Development of a questionnaire to assess interprofessional collaboration between two different care levels.

INTRODUCTION: This paper reports the development and validation of a questionnaire to assess collaboration between clinical professionals from two different care levels (primary and specialised care), according to the clinicians' own perceptions. This questionnaire has been elaborated to be used as part of the monitoring and evaluation process of the integrated care pilots in the public Basque Health Service. METHODS: THE PROCESS WAS CARRIED OUT IN FOUR PHASES: development of the first version of the questionnaire, validation of the content, pre-testing, and evaluation of its construct validity and homogeneity in a sample of doctors and nurses. This last phase involved confirmatory factor analysis, as well as the calculation of Cronbach's α and various correlation coefficients. RESULTS: The process demonstrated that the theoretical content of the questionnaire was appropriate, and also that its items were clear, relevant and intelligible. The fit indices for the confirmatory factor analysis were: χ(2) of 45.51 (p=0.089), RMSEA of 0.043, RMR of 0.046, GFI of 0.92 and CFI of 0.99. DISCUSSION: The statistics indicate a good fit between the data and a conceptual two-factor structure, in which both personal relationships between professionals and characteristics of the organisational environment are understood to underlie interprofessional collaboration. CONCLUSION: The end-product is a new instrument with good validity to assess the degree of interprofessional collaboration between clinicians working at two different levels of care.

[Quality of spirometry tests done in primary care units in the province of Gipuzkoa]. / Calidad de las espirometrías realizadas en las unidades de atención primaria de la provincia de Guipúzcoa.

OBJECTIVE: To determine the validity of Spirometry tests done in primary care in our province and to find in what parts of the test errors are committed. DESIGN: Transversal, descriptive study. SETTING: All the primary care units in the province of Gipuzkoa, Spain. PARTICIPANTS: Thirty of the 44 existing units took part, contributing the last 10 spirometry tests conducted in November, 2005. MAIN MEASUREMENTS: Two primary care doctors who were skilled in spirometry analysed the acceptability, reproducibility, possible utility of invalid tests and their spirometric patterns. They also looked at aspects of the curve that were not sufficient. Tests were considered acceptable, reproducible and possibly useful when the 2 doctors coincided. Where they did not coincide, these characteristics were determined by a pneumologist. The validity criteria of the ATS were followed. RESULTS: Of the 44 units in our province, 30 took part. They contributed 300 spirometry tests, of which 12 were excluded as illegible. A total of 48% were considered acceptable, 78% met reproducibility criteria and 38.5% met both characteristics. The most common error was the scant length of exhalation, insufficient in 38.19% of cases. The most usual pattern found was the normal one with 58%, followed by the restrictive with 18%, the obstructive with 13%, and the mixed one, with 11%. CONCLUSIONS: Quality of spirometry tests in primary care is deficient. The most common error is that exhalation is too brief. We think this is why we find a predominance of restrictive patterns over obstructive ones. Just by prolonging the spirometry operation, we would manage to increase markedly the number of valid tests.

Calidad de las espirometrías realizadas en las unidades de atención primaria de la provincia de Guipúzcoa / Quality of spirometry tests done in primary care units in the province of Gipuzkoa

Objetivo. Determinar la validez de las espirometrías realizadas en atención primaria en nuestra provincia y conocer en qué aspectos de la maniobra se cometen los errores. Diseño. Estudio descriptivo, transversal. Emplazamiento. Provincia de Guipúzcoa. Participantes. Participaron 30 de las 44 unidades existentes aportando las últimas 10 espirometrías. Mediciones principales. Dos médicos de atención primaria analizaron las espirometrías siguiendo los criterios de validez de la American Thoracic Society. Un neumólogo revisó los resultados no coincidentes. Resultados. De las 300 espirometrías analizadas se excluyeron 12 por ser ilegibles. El 48% fueron aceptables, un 78% reunía criterios de reproducibilidad y un 38,5% reunía ambas características. El patrón más habitual era el normal con un 58%, seguido del restrictivo con un 18%, el obstructivo un 13% y el mixto un 11%. El error más frecuente (38,19%) era la escasa prolongación de la espiración. Conclusiones. La calidad de las espirometrías realizadas en atención primaria es deficiente. El error más frecuente es la brevedad de la espiración, por ello encontramos un predominio de patrones restrictivos. Simplemente prolongando la maniobra espiratoria se conseguiría aumentar considerablemente el número de espirometrías válidas

Objective. To determine the validity of Spirometry tests done in primary care in our province and to find in what parts of the test errors are committed. Design. Transversal, descriptive study. Setting. All the primary care units in the province of Gipuzkoa, Spain. Participants. Thirty of the 44 existing units took part, contributing the last 10 spirometry tests conducted in November, 2005. Main measurements. Two primary care doctors who were skilled in spirometry analysed the acceptability, reproducibility, possible utility of invalid tests and their spirometric patterns. They also looked at aspects of the curve that were not sufficient. Tests were considered acceptable, reproducible and possibly useful when the 2 doctors coincided. Where they did not coincide, these characteristics were determined by a pneumologist. The validity criteria of the ATS were followed. Results. Of the 44 units in our province, 30 took part. They contributed 300 spirometry tests, of which 12 were excluded as illegible. A total of 48% were considered acceptable, 78% met reproducibility criteria and 38.5% met both characteristics. The most common error was the scant length of exhalation, insufficient in 38.19% of cases. The most usual pattern found was the normal one with 58%, followed by the restrictive with 18%, the obstructive with 13%, and the mixed one, with 11%. Conclusions. Quality of spirometry tests in primary care is deficient. The most common error is that exhalation is too brief. We think this is why we find a predominance of restrictive patterns over obstructive ones. Just by prolonging the spirometry operation, we would manage to increase markedly the number of valid tests

La confusión en torno al concepto de gerencia única: un caso de sinécdoque. Respuesta de los autores / Confusion concerning the concept of single management (a case of synecdoche). Reply

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