Cross-cultural validation of the patient-practitioner orientation scale among primary care professionals in Spain.

BACKGROUND: In recent decades, many self-report instruments have been developed to assess the extent to which patients want to be informed and involved in decisions about their health as part of the concept of person-centred care (PCC). The main objective of this research was to translate, adapt and validate the Patient-Practitioner Orientation Scale (PPOS) using a sample of primary care health-care professionals in Spain. METHODS: Baseline analysis of PPOS scores for 321 primary care professionals (general practitioners and nurses) from 63 centres and 3 Spanish regions participating in a randomized controlled trial. We analysed missing values, distributions and descriptive statistics, item-to-scale correlations and internal consistency. Performed were confirmatory factor analysis (CFA) of the 2-factor model (sharing and caring dimensions), scale depuration and principal component analysis (PCA). RESULTS: Low inter-item correlations were observed, and the CFA 2-factor model only obtained a good fit to the data after excluding 8 items. Internal consistency of the 10-item PPOS was acceptable (0.77), but low for individual subscales (0.70 and 0.55). PCA results suggest a possible 3-factor structure. Participants showed a patient-oriented style (mean = 4.46, SD = 0.73), with higher scores for caring than sharing. CONCLUSION: Although the 2-factor model obtained empirical support, measurement indicators of the PPOS (caring dimension) could be improved. Spanish primary care health-care professionals overall show a patient-oriented attitude, although less marked in issues such as patients' need for and management of medical information.

Effectiveness and cost-effectiveness of a virtual community of practice to improve the empowerment of patients with ischaemic heart disease: study protocol of a randomised controlled trial.

INTRODUCTION: Virtual Communities of Practice (VCoP) or knowledge-sharing virtual communities offer ubiquitous access to information and exchange possibilities for people in similar situations, which might be especially valuable for the self-management of patients with chronic diseases. In view of the scarce evidence on the clinical and economic impact of these interventions on chronic conditions, we aim to evaluate the effectiveness and cost-effectiveness of a VCoP in the improvement of the activation and other patient empowerment measures in patients with ischaemic heart disease (IHD). METHODS AND ANALYSIS: A pragmatic randomised controlled trial will be performed in Catalonia, Madrid and Canary Islands, Spain. Two hundred and fifty patients with a recent diagnosis of IHD attending the participating centres will be selected and randomised to the intervention or control group. The intervention group will be offered participation for 12 months in a VCoP based on a gamified web 2.0 platform where there is interaction with other patients and a multidisciplinary professional team. Intervention and control groups will receive usual care. The primary outcome will be measured with the Patient Activation Measure questionnaire at baseline, 6, 12 and 18 months. Secondary outcomes will include: clinical variables; knowledge (Questionnaire of Cardiovascular Risk Factors), attitudes (Self-efficacy Managing Chronic Disease Scale), adherence to the Mediterranean diet (Mediterranean Diet Questionnaire), level of physical activity (International Physical Activity Questionnaire), depression (Patient Health Questionnaire), anxiety (Hospital Anxiety Scale-A), medication adherence (Adherence to Refill Medication Scale), quality of life (EQ-5D-5L) and health resources use. Data will be collected from self-reported questionnaires and electronic medical records. ETHICS AND DISSEMINATION: The trial was approved by Clinical Research Ethics Committee of Gregorio Marañón University Hospital in Madrid, Nuestra Señora de Candelaria University Hospital in Santa Cruz de Tenerife and IDIAP Jordi Gol in Barcelona. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, local/international conferences. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov Registry (NCT03959631). Pre-results.

Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment: a qualitative pilot study.

BACKGROUND: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. METHODS: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. RESULTS: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. CONCLUSIONS: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02757781 . Registered on 25 April 2016.

Educación interprofesional a través de la atención domiciliaria: experiencia tras 2 años de implementación en los grados de Medicina y Enfermería de la Universidad Europea de Madrid / Interprofessional education at home care: A 2 year experience in the degrees of Medicine and Nursing at the Universidad Europea (Madrid)

INTRODUCCIÓN: La Organización Mundial de la Salud recomienda la educación interprofesional cuando estudiantes de 2 o más profesiones sanitarias aprenden juntos, para favorecer el desarrollo de las competencias interprofesionales que les van a permitir trabajar en equipo proporcionando la mejor asistencia sanitaria. En la Universidad Europea de Madrid existe un programa de educación interprofesional que trabaja las competencias de clarificación de roles, comunicación y autoridad, con estudiantes de diferentes titulaciones. Una de sus actividades es la de atención domiciliaria, en la que participan estudiantes de último curso de Medicina y de Enfermería. El objetivo de este estudio es analizar la percepción de los estudiantes que han participado en la actividad de atención domiciliaria durante el curso 2016-2017 en relación con las 3 competencias interprofesionales. MATERIAL Y MÉTODOS: Estudio cualitativo descriptivo, de corte fenomenológico. Análisis de los fragmentos de texto de las reflexiones de los estudiantes acerca de la actividad de atención domiciliaria mediante el método de comparaciones constantes (codificación abierta y codificación axial). RESULTADOS: Los estudiantes refieren que la actividad les ha ayudado a conocer mejor el rol y las tareas de los médicos y los enfermeros, de una forma diferente a las prácticas clínicas. En cuanto a la comunicación, la basan en el respeto y la confianza. Por último, en cuando a la autoridad, se decantan mayoritariamente por modelos democráticos y horizontales de toma de decisiones. DISCUSIÓN: Los estudiantes perciben que la actividad resulta útil para el desarrollo de las 3 competencias interprofesionales, lo cual coincide con la literatura científica

INTRODUCTION: The World Health Organization recommends implementing interprofessional education programs, where students from 2 or more health professions learn together, to improve interprofessional competency development that will help them to improve collaboration and the quality of care and services. At the Universidad Europea from Madrid there is a program on interprofessional education that develops the following competences: role, communication and authority, with students from several degrees. Home care is one of those activities, undertaken by students from the last years of medicine and nursing. The purpose of this research is to analyze the perception of the students about the interprofessional competences after taken the home care activity during the 2016-17 academic year. MATERIAL AND METHODS: Phenomenological qualitative design. Student's written comments were analyzed using the constant comparative method (open and axial coding). RESULTS: They got to know better the roles played by each other (doctors and nurses) thanks to the fact of working together. In relation to the way they communicate, they mentioned that adequate communication is based in respect and trust to each other. In relation to the different authority models, most of them tended to use and feel better in more horizontal and democratic ways of decision making. DISCUSSION: Students reported that the activity is useful for improving their interprofessional competencies. It is coincident with other studies

Effectiveness of a virtual intervention for primary healthcare professionals aimed at improving attitudes towards the empowerment of patients with chronic diseases: study protocol for a cluster randomized controlled trial (e-MPODERA project).

BACKGROUND: Communities of practice are based on the idea that learning involves a group of people exchanging experiences and knowledge. The e-MPODERA project aims to assess the effectiveness of a virtual community of practice aimed at improving primary healthcare professional attitudes to the empowerment of patients with chronic diseases. METHODS: This paper describes the protocol for a cluster randomized controlled trial. We will randomly assign 18 primary-care practices per participating region of Spain (Catalonia, Madrid and Canary Islands) to a virtual community of practice or to usual training. The primary-care practice will be the randomization unit and the primary healthcare professional will be the unit of analysis. We will need a sample of 270 primary healthcare professionals (general practitioners and nurses) and 1382 patients. We will perform randomization after professionals and patients are selected. We will ask the intervention group to participate for 12 months in a virtual community of practice based on a web 2.0 platform. We will measure the primary outcome using the Patient-Provider Orientation Scale questionnaire administered at baseline and after 12 months. Secondary outcomes will be the sociodemographic characteristics of health professionals, sociodemographic and clinical characteristics of patients, the Patient Activation Measure questionnaire for patient activation and outcomes regarding use of the virtual community of practice. We will calculate a linear mixed-effects regression to estimate the effect of participating in the virtual community of practice. DISCUSSION: This cluster randomized controlled trial will show whether a virtual intervention for primary healthcare professionals improves attitudes to the empowerment of patients with chronic diseases. TRIAL REGISTRATION: ClicalTrials.gov, NCT02757781 . Registered on 25 April 2016. Protocol Version. PI15.01 22 January 2016.