Search

The third Global Patient Safety Challenge, Medication Without Harm, was launched in 2017 by the World Health Organization with the goal of reducing the already well-known severe preventable medication-related harm by 50% over the next 5 years. Nothing suggested that, two years later, the world would suffer a terrible pandemic, which has been a much greater challenge than the aforementioned one and that would put it to test from the first stages of the medication use process. The rapid pace imposed by the pandemic has created new risks in the use of medication in those affected by COVID-19 and in the population due to organizational changes in the provision of health care in health services. Therefore, prudent prescribing is becoming more important than ever in health systems. This article aims to analyze the main risks produced during the pandemic period and offer Primary Care professionals an update and a reminder of the main aspects related to the safety use of medications., (Copyright © 2021 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Patient-centered approach to care and regulatory advances developed in recent years have promoted patient involvement in decision-making about diagnostic tests and treatments. In other aspects, such as participating in their own safety, there is still a lot to do. Until recently, the patient has been considered as a simple health services receiver, not as an active part of the system, much less as a safety barrier against failures and errors that occur in health care. Some patients have been activated thanks to their experiences. However, many others do not. That is why it is necessary to proactively sensitize, inform and train patients to participate in their own safety. It is not about holding them responsible, but about facilitating and promoting their participation by reinforcing their safety during the care process. The health system must be committed, and the patient informed and trained. We provide tools and online resources to apply in primary care., (Copyright © 2021 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To explore the decisional process of people living with human immunodeficiency virus (HIV) currently enrolled in antiretroviral clinical trials., Method: Cross-sectional retrospective study. Outcome variables were reasons to participate, perceived decisional role (Control Preference Scale), the Decisional Conflict Scale and the Decisional Regret Scale. Descriptive statistics were calculated, and associations among these variables and with sociodemographic and clinical characteristics were analyzed with non-parametric techniques., Results: Main reasons to participate were gratitude towards Fundación Huesped (47%), the doctor's recommendation (32%), and perceived difficulty to access treatment in a public hospital (28%). Most patients thought that they made their decision alone (54.8%) or collaboratively with the physician (43%). Decisional conflict was low, with only some conflict in the support subscale (median=16.67). Education was the only significant correlate of the total decisional conflict score (higher in less educated patients; p=0.018), whereas education, recent diagnosis, living alone, lower age, being man and doctor's recommendation to go to Fundación Huésped related to higher conflict in different subscales. Nobody regretted to participate., Conclusions: The decision making regarding participation in HIV trials, from the perspective of participants, was made respecting their autonomy and with very low decisional conflict. Currently, patients show no signs of regret. However, even in this favorable context, results highlight the necessity of enhancing the decision support in more vulnerable patients (e.g., less educated, recently diagnosed or with less social support), thus warranting equity in the quality of the decision making process., (Copyright © 2020 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Public participation in research projects is an emerging area in Spain and Latin American countries. There are five types of projects according to the degree of involvement that the participants have in the processes: contributory, collaborative, co-created, contractual and independent. In order to promote public participation in health research teams, their practices and competencies need to be redefined. To this end, it may be useful to ask questions in the different phases of the research, as well as to develop strategies that include audiences that have fewer channels of participation in favour of favouring equity in health. This way of doing science allows gathering experience and expertise prioritizing and adapting the research to the needs of the population, which increases its transforming capacity and the social impact of its results., (Copyright © 2019 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To measure the impact of the peer-led training for chronic patients on their health status and behaviors., Design: Descriptive, transversal pretest and posttest quantitative approach., Placement: Andalusia., Participants: Nine hundred sixty-four patients with Diabetes, fibromyalgia and heart failure, trained at the School of Patients between 2013 and 2015., Interventions: Peer-training intervention for self-efficacy for chronic patients., Main Measurement: Self-reported health status, activity limitation, diet and physical activity. Statistical analysis included descriptive and bivariate statistics, correlation coefficient and net gains for paired variables., Results: Health status improved after the training, with less limitations and better diet and physical activity, with significant differences by sex, chronic illness, education level and marriage status. Improvement areas where identified for the training strategy, with special attention on the needs of more vulnerable groups (women, people with less education level)., Conclusions: The peer training had a positive impact, with differences depending on social profiles. 1-year and 2-years posttest measurements are needed and a qualitative study is required in order to better evaluate the peer-led strategy and to adapt it to participants' needs and expectations., (Copyright © 2019 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To evaluate a peer-training intervention for women with breast cancer, from a gender perspective: to discover the results of the intervention and examine in-depth the personal experiences of patients and health professionals participating in the training activity., Method: Mixed method multicentre design completed in 2017 in Andalusia (Spain), with a pre and post evaluation questionnaire with 102 patients, measuring life style, limitations, use of health services, communication with professionals and self-management; and content analysis of semi-structured interviews and focus groups with 21 patient-trainers and 5 health professionals, looking at experiences, needs and suggestions for improvement., Results: The patients described a good general health status, with improvements of: diet quality (7 in pre-test to 7.7 in post-test), limitations for daily life (from 1.93 to 1.64 points), self-efficacy (from 6.46 to 7.42 points). Age, civil status and level of education generated statistically significant differences, with more improvement in more vulnerable social profiles. Participants revealed the benefits of the peer-training at a personal, relational, psycho-emotional and socio-cultural level and expressed how the training changed their experiences around identity-construction and gender roles. The improvement dimensions related to organization, evaluation and continuity., Conclusions: The peer-training intervention is a positive experience for women's physical, relational and emotional health and, from a gender perspective, it represents an opportunity, at both individual and group level, to negotiate and deconstruct gender roles when living with breast cancer., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: We analyse how reproductive health strategies have been incorporated into the everyday activities of the services and the resulting transformation of professional and user practices., Method: Cartographic research taking a multi-sited ethnographic approach that seeks to reveal the processes of transformation. Data generation techniques featuring participant observation and situated interviews. Discourse analysis of the text corpus using three analytical axes based on three main lines of action promoted by the strategies., Results: We identified transformations in: 1) demedicalisation: an increase in midwives' know-how and autonomy, changes in episiotomy practice and the facilitation of bonding practices; 2) warmth of care: incorporation of women's needs and expectations and improvements in the comfortableness of birth settings, especially in assistance at physiological birth; and 3) participation: actions that foster shared decision-making and the involvement of the persons accompanying women in labour., Conclusions: Above all, transformation is visible in the incorporation of new attitudes, sensibilities and practices that have developed around the old structures, especially during physiological childbirth. The more technological areas have been less permeable to change. Risk management in decision-making and addressing diversity are identified as areas where transformation is less evident., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Purpose: To describe the process of translation and cultural adaptation of the Patient empowerment in long-term condition to the Spanish language., Design: Translation, cross-cultural adaptation, and pilot testing (cognitive debriefing) LOCATION: Primary and Hospital care., Participants: Ten patients admitted to a cardiology department of a University Hospital MAIN MEASUREMENTS: 1) Direct translation, 2) conciliation and synthesis of the versions by expert panel, 3) back- translation, 4) agreement on the back-translated version with the author of the original version, 5) analysis of comprehensibility through cognitive interviews., Results: There were no differences between the direct-translated versions. The expert panel introduced changes in 23 out of the 47 items of the questionnaire. The author of the original version agreed with the version of the back-translation. In the cognitive interviews, patients reported high difficulty in one item and low difficulty in 4., Conclusions: The Spanish version of the Patient Empowerment in long-term conditions questionnaire is semantically and conceptually equivalent to the original tool. The assessment of the psychometric properties of the Spanish version of the questionnaire will be carried out at a later stage., (Copyright © 2017 The Authors. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Examine the effects of an educational intervention to improve patients' level of activation and promote their participation improving their safety during health system pathway., Material and Methods: Selection and study of the care process on which to apply the research. Design and edition the audiovisual educational material. Intentional sampling of patients on the waiting list for scheduled operation by the Traumatology Service. Telephone collection through study's explanatory script. Realization of two focus groups, with heterogeneous distribution by gender, age and level of studies. Visualization of the educational video and exploration of aspects of interest through semi-structured questions script, based on the research objectives. Recording and transcription of generated speeches. Qualitative analysis of resulting information., Results: Patients are aware that failures and errors occur, and recognize the weaknesses of the system and professionals. The educational activity brings more value to people with less previous experience or less knowledge about the dynamics of the health system. The interaction between people with different experiences entails an exchange of knowledge, enhancing the educational effect of the intervention. The level of knowledge and the degree of activation increases in all participants, regardless of their starting situation., Conclusions: Strengthening the role of the patient as a safety barrier through an educational intervention of an audiovisual nature is feasible in real conditions and useful for the objective pursued., (Copyright © 2019 FECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To determine, from the point of view of the oncological patient, who made the decision about their treatment, as well as the major barriers and facilitators that enabled Shared Decision Making to be implemented., Material and Methods: A cross-sectional, descriptive, sand association study using a self-report questionnaire to selected cancer patients, with casual sampling in different oncology clinics and random time periods. A total of 108 patients provided analysable data. The information was collected on sociodemographic and clinical variables, who made the decision about treatment, and level of agreement or disagreement with various barriers and facilitators., Results: More than one-third (38.1%) of patients claimed to have participated in shared decision making with their doctor. Barriers such as, time, the difficulty of understanding, the paternalism, lack of fluid communication, and having preliminary and often erroneous information influenced the involvement in decision-making. However, to have or not have sufficient tools to aid decision making or the patient's interest to participate had no effect. As regards facilitators, physician motivation, their perception of improvement, and the interest of the patient had a positive influence. The exception was the possibility of financial incentives to doctors., Conclusions: The little, or no participation perceived by cancer patients in decisions about their health makes it necessary to introduce improvements in the health care model to overcome barriers and promote a more participatory attitude in the patient., (Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

The purpose of this article is to support the need for a change of care, based on cooperation between those who provide care and those who receive it. This article develops the decisive factors for change: the investee cooperation, the reference in case management, the concept of recovery and terminal care, the reduction of suffering and the value of change reflected in the 'win-win'. In each of them a questioning of the current situation, a methodological analysis and an input of tools and consequences of the change is made. To conclude, the article incorporates the 'itinerary of shared care' as a resource and one of the ways to bring these changes to the reality of day-to-day care., (Copyright © 2015 Elsevier España, S.L.U. All rights reserved.)

Objective: To identify and describe the needs and problems of the immigrant population related to access and utilization of health services., Method: A descriptive, qualitative, phenomenological study was conducted using focus groups. The study area was the county of Campo de Gibraltar (Spain), which represents the gateway to Europe for immigration from Africa. The final sample size (51 immigrants from 11 countries) was determined by theoretical saturation. A narrative analysis was conducted with QSR NVivo9 software., Results: Immigrants' discourse showed four categories of analysis: response to a health problem, system access, knowledge of social and health resources, and health literacy needs. Responses to health problems and the route of access to the health care system differed according to some sociodemographic characteristics (nationality/culture of origin, length of residence, and economic status). In general, immigrants primarily used emergency services, hampering health promotion and prevention. The health literacy needs identified concerned language proficiency and the functioning of the health system., Conclusions: There is a need to promote interventions to enhance health literacy among immigrants. These interventions should take into account diversity and length of residence, and should be based on an action-participation methodology., (Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.)

Objective: The aim of this study is to develop a Spanish version of the Satisfaction With Decision scale (SWDs) and analyse the psychometric properties of validity and reliability., Design: An observational, descriptive study and validation of a tool to measure satisfaction with the decision., Setting: Urology, Radiation oncology, and Medical oncology Departments of the Hospital Universitari Germans Trias i Pujol, Institut Català d'Oncologia and the Institut Oncològic del Vallès - Hospital General de Catalunya., Participants: A total of 170 participants diagnosed with prostate cancer, and who could read and write in Spanish and gave their informed consent., Main Measurements: A translation, back-translation and cross-cultural adaptation to Spanish was performed on the SWDs. The content validity, criterion validity, construct validity and reliability (internal consistency and stability) of the Spanish version were evaluated., Results: The SWDs contains 6 items with 5-item Likert scales. A Spanish version (ESD) was obtained that was linguistically and conceptually equivalent to the original version. Criterion validity, the ESD correlated with "satisfaction with the decision" using a linear analogue scale, was significant (r=0.63, P<.01) for all items. The factorial analysis showed a unique dimension to explain 82.08% of the variance. The ESD showed excellent results in terms of internal consistency (Cronbach alpha=0.95) and good test-retest reliability with intraclass correlation coefficient of 0.711., Conclusions: The ESD is a validated Spanish scale to measure the satisfaction with the decisions taken in health, and demonstrates a correct validity and reliability., (Copyright © 2015 Elsevier España, S.L.U. All rights reserved.)

Objective: To evaluate the impact of a mobile phone short message on women's uptake in a breast cancer screening programme., Methods: A total of 703 women from a Basic Health Area of Barcelona, and with a mobile phone number registered, were invited to participate in a breast cancer screening programme between 25 January 2011 and 22 March 2011. The control group (n=470) followed the usual appointment track, and the intervention group (n=233) received, after the first letter of invitation, a mobile phone short message reminder. The differences between the two groups were analysed, comparing the uptake rates according to age, educational level, and participation in previous round, as well as the number of re-invitation calls to non-attenders according to uptake, age and level of education;and the percentages of exclusions of both groups., Results: The intervention group had a greater uptake than the control group (78.1% vs. 72.3%), with a significant trend observed in the 55-59 years age group (P=.036) and the low secondary educational level (P=.014).The intervention group mean of re-invitation calls of non-attenders lower than the control group (.41 vs. .65, P<.05), a pattern observed in all the categories of the independent variables, and among younger age groups, lower and middle educational levels, and previously participating women (.09 vs. .19, P=.012)., Conclusions: The inclusion of a mobile phone short message in a breast cancer screening programme may increase uptake rates and lead to a management improvement., (Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.)

This project supports the initiative promoted by the Spanish National Health System to provide informational materials, in printed or interactive format, to encourage public participation in decision making and healthcare. We present the newly created PyDEsalud.com, a web platform aimed at people with chronic diseases with a high socioeconomic impact, such as breast cancer, depression, and diabetes. This platform uses scientific methodology and contains three information service modules (Patients' experiences, Shared decision making, and Research needs), aimed at promoting health education for patients and families., (Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.)