¿Qué atención reciben los profesionales médicos como pacientes?

Objetivos: Comprender el proceso de enfermar del profesional médico y si éste es diferente por el hecho de serlo para poder plantear estrategias de mejora de la atención al profesional enfermo con años de ejercicio profesional. Métodos: Se ha realizado una revisión bibliográfica utilizando la base de datos MEDLINE a través de Pubmed y EMBASE e Indice Médico Español. Se han realizado entrevistas en profundidad a cinco médicos en activo con enfermedad. Se ha realizado un análisis cualitativo de la información de cada entrevista con el programa MAXqda. Resultados: Se han entrevistado a tres varones y dos mujeres, con una edad media de ambos sexos de 53 años. De las entrevistas hemos extraído los códigos más prevalentes, entre los que destacan, la pérdida de confidencialidad como perjuicio, los sentimientos de miedo y negación y la hipocondriasis del proceso. También hemos observado que el proceso de diagnóstico se ve acelerado y sin embargo en cuanto al tratamiento y el seguimiento se pierde la continuidad del proceso. Conclusión: Debido a la limitación en cuanto al tiempo y extensión de la investigación vemos necesario ampliar el estudio de campo para poder extraer conclusiones extrapolables. Se detecta la necesidad de la creación de sistemas impulsados por las instituciones colegiales que ofrezcan un apoyo a los médicos en el proceso de enfermar.Es indiscutible la necesidad de definir la figura del médico de médicos para conseguir una atención sanitaria que responda a las particularidades del profesional médico enfermo

Estudio sobre la prevalencia e impacto de los incidentes de seguridad del paciente (ISP) de atención primaria de los sectores Zaragoza I, II, III y Calatayud desde la perspectiva del paciente a través de las reclamaciones de los usuarios

Introducción/ Objetivo: El análisis de los incidentes de seguridad del paciente (ISP) en atención primaria permite elaborar estrategias de mejora para reducir la probabilidad de su ocurrencia y mejorar la seguridad. Las fuentes de información de ISP son los sistemas de notificación y aprendizaje para la seguridad del paciente, las quejas de los usuarios y las incidencias registradas en los sistemas de calidad de los equipos de atención primaria. La comisión de seguridad del paciente de atención primaria (CSPAP) de los sectores I, II, III y Calatayud cuenta con información de notificaciones y considera incorporar las quejas de usuarios como fuente de información de ISP. El objetivo de este estudio es identificar los ISP en las quejas realizadas por los usuarios en relación con la atención recibida en los equipos de atención primaria de los sectores mencionados y evaluar su utilidad como fuente de información para la CSPAP.Método/ Material y métodos: Se realizó un muestreo aleatorio simple de quejas de los 4 sectores de salud basado en el número de quejas registradas en el año 2017. Se seleccionaron un total de 342, Sector I 77, Sector II 155, Sector III 71, Sector Calatayud 10, y 29 de reposición por pérdidas. Se elaboró un checklist para analizar las quejas considerando la recogida de variables sociodemográficas del paciente, del centro y lugar de la asistencia, variables sobre el proceso asistencial, sobre los ISP, sobre la gestión de la reclamación, el mes en que se efectúo la queja, el tiempo de respuesta y la evitabilidad. Se calcularon frecuencias de las variables y se analizó la relación entre las mismas.Resultados: El total de quejas analizadas fueron 346 presentadas en los sectores sanitarios Zaragoza I, II, III y Calatayud. El 64 % de los pacientes que reclaman son mujeres y el 36% hombres. Según la edad del paciente al que se refiere en el escrito, en un 78 % de las quejas se trata de una persona adulta mientras que en un 22 % se trata de un paciente pediátrico. El 83,3 % de los usuarios corresponde a centros de salud urbanos y el 16,7% a centros de salud rurales.El profesional con mayor número de quejas era el profesional de medicina de familia (44,9%) seguido de profesional de enfermería (15 %), pediatría (14,7 %) y administrativos (13,2%). El 62,8% de los incidentes de seguridad ocurrieron dentro de la consulta de Atención Primaria (bien del médico de familia, pediatra, Enfermera/o, fisioterapia). La mayoría de las quejas (30,7%) ocurrieron por problemas de retrasos en la atención médica o demoras en la lista de espera. Un 25,1% de las quejas referían motivos relacionados con la asistencia sanitaria y un 17,3% reflejan motivos relacionados con el trato personal. Por sectores destaca que el sector 3 (42%) y Calatayud (41,7%) la mayoría de las quejas son sobre la asistencia sanitaria.El número de ISP del total de las quejas analizadas asciende a 24,3%. Entre los ISP detectados la queja era por problemas en la Asistencia Sanitaria (52,3%), seguida de la Organización/Coordinación (23.5%). Atendiendo a los factores causales, el 12,4 % del total de las quejas reflejan problemas relativos al diagnóstico. El 3,2 % de todas las quejas analizadas alude a problemas relativos a la medicación. El 2,3% del total de quejas fue por los cuidados y/o procedimientos. Un 2,3 % de las quejas fue por problemas de comunicación, o información sanitaria. El 3,8 % fueron factores causados por la gestión. Según el tipo de suceso adverso o impacto en el paciente: el 15% (52/346) del total de quejas ocurrió un casi-incidente, 61,9% del total de ISP (52/84 quejas). Incidentes sin daño fueron el 2,6% del total de quejas y 10,7% de los ISP. Incidentes leves fueron 4,3% respecto del total de quejas y el 17,9% de los ISP. Eventos Adversos Moderados eran 1,8% de todas, un 6,0% de los ISP. Hubo 2 Eventos Adversos Graves, 0,6% de todas y 2,4% de los ISP.Se gestionaron el 100% de las reclamaciones recogidas en el estudio. Se investigaron el 96,2% de las quejas recopilando información sobre lo ocurrido. Si bien, la respuesta a la queja tuvo carácter burocrático, limitada a pedir disculpas o a sugerir cambio de profesional en un 13,9%. Se entrevistó al reclamante o éste aportó informes en un 6,6% de quejas recibidas. Se solicitó información al profesional en un 32,7%. Se revisó la Historia Clínica en el 11,6 % de las reclamaciones. Las versiones que aportaron el reclamante y el profesional fueron concordantes en un 14,2% de los casos. La distribución por meses es muy homogénea, siendo el periodo entre mayo y julio el de incidencia más baja de presentación de quejas. No existe diferencia estadísticamente significativa entre los tiempos de respuesta entre sectores, media de todos los sectores de atención primaria de Zaragoza de 35 días. Respecto a la evitabilidad de los ISP con daño el 2.6% (1/39 ISP) fue No evitable mientras que el 97,4% (38/39 quejas con ISP) podrían haberse evitado.Discusión y Conclusiones: La revisión de las quejas de los pacientes permite identificar ISP en APS. Los ISP identificados a través de las quejas están relacionados con el proceso diagnóstico hecho que contrasta con la naturaleza de los ISP declarados por los profesionales cuya causa principal está en relación con medicación. El análisis de las quejas de los usuarios desde la perspectiva de la SP puede contribuir a definir mejor el mapa de riesgos de atención primaria y a elaborar estrategias apropiadas de reducción de riesgos en el sistema de salud. Se proponen como mejoras la formación y sensibilización en cultura de seguridad del paciente a los profesionales que participan en el circuito de las quejas para que puedan detectar los ISP en el proceso de gestión de las mismas y remitirlas a la CSPAP, así como homogenizar los criterios de clasificación.Palabras clave: Quejas, Calidad Asistencial, Incidente de Seguridad del paciente, Evento Adverso, Atención Primaria de Salud.<br /

Medical deserts in Spain—Insights from an international project

Introduction Medical deserts are a growing phenomenon across many European countries. They are usually defined as (i) rural areas, (ii) underserved areas or (iii) by applying a measure of distance/time to a facility or a combination of the three characteristics. The objective was to define medical deserts in Spain as well as map their driving factors and approaches to mitigate them. Methods A mixed methods approach was applied following the project “A Roadmap out of medical deserts into supportive health workforce initiatives and policies” work plan. It included the following elements: (i) a scoping literature review; (ii) a questionnaire survey; (iii) national stakeholders' workshop; (iv) a descriptive case study on medical deserts in Spain. Results Medical deserts in Spain exist in the form of mostly rural areas with limited access to health care. The main challenge in their identification and monitoring is local data availability. Diversity of both factors contributing to medical deserts and solutions applied to eliminate or mitigate them can be identified in Spain. They can be related to demand for or supply of health care services. More national data, analyses and/or initiatives seem to be focused on the health care supply dimension. Conclusions Addressing medical deserts in Spain requires a comprehensive and multidimensional approach. Effective policies are needed to address both the medical staff education and planning system, working conditions, as well as more intersectoral approach to the population health management.© 2024 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.fi=vertaisarvioitu|en=peerReviewed

Addressing acute stress among professionals caring for COVID-19 patients: lessons learned during the first outbreak in Spain (March–April 2020)

To describe lessons learned during the first COVID-19 outbreak in developing urgent interventions to strengthen healthcare workers’ capacity to cope with acute stress caused by health care pressure, concern about becoming infected, despair of witnessing patients’ suffering, and critical decision-making requirements of the SARS-CoV-2 pandemic during the first outbreak in Spain. Methods: A task force integrated by healthcare professionals and academics was activated following the first observations of acute stress reactions starting to compromise the professionals’ capacity for caring COVID-19 patients. Literature review and qualitative approach (consensus techniques) were applied. The target population included health professionals in primary care, hospitals, emergencies, and nursing homes. Interventions designed for addressing acute stress were agreed and disseminated. Findings: There are similarities in stressors to previous outbreaks, and the solutions devised then may work now. A set of issues, interventions to cope with, and their levels of evidence were defined. Issues and interventions were classified as: adequate communication initiative to strengthen work morale (avoiding information blackouts, uniformity of criteria, access to updated information, mentoring new professionals); resilience and recovery from physical and mental fatigue (briefings, protecting the family, regulated recovery time during the day, psychological first aid, humanizing care); reinforce leadership of intermediate commands (informative leadership, transparency, realism, and positive messages, the current state of emergency has not allowed for an empirical analysis of the effectiveness of proposed interventions. Sharing information to gauge expectations, listening to what professionals need, feeling protected from threats, organizational flexibility, encouraging teamwork, and leadership that promotes psychological safety have led to more positive responses. Attention to the needs of individuals must be combined with caring for the teams responsible for patient care. Conclusions: Although the COVID-19 pandemic has a more devastating effect than other recent outbreaks, there are common stressors and lessons learned in all of them that we must draw on to increase our capacity to respond to future healthcare crises

Safety Culture and the Positive Association of Being a Primary Care Training Practice during COVID-19: The Results of the Multi-Country European PRICOV-19 Study.

The day-to-day work of primary care (PC) was substantially changed by the COVID-19 pandemic. Teaching practices needed to adapt both clinical work and teaching in a way that enabled the teaching process to continue, while maintaining safe and high-quality care. Our study aims to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of PC practices. PRICOV-19 is a multi-country cross-sectional study that researches how PC practices were organized in 38 countries during the pandemic. Data was collected from November 2020 to December 2021. We categorized practices into training and non-training and selected outcomes relating to safety culture: safe practice management, community outreach, professional well-being and adherence to protocols. Mixed-effects regression models were built to analyze the effect of being a training practice for each of the outcomes, while controlling for relevant confounders. Of the participating practices, 2886 (56%) were non-training practices and 2272 (44%) were training practices. Being a training practice was significantly associated with a lower risk for adverse mental health events (OR: 0.83; CI: 0.70–0.99), a higher number of safety measures related to patient flow (Beta: 0.17; CI: 0.07–0.28), a higher number of safety incidents reported (RR: 1.12; CI: 1.06–1.19) and more protected time for meetings (Beta: 0.08; CI: 0.01–0.15). No significant associations were found for outreach initiatives, availability of triage information, use of a phone protocol or infection prevention measures and equipment availability. Training practices were found to have a stronger safety culture than non-training practices. These results have important policy implications, since involving more PC practices in education may be an effective way to improve quality and safety in general practice

Quality and safety issues of Spanish primary healthcare by high and low Covid-19 prevalence regions : Pricov-19 study in Spain

Background: Primary Health Care (PHC) was a key element in providing care during the pandemic in Spain. We describe how PHC practices (PCPs) are organized according to the COVID-19 prevalence of the different regions in Spain (<5% COVID-19 prevalence or higher). Methods: Cross-sectional study through the PRICOV-19 European Online Survey in PCPs in Spain in 2021. Descriptive analysis and logistic regression model were performed to identify differences among regions by COVID-19 prevalence. Results: 266 PCPs answered. A total of 83.8% PCPs were in high COVID-19 prevalence areas. COVID-19 patients were asked if it was feasible to isolate in 83.5% of the PCPs, high prevalence areas questioned it more often compared to low prevalence areas (84.8% vs 76.7%, p:0.21). Accessibility was compromised in 41.0% PCPs. Patients with serious conditions did not know how to get an appointment in 24.1% of PCPs. Urgent conditions suffered delayed care in 79.1% of PCPs in low prevalence areas compared to 65.9% in high prevalence areas (p 0.24). Proactive care for chronic patients was provided in 63.5% PCPs (high prevalence:65% vs low prevalence:55.8%, p:0.25; OR: 0.83 (0.44-1.57)), lists from the electronic medical record were collected in 35.7% PCPs (OR:1.13 (0.55-2.31). Patients with a background of intimate partner violence or mental health issues were checked by the staff in 11.7% and 30.8%, respectively. Conclusions: There were no differences in medical care among regions with high and low COVID-19 prevalence. Accessibility was limited, but proactive care was provided for chronic conditions

Addressing health inequity during the COVID-19 pandemic through primary health care and public health collaboration : a multiple case study analysis in eight high-income countries

BackgroundThe COVID-19 pandemic substantially magnified the inequity gaps among vulnerable populations. Both public health (PH) and primary health care (PHC) have been crucial in addressing the challenges posed by the pandemic, especially in the area of vulnerable populations. However, little is known about the intersection between PH and PHC as a strategy to mitigate the inequity gap. This study aims to assess the collaboration between PHC and PH with a focus on addressing the health needs of vulnerable populations during the COVID-19 pandemic across jurisdictions.MethodsWe analyzed and compared data from jurisdictional reports of COVID-19 pandemic responses in PHC and PH in Belgium, Canada (Ontario), Germany, Italy, Japan, the Netherlands, Norway, and Spain from 2020 to 2021.ResultsFour themes emerge from the analysis: (1) the majority of the countries implemented outreach strategies targeting vulnerable groups as a means to ensure continued access to PHC; (2) digital assessment in PHC was found to be present across all the countries; (3) PHC was insufficiently represented at the decision-making level; (4) there is a lack of clear communication channels between PH and PHC in all the countries.ConclusionsThis study identified opportunities for collaboration between PHC and PH to reduce inequity gaps and to improve population health, focusing on vulnerable populations. The COVID-19 response in these eight countries has demonstrated the importance of an integrated PHC system. Consequently, the development of effective strategies for responding to and planning for pandemics should take into account the social determinants of health in order to mitigate the unequal impact of COVID-19. Careful, intentional coordination between PH and PHC should be established in normal times as a basis for effective response during future public health emergencies. The pandemic has provided significant insights on how to strengthen health systems and provide universal access to healthcare by fostering stronger connections between PH and PHC

Effectiveness of New Tools to Define an Up-to-Date Patient Safety Risk Map: A Primary Care Study Protocol

Background: Reducing incidents related to health care interventions to improve patient safety is a health policy priority. To strengthen a culture of safety, reporting incidents is essential. This study aims to define a patient safety risk map using the description and analysis of incidents within a primary care region with a prior patient safety improvement strategy organisationally developed and promoted. Methods: The study will be conducted in two phases: (1) a cross-sectional descriptive observational study to describe reported incidents; and (2) a quasi-experimental study to compare reported incidents. The study will take place in the Camp de Tarragona Primary Care Management (Catalan Institute of Health). In Phase 1, all reactive notifications collected within one year (2018) will be analysed; during Phase 2, all proactive notifications of the second and third weeks of June 2019 will be analysed. Adverse events will also be assessed. Phases 1 and 2 will use a digital platform and the proactive tool proSP to notify and analyse incidents related to patient safety. Expected Results: To obtain an up-to-date, primary care patient safety risk map to prioritise strategies that result in safer practices

Epidemiological study on gender bias and low-value practices in primary care: a study protocol

Introduction Evidence shows that gender has a substantial impact on health behaviours, access to and use of health systems and health system responses. This study aims to assess gender bias in patients subjected to low-value practices in the primary care setting and to develop recommendations for reducing adverse events that women experience for this reason.Methods and analysis A Delphi study will be performed to reach a consensus on the ‘Do Not Do’ recommendations with a possible gender bias. A retrospective cohort study in a random selection of medical records will then be carried out to identify the frequency of adverse events that occur when the selected ‘Do Not Do’ recommendations are ignored. Qualitative research techniques (consensus conference and nominal group) will be carried out to develop recommendations to address any gender bias detected, considering barriers and facilitators in clinical practice.Ethics and dissemination The study was approved by the ethics committee of San Juan de Alicante Hospital (San Juan de Alicante, Spain) Reference N. 21/061. We will disseminate the research findings via peer-reviewed articles, presentations at national and international scientific forums and webinars.Trial registration number The study was registered at ClinicalTrials.gov (NCT05233852) on 10 February 2022