[Experience of patients with immune-mediated inflammatory diseases seen in a multidisciplinary integrated care unit]. / Experiencia de los pacientes con enfermedades inflamatorias inmunomediadas atendidos en una unidad de atención integral multidisciplinar.

OBJECTIVE: To describe the aspects with the greatest impact on the satisfaction of patients treated in a multidisciplinary unit specialising in immune-mediated inflammatory diseases (IMIDs) and to identify areas for improvement in the care model. METHODS: Cross-sectional descriptive study using a satisfaction survey structured in three blocks: sociodemographic variables, functional aspects of the unit and satisfaction with the professionals. Immediate satisfaction was measured on aspects related to the care received, the physical structure and the likelihood of recommending the unit. RESULTS: A total of 168 patients completed the surveys, the mean score of overall satisfaction with the unit was 4.75 (SD:0.4). The regression model showed the relationship between overall satisfaction and unit signage (OR:3.558, p=0.045, 95% CI: 1.027-12.33), coordination between professionals (OR:9.043, p=0.000, 95% CI: 2.79-29.28) and participation in decision making (OR: 44.836, p=0.000, 95% CI: 5.49-365.97). In terms of immediate satisfaction, the overall Net Promoter Score (NPS) was 87 (excellent). The mean score for coordination with Primary Care was 4.54 (SD:0.8) and they scored waiting time to be seen with 4.49 (SD:0.8), so they have been considered an area for improvement The mean score for coordination with Primary Care was 4.54 (SD:0.8) and they scored waiting time to be seen with 4.49 (SD:0.8), so both were considered areas for improvement. CONCLUSIONS: Coordination between intra-centre professionals and patient participation in decision-making explain the excellent level of patient satisfaction. The monitoring of satisfaction has made it possible to implement immediate improvement actions.

Colonoscopy Satisfaction and Safety Questionnaire based on patient experience (CSSQP): A valuable quality tool for all colonoscopies / Cuestionario de Satisfacción y Seguridad de la Colonoscopia basado en la experiencia del Paciente (CSSQP): una valiosa herramienta de calidad para todas las colonoscopias

Introduction The Colonoscopy Satisfaction and Safety Questionnaire based on Patient experience (CSSQP) was recently developed and validated within a Bowel Cancer Screening Program. We aimed to identify factor related to patient experience through the CSSQP, including all indications for colonoscopy. Indicators of satisfaction and perceived safety with colonoscopy were also assessed to compare the different centers. Methods Multicenter study in nine Spanish hospitals. Consecutive patients who had undergone a colonoscopy completed the CSSQP adding a novel item on bowel preparation. Factors related to patient experiences and data from non-respondents were analyzed. Results Of 2200 patients, 1753 filled out the questionnaire (response rate 79.7%, sample error 2%). Patients whose colonoscopy indication was a primary colorectal cancer screening (OR: 1.68, 95% CI: 1.15–2.44, p=0.007) or due to a +FIT (OR: 1.73, 95% CI: 1.18–2.53) reported higher satisfaction than patients with gastrointestinal symptoms. In addition, college-educated patients (OR: 2.11, 95% CI: 1.25–3.56) were more likely to report better overall satisfaction than patients with lower education level. Significant differences were observed in the majority of the CSSQP items between centers. Safety incidents were reported by 35 (2%) patients, and 176 (10%) patients reported that they received insufficient information. Conclusion The CSSQP identifies several significant factors on satisfaction and perceived safety in patients referred for colonoscopy for any reason. The CSSQP also allows comparison of patient-identified colonoscopy quality indicators between centers (AU)

Introducción El Cuestionario de Satisfacción y Seguridad de la Colonoscopia basado en la experiencia del Paciente (CSSQP) ha sido desarrollado y validado recientemente en pacientes del Programa de cribado de cáncer colorrectal (CCR). El objetivo del estudio fue identificar los factores relacionados con la experiencia de los pacientes a través del CSSQP, incluyendo todas las indicaciones de la colonoscopia. Además, se evaluaron los factores relacionados con la satisfacción y la seguridad del paciente con el fin de comparar diferentes departamentos. Métodos Estudio multicéntrico de nueve hospitales españoles en el que se incluyeron pacientes consecutivos que completaron el CSSQP incorporando un nuevo ítem sobre la preparación intestinal. Se analizaron los factores relacionados con la experiencia de los pacientes y los datos de los no respondedores. Resultados De 2.200 pacientes, 1.753 completaron el cuestionario (tasa de respuesta del 79,7%, error muestral del 2%). Los pacientes en los que la indicación era por cribado de CCR (OR: 1,68; IC 95%: 1,15-2,44; p=0,007) o por FIT positivo (OR: 1,73; IC 95%: 1,18-2,53) informaron mayor satisfacción que en aquellos que se solicitó la colonoscopia por síntomas gastrointestinales. Además, los pacientes con estudios universitarios (OR: 2,11; IC 95%: 1,25-3,56) informaron mayor satisfacción que aquellos con menor nivel de estudios. Se observaron diferencias significativas en la mayoría de los ítems del CSSQP entre los centros participantes. Treinta y cinco (2%) pacientes reportaron incidentes de seguridad y 176 (10%) reconocieron haber recibido información insuficiente. Conclusiones El CSSQP identifica los factores determinantes que influyen en la satisfacción y la seguridad de los pacientes a los que se les realiza colonoscopia por cualquier indicación. Además, permite comparar los indicadores de calidad de la colonoscopia desde la perspectiva del paciente entre los distintos centros (AU)

Colonoscopy Satisfaction and Safety Questionnaire based on patient experience (CSSQP): A valuable quality tool for all colonoscopies.

INTRODUCTION: The Colonoscopy Satisfaction and Safety Questionnaire based on Patient experience (CSSQP) was recently developed and validated within a Bowel Cancer Screening Program. We aimed to identify factor related to patient experience through the CSSQP, including all indications for colonoscopy. Indicators of satisfaction and perceived safety with colonoscopy were also assessed to compare the different centers. METHODS: Multicenter study in nine Spanish hospitals. Consecutive patients who had undergone a colonoscopy completed the CSSQP adding a novel item on bowel preparation. Factors related to patient experiences and data from non-respondents were analyzed. RESULTS: Of 2200 patients, 1753 filled out the questionnaire (response rate 79.7%, sample error 2%). Patients whose colonoscopy indication was a primary colorectal cancer screening (OR: 1.68, 95% CI: 1.15-2.44, p=0.007) or due to a +FIT (OR: 1.73, 95% CI: 1.18-2.53) reported higher satisfaction than patients with gastrointestinal symptoms. In addition, college-educated patients (OR: 2.11, 95% CI: 1.25-3.56) were more likely to report better overall satisfaction than patients with lower education level. Significant differences were observed in the majority of the CSSQP items between centers. Safety incidents were reported by 35 (2%) patients, and 176 (10%) patients reported that they received insufficient information. CONCLUSION: The CSSQP identifies several significant factors on satisfaction and perceived safety in patients referred for colonoscopy for any reason. The CSSQP also allows comparison of patient-identified colonoscopy quality indicators between centers.

Adaptación transcultural al español de la Escala de Sensibilidad Percibida a los Medicamentos / Cross-cultural adaptation to Spanish of the Perceived Sensivity to Medicines scale

Antecedentes y objetivo Las opiniones de los pacientes sobre las acciones y efectos secundarios de los fármacos pueden evaluarse con la escala Perceived Sensivity to Medicines (PSM). El objetivo de este estudio fue traducir y adaptar la escala PSM para su uso en población española. Materiales y métodos Se realizó la traducción y adaptación cultural de la escala PSM y un pretest de la versión española con 50 pacientes atendidos en consultas externas de diferentes especialidades. Resultados No hubo dificultades en las etapas del proceso de traducción y adaptación. En la entrevista cognitiva, los participantes encontraron fácil de entender los 5 ítems (puntuación media de 3,86±0,24 sobre 4). Conclusiones Dada su brevedad, la versión española de la escala PSM constituye una herramienta de fácil aplicación tanto para propósitos de investigación como clínicos (AU)

Background and objective Patients’ views regarding the actions and side effects of medicines can be measured with the Perceived Sensitivity to Medicines (PSM) scale. The aim of this study was to translate and adapt the PSM scale for use in the Spanish population. Materials and methods The translation and cultural adaptation of the PSM scale and a pretest of the Spanish version were carried out with 50 patients receiving outpatient care in various specialties. Results There were no difficulties in the stages of the translation and adaptation process. In the cognitive interview, participants found the five items easy to understand (mean score of 3.86±0.24 out of 4). Conclusion Given its brevity, the Spanish version of the PSM scale represents an easily applicable tool for both research and clinical purposes (AU)

[Cross-cultural adaptation to Spanish of the Perceived Sensitivity to Medicines scale]. / Adaptación transcultural al español de la Escala de Sensibilidad Percibida a los Medicamentos.

BACKGROUND AND OBJECTIVE: Patients' views regarding the actions and side effects of medicines can be measured with the Perceived Sensitivity to Medicines (PSM) scale. The aim of this study was to translate and adapt the PSM scale for use in the Spanish population. MATERIALS AND METHODS: The translation and cultural adaptation of the PSM scale and a pretest of the Spanish version were carried out with 50 patients receiving outpatient care in various specialties. RESULTS: There were no difficulties in the stages of the translation and adaptation process. In the cognitive interview, participants found the five items easy to understand (mean score of 3.86±0.24 out of 4). CONCLUSION: Given its brevity, the Spanish version of the PSM scale represents an easily applicable tool for both research and clinical purposes.

Evaluación de la experiencia asistencial en pacientes con Enfermedad Renal Crónica Avanzada / Assessment of the Care Experience in Patients with Advanced Chronic Kidney Disease

Introducción: Los resultados clínicos están más condicionados al papel activo del paciente en su autocuidado que por la cualificación profesional, por ello es importante capturar la experiencia del paciente para mejorar la calidad asistencial.Objetivo: Evaluar la experiencia del paciente renal en la atención recibida por los profesionales.Material y Método: Estudio descriptivo transversal en pacientes de Hemodiálisis y consulta de Enfermedad Renal Crónica Avanzada. Se administró el Instrumento de Evaluación de la eXperiencia del PAciente Crónico, 15 ítems que puntuaron de 0 (peor) a 10 (mejor experiencia) y que, midió 3 factores: interacciones productivas, autogestión del paciente y nuevo modelo relacional. Los datos se analizaron con el software R.Resultados: Se incluyeron 76 pacientes. La puntuación de la experiencia del paciente (ítems 1-11) fue de 6,68±1,41 puntos, siendo para cada factor: “interacciones productivas” (9,00±1,37 puntos), “autogestión del paciente” (7,80±1,78 puntos) y “nuevo modelo relacional” (1,86±2,01 puntos). Los ítems 12-15 obtuvieron bajas puntuaciones con valores medios entre 2-4 puntos. Al comparar los pacientes de consulta y hemodiálisis, el grupo hemodiálisis puntuó menos en los factores: “autogestión del paciente” (p=0,01) y “nuevo modelo relacional” (p=0,03); y con respecto a los ítems 12-15, también se obtuvo menor puntuación en el ítem “atención continuada tras un ingreso/urgencia (p=0,04).Conclusiones: La experiencia del paciente renal es positiva en la interacción con los profesionales y en la gestión del autocuidado, pero surgen áreas de mejora como el uso de tecnología digital, compartir experiencias con iguales y, el seguimiento de la salud tras un episodio agudo. (AU)

Introduction: Clinical outcomes are more influenced by the active role of the patient in self-care than by professional qualifications. Therefore, it is important to capture the patient’s experience to enhance the quality of care. Objetives: To evaluate the renal patient’s experience with the care provided by healthcare professionals. Material and Method: A cross-sectional descriptive study was conducted with hemodialysis patients and those attending the Advanced Chronic Kidney Disease consultation. The Patient Experience Assessment Instrument, comprising 15 items rated from 0 (worst) to 10 (best experience), measuring three factors: productive interactions, patient self-management, and a new relational model, was administered. Data were analyzed using R software. Results: A total of 76 patients were included. The patient experience score (items 1-11) was 6.68±1.41 points, with scores for each factor being: “productive interactions” (9.00±1.37 points), “patient self-management” (7.80±1.78 points), and “new relational model” (1.86±2.01 points). Items 12-15 received low scores with average values between 2-4 points. When comparing clinic and hemodialysis patients, the hemodialysis group scored lower in the “patient self-management” (p=0.01) and “new relational model” (p=0.03) factors. Additionally, regarding items 12-15, a lower score was obtained in the “continuing care following admission/emergency” item (p=0.04). Conclusions: The renal patient’s experience is positive in interactions with healthcare professionals and in self-care management. However, there are areas for improvement, such as the use of digital technology, sharing experiences with peers, and post-acute episode health monitoring. (AU)

Facilitators and barriers of patient involvement in hospital services: integrative review / Facilitadores y barreras para la participación del paciente en los servicios hospitalarios: revisión integrativa / Facilitadores e barreiras do envolvimento do paciente nos serviços hospitalares: revisão integrativa

ABSTRACT Objective to identify the facilitating factors and barriers that influence patient involvement in hospital services. Method integrative review; search of articles published between January 2011 and December 2020, in the electronic databases PubMed, Web of Science, Cinahl, Lilacs and Scopus, using descriptors related to "patient involvement", Barriers, Facilitators, in English, Spanish and Portuguese. Data collection was performed from May to June 2021, identifying 32 publications that met the inclusion criteria. Results the analysis resulted in three categories of facilitating factors and barriers: communication, actors of involvement and organizational culture, allowing the elaboration of a theoretical model of patient involvement. This model shows that in the centrality of the process are the actors involved, that is, patients and professionals, inserted in an organizational context, being influenced by leadership, culture, environment, available resources and processes, where communication permeates as a basis for involvement. Conclusion the facilitating factors and barriers identified in this review, synthesized in a theoretical model, allow transcending theoretical knowledge for practice. The complexity to operationalize this model requires patients, professionals, health services and society join forces to make this theoretical proposition a practice incorporated by the services.

RESUMEN Objetivo incidir en los factores y barreras de la implicación del paciente en los servicios hospitalarios. Método revisión integradora; búsqueda de artículos publicados entre enero de 2011 y diciembre de 2020, en las bases de datos electrónicas PubMed, Web of Science, Cinahl, Lilacs y Scopus, utilizando descriptores relacionados con "involucramiento del paciente", Barreras, Facilitadores, en inglés, español y portugués. La recolección de datos se realizó de mayo a junio de 2021, identificándose 32 publicaciones que cumplieron con los criterios de inclusión. Resultados el análisis resultó en las tres categorías de facilitadores y barreras: comunicación, factores de involucramiento y cultura organizacional, permitiendo la elaboración de un modelo teórico de involucramiento. Este modelo muestra que en la centralidad del proceso están los actores involucrados, es decir, pacientes y profesionales, insertos en un contexto organizacional, siendo influenciados por el liderazgo, la cultura, el ambiente, los recursos disponibles y los procesos, donde la comunicación permea como base para el involucramiento. Conclusión los factores y barreras identificados en esta revisión sintetizados en un modelo teórico, permiten trascender el conocimiento teórico para la práctica. La complejidad para operacionalizar este modelo requiere que los pacientes, los profesionales, los servicios de salud y la sociedad se unan para hacer de esta propuesta teórica una práctica incorporada por los servicios.

RESUMO Objetivo identificar os fatores facilitadores e as barreiras que influenciam no envolvimento do paciente nos serviços hospitalares. Método revisão integrativa; realizada busca de artigos publicados entre janeiro de 2011 e dezembro de 2020, nas bases eletrônicas PubMed, Web of Science, Cinahl, Lilacs e Scopus, utilizando descritores relacionados a "patient involvement", Barriers, Facilitators, nos idiomas inglês, espanhol e português. Coleta de dados realizada de maio a junho de 2021, identificando-se 32 publicações que atenderam aos critérios de inclusão. Resultados a análise resultou em três categorias de fatores facilitadores e barreiras: comunicação, atores do envolvimento e cultura organizacional, permitindo a elaboração de um modelo teórico de envolvimento do paciente. Esse modelo mostra que na centralidade do processo estão os atores envolvidos, ou seja, pacientes e profissionais, inseridos em um contexto organizacional, sendo influenciados pela liderança, cultura, ambiente, recursos disponíveis e processos, onde a comunicação perpassa como base para o envolvimento. Conclusão os fatores facilitadores e as barreiras identificadas nesta revisão, sintetizados num modelo teórico, permitem transcender o conhecimento teórico para a prática. A complexidade para operacionalizar esse modelo requer que pacientes, profissionais, serviços de saúde e sociedade unam os esforços para tornar esta proposição teórica em uma prática incorporada pelos serviços.

Percepción de pacientes y profesionales respecto al papel del farmacéutico de hospital en el proceso asistencial. Proyecto Fharmaconectados / Patient and health practitioner perceptions about the role of hospital pharmacists along the care continuum: the Fharmaconectados Project

Objetivo: Determinar la percepción de los pacientes y profesionales respecto al papel del farmacéutico de hospital en el proceso asistencial sanitario.Método: Estudio multicéntrico, observacional, analítico y transversal,realizado en dos fases entre el 15 de octubre y el 31 de diciembre de2020. En la primera fase se realizó una búsqueda bibliográfica paraidentificar cuestionarios específicos que midieran la satisfacción global delos pacientes en relación con la actividad asistencial de los farmacéuticosde hospital. Al no identificarse ninguno validado y adaptado, se elaboróun cuestionario específico. Se estructuró en tres áreas: asistencial, relacional y de capacitación y formación. Se incluyeron pacientes atendidos enlos centros participantes y asociaciones de pacientes colaboradoras en elproyecto, mayores de 18 años, con patología crónica y tratamiento conmedicación de uso hospitalario. En la segunda fase se llevó a cabo unestudio cualitativo en formato focus group para analizar cómo son percibidos y cómo les gustaría ser reconocidos a los farmacéuticos de hospitalpor parte de los pacientes. Se realizaron cuatro reuniones en diferentesterritorios de España. Previamente el equipo investigador acordó el guiony las preguntas a llevar a cabo, incluyéndose 13, agrupadas por bloques: asistencial, relacional, formación e información.Resultados: Se obtuvieron un total de 482 encuestas. El porcentajede pacientes que valoraron positivamente el papel del farmacéutico de hospital fue del 88,0% (n = 424). Se identificó que tienen mejor opinión sobre los farmacéuticos hospitalarios las mujeres, los pacientes quehabían recibido atención previa en el hospital, los que valoraron mejorla coordinación de estos profesionales con el resto del equipo y aquellos con mayor apoyo emocional previo recibido. (AU)

Objective: To determine the perception of patients and practitionersregarding the role of the hospital pharmacist along the care continuum.Method: This was a multicenter cross-sectional observational analyticalstudy, carried out in two phases between 15 October and 31 December2020. In the first phase, a literature search was carried out to identifyspecific questionnaires that measured the overall satisfaction of patientsin relation to the work of hospital pharmacists. Subsequently, a specific consensus-based questionnaire was developed, structured into threeareas: care, relationships, and capacity-building and training. The studyincluded patients treated in the participating centers and served by patientassociations. They had to be older than 18 years, present with a chroniccondition, and be treated with medication for hospital use. In the secondphase, a qualitative study was carried out using focus group discussionsto analyze how hospital pharmacists are perceived and how they wouldlike to be recognized by patients. Four meetings were held in differentterritories of Spain. Previously, the research team agreed on the questionsto be asked, which were grouped into four sections: healthcare, relational,training and information.Results: A total of 482 surveys were obtained. The percentage ofpatients who expressed a positive view of the role of the hospital pharmacist was 88.0% (n = 424). In the multivariate analysis, the most positive opinions about these professionals were expressed by women and bypatients who had received previous care in the hospital, those who had ahigh opinion of the coordination of these professionals with the rest of thecare team, and those who had received the greatest amount of emotionalsupport. (AU)

[Evaluation of the experience of children and parents in a Pediatric service]. / Evaluación de la experiencia de niños y padres en un servicio de Pediatría.

BACKGROUND AND OBJECTIVE: Pediatric patient care implies a duplication of user, the children who receive assistance and their parents. OBJECTIVE: to evaluate the perception and compared experience between children seen in pediatric observation and their parents. PATIENTS AND METHODS: Cross-sectional study using a survey prior to discharge, to children aged 4-13 years admitted between April 2017 and November 2018 and their parents. A random sample of 125 child-parent pairs was taken. Both groups were compared with the Chi-square test and the child-father agreement with the Kappa index (KI), using SPSS v.25. RESULTS: Overall satisfaction was 99.2% in children and 100% in adults, with no significant differences between the two (p=0.314). There were also no significant differences between children and parents in the best valued aspects: staff interest (100% and 100%; p=not calculable); treatment of staff (100% and 99.2%; p=0.318); space (99.2% and 99.2%; p=1); information (98.4% and 100%; p=0.993); time with relatives (98.4% and 98.4%; p=0.993); cleaning (98.4% and 97.6%; p=0.651). The worst valued aspects in children: food (83.2% and 93.2%; p=0.016) and entertainment (89.5% and 94.2%; p=0.179); in adults: comfort (96.8% and 90.2%; p=0.036). There was moderate child-parent concordance in speed of attention (IK 0.561; p<0.001), time with relatives (0.492; p<0.001) and entertainment (0.489; p<0.001). In four questions, the IK could not be calculated because there were no dissatisfied adults and / or children. CONCLUSIONS: The global satisfaction of children and adults was high and consistent in most items. Parent surveys reflect the views of children.

El análisis de la calidad asistencial desde la perspectiva de la satisfacción y la experiencia del paciente: una mirada enfermera / An analysis of assistance quality from the perspective of patience satisfaction and experience: A nursing view

Este artículo pretende describir dos grandes aspectos: la satisfacción y la experiencia del paciente, y cómo medirlos y analizarlos en los campos de la gestión sanitaria, la gestión clínica y los servicios sanitarios. Dichos elementos están inmersos en el abordaje en seguridad del paciente y permiten que la enfermería se relacione con temas como la calidad de los cuidados, la satisfacción del usuario, su experiencia dentro del sistema, los cambios y la implementación de mejoras así como sus formas de medición y análisis dentro del vasto campo de la gestión clínica y sanitaria. Aunque se trata de un tema ampliamente explorado y complejo, susceptible de ser abordado por métodos cuantitativos y cualitativos, en el que la encrucijada entre calidad total, calidad percibida, satisfacción y experiencia parece conformar la hoja de ruta, el artículo aporta conceptos de reciente aparición como Healthcare Improvement Science (mejora de la ciencia de la salud), centrado en la mejora de la calidad del cuidado de la salud y la reducción de daños a los usuarios de los servicios y sus familias; Magnet Hospital (hospital magnético), que relaciona la satisfacción de los profesionales con la calidad de los cuidados, y Patient Experience Officer (director de la experiencia del paciente), nuevo perfil laboral creado en Estados Unidos, centrado en la mejora continua de la calidad a partir de la experiencia del paciente. Todos estos conceptos han sido desarrollados por instituciones e investigadores reconocidos en la materia. En conclusión, en este artículo se resumen algunas de las cuestiones clave que se deben tener en cuenta a la hora de analizar la experiencia del paciente, que es un elemento importante para la mejora y el mantenimiento de la calidad en la atención sanitaria.

This article aims to describe two major aspects: patient satisfaction and experience and the way these are measured and analyzed within health management, clinical management, and health services. These elements are immersed within processes of patient safety and assume a motive for nursing of interweaving issues such as quality of care, user satisfaction, user experience within the system, change and the implementation of improvements, as well as ways of measuring and analyzing these issues within the vast field of clinical and health management. This is a widely explored and complex topic where total quality, perceived quality, satisfaction, and experience appear to make up a crossroad that needs to be taken into account and whose engagement is susceptible to qualitative and quantitative measurements. This article, however, contributes new concepts like Healthcare Impro-vement Science, centered on the improving the quality of health care and reducing harm to users of services and their families, Magnet Hospital, where the satisfaction of employed professionals is related with quality of care, and Patient Experience Officer, a new job profile created in the United States focused on the continuous improvement of patient experience quality. All these concepts were developed by recognized institutions and researchers in the field. In conclusion, this article summarizes some of the key issues that must be taken into account when analyzing the patient's experience, which is an important element for the improvement and maintenance of quality in health care.

[Towards excellence in hospital management. A description of strategical management model]. / Hacia la excelencia en gestión hospitalaria. Un modelo de gestión estratégica.

BACKGROUND AND OBJECTIVE: Health services are evolving from the traditional view of paternalistic medicine towards a more informed and participatory patient-provider relationship. This situation includes the empowerment and participation of patients and their families in health management, including their joint responsibility in the development of health services. The objective of this article is to describe the experience in a large teaching hospital in Spain on the application of a model that focuses on a three-fold approach to healthcare management that includes the experience of the patient. MATERIAL AND METHODS: This approach is identified by the initials EMC2 transforming the E of excellence into 3main areas of improvement: methodology, clinical knowledge and client, or patient, experience. the model has been implemented in different areas: childbirth, asthma care, outpatient clinics, and operating theatre. RESULTS: In the case of childbirth, there was a reduction in caesarean sections, episiotomies, induction of delivery, mean hospital stay, and number of deliveries with instrumentation. The Net Promoter Score went from 82 to 86. There was also an improvement in the areas of patient experience, hospital procedures, and clinical knowledge. Qualitative improvement results were obtained in other areas such as, asthma management, outpatient visits, and the operating room. CONCLUSIONS: This model can be applied to different areas. It promotes patient-focused practice, as well as system sustainability, efficiency, effectiveness, and level of satisfaction with the health care process.

Experiences and real life management of insulin pump therapy in adults with type 1 diabetes.

OBJECTIVE: There is scarce information regarding the performance of a specific, structured education program addressed to patients with type 1 diabetes (T1D) using continuous subcutaneous insulin infusion (CSII) including both routine use of the therapy and patient experience evaluation. We aimed to assess the routine use of CSII and patient's experience and satisfaction regarding a specific structured patient self-management education and care program. METHODS: A retrospective, observational, cross-sectional study collecting CSII routine use downloaded data. Patient experience and satisfaction were evaluated using an anonymous online survey covering different aspects of CSII self-management education and care program. RESULTS: 380 T1D subjects were included (aged 45.3±12.17 years, 62.1% women, diabetes duration 27.8±10.3 years, 9.7±4.7 years on CSII, HbA1c 7.7+1.0%; 61.0±7.9mmol/mol). Participants with HbA1c≤7.5% (58mmol/mol, n=178) did more SMBGs per day (4.4±2.1 vs. 3.9±1.9); used more boluses (5.0±1.8 vs. 4.5±2.0); the percentage of insulin given as bolus was higher (50.1±12.8 vs. 44.9±13.2%); the night bolus wizard (BW) high glucose target was lower (125.9±4.4 vs. 130.5±12.8mg/dl) and time on CSII therapy was shorter (8.9±4.6 vs. 10.3±4.6 years. p<0.05 all comparisons). More SMBG/day, shorter duration of CSII treatment, a lower BW low glucose target at night, a lower BW high glucose target at night, total insulin dose per day and total number of carbohydrates per day were related with better HbA1c levels. 60% of 373 patients answered the questionnaire. The response to the different aspects of the educational program was homogeneously highly satisfactory. Seventy-seven percent of patients scored the program as very useful. Ninety-three percent of CSII users would not return to their previous insulin treatment. CONCLUSIONS: The analysis of routine clinical use of CSII by T1D patients demonstrates that glucose control may be associated with some pump usage and adherence parameters. The overall user experience and satisfaction with our CSII self-management education and care program was remarkably favorable.

A experiência do paciente na coprodução de cuidados: percepções acerca da qualidade no serviço hospitalar / Experiencia del paciente en la coproducción de cuidados: percepciones acerca de la calidad en el servicio hospitalario / Patient experience in coproduction of care: perceptions about quality in the hospital service

Trata-se de estudo qualitativo, do tipo exploratório-descritivo, acerca da experiência do paciente atendido em serviço hospitalar, na perspectiva da coprodução de cuidados em saúde. Pauta-se na sistematização de Donabedian, a qual enfatiza o engajamento do paciente na avaliação da qualidade em saúde, com base na tríade estrutura, processo e resultado. O objetivo geral consistiu em analisar a experiência do paciente durante a internação hospitalar em unidades clínicas e cirúrgicas, com foco na coprodução de cuidados orientados para a qualidade. O cenário de estudo foi um hospital universitário público do sul do país. Participaram 10 profissionais da equipe de saúde, 22 pacientes e 8 familiares adultos procedentes de 12 unidades de internação clínicas e cirúrgicas do hospital. Para a coleta de dados, procedeu-se à triangulação de múltiplas fontes: análise documental, observação e entrevistas. Os dados primários da observação de 30 encontros de serviço durante a prestação dos cuidados em duas unidades e da realização de 24 entrevistas com pacientes-famílias, conduzidas com base na Técnica de Incidente Crítico, foram submetidos à análise temática. A pesquisa atendeu aos preceitos éticos para seu desenvolvimento. A análise resultou em quatro categorias empíricas, cujo eixo transversal foi o papel dos pacientes-famílias como coprodutores do cuidado seguro, sendo elas: i) um recorte da qualidade e segurança assistencial no campo estudado; ii) protocolos de segurança segundo a experiência do paciente iii) caminhos percorridos e a percorrer no cuidado centrado no paciente e; iv) atributos de satisfação de segurança na experiência do paciente. Constatou-se que há alinhamento entre as percepções dos pacientes, as definições institucionais e os protocolos básicos do Programa Nacional de Segurança do Paciente. No entanto, viu-se que os pacientes percebem que esses protocolos nem sempre são seguidos pelos profissionais. A coprodução para um cuidado seguro foi percebida em relação aos protocolos de cirurgia segura e de prevenção de lesões decorrentes de queda. Na identificação do paciente, higienização de mãos e processo de medicação, verificou-se que a coprodução depende do comportamento proativo de pacientes-famílias. Por um lado, foi possível constatar oportunidades para coprodução no cuidado centrado no paciente, mediante o comportamento de profissionais em instigar, envolver e esclarecer pacientes-famílias. Por outro, verificou-se que os encontros de serviço se centraram no motivo da internação e em intervenções técnicas. Ao passo que o comportamento dos profissionais foi valorizado pelos pacientes-famílias, quando houve maior interação e pela percepção de padrões assistenciais de qualidade, o seu oposto emergiu como falta de subsídios para acompanhar o tratamento, ou falta de cuidados em alguns momentos demandados. Emergiram atributos de satisfação de segurança sobre estrutura, processo e resultados assistenciais. Considera-se que a experiência do paciente sustenta a tese que o processo de atendimento hospitalar, quando orientado pelos pressupostos da segurança do paciente, conduz ao cuidado centrado no paciente e, a experiência do paciente como coprodutor de serviços de saúde, oportuniza identificar atributos de satisfação em relação à segurança do cuidado.

This is a qualitative, exploratory-descriptive study about the experience of patients treated in hospitals with a view to health care co-production. It is based on Donabedian model, which emphasizes patient's engagement in the evaluation of health quality, with focus on the triad: structure, process and outcome. The general objective was to analyze patient's experience during hospital stay in medical and surgical units, focusing on co-production of quality-oriented care. The study scenario was a public university hospital in the south of Brazil. A total of 10 professionals from the health team, 22 patients and 8 adult family members from 12 medical and surgical hospital units participated in the study. For data collection a triangulation of multiple sources ­ documentary analysis, observation and interviews ­ was done. The primary data came from the observation of 30 service encounters during health care in two units, and the accomplishment of 24 interviews with patient-families which were conducted based on the Critical Incident Technique. For the analysis of data and information, descriptive statistics and thematic analysis were used. The research met the ethical precepts for its development. The analysis resulted in four empirical categories, whose transversal axis was the role of patient-families as co-producers of safe care, being: i) a cutoff in quality and safety of care in the field studied; ii) safety protocols according to patient's experience; iii) paths covered and to be covered in patient-centered care; and iv) attributes of safety satisfaction in patient's experience. It was found that there is an alignment among patients' perceptions, institutional definitions, and basic protocols of the National Patient Safety Program. However, it has been seen that patients realize that those protocols are not always followed by the professionals. The co-production to a safe care was perceived in relation to the protocols of safe surgery and prevention of injuries due to fall. In the identification of the patient, hand hygiene, and medication process it was verified that the co-production depends on the proactive behavior of patient-families. On the one hand, it was possible to verify opportunities for co-production in patient-centered care, through the behavior of professionals in instigating, involving and clarifying patient-families. On the other hand, it was found that the service meetings focused on the reason of hospitalization and in technical interventions. While the behavior of the professionals was valued by patient-families when there was more interaction and perception of quality care standards, its opposite emerged as a lack of subsidies to follow the treatment, or lack of care in some moments. Attributes of safety satisfaction on structure, process, and outcomes emerged. It is considered that patient's experience supports the thesis that hospital care process, when guided by the assumptions of patient safety, leads to patient-centered care, and patient's experience as a co-producer of health services, allows the identification of satisfaction attributes regarding the safety of care.

Se trata de un estudio cualitativo, de tipo exploratorio-descriptivo, a cerca de la experiencia del paciente atendido en servicio hospitalar, en la perspectiva de la coproducción de los cuidados en salud. Se guía en la sistematización de Donabedian, la cual enfatiza el compromiso del paciente en la evaluación de la calidad en salud, con base en la tríada estructura, proceso y resultado. El objetivo general consistió en analizar la experiencia del paciente durante la internación hospitalar en unidades clínicas y quirúrgicas, con foco en la coproducción de cuidados orientados para la calidad. El escenario de estudio fue un hospital universitario público del sur del país. Participaron 10 profesionales del equipo de salud, 22 pacientes y 8 familiares adultos procedentes de 12 unidades de internación clínica y quirúrgica del hospital. Para la colecta de datos, se procedió a la triangulación de múltiples fuentes: análisis documental, observación y entrevistas. Los datos primarios fueron oriundos de la observación de 30 encuentros de servicio durante la prestación de los cuidados en 2 unidades y la realización de 24 entrevistas con pacientes-familiares, conducidas con base en la Técnica de Incidente Crítico. Para el análisis de los datos e informaciones, se utilizó estadística descriptiva y análisis temática. La pesquisa atendió los preceptos éticos para su desarrollo. El análisis resultó en cuatro categorías empíricas, cuyo eje transversal fue el papel de los pacientes-familias como coproductores del cuidado seguro, siendo ellas: i) un recorte de la calidad y seguridad asistencial en el campo estudiado; ii) protocolos de seguridad según la experiencia del paciente, iii) caminos recorridos y por recorrer en el cuidado centrado en el paciente y; iv) atributos de satisfacción de seguridad en la experiencia del paciente. Se constató que hay alineamiento entre las percepciones de los pacientes, las definiciones institucionales y los protocolos básicos del Programa Nacional de Seguridad del Paciente. Sin embargo, se vio que los pacientes perciben que esos protocolos ni siempre son seguidos por los profesionales. La coproducción para un cuidado seguro fue percibida en relación a los protocolos de cirugía segura y de prevención de lesiones provenientes de caída. En la identificación del paciente, higiene de las manos y proceso de medicación, se verificó que la coproducción depende del comportamiento colaborador de pacientes-familias. Por un lado, fue posible constatar oportunidades para coproducción en el cuidado centrado en el paciente, mediante el comportamiento de profesionales en instigar, involucrar e informar pacientes-familias. Por otro, se verificó que los encuentros de servicio se centraron en el motivo de la internación y en intervenciones técnicas. Al mismo tiempo que el comportamiento de los profesionales fue valorado por los pacientes-familias, cuando hubo mayor interacción y por la percepción de padrones asistenciales de calidad, lo opuesto emergió como falta de subsidios para acompañar el tratamiento, o falta de cuidados demandados en algunos momentos. Emergieron atributos de satisfacción de seguridad sobre la estructura, proceso y resultados asistenciales. Se considera que la experiencia del paciente sostiene la tesis de que el proceso de atención hospitalar, cuando orientado por lo que él presupone al respecto de seguridad, conduce al cuidado centrado en el paciente y, la experiencia del paciente como coproductor de servicios de salud, nos da la oportunidad de identificar atributos de satisfacción en relación a la seguridad de aquél que está siendo cuidado.