Opinions and perceptions of patients with cardiovascular disease on adherence: a qualitative study of focus groups.

BACKGROUND: Cardiovascular diseases are becoming more frequent throughout the world. Adherence to both pharmacological and non-pharmacological treatment, as well as lifestyles, is important for good management and control of the disease. This study aims to explore the opinions and perceptions of patients with ischemic heart disease on the difficulties associated with therapeutic adherence. METHODS: An interpretive phenomenological study was carried out using focus groups and one semi-structured interview. The MAXQDA qualitative data analysis program was used for inductive interpretation of the group discourses and interview. Data were coded, and these were grouped by categories and then consolidated under the main themes identified. RESULTS: Two in-person focus groups and one remote semi-structured interview were performed. Twelve participants (6 men and 6 women) from the Hospital de San Juan de Alicante participated, two of them being family companions . The main themes identified were aspects related to the individual, heart disease, drug treatment, and the perception of the health care system. CONCLUSIONS: Adhering to recommendations on healthy behaviors and taking prescribed medications for cardiovascular disease was important for most participants. However, they sometimes found polypharmacy difficult to manage, especially when they did not perceive the symptoms of their disease. Participants related the concept of fear to therapeutic adherence, believing that the latter increased with the former. The relationship with health professionals was described as optimal, but, nevertheless, the coordination of the health care system was seen as limited.

Acute Stress in Health Workers in Colombia 2017-2021: A Cross-Sectional Study.

Objectives: Analyze the presence of acute stress response after adverse events in human talent in Colombian health institutions from 2017 to 2021. Methods: Cross-sectional study of prevalence, carried out on 838 members of the human talent in health (professionals, technicians, technologists, and auxiliaries) of Colombian health institutions in the study period with the application of the EASE instrument. Univariate analysis using descriptive statistical techniques, chi-square and Student's t-test, and bivariate analysis with a Poisson regression model using the institucional SPSS v. 26. Results: The prevalence of adverse events in the last 5 years was 33.8%, presenting levels of acute stress qualifying as Medium-high emotional overload at 21.91%, while extreme acute stress was at 3.53%. The prevalence of risk for presenting acute stress after being involved in an adverse event was PR: 1.30 (CI: 1.24-1.36). Conclusion: Acute stress in human talent after adverse events is limiting health and care capacity and must be efficiently addressed by health institutions. Psychosocial risk is linked within the framework of the patient safety program and the institutional occupational health and safety management systems.

Knowledge about Chagas Disease among Family and Community Medicine Residents in a Non-Endemic Region: A Cross-Sectional Study.

Chagas disease (CD) is a parasitic disease endemic to continental Latin America that has globalized in recent years. The most relevant mechanisms of transmission of CD in non-endemic countries are transfusion with infected blood and mother-to-child transmission. There is limited information regarding practicing physicians' knowledge of CD transmission, clinical presentation, and treatment in non-endemic countries, including Spain. Our objective was to analyze the level of knowledge about CD in family and community medicine residents and how it has evolved over the last 5 years. A cross-sectional study was performed in the framework of the training program for family and community medicine specialists in Alicante, Spain. Convenience sampling was used to enroll 214 fourth-year family and community medicine residents from 2016 to 2020. Participants completed the validated Chagas Level of Knowledge Scale questionnaire prior to attending the seminar "Health Care for the Immigrant Population." The mean score on the scale was 7.1/10 points. Only 12 participants (5.6%) answered all questions correctly. Resident physicians who reported having received prior information on CD scored better than those who were not informed (mean, 7.2 versus 6.1 points). Participants from Latin America had scores similar to those of the rest of the participants. Over the 5-year study period, questionnaire scores tended to increase. Knowledge about CD among family and community medicine residents has improved in recent years, although it is still not optimal. Specific training on CD during specialized health care training is warranted.

Surgical Error Compensation Claims as a Patient Safety Indicator: Causes and Economic Consequences in the Murcia Health System, 2002 to 2018.

OBJECTIVES: Compensation claims are a useful source of information on patient safety research. The purpose of this study was to determine the main causes of surgical compensation claims and their financial impact on the health system. METHODS: A descriptive observational study with analytical components was carried out on compensation claims brought against the surgical area of the Murcia Health System between 2002 and 2018. We analyzed the frequency, causes, consequences, locations and surgical settings of these claims, the time of judicial procedure, and compensation adjusted to the Consumer Price Index. RESULTS: There were 1172 compensation claims. "orthopedic surgery and traumatology" (27.4%), "gynecology and obstetrics" (25.7%), and "general surgery" (17.2%) were the main surgical settings involved. The most frequent causes were surgical error (42.4%) and treatment error (30.9%). The main sequelae were musculoskeletal (20.0%), neurological (17.7%), and obstetric (17.7%). The average time from incident to resolution of claims was 6.3 years. A total of 20.1% of these claims were successful, particularly those involving retained surgical foreign bodies (71.4% successful claims; P < 0.001). The total compensation paid was €56,338,247 (an average of €17,207 per claim). Compensation was higher in cases with respiratory sequelae (median, 131,600; P = 0.033), death (75,916; P < 0.001), and neurological (60,000; P = 0.024). CONCLUSIONS: Compensation claims associated with surgical procedures are made on a variety of grounds. They are drawn-out proceedings, and patients are only successful in 20% of cases.

A systematic review on pediatric medication errors by parents or caregivers at home.

INTRODUCTION: Medication errors (MEs) are frequent and, in some cases, can lead to hospitalization, disability, increased healthcare costs or, even, death. Most of pediatric medications are administered by parents or caregivers at home. It is necessary to explore the MEs at home to improve pediatric patient safety. AREAS COVERED: This study aimed to review the current literature on the frequency of pediatric MEs by parents or caregivers at home, their associated factors, and pediatric ME reporting systems. Citable original articles of any type of study design or reviews published from 2013 to 2021 were searched in Medline, Scopus, Embase, and ScienceDirect databases. EXPERT OPINION: The available data about the frequency of pediatric MEs at home varied from 30% to 80%. Current research suggests the risk of making a ME in pediatric patients at home may depend on the characteristics of the caregiver and may increase if a prescription contains ≥3 drugs. Findings conclude that providing dosing tools more closely matched to prescribed dose volumes, recommending the use of syringes as a measurement tool, and educational intervention for caregivers could be useful to reduce MEs. Concerning the reporting systems for pediatric MEs in the outpatient setting, no information was found.

Patient-Reported Experience and Outcome Measures in People Living with Diabetes: A Scoping Review of Instruments.

BACKGROUND: Diabetes mellitus is a global public health concern, with over 463 million people living with this chronic disease. Pathology complexity, management difficulty, and limited participation in care has resulted in healthcare systems seeking new strategies to engage people living with diabetes. Patient-reported experience measures (PREMs) and patient-reported outcome measures (PROMs) were developed to address the gap between the healthcare system expectation and patient preference. OBJECTIVE: This study aimed to review the existing literature on PREMs and PROMs specific to type 1 and 2 diabetes, and report the dimensions report the dimensions they have measured. METHODS: A scoping review was conducted from January 1985 to March 2020 of six databases, MEDLINE, EMBASE, PsycINFO, CINHAL, Scopus, and BiblioPro, to identify PREM and PROM instruments specific for type 1 and 2 diabetes. RESULTS: Overall, 34 instruments were identified, 32 PROMs and two PREMs. The most common instrument included outcomes related to quality of life at 44% (n = 15), followed by satisfaction (whether with treatment, device, and healthy habits) at 26% (n = 9). Furthermore, instruments regarding personal well-being accounted for 15% (n = 5). For instruments that measure experiences of persons with diabetes, there were two scales of symptoms, and one related to the attitude patients have toward the disease. CONCLUSIONS: Diabetes-specific validated instruments mainly focus on quality of life, education, and treatment, and sometimes overlap each other, in their subscales and assessment dimensions. Constructs such as cultural and religious beliefs, leisure, and work life may need more attention. There appears to be a gap in instruments to measure experiences of individuals who "live with diabetes" and seek to lead a "normal life."

Estimation of the Overuse of Preoperative Chest X-rays According to "Choosing Wisely", "No Hacer", and "Essencial" Initiatives: Are They Equally Applicable and Comparable?

BACKGROUND: Overuse reduces the efficiency of healthcare systems and compromises patient safety. Different institutions have issued recommendations on the indication of preoperative chest X-rays, but the degree of compliance with these recommendations is unknown. This study investigates the frequency and characteristics of the inappropriateness of this practice. METHODS: This is a descriptive observational study with analytical components, performed in a tertiary hospital in the Community of Madrid (Spain) between July 2018 and June 2019. The inappropriateness of preoperative chest X-ray tests was analyzed according to "Choosing Wisely", "No Hacer" and "Essencial" initiatives and the cost associated with this practice was estimated in Relative Value and Monetary Units. RESULTS: A total of 3449 preoperative chest X-ray tests were performed during the period of study. In total, 5.4% of them were unjustified according to the "No Hacer" recommendation and 73.3% according to "Choosing Wisely" and "Essencial" criteria, which would be equivalent to 5.6% and 11.8% of the interventions in which this test was unnecessary, respectively. One or more preoperative chest X-ray(s) were indicated in more than 20% of the interventions in which another chest X-ray had already been performed in the previous 3 months. A higher inappropriateness score was also recorded for interventions with an American Society of Anesthesiologists (ASA) grade ≥ III (16.5%). The Anesthesiology service obtained a lower inappropriateness score than other Petitioning Surgical Services (57.5% according to "Choosing Wisely" and "Essencial"; 4.1% according to "No Hacer"). Inappropriate indication of chest X-rays represents an annual cost of EUR 52,122.69 (170.1 Relative Value Units) according to "No Hacer" and EUR 3895.29 (2276.1 Relative Value Units) according to "Choosing Wisely" or "Essencial" criteria. CONCLUSIONS: There was wide variability between the recommendations that directly affected the degree of inappropriateness found, with the main reasons for inappropriateness being duplication of preoperative chest X-rays and the lack of consideration of the particularities of thoracic interventions. This inappropriateness implies a significant expense according to the applicable recommendations and therefore a high opportunity cost.

Impact of adherence to Mediterranean diet and/or drug treatment on glycaemic control in type 2 diabetes mellitus patients: DM2-CUMCYL study.

AIMS: This study aimed to analyse the association between adherence to treatment and glycaemic control in people with type 2 diabetes mellitus. METHODS: Multicentre, cross-sectional study in patients with type 2 diabetes mellitus recruited by primary care professionals in Castilla y León (Spain). Sociodemographic and clinical characteristics were reflected in self-reported questionnaire, which included the Morisky-Green Medication Adherence Scale and the 14-point Mediterranean Diet Adherence Screener. Medication non-adherence and poor glycaemic control were analysed by bivariable and multivariable analyses. RESULTS: Of 3536 included patients, the 33.8% reported non-adherence to pharmacological treatment, and the 33.7% had poor glycaemic control (HbA1c ≥58 mmol/mol [7.5%]); 50.6% of patients reported moderate-high adherence to the Mediterranean diet (≥9 points). The multivariable logistic regression model showed that educational level (OR 0.73; 95% CI 0.61-0.87; p < 0.001) and sedentarism (OR 1.64; 95% CI 1.36-1.98; p < 0.001) were associate with low adherence. Younger age, rural residence, smoking, time since diagnosis (OR 1.04; 95% CI 1.03-1.05; p < 0.001) and polypharmacy were associated with poor glycaemic control. CONCLUSION: Lower educational level and sedentarism were associated with low adherence. Younger age, rural residence, smoking, time since diagnosis and polypharmacy, increased risk of poor glycaemic control.

Low-Value Clinical Practices: Knowledge and Beliefs of Spanish Surgeons and Anesthetists.

OBJECTIVES: To know the frequency and causes of low value surgical practices, according to the opinion of surgeons and anesthetists, and to determine their degree of knowledge about the Spanish "Choosing wisely" initiative. METHODS: Cross-sectional observational study, based on a self-administered online questionnaire through an opportunistic sample of 370 surgeons and anesthetists from three Spanish regions, contacted through Scientific Societies. The survey took part between July and December 2017. RESULTS: A patient profile requesting unnecessary practices was identified (female, 51-65 years old and unaffiliated disease). The frequency of requests was weekly or daily for 50.0% of the professionals, of whom 15.1% acknowledged succumbing to these pressures. To dissuade the patient, clinical reasons (47%) were considered the most effective. To increase control and safety in the case was the main reason to indicate them. The greatest responsibility for overuse was attributed to physicians, defensive medicine and mass media. Assessing professionals' knowledge on unnecessary practices, an average of 5 correct answers out of 7 was obtained. Some 64.1% of the respondents were unaware of the Spanish "Choosing wisely" initiative. CONCLUSIONS: Low value surgical practices are perceived as a frequent problem, which requires an approach entailing intervention with patients and the media as well as professionals. Increase awareness on unnecessary surgical practices, and how to avoid them remain essential.

Healthcare Professionals and Students' Awareness of Chagas Disease: Design and Validation of Chagas Level of Knowledge Scale (ChaLKS).

There are few studies evaluating awareness of Chagas disease among healthcare professionals attending migrants from Latin America or working in Chagas-endemic areas. The objective of this study was to design and validate instruments for assessing knowledge about Chagas disease among healthcare students and residents as well as students and professionals of social and other health science disciplines. Two validated scales have been developed: the 10-item Chagas Level of Knowledge Scale for healthcare professionals (ChaLKS-Medical) and the 8-item ChaLKS-Social&Health for potential aid workers from those fields. Both scales were considered adequate in terms of readability, internal consistency, construct validity, and discriminant validity. The mean number of correct answers on the ChaLKS-Medical among respondents from non-healthcare versus healthcare sectors was 1.80 versus 7.00 (P < 0.001). The scores on the ChaLKS-Social&Health also discriminated between the knowledge levels in these two groups (1.76 versus 6.78, P < 0.001). Knowledge among medical/pharmacy students and residents on the ChaLKS-Medical was acceptable and different (mean: 5.8 and 7.4, respectively; P < 0.001). Respondents' knowledge of Chagas disease was greater in those who had previously received information on the disease; this was true in both respondents from the healthcare sector (mean correct answers, ChaLKS-Medical: 7.2 versus 4.3, P < 0.001) and in potential aid workers (mean correct answers, ChaLKS-Social&Health: 5.1 versus 1.1, P = 0.001). The metric properties of both scales are adequate for their use in supporting aid operations in Chagas-endemic countries or in providing health and social care to migrant populations in non-endemic countries.

Root Cause? Yes of course … but then what?

[EXCERPT]. Analyzing the causes of unsafe care can reduce the number of ‘near misses’ (incidents that may cause harm to patients) and adverse events (that actually produce harm). This is an important mandate for health care organizations committed to providing a safe environment for patients. Although guaranteeing absolute safety in all interventions is not always possible, hospitals and other health care institutions implement safety practices and surveillance methods to understand how these unsafe incidents occur. In many cases, these incidents were not generated by a single cause; and remote causes are as significant as more proximate ones...

Do not do in COPD: consensus statement on overuse.

Background: To identify practices that do not add value, cause harm, or subject patients with chronic obstructive pulmonary disease (COPD) to a level of risk that outweighs possible benefits (overuse). Methods: A qualitative approach was applied. First, a multidisciplinary group of healthcare professionals used the Metaplan technique to draft and rank a list of overused procedures as well as self-care practices in patients with stable and exacerbated COPD. Second, in successive consensus-building rounds, description files were created for each "do not do" (DND) recommendation, consisting of a definition, description, quality of supporting evidence for the recommendation, and the indicator used to measure the degree of overuse. The consensus group comprised 6 pulmonologists, 2 general practitioners, 1 nurse, and 1 physiotherapist. Results: In total, 16 DND recommendations were made for patients with COPD: 6 for stable COPD, 6 for exacerbated COPD, and 4 concerning self-care. Conclusion: Overuse poses a risk for patients and jeopardizes care quality. These 16 DND recommendations for COPD will lower care risks and improve disease management, facilitate communication between physicians and patients, and bolster patient ability to provide self-care.

El impacto que tienen los eventos adversos sobre los profesionales sanitarios de atención primaria y sus instituciones / The impact of adverse events on health primary care professionals and institutions

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[Evaluation of satisfaction with telemedicine devices and with the results of the care received among chronic patients. The ValCrònic program]. / Evaluación de la satisfacción de los pacientes crónicos con los dispositivos de telemedicina y con el resultado de la atención recibida. Programa ValCrònic.

OBJECTIVE: To evaluate patient satisfaction with the ValCrònic program, telemedicine devices, and the results of the care received after a 2-year follow-up. DESIGN: Observational, descriptive study based on telephone surveys. SETTING: The autonomous community of Valencia (Spain). PARTICIPANTS: Participants consisted of 410 patients with one or more of the following diseases: hypertension, heart failure, diabetes, or chronic obstructive pulmonary disease. A total of 585 patients were included, of whom 104 left the program (18 due to death) and 71 refused to participate. METHODS: We designed and validated a specific scale. Floor and ceiling effects were considered. Internal consistency was analyzed using Cronbach's alpha. RESULTS: Responses were obtained from 322 patients (response rate, 78.5%). Of these, 118 (36.6%) were women. In 48 patients (14.9%), the person responding was a caregiver. Cronbach's alpha was 0.7. For 278 patients (86.3%), the ValCrònic program helped them to understand their disease better, 270 (83.9%) reported that it helped them use their medication more safely, and 283 (87.9%) reported they had better knowledge of their disease. For 288 (89.4%), the devices were easy to manage at home. Only 12 patients (3.7%) found that the devices involved a heavy workload that was difficult to incorporate into their daily lives. CONCLUSIONS: The ValCrònic program promotes self-care among patients.

Evaluación de la satisfacción de los pacientes crónicos con los dispositivos de telemedicina y con el resultado de la atención recibida. Programa ValCrònic / Evaluation of satisfaction with telemedicine devices and with the results of the care received among chronic patients. The ValCrònic program

OBJETIVO: Evaluar la satisfacción de los pacientes con el programa ValCrònic, los dispositivos de telemedicina y con el resultado de la atención recibida tras 2 años de seguimiento. DISEÑO: Estudio observacional descriptivo basado en encuestas telefónicas. Emplazamiento: Comunidad Valenciana. Participantes: En total participaron 410 pacientes que presentaban una o varias de las siguientes patologías: hipertensión, insuficiencia cardíaca, diabetes o enfermedad pulmonar obstructiva crónica. Se incluyó a 585 pacientes, de los cuales 104 abandonaron el programa (18 por fallecimiento) y 71 rehusaron participar. MÉTODOS: Se diseñó y validó una escala específica. Se consideraron los efectos techo y suelo. Se analizó la consistencia interna mediante alfa de Cronbach. Para comprobar la validez de constructo se empleó un análisis exploratorio de componentes principales con criterio de autovaloración igual a 1. Se aplicó el procedimiento de rotación Varimax. Se consideraron como pérdidas aceptables de información cargas factoriales ≥ 0,55. La escala se conformó con 7 preguntas cerradas y 1 abierta. RESULTADOS: Respondieron un total de 322 pacientes (tasa de respuesta del 78,5%). 118 (36.6%) fueron mujeres. En 48 (14,9%) casos respondió un cuidador. El valor del alfa de Cronbach fue de 0,7. ValCrònic supuso para 278 (86,3%) pacientes una ayuda para conocer mejor su enfermedad, 270 (83,9%) afirmaron hacer un uso más seguro de la medicación gracias a ValCrònic y 283 (87,9%) dijeron conocer ahora mejor su enfermedad. Para 288 (89,4%) los dispositivos fueron fáciles de manejar en casa. Solo en 12 (3,7%) casos el paciente consideró que los dispositivos de telemedicina suponían una carga de trabajo difícil de conciliar en su día a día. CONCLUSIONES: ValCrònic ha contribuido a la activación de los pacientes para autocuidado

OBJECTIVE: To evaluate patient satisfaction with the ValCrònic program, telemedicine devices, and the results of the care received after a 2-year follow-up. DESIGN: Observational, descriptive study based on telephone surveys. Setting: The autonomous community of Valencia (Spain). Participants: Participants consisted of 410 patients with one or more of the following diseases: hypertension, heart failure, diabetes, or chronic obstructive pulmonary disease. A total of 585 patients were included, of whom 104 left the program (18 due to death) and 71 refused to participate. METHODS: We designed and validated a specfic scale. Floor and ceiling effects were considered. Internal consistency was analyzed using Cronbach's alpha. RESULTS: Responses were obtained from 322 patients (response rate, 78.5%). Of these, 118 (36.6%) were women. In 48 patients (14.9%), the person responding was a caregiver. Cronbach's alpha was 0.7. For 278 patients (86.3%), the ValCrònic program helped them to understand their disease better, 270 (83.9%) reported that it helped them use their medication more safely, and283 (87.9%) reported they had better knowledge of their disease. For 288 (89.4%), the devices were easy to manage at home. Only 12 patients (3.7%) found that the devices involved a heavy workload that was difficult to incorporate into their daily lives. CONCLUSIONS: The ValCrònic program promotes self-care among patients

Desarrollo de IEMAC, un Instrumento para la Evaluación de Modelos de Atención ante la Cronicidad / Development of an instrument for the assessment of chronic care models

Objetivos: Presentar el contexto, los objetivos y el proceso de elaboración de IEMAC, Instrumento de Evaluación de Modelos de Atención ante la Cronicidad, desarrollado para trasladar al terreno operativo los marcos conceptuales del Chronic Care Model (CCM), en el entorno del Sistema Nacional de Salud. Métodos: Mediante técnicas de investigación cualitativa y contando sucesivamente con expertos nacionales de diferentes perfiles, se desarrolló el IEMAC para operativizar el CCM a nuestro contexto sanitario. Se construyó una matriz considerando qué dimensiones básicas debían conformar el nuevo modelo. Se identificaron y categorizaron posibles acciones en cada dimensión, creando una taxonomía de componentes e intervenciones. Se evaluó la claridad, la pertinencia y el nivel de evidencia de cada intervención. El cuestionario resultante fue validado por otros expertos de diversas disciplinas y ámbitos. Finalmente, el instrumento IEMAC 1.0ha sido pilotado a niveles macro, meso y micro. Resultados: IEMAC es un instrumento para ser autoadministrado por organizaciones sanitarias a niveles macro, meso y micro. Consta de 6 dimensiones, 27 componentes y 80 intervenciones, cuya implantación se evalúa en una escala que combina despliegue, evaluación sistemática y orientación a la mejora. IEMAC tiene un enfoque sistémico y poblacional, integrando promoción, prevención y coordinación con servicios sociales. Conclusiones: IEMAC muestra un conjunto de intervenciones que pueden servir de hoja de ruta a decisores, gestores y clínicos interesados en construir un modelo de excelencia para la atención a pacientes crónicos, a la vez que permite que las organizaciones sanitarias conozcan su situación basal y el progreso alcanzado tras intervenciones de mejora (AU)

Objective: To present the context, aim and process of designing the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluación de Modelos de Atención ante la Cronicidad [IEMAC]), which was developed to make the conceptual framework of the chronic care model operational in the Spanish national health system. Methods: The IEMAC was developed by a series of national experts with distinct profiles of expertise using qualitative research techniques. A matrix was built with the dimensions selected as basic for the new model. In each dimension, actions were identified and categorized, creating a taxonomy of components and interventions. The clarity and appropriateness of each intervention, and the degree of evidence to support it, were assessed. The resulting questionnaire was validated by other experts from diverse disciplines and settings. Finally, the IEMAC 1.0 was piloted at macro, meso and micro levels. Results: The IEMAC is a tool to be self-administered by health organizations at macro, meso and micro levels. This instrument is composed of six dimensions, 27 components and 80 interventions, whose implementation is assessed with the aid of a scale that combines deployment, systematic evaluation, and orientation improvement. The IEMAC uses a systemic, population-based approach and integrates promotion, prevention, and coordination with social services. Conclusions: The IEMAC contains a set of interventions that can be used as a road map by decision makers, managers and clinicians interested in building a state-of-the-art chronic care model. At the same time, the IEMAC allows healthcare organizations to identify their baseline score and the progress achieved after improvement interventions (AU)