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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 difculties 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 identifed. 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 identifed 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 difcult 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.

Introduction and objectives Only about 50% of chronic patients in high-income countries adhere to their treatment. There are methods to measure medication adherence but none of them can be considered optimal. This study will aim to design and validate a questionnaire to measure medication adherence in patients with ischaemic heart disease using a direct method as a gold-standard adherence measure and taking into account the gender perspective. Moreover, the profile of low adherence in these patients will be determined. Methods and analysis First study phase consists on the questionnaire design following the next steps: identification of the dimensions, definition of the target population, questionnaire items and order, response coding, questionnaire instructions, content validity by experts and understandability. In the second phase, a cross-sectional study will be performed to end the questionnaire development and validate it. Four hundred and forty patients (50% female) with acute coronary syndrome receiving treatment within the previous 12 months will be included. Patient will answer the initial questionnaire and adherence to aspirin and statin will be measured using a direct method (drug concentration analysis in blood) and other questionnaires. From the set of preselected questionnaire items, those most closely associated with the gold standard measure will be selected using multivariate statistics. Ethics and dissemination All participants gave their written informed consent before participating in the study. The study protocol follows the recommendations of the Declaration of Helsinki and was approved by the ethics committees of the three participating centres. The results of this study will be displayed at national and international conferences and in peer-reviewed scientific journals.

Background: Inertia has been described as one of the causes of persistent poor glycemic control. The aim of this study was to evaluate, after one year of implementation in a health area, the effect of an intervention to improve the degree of glycemic control of patients with type 2 diabetes (DM2). Methods: A pre-post intervention study was carried out in one health department during 2018. Health department with 222,767 inhabitants, 111 primary care physicians and 14,154 patients with DM2. Each primary care physician reviewed, outside consultation hours (“working without patients”), the electronic health record to identify patients with DM2 and with poor glycemic control, and they cited them for review. The glycemic control for the month of December 2017 and 2018 were compared, defined as the percentage of patients who reach the control objective of glycosylate hemoglobin (HbA1c). Results: The proportion of patients with good glycemic control was 44.8% in 2017 and 50.1% in 2018, being the department that obtained the greatest improvement in the indicator in 2018 in the Valencian Community. The proportion of primary care physicians that had at least half of their patients with good glycemic control increased from 39% to 51% after the intervention. Conclusions: The strategy “working without patients” was associated with an improvement in the degree of glycemic control of patients with DM2., Fundamentos: La inercia se ha descrito como una de las causas de la persistencia del mal control glucémico. El objetivo del este estudio fue evaluar, tras un año de implantación en un área de salud, el efecto de una intervención para mejorar el grado de control glucémico de los pacientes con diabetes mellitus tipo 2 (DM2). Métodos: Estudio de intervención antes-después en un departamento de salud (área de salud) con 222.767 habitantes, 111 médicos de atención primaria y 14.154 pacientes con DM2. Cada médico de atención primaria revisó, fuera del horario de consulta (“trabajando sin pacientes”), la historia de salud electrónica para identificar pacientes con DM2 y con mal control glucémico, y los citaron para revisión. Se comparó el control glucémico del mes de diciembre de 2017 y 2018 definido como porcentaje de pacientes que alcanza objetivo de control de hemoglobina glicosilada (HbA1c). Resultados: La proporción de pacientes con buen control glucémico fue de 44,8% en 2017 y 50,1% en 2018, siendo el departamento que obtuvo la mayor mejora del indicador en 2018 en la Comunidad Valenciana. La proporción de médicos de atención primaria que tenían al menos la mitad de sus pacientes con buen control glucémico pasó del 39% al 51% tras la intervención. Conclusiones: La estrategia “trabajando sin pacientes” se asoció a una mejora del grado de control glucémico de los pacientes con DM2.

[Abstract] Aim: To assess the experience with health care among patients with type 2 diabetes (T2DM) and to evaluate patients' demographic variables and healthcare-related characteristics which may affect their experience. Methods: A cross-sectional survey was delivered to T2DM adults. Patient experiences were assessed with the 'Instrument for Evaluation of the Experience of Chronic Patients' (IEXPAC) questionnaire, a validated 12-item survey, which describes patient experience within the last 6 months (items 1-11) and hospitalization in the last 3 years (item 12), with possible scores ranging from 0 (worst) to 10 (best experience). Results: A total of 451 T2DM patients responded to the survey (response rate 72.3%; mean age 69.5 ± 10.1 years, 67.8% men). The mean overall IEXPAC score was 5.92 ± 1.80. Mean scores were higher for productive interactions (7.92 ± 2.15) and self-management (7.08 ± 2.27) than for new relational model (1.72 ± 2.01). Only 32.8% of patients who had been hospitalized in the past 3 years reported having received a follow-up call or visit after discharge. Multivariate analyses identified that regular follow-up by the same physician and follow-up by a nurse were associated with a better patient experience. Continuity of healthcare score was higher only in those patients requiring help from others. Conclusions: The areas of T2DM care which may need to be addressed to ensure better patient experience are use of the Internet, new technologies and social resources for patient information and interaction with healthcare professionals, closer follow-up after hospitalization, and a comprehensive multidisciplinary approach with regular follow-up by the same physician and a nurse.

[Abstract] Background: Patients' experience with health care is becoming a key component for the provision of a patient-centered health care model. The aim of this study was to assess the experience with health care of patients with inflammatory arthritis and patient- and health care-related factors. Methods: Patients responded to an anonymous survey provided by their treating clinical teams. The survey comprised the validated 12-item IEXPAC (Instrument to Evaluate the EXperience of PAtients with Chronic diseases) tool and demographic variables and health care-related characteristics that may affect patients' experience. Results: A total of 359 of 625 surveys were returned (response rate, 57.4%). Overall, patient responses were positive (>60% gave "always/mostly" answers) for statements assessing the interaction between patients and health care professionals or patient self-management following health care professional guidance. However, positive patient responses for items regarding patient interaction with the health care system via the internet or with other patients were less than 13%. Only 25.6% of patients who had been hospitalized reported receiving a follow-up call or visit following discharge. In the bivariate analysis, experience scores were higher (better experience) in men, those seen by fewer specialists or by the same physician, and in patients treated with a fewer number of drugs or with subcutaneous/intravenous drugs. Multivariate analyses identified regular follow-up by the same physician and treatment with subcutaneous/intravenous drugs as variables associated with a better patient experience. Conclusions: This study identifies areas of care for patients with inflammatory arthritis with the potential to improve patients' experience and highlights the importance of patient-physician relationships and comprehensive patient care.

163 p., Ante el incremento de la prevalencia de las enfermedades crónicas y de la comorbilidad por el aumento de la esperanza de vida, en la mayoría de los países desarrollados se plantea la necesidad de repensar los modelos de atención para que respondan adecuadamente a las diferentes necesidades sanitarias y sociodemográficas de la población. Las personas con enfermedades crónicas y con pluripatología son las que presentan mayores necesidades de servicios sanitarios y sociales, experimentando con mayor intensidad, los desajustes de ambos sistemas.Centramos nuestras investigaciones en los pacientes que ingresan por insuficiencia cardíaca (IC) por su alta complejidad y prevalencia. En general, son pacientes de edad avanzada, con alto grado de comorbilidad y polimedicación, baja adherencia al tratamiento y dificultades para el autocuidado. La atención integral al paciente con IC, tanto desde el punto de vista de contenidos de las intervenciones, como de la organización de la atención, se ha demostrado necesaria en la literatura.Desarrollamos nuestra investigación en tres fases diferenciadas, utilizando métodos mixtos cuantitativos y cualitativos tanto en la metodología como en el análisis.Las tres fases fueron las siguientes:1. DISEÑO Y MODELAJE DE LA INTERVENCIÓN, que a su vez se diferenció en una revisión bibliográfica y en el pilotaje de la intervención diseñada a la que denominamos ProMIC: Programa Multidisciplinar de atención a pacientes con IC (1).2. ESTUDIO CUASI EXPERIMENTAL de intervención con un grupo control de seguimiento a un año para objetivar la eficacia del programa diseñado en las fases previas (2).3. ESTUDIO DE LA PERCEPCIÓN DE LOS PROFESIONALES sobre el nivel de integración asistencial del programa a través de un cuestionario validado y sobre el funcionamiento del programa en sí a través de un grupo focal de investigadores (3).

[Abstract] Purpose: To investigate relationships between intentional and non-intentional non-adherence behaviors and patient experience with healthcare and beliefs in medications. Patients and methods: This is a post hoc analysis of a cross-sectional anonymous survey distributed between May and September 2017 to patients with rheumatic disease, inflammatory bowel disease, HIV infection or diabetes mellitus from outpatient and primary care clinics in Spain. Patients answered five questions about non-adherence behaviors and completed questionnaires on their experience with healthcare (IEXPAC: Instrument to Evaluate the EXperience of PAtients with Chronic diseases) and beliefs about medicines (BMQ: Beliefs About Medicines Questionnaire). Results: Among 1530 respondents, 53% showed ≥1 non-adherence behavior; 35% had ≥1 non-intentional non-adherence behavior, and 33% had ≥1 intentional non-adherence behavior. Patients with HIV infection had the lowest frequency of intentional non-adherence behaviors. Non-intentional non-adherence was associated with patient beliefs (inversely with BMQ overall score) and patient experiences (inversely with IEXPAC Factor 3 sub-score, self-management). Intentional non-adherence was strongly associated with beliefs scores (directly with BMQ concerns and inversely with BMQ necessity sub-score) and inversely associated with HIV infection. Conclusion: The different associations of intentional and non-intentional non-adherence behaviors found in this study help to understand how patient experiences and beliefs influence medical non-adherence, and in the development of strategies for reducing non-adherence.