Self-perception of leadership styles and behaviour in primary health care

Background: The concept of leadership has been studied in various disciplines and from different theoretical approaches. It is a dynamic concept that evolves over time. There are few studies in our field on managers' self-perception of their leadership style. There are no pure styles, but one or another style is generally favoured to a greater or lesser degree. In the primary health care (PHC) setting, managers' leadership style is defined as a set of attitudes, behaviours, beliefs and values. The objectives of this study were to describe and learn about the self-perception of behaviours and leadership styles among PHC managers; to determine the influence of the leadership style on job satisfaction, efficiency, and willingness to work in a team; and to determine the relationship between transformational and transactional styles according age, gender, profession, type of manager years of management experience, and the type of organization. Methods: To describe leadership styles as perceived by PHC managers, a cross sectional study was performed using an 82 items-self-administered Multifactor Leadership Questionnaire (MLQ). This questionnaire measures leadership styles, attitudes and behaviour of managers. The items are grouped into three first order variables (transformational, transactional and laissez-faire) and ten second order variables (which discriminate leader behaviours). Additionally, the questionnaire evaluates organizational consequences such as extra-effort, efficiency and satisfaction. Results: One hundred forty responses from 258 managers of 133 PHC teams in the Barcelona Health Area (response rate: 54.26%). Most participants were nurses (61.4%), average age was 49 years and the gender predominantly female (75%). Globally, managers assessed themselves as equally transactional and transformational leaders (average: 3.30 points). Grouped by profession, nurses (28.57% of participants) showed a higher transactional leadership style, over transformational leadership style, compared to physicians (3.38 points, p < 0.003). Considering gender, men obtained the lowest results in transactional style (p < 0.015). Both transactional and transformational styles correlate with efficiency and job satisfaction (r = 0.724 and r = 0.710, respectively). Conclusions: PHC managers' self-perception of their leadership style was transactional, focused on the maintenance of the status quo, although there was a trend in some scores towards the transformational style, mainly among nurse managers. Both styles correlate with satisfaction and willingness to strive to work better. Keywords: Leadership, Primary health care, Self-concept, Job satisfaction, MLQ, Manager

Evaluación de la implementación del programa de Preparación para el Nacimiento en Cataluña: características de las matronas y fidelidad al programa

Objetivo: conocer las características de las matronas y su grado de fidelidad a la metodología, contenidos, actividades y evaluación del programa de Preparación para el Nacimiento (PN) del Departament de Salut de la Generalitat de Catalunya, para la evaluación de su implementación. Método: estudio observacional, descrip-tivo y transversal en 38 unidades de atención a la salud sexual y reproductiva de Cataluña, en el que participaron 334 matronas que dinamizaban grupos de PN. La información se recogió a través de un cuestionario ad hoc y permitió obtener información respecto a variables sociodemográficas, experiencia profesional, formación, conocimiento y utilización del programa, así como variables rela-cionadas con la fidelidad al mismo. Resultados: se envió el cuestionario a 451 matronas y lo respondieron 334 (74,1%). El programa lo conocía el 97,6% de las matronas (n= 325), y el 81,4% (n= 272) lo está utilizando. El 49,4% de las matronas realiza el número de sesiones recomendadas y el 85,3% procura una participación activa de las gestantes, aunque el 51,5% utiliza sesiones expositivas. El 64,1% no puede ajustarse al tiempo establecido para cada sesión, y tan sólo un 11,4% evalúa el programa. Conclusiones: Las matronas que utilizan el programa y tienen más años de experiencia mantienen una mayor fidelidad a los contenidos y metodología. La formación previa a la implantación del programa es clave para su conocimiento y utilización, pero requiere mantenerse en el tiempo. Se ha producido una adaptación al programa y las matronas no lo evalúan sistemáticamente, por lo que debe haber una implicación institucional para su ejecución

Heart failure labelled patients with missing ejection fraction in primary care: prognosis and determinants

BACKGROUND: It is common to find a high variability in the accuracy of heart failure (HF) diagnosis in electronic primary care medical records (EMR). Our aims were to ascertain (i) whether the prognosis of HF labelled patients whose ejection fraction (EF) was missing in their EMR differed from those that had it registered, and (ii) the causes contributing to the differences in the availability of EF in EMR. METHODS: Retrospective cohort analyses based on clinical records of HF and attended at 52 primary healthcare centres of Barcelona (Spain). Information of 8376 HF patients aged > 40 years followed during five years was analyzed. RESULTS: EF was available only in 8.5% of primary care medical records. Cumulate incidence for mortality and hospitalization from 1st January 2009 to 31th December 2012 was 37.6%. The highest rate was found in patients with missing EF (HR 1.84, 95% CI 1.68 -1.95) compared to those with preserved EF. Patients hospitalized the previous year and those requiring home healthcare (HR 1.81, 95% Confidence Interval 1.68-1.95 and HR 1.58, 95% CI 1.46-1.71, respectively) presented a higher risk of having an adverse outcome. Older patients, those more socio-economically disadvantaged, obese, requiring home healthcare, and taking loop diuretics were less likely to have an EF registered. CONCLUSIONS: EF is poorly recorded in primary care. HF patients with EF missing at medical records had the worst prognosis. They tended to be older, socio-economically disadvantaged, and more fragile

Predictive model for atrial fibrillation in hypertensive diabetic patients

Background: Several scores to identify patients at high risk of suffering atrial fibrillation have been developed. Their applicability in hypertensive diabetic patients, however, remains uncertain. Our aim is to develop and validate a diagnostic predictive model to calculate the risk of developing atrial fibrillation at five years in a hypertensive diabetic population. Methods: The derivation cohort consisted of patients with both hypertension and diabetes attended in any of the 52 primary healthcare centres of Barcelona; the validation cohort came from the 11 primary healthcare centres of Terres de l'Ebre (Catalonia South) from January 2013 to December 2017. Multivariable Cox regression identified clinical risk factors associated with the development of atrial fibrillation. The overall performance, discrimination and calibration of the model were carried out. Results: The derivation data set comprised 54 575 patients. The atrial fibrillation rate incidence was 15.3 per 1000 person/year. A 5-year predictive model included age, male gender, overweight, heart failure, valvular heart disease, peripheral vascular disease, chronic kidney disease, number of antihypertensive drugs, systolic and diastolic blood pressure, heart rate, thromboembolism, stroke and previous history of myocardial infarction. The discrimination of the model was good (c-index = 0.692; 95% confidence interval, 0.684-0.700), and calibration was adequate. In the validation cohort, the discrimination was lower (c-index = 0.670). Conclusions: The model accurately predicts future atrial fibrillation in a population with both diabetes and hypertension. Early detection allows the prevention of possible complications arising from this disease

Impact of the sustained control of cardiovascular risk factors on first episode heart failure: The relevant role of primary care

BACKGROUND: The role of cardiovascular risk factor control in the development of heart failure (HF) has not yet been clearly established. OBJECTIVE: To determine the effect of cardiovascular risk factor control on the occurrence of a first episode of hospital admission for HF. METHODS: A case-control study using propensity score-matching was carried out to analyse the occurrence of first hospital admission for HF taking into account the degree of cardiovascular risk factor control over the previous 24 months. All patients admitted to the cardiology unit of the Hospital del Mar between 2008 and 2011 because of a first episode of HF were considered cases. Controls were selected from the population in the hospital catchment area who were using primary care services. Cardiovascular risk factor measurements in the primary healthcare electronic medical records prior to the first HF episode were analysed. RESULTS: After the matching process, 645 participants were analysed (129 HF cases and 516 controls). Patients suffering a first HF episode had modest increments in body mass index and blood pressure levels during the previous two years. Adjusted odds ratio for experiencing a first HF hospital admission episode according to systolic blood pressure levels and body mass index was (OR: 1.031, 95% CI: 1.001-1.04), and (OR: 1.09, 95% CI: 1.03-1.15), respectively. CONCLUSION: Increased levels of body mass index and systolic blood pressure during the previous 24 months may determine a higher risk of having a first HF hospital admission episode

Association between serum copper levels and risk of cardiovascular disease: A nested case-control study in the PREDIMED trial

Background and aim: Certain trace elements have been associated with increased cardiovascular risk. The aim of this study was to evaluate the association between serum copper (S-Cu) levels and the risk of a first event of cardiovascular disease (CVD) in a population of older adults with high cardiovascular risk. Methods and results: We conducted a case-control study nested within the PREDIMED trial. During a median follow-up of 4.8 years, a total of 207 incident cases diagnosed with CVD were matched for sex, age, and intervention group with 436 controls. Personal interviews, reviews of medical records, and validated questionnaires were used to assess known CVD risk factors. Biological serum samples were collected annually. Inductively coupled plasma mass spectrometry analysis was used to determine S-Cu levels. Adjusted odds ratios were calculated using multivariate conditional logistic regression models. All participants had S-Cu levels within the reference values, 750 μg/L to 1450 μg/L. Among men, but not among women, the mean S-Cu concentration was higher in cases 1014.1 μg/L than in controls 959.3 μg/L; (p = 0.004). In men, the multivariable-adjusted odds ratio for CVD was 2.36 (95% CI 1.07-5.20 for the comparison of the highest vs. the lowest quartile; p for trend = 0.02), in women, it was 0.43 (95% CI 0.11-1.70; p for trend = 0.165). Conclusion: In older Spanish men with high cardiovascular risk, a significant association was observed between high S-Cu levels, but still within the reference values, and an increased risk of a first event of CVD. Our findings suggest a sex difference in CVD risk and S-Cu levels. To confirm this relationship and to analyze the differences observed between men and women, further studies are needed

Serum Selenium and Incident Cardiovascular Disease in the PREvención con DIeta MEDiterránea (PREDIMED) Trial: Nested Case-Control Study

Background: Selenium is an essential trace mineral with potential interest for cardiovascular disease (CVD) prevention owing to its antioxidant properties. Epidemiological data on selenium status and CVD remain inconsistent. The objective of this study was to ascertain whether low serum selenium (SSe) concentrations are related to an increased risk of a first CVD event in a population at high cardiovascular risk. Methods: We undertook a case-control study nested within the PREvencion con DIeta MEDiterranea (PREDIMED) trial. A total of 207 participants diagnosed with CVD (myocardial infarction, stroke, or cardiovascular death) during the follow-up period (2003-2010) were matched by sex, age, and intervention group to 436 controls by incidence density sampling. Median time between serum sample collection and subsequent CVD event occurrence was 0.94 years. SSe levels were determined using inductively coupled plasma mass spectrometry analysis. Covariates were assessed through validated questionnaires, in-person interviews, and medical record reviews. Conditional logistic regression was used to calculate multivariable-adjusted odds ratios (ORs). Results: Among women, the mean SSe concentration was lower in cases than in controls (98.5 mu g/L vs. 103.8 mu g/L; p = 0.016). In controls, SSe levels were directly associated with percentage of total energy intake from proteins and fish intake (p for linear trend < 0.001 and 0.049, respectively), whereas SSe concentrations were inversely associated with age, body mass index, and percentage of total energy intake from carbohydrates (p for linear trend < 0.001, 0.008 and 0.016 respectively). In the total group, we observed an inverse dose-response gradient between SSe levels and risk of CVD in the fully-adjusted model (highest vs. lowest quartile: OR = 0.47, 95% CI: 0.27-0.81; ptrend = 0.003). Conclusions: Among elderly individuals at high cardiovascular risk, high SSe concentrations within population reference values are associated with lower first CVD incidence

Evaluación de la implementación del programa de Preparación para el Nacimiento en Cataluña: características de las matronas y fidelidad al programa

Objetivo: conocer las características de las matronas y su grado de fidelidad a la metodología, contenidos, actividades y evaluación del programa de Preparación para el Nacimiento (PN) del Departament de Salut de la Generalitat de Catalunya, para la evaluación de su implementación. Método: estudio observacional, descrip-tivo y transversal en 38 unidades de atención a la salud sexual y reproductiva de Cataluña, en el que participaron 334 matronas que dinamizaban grupos de PN. La información se recogió a través de un cuestionario ad hoc y permitió obtener información respecto a variables sociodemográficas, experiencia profesional, formación, conocimiento y utilización del programa, así como variables rela-cionadas con la fidelidad al mismo. Resultados: se envió el cuestionario a 451 matronas y lo respondieron 334 (74,1%). El programa lo conocía el 97,6% de las matronas (n= 325), y el 81,4% (n= 272) lo está utilizando. El 49,4% de las matronas realiza el número de sesiones recomendadas y el 85,3% procura una participación activa de las gestantes, aunque el 51,5% utiliza sesiones expositivas. El 64,1% no puede ajustarse al tiempo establecido para cada sesión, y tan sólo un 11,4% evalúa el programa. Conclusiones: Las matronas que utilizan el programa y tienen más años de experiencia mantienen una mayor fidelidad a los contenidos y metodología. La formación previa a la implantación del programa es clave para su conocimiento y utilización, pero requiere mantenerse en el tiempo. Se ha producido una adaptación al programa y las matronas no lo evalúan sistemáticamente, por lo que debe haber una implicación institucional para su ejecución

Impact of the sustained control of cardiovascular risk factors on first episode heart failure: The relevant role of primary care

BACKGROUND: The role of cardiovascular risk factor control in the development of heart failure (HF) has not yet been clearly established. OBJECTIVE: To determine the effect of cardiovascular risk factor control on the occurrence of a first episode of hospital admission for HF. METHODS: A case-control study using propensity score-matching was carried out to analyse the occurrence of first hospital admission for HF taking into account the degree of cardiovascular risk factor control over the previous 24 months. All patients admitted to the cardiology unit of the Hospital del Mar between 2008 and 2011 because of a first episode of HF were considered cases. Controls were selected from the population in the hospital catchment area who were using primary care services. Cardiovascular risk factor measurements in the primary healthcare electronic medical records prior to the first HF episode were analysed. RESULTS: After the matching process, 645 participants were analysed (129 HF cases and 516 controls). Patients suffering a first HF episode had modest increments in body mass index and blood pressure levels during the previous two years. Adjusted odds ratio for experiencing a first HF hospital admission episode according to systolic blood pressure levels and body mass index was (OR: 1.031, 95% CI: 1.001-1.04), and (OR: 1.09, 95% CI: 1.03-1.15), respectively. CONCLUSION: Increased levels of body mass index and systolic blood pressure during the previous 24 months may determine a higher risk of having a first HF hospital admission episode