METHOD: Convenience sample. Participants were heterogeneous as regards sex, age, experience and workplace. Interviews were recoded and transcribed. Content analysis. Triangulation between techniques and results comparisons with participants was carried out as quality control. RESULTS: The main advantages of CPGs were that they helped in decision making and gave security. On the other hand, participants were sceptical about the objectivity of GPC and considered that recommendations could not be applied to their individual patients. Additionally, they perceived CPG as inflexible. At the time of the study, GPs did not know of any CPG for depression. Specialists knew several CPGs but they did not use them as they prioritise their own experience. CONCLUSIONS: There are some erroneous ideas about what a CPG is. If we want to implement CPGs, it is important to carry out some previous work presenting what a CPG is, what it is not and when it could be useful.
