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Background. Understanding the hospital impact of influenza requires enriching epidemiological surveillance registries with other sources of information. The aim of this study was to determine the validity of the Hospital Care Activity Record – Minimum Basic Data Set (RAE-CMBD) in the analysis of the outcomes of patients hospitalised with this infection. Methods. Observational and retrospective study of adults admitted with influenza in a tertiary hospital during the 2017/2018 and 2018/2019 seasons. We calculated the concordance of the RAE-CMBD with the influenza epidemiological surveillance registry (gold standard), as well as the main parameters of internal and external validity. Logistic regression models were used for risk adjustment of in-hospital mortality and length of stay. Results. A total of 907 (97.74%) unique matches were achieved, with high inter-observer agreement (ƙ=0.828). The RAE-CMBD showed a 79.87% sensitivity, 99.72% specificity, 86.71% positive predictive value and 99.54% negative predictive value. The risk-adjusted mortality ratio of patients with influenza was lower than that of patients without influenza: 0.667 (0.53-0.82) vs. 1.008 (0.98-1.04) and the risk-adjusted length of stay ratio was higher: 1.15 (1.12-1.18) vs. 1.00 (0.996-1.001). Conclusion. The RAE-CMBD is a valid source of information for the study of the impact of influenza on hospital care. The lower risk-adjusted mortality of patients admitted with influenza compared to other inpatients seems to point to the effectiveness of the main clinical and organisational measures adopted

Producción Científica, The high morbidity and mortality caused by influenza viruses translate into a great impact on specialized health care. Apart from the annual vaccination, the relevance of other measures to prevent and control this infection is unknown. The objective of our research was to determine the importance of a real-time surveillance system to establish early extended transmission precautions.

El tercer reto mundial de seguridad del paciente, «Medicación sin Daño», fue lanzado en 2017 por la Organización Mundial de la Salud con el objetivo de reducir el ya bien conocido daño evitable severo relacionado con la medicación en un 50% en los siguientes cinco años. Nada hacía presagiar que, dos años más tarde, el mundo sufriría una terrible pandemia que ha supuesto un desafío mucho mayor que el reto mencionado y que lo pondría a prueba ya desde las primeras etapas del proceso de uso de medicamentos. El ritmo frenético impuesto por la pandemia ha generado nuevos riesgos en el uso de la medicación en los afectados por la COVID-19 y en el conjunto de la población por los cambios organizativos de la provisión de atención sanitaria en los servicios de salud. La prescripción prudente se hace más importante que nunca en los sistemas de salud. Este artículo pretende analizar los principales riesgos producidos durante el periodo de pandemia y ofrecer a los profesionales de Atención Primaria una actualización y un recordatorio de los aspectos principales relacionados con la seguridad de los medicamentos.

Resumen Objetivo Identificar los enfoques metodologicos y avances de un conjunto de estudios que se han realizado en Espana desde 2014 en la linea de investigacion sobre segundas victimas, mediante la evaluacion del impacto de los eventos adversos (EA) en los profesionales sanitarios. Elaborar un conjunto de herramientas de ayuda para reducir su impacto. Metodo Estudio descriptivo en el que se encuesto a directivos y coordinadores de seguridad de hospitales y atencion primaria para conocer que actividades se estaban llevando a cabo en materia de segundas victimas, y a profesionales asistenciales para describir su posible experiencia como segundas victimas, junto a estudios cualitativos para disenar una guia de acciones recomendadas tras un EA, un programa online de sensibilizacion sobre este fenomeno, una app con actividades en seguridad responsabilidad de los directivos y una herramienta web para el analisis de los EA. Resultados Participaron 1.493 profesionales (directivos, coordinadores de seguridad y personal asistencial) de 8 comunidades autonomas. La guia de recomendaciones, el programa online y las aplicaciones desarrolladas se encuentran accesibles en el sitio web: www.segundasvictimas.es , que recibio mas de 2.500 visitas en un ano. Discusion Los resultados del estudio representan un punto de partida en el estudio del fenomeno de las segundas victimas en Espana. Las herramientas desarrolladas sensibilizan a la comunidad sanitaria acerca de esta problematica y dotan a los profesionales de habilidades para gestionar el impacto de los EA.

Background: Knowledge about safety culture improves patient safety (PS) in health-care organizations. The first contact a patient has with health care occurs at the primary level. We conducted a survey to measure patient safety culture (PSC) among primary care professionals (PCPs) of health centres (HCs) in Spain and analyzed PS dimensions that influence PSC. Methods: We used Agency for Healthcare Research and Quality (AHRQ) Medical Office Survey on Patient Safety Culture translated and validated into Spanish to conduct a cross-sectional anonymous postal survey. We randomly selected a sample of 8378 PCPs at 289 HCs operated by 17 Regional Health Services. Statistical analysis was performed on sociodemographic variables, survey items, PS dimensions and a patient safety synthetic index (PSSI), calculated as average score of the items per dimension, to identify potential predictors of PSC. We used AHRQ data to conduct international comparison. Results: A total of 4344 PCPs completed the questionnaire. The response rate was 55.69%. Forty-two percent were general practitioners, 34.9% nurses, 18% administrative staff and 4.9% other professionals. The highest scoring dimension was ‘PS and quality issues’ 4.18 (4.1–4.20) ‘Work pressure and pace’ was the lowest scored dimension with 2.76 (2.74–2.79). Professionals over 55 years, with managerial responsibilities, women, nurses and administrative staff, had better PSSI scores. Professionals with more than 1500 patients and working for more than 11 years at primary care had lower PSSI scores. Conclusions: This is the first national study to measure PSC in primary care in Spain. Results may reflect on-going efforts to build a strong PSC. Further research into its association with safety outcomes and patients’ perceptions is required.

BackgroundPrimary health care (PHC) is the ideal setting to provide integrated services centred on the person and to implement health promotion (HP) activities. ObjectiveTo identify proposals to approach HP in the context of primary care according to health-care users aged 45-75years, key community informants and primary care centre (PCC) workers. MethodsDescriptive-interpretive qualitative research with 276 participants from 14 PCC of seven Spanish regions. A theoretical sampling was used for selection. A total of 25 discussion groups, two triangular groups and 30 semi-structured interviews were carried out. A thematic interpretive contents analysis was carried out. ResultsParticipants consider that HP is not solely a matter for the health sector and they emphasize intersectoral collaboration. They believe that it is important to strengthen community initiatives and to create a healthy social environment that encourages greater responsibility and participation of health-care users in decisions regarding their own health and better management of public services and resources. HP, care in the community and demedicalization should be priorities for PHC. Participants propose organizational changes in the PCC to improve HP. PCC workers are aware that HP falls within the scope of their responsibilities and propose to increase their training, motivation, competences and knowledge of the social environment. Informants emphasize that HP should be person-centred approach and empathic communication. HP activities should be appealing, ludic and of proven effectiveness. ConclusionsAccording to a socio-ecological and intersectoral model, PHC services must get actively involved in HP together with community and through outreach interventions., This project has been funded by the Carlos III Health Institute (Ministry of Economy and Competitiveness, Spain) with a grant for research projects on health (PI12/01914; PI12/00616; PI12/02608; PI12/01974; PI12/02774; PI12/02635; PI12/02379) through the Network for Prevention and Health Promotion in Primary Care (redIAPP, RD12/0005/0001) and by European Union ERDF funds.

ResumenObjetivoValidar un instrumento para medir la cultura de seguridad del paciente de los profesionales de atención primaria (AP) en España.MétodosCuestionario Medical Office Survey on Patient Safety Culture (MOSPSC) elaborado por la Agency for Healthcare and Research in Quality (AHRQ). El proceso se realizó en 5 etapas: traducción de la versión original, evaluación de la equivalencia conceptual, valoración de la aceptabilidad y viabilidad, análisis de la validez del contenido y pilotaje del cuestionario adaptado y análisis de la respuesta y evaluación de las propiedades psicométricas.EmplazamientoAtención primaria.ParticipantesSe solicitó la colaboración de profesionales de AP de distintos servicios de salud siendo la muestra final de 185 profesionales.Mediciones principalesFrecuencia, patrón de respuesta y poder de discriminación de cada pregunta. α de Cronbach y dimensiones obtenidas mediante análisis factorial.ResultadosEl 17,8% de los participantes contestaron todas las preguntas y el 28,7% dejaron sin responder o marcaron la opción «no lo sé/no procede» entre 1 y 4 preguntas. Todas las sentencias, con una única excepción, tienen capacidad de discriminación. El α de Cronbach es de 0,96 y la información se resume en 15 dimensiones con una adscripción de variables idéntica en 7 de las 12 dimensiones del cuestionario original.ConclusionesEl cuestionario de la AHRQ traducido, adaptado, ampliado y validado es, para nuestro medio, un instrumento fiable y útil y debe emplearse para realizar comparaciones internacionales.AbstractObjetiveTo validate a tool to measure patient safety culture in Spanish primary care professionals.MethodsMedical Office Survey on Patient Safety Culture (MOSPSC), from the Agency for Healthcare and Research in Quality (AHRQ). The process has been performed in five steps: original version traslation, conceptual equivalence evaluation, acceptability and viability assessment, content validity and questionnaire test and response analysis and psichometric properties assessment.SettingPrimary care.Subjects185 Primary care professionals from different Spanish regions represented the sample test.Main outcome measuresFrecuency, response pattern and discrimination power of each item.Cronbach's alpha coefficient and dimensions obtained through factor analysis.Results17, 8% of respondents answered all the items and 28, 7% of them did not answer, or answered the option “Don’t know/Does not apply”, to one to four items. All the sentences, with only one exception, present discrimination capacity. Cronbach's alpha coefficient results 0,96 and information is sumarized in 15 factors obtaining the same items in 7 of the total 12 factors in the original questionnaire.ConclusionsTraslated, adapted, extended and validated AHRQ questionnaire is, in this setting, a reliable and useful instrument and it must be used for international comparisons.

En el contexto de las sociedades contemporaneas o de mercado, la medicina se encuentra con un escollo nuevo, diferenciar que intervenciones medicas estan justificadas cientifica y socialmente y cuales son fruto primordial del interes comercial. El termino medicalizacion tiene usos variados. Por un lado denota la expansion del ambito de actuacion de la medicina mas alla de lo justificado (medicalizacion de la vida cotidiana). Por otro, el papel desmesurado del medicamento en el acto medico. Lo comun a estas situaciones es la utilizacion innecesaria de intervenciones medicas. Innecesarias por no haber demostrado eficacia, por tener efectividad escasa o dudosa o por no ser coste-efectivas o prioritarias. Tambien, por no ser el ambito medico el mas adecuado para llevarlas a cabo. Un campo privilegiado de la medicalizacion asi entendida es el de las intervenciones preventivas, y entre ellas las que utilizan farmacos y/o tecnicas como elemento principal de la intervencion. Es una regla fundamental que cualquier intervencion clinica debe cumplir dos condiciones basicas

Background Adverse events (AE) are also the cause of suffering in health professionals involved. This study was designed to identify and analyse organization-level strategies adopted in both primary care and hospitals in Spain to address the impact of serious AE on second and third victims. Methods A cross-sectional study was conducted in healthcare organizations assessing: safety culture; health organization crisis management plans for serious AE; actions planned to ensure transparency in communication with patients (and relatives) who experience an AE; support for second victims; and protective measures to safeguard the institution’s reputation (the third victim). Results A total of 406 managers and patient safety coordinators replied to the survey. Deficient provision of support for second victims was acknowledged by 71 and 61 % of the participants from hospitals and primary care respectively; these respondents reported there was no support protocol for second victims in place in their organizations. Regarding third victim initiatives, 35 % of hospital and 43 % of primary care professionals indicated no crisis management plan for serious AE existed in their organization, and in the case of primary care, there was no crisis committee in 34 % of cases. The degree of implementation of second and third victim support interventions was perceived to be greater in hospitals (mean 14.1, SD 3.5) than in primary care (mean 11.8, SD 3.1) (p

Background Adverse events (AEs) cause harm in patients and disturbance for the professionals involved in the event (second victims). This study assessed the impact of AEs in primary care (PC) and hospitals in Spain on second victims. Methods A cross-sectional study was conducted. We carried out a survey based on a random sample of doctors and nurses from PC and hospital settings in Spain. A total of 1087 health professionals responded, 610 from PC and 477 from hospitals. Results A total of 430 health professionals (39.6%) had informed a patient of an error. Reporting to patients was carried out by those with the strongest safety culture (Odds Ratio –OR- 1.1, 95% Confidence Interval –CI- 1.0-1.2), nurses (OR 1.9, 95% CI 1.5-2.3), those under 50 years of age (OR 0.7, 95% CI 0.6-0.9) and primary care staff (OR 0.6, 95% CI 0.5-0.9). A total of 381 (62.5%, 95% CI 59-66%) and 346 (72.5%, IC95% 69-77%) primary care and hospital health professionals, respectively, reported having gone through the second-victim experience, either directly or through a colleague, in the previous 5 years. The emotional responses were: feelings of guilt (521, 58.8%), anxiety (426, 49.6%), re-living the event (360, 42.2%), tiredness (341, 39.4%), insomnia (317, 38.0%) and persistent feelings of insecurity (284, 32.8%). In doctors, the most common responses were: feelings of guilt (OR 0.7 IC95% 0.6-0.8), re-living the event (OR 0.7, IC95% o.6-0.8), and anxiety (OR 0.8, IC95% 0.6-0.9), while nurses showed greater solidarity in terms of supporting the second victim, in both PC (p = 0.019) and hospital (p = 0.019) settings. Conclusions Adverse events cause guilt, anxiety, and loss of confidence in health professionals. Most are involved in such events as second victims at least once in their careers. They rarely receive any training or education on coping strategies for this phenomenon. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0790-7) contains supplementary material, which is available to authorized users.

Resumen Objetivo Conocer, interpretar y comprender las necesidades de información sobre salud y enfermedad en usuarios de servicios sanitarios de atención primaria urbana de Salamanca. Diseño Investigación cualitativa. Diseño exploratorio desde la perspectiva cualitativa-estructural. Emplazamiento Atención primaria. Área urbana de Salamanca en 2007. Participantes y/o contextos Diez grupos de discusión: 2 integrados por miembros de asociaciones relacionadas con la salud y 8 por usuarios de atención primaria, participando un total de 83 personas. Las variables estructurales consideradas son: género, edad, nivel de estudios y pertenencia o no a asociaciones. Método Generar información hasta alcanzar la saturación informativa en los grupos de discusión. Previo compromiso de confidencialidad y consentimiento informado, se procedió a la grabación y transcripción literal de la conversación grupal. Cuatro investigadores categorizaron los contenidos, la intencionalidad del discurso y elaboraron el mapa conceptual. Después de triangular los resultados y codificar los párrafos se analizaron con el programa Nudist6.0. Resultados Los contenidos informativos señalan 4 necesidades de información: salud y prevención, diagnóstico precoz, primeros auxilios y enfermedad. Se detectan diferentes intencionalidades (necesidad, observación, reivindicación y mejora) y perfiles según las variables estructurales analizadas. Las principales necesidades informativas se refieren al diagnóstico, pronóstico y opciones terapéuticas del motivo de consulta. Existe concordancia entre los grupos en que la información transmitida al paciente debe ser inteligible, actualizada y coordinada entre los diferentes profesionales y niveles asistenciales. Conclusiones Los participantes demandan información de carácter clínico para ejercer su derecho de autonomía traduciendo la tendencia al empoderamiento de los usuarios como parte del cambio social.

ResumenObjetivosConocer las necesidades de información de los usuarios en relación a la oferta de servicios de Atención Primaria desde la perspectiva de los profesionales sanitarios.MétodosSe ha utilizado la técnica Delphi como método de consenso. Se solicitó la participación de 70 expertos: 35 médicos de familia, 32 enfermeras y tres pediatras de centros de salud urbanos y rurales del Área de Salud de Salamanca, entre mayo y diciembre de 2006. Los cuestionarios estaban estructurados en seis apartados: conocimientos sobre su salud, oferta de su centro de salud, aspectos administrativos, medios de difusión, expectativas sobre información y barreras en la comunicación. Las respuestas priorizadas en el tercer cuestionario se puntuaron según una escala que otorga cinco puntos a la sentencia más importante y un punto a la seleccionada en quinto lugar.ResultadosContestaron los tres cuestionarios 44 (62,8%) expertos. Las necesidades de información más puntuadas fueron la información sobre su enfermedad (4,0 puntos), los aspectos relacionados con la responsabilidad sobre su salud (3,8) y los consejos preventivos (3,6), seguidos de aspectos relativos a la accesibilidad (4,2), urgencias (3,4), oferta de servicios de médico/a y enfermera/o (3,6) y sitios donde dirigirse para obtener información (4,0). La falta de coordinación entre niveles (4,1) y la burocratización (3,5) se consideraron barreras en la comunicación y la información.ConclusionesLos factores identificados se centran en contenidos que permitan a los pacientes implicarse en su propio proceso y participar en la toma de decisiones que les incumben. También destacaron la información sobre los servicios y el acceso a éstos.AbstractObjectiveTo determine the information needed by patients in relation to the supply of primary care services from the perspective of health professionals.MethodsThe Delphi technique was used as a consensus method. Seventy experts were asked to participate: 35 primary care physicians, 32 nurse practitioners, and three pediatricians in rural and non-rural health centers in the Health Area of Salamanca between May and December 2006. The questionnaires used were structured into six sections: patients′ knowledge of their health, services in their health centers, administrative topics, the media, information expectations, and communication barriers. In the third questionnaire, prioritized answers were scored between 5 points and 1 point according to their importance.ResultsAll three questionnaires were completed by 44 experts (62.8%). The information needs with the highest scores were information on patients′ diseases (4.0 points), subjects related to patients′ responsibility for their health (3.8) and preventive advice (3.6), followed by subjects relating to access (4.2), emergencies (3.4), physicians’ and nurse practitioners’ services (3.6), and places to go to get information (4.0). The lack of coordination between primary and hospital care (4.1) and excessive bureaucracy (3.5) were considered to limit communication and information.ConclusionsThe factors identified focus on contents that allow patients to get involved in their own process and to take active part in the decision-making that concerns them. Other important factors were information about services and the access to them.