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The development of collaborative nurse prescribing (NP) in Andalusia (Spain) in 2018 gives us the opportunity to measure the impact of this practice. Scientific evidence indicates that prescribing is not more costly when performed by nurses and, in fact, is more economical in some cases. The aim of this study is to determine the effects of NP on the effectiveness, health outcomes and adverse events related to prescribing including in the follow-up of patients treated with antivitamin K oral anticoagulants in primary care (PC) by nurses. The design is a randomized clinical trial. The population comprises 1208 anticoagulated patients in 2019. The sample size calculation considers an alpha error of 0.05, a power of 99% and an effect size of 0.5, resulting in 127 users per group. Therefore, a total sample of 254 participants is needed. However, as the project intends to treat patients it will include the universal sample that meets the criteria in the two health centers participating in the study, with 575 participants in total. Data collection was carried out in the PC District of the Alamillo-San Jerónimo Clinical Management Unit of Sevilla for one year from January 2020. Data analysis is performed using the SPSS Statistics 25 package. We intend to study if nurse collaborative prescription in the follow-up and management of patients taking antivitamin K oral anticoagulants in PC is as effective as the traditional approach to follow-ups carried out by a family physician.

Objective: To conduct an assessment of migrant people regarding their access to the health system following entry into force of Royal Decree-Law 16/2012 along with the impact of economic cuts on such access., Method: Qualitative phenomenological study with semi-structured interviews, conducted in Andalusia (Spain), in two phases (2009-2010 and 2012-2013), with 36 participants. The sample was segmented by length of stay, nationality and area of residence. The nationalities of origin are Bolivia, Morocco and Romania., Results: Elements facilitating access in both periods: regular administrative situation, possession of Individual Health Card, knowledge of the language, social networks and information. The results show differences in access to health care for migrants before and after the enforcement of the RDL 16/2012, within austerity policies. In the second period, access barriers such as waiting times or incompatibility of schedules are aggravated and the socio-economic and administrative conditions of participants worsen., Conclusions: The design of policies, economic and regulatory health care, should take into account barriers and facilitators of access as fundamental main points of health protection for migrants and, therefore, for the general population., (Copyright © 2018 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.)

Incorporating community health teaching in the undergraduate nursing and medicine curriculum and postgraduate training programmes contributes to enhance the quality, rigour and sustainability of health-promoting community interventions. In this article, we discuss the failure of Spanish Medical Universities to include family and community medicine and primary health care as integrated and cross-cutting disciplines on the undergraduate curriculum. During specialized medical and nursing training, community health teaching varies widely depending on the qualification, priorities and motivation of the primary health care workers, teaching units and trainees. Growing job instability and current nurse and medical recruitment systems, are hindering learning being put into practice, as well as the development of health-promoting community activities and the strengthening of training networks and facilities. Amid such adversity, there are initiatives that provide quality training on community health and should, accordingly, be fostered and acknowledged., (Copyright © 2018 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: To evaluate the (inter)relation between chronic patient activation and its relationship with health professionals in Andalusia., Methods: Descriptive and quantitative study involving 258 chronic patients from the School of Patients, contacted by email. One hundred and forty-two answered the Patient Activation Measurement (PAM) and the chronic patient's experience (IEXPAC) questionnaires. Statistical analyses included correlation study and comparison of means., Results: The mean of Patient Activation Measurement was 87 points (scale from 0 to 100) and IEXPAC scale was 5.3 (scale from 0 to 10), with a directly proportional relation between variables. Males and participants belonging to patients' associations had higher levels of activation. The relationship with health professionals was better among patients with primary education and with <10 years of chronic disease. In general, medical staff received better evaluation, yet nurses were considered more prone to encouraging relationships among patients. The dimensions with higher impact on patient activation were inter-professional coordination and the attention paid to treatment and medication. Feeling confident to communicate one's concerns had more impact on IEXPAC scale., Conclusions: The correlation observed between patient activation and its relationship with health professionals leads to the need to improve the involvement and self-management of chronic patients, as well as to strengthen improved professional coordination and patient-staff communication.

Objective: To determine the perception and self-assessment on leadership among health care team leaders in Andalusia., Material and Methods: Design: Exploratory descriptive study using quantitative and qualitative methodology, developed between 2013 and 2015, using a questionnaire and semi-structured interviews., Place: Andalusia., Participants: All health managers from the Primary Care Management Units and Health Management Areas of the Departments of Paediatrics, Emergency and Internal Medicine, for the quantitative study. A purposive sample of 24 health managers was used for the qualitative study., Methods: Descriptive statistical study and bivariate analysis of comparison of means. Content analysis of the semi-structured interviews: Codification, category tree, and triangulation of results., Results: The best self-assessment dimension relates to support, and the worst to considering oneself as a 'good leader'. The definition of a 'good leader' includes: Honesty, trust, and attitudes of good communication, closeness, appreciation, and reinforcement of the health team members. Different leadership styles were perceived. Main difficulties for leadership are related to the economic crisis and the management of personal conflicts., Conclusions: Health managers describe an adaptive leadership style, based on personal and professional support, and using communication as the main cohesive element for the team project. More studies on leaders' perspectives are important, in order to better understand their experiences, needs and expectations., (Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To evaluate a peer training strategy for patients with type2 diabetes mellitus, developed in two training programmes in the Basque Country and Andalusia., Design: Quantitative pre- and post-intervention and qualitative evaluation, developed between 2012 and 2014., Place: The Basque Country and Andalusia., Participants: A total of 409 patients and trainer-patients, participating in self-management peer training programmes. Intentional sample of 44 patients for the qualitative study., Method: Bivariate analysis and net gains for common variables used in questionnaires in the Basque Country and Andalusia: self-reported health, daily activities, physical activity, use of health services, and self-management. Content analysis of 8 focus groups with patients and trainer-patients, including: coding, categorisation, and triangulation of results., Results: Peer training has a positive impact on physical activity, the use of health services, and self-management, with some gender differences. The peer-training strategy is considered positive, as it strengthens the patient-health provider relationship, generates group support and self-confidence, and improves the emotional management. Patients identify two areas of potential improvement: access and continuity of training strategies, and more support and recognition from health providers and institutions., Conclusions: The positive impact on health and quality of life that this patient peer-training provides, requires the collaboration of health professionals and institutions, which should improve the access, continuity and adaptation to patient needs and expectations., (Copyright © 2015 Elsevier España, S.L.U. All rights reserved.)

Objective: The recent publication of the Royal Decree-Law 16/2012 (RDL 16/2012), which introduces structural changes in the Spanish Public Healthcare System, can be placed in the broader context of budgetary adjustments in response to the current economic crisis. An analysis of the interrelationships among economic crisis, healthcare policies, and health reveals that citizen participation is one of several potential strategies for reducing the impact of this situation on the population. This observation raises the interest to know the citizens' perspectives on the modifications introduced by the RDL 16/2012., Methods: Narrative review of documents related to the RDL 16/2012 published by civil society organizations and professional associations in the Spanish context., Results: A broad citizen response can be observed to the introduction of RDL 16/2012. The documents reviewed include an analysis of changes in the healthcare model inherent to the RDL 16/2012, as well as predictions on its impact on access to healthcare, healthcare quality, and health. The civil society organizations and professional associations offer recommendations and proposals, as well as collaboration in elaborating alternative strategies to reduce costs., Conclusions: The response of civil society organizations and professional associations underscores the importance of strengthening citizen participation in the development of healthcare policies aimed at maintaining the universal character and sustainability of the Spanish Public Healthcare System in the current moment of economic and systemic crisis., (Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: The recent introduction of adjustment measures in the Spanish context by means of the Royal Decree-law 16/2012 (RDL 16/2012), which limits access to health care for undocumented migrants, raises the question about the state of the matter in different European Union member states., Methods: Narrative review of comparative studies published between 2009 and 2012 that analyzes the right to health care for undocumented migrants in the European context., Results: The review shows a high degree of variability regarding health care entitlements of undocumented migrants in different European countries, a frequent legal restriction of access to health care, as well as barriers in the effective access to health care. The studies coincide in recommending access at all health care levels, regardless of the administrative status of the person seeking treatment. The analysis of the impact of the current economic crisis on access and quality of the health care directed to undocumented migrants, as well as the knowledge of the migrants' perspective are identified as future research areas., Conclusions: Compared with other European countries, the introduction of the measures established in the RDL 16/2012 modifies the place of the Spanish Public Health Care System from being situated in the group of countries that permit undocumented migrants access to all health care levels, towards the category of highest restriction., (© The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Objectives: To know the experiences and expectations of diabetes mellitus type 1 (DM1) patients and their relatives as regards the relationships established with doctors, and the impact of such relationships on their strategies to cope with the disease and treatment., Design: Qualitative design based on focus groups conducted in 2001., Location: Several health care centres in Granada and Seville, Spain., Participants: DM1 patients and their relatives and/or carers., Method: Theory-based sampling including the most representative profiles. Qualitative analysis procedure: text coding, triangulation and interpretation of results., Results: Doctor/patient relationship highly influences the emotional experience of disease and the way patients gain control over it. Interviewed patients said that the relationship with doctors is focused on disease signs and symptoms, leaving emotional aspects aside. Very often, provider communication is built on recrimination and threat. Treatment is imposed rather than agreed, with scarce opportunities for participating in clinical decisions. Patients develop strategies to take their own decisions and adapting treatment to their daily life., Conclusions: Patients value a relationship model whereby providers listen and empathise with their situation, understand their difficulties in treatment compliance, encourage them, and adapt recommendations to the personal and emotional circumstances of each patient. They prefer doctors combining professional competence-including relational skills-with humanity and kindness, as well as being capable of assuming their co-responsibility in treatment success.

Objective: Heroin use has stabilized in recent years in Spain, and the use of injected heroin having decreased. Nevertheless,major differences exist among different Autonomous Communities and among injected heroin users profile. This study is aimed at ascertaining the forms of heroin use (how administered) in an intentional sample of users in a situation of social exclusion andsome variables related to said forms of use., Methods: The sample was comprised of 285 participants (82.8% males; average age 36.06). This study was conducted in the city of Granada in July-October 2002. Structured surveys conducted by onthe-street interviewers and individuals having knowledge of the environment («peers») using the «snowball» technique., Results: A total of 48.4% of the participants alternate inhaled and intravenous heroin use; 25.6% using only inhaled and 25.6% only intravenous. Following a regression analysis, it was found that the females, the youngest users and those having started use at an older age were at less risk of intravenous heroin use. A total of 21.5% of the participants who started using heron in inhaled form, also currently use both the injected and inhaled forms, the remaining 79.5% continue to use the inhaled form., Conclusions: Among individuals in a situation of social exclusion the intravenous form exceeds the estimated percentages in the Autonomous Community of Andalusia.

Background: The study of the health condition of the populations under confinement in penitentiaries is based on the evidence of a more deteriorated health than the general population and a greater degree of social exclusion, which is associated with worse general health. This study is aimed at ascertaining how the inmates of an Andalusian penitentiary perceive their health condition and the use made thereby of the healthcare services, as well as the factors associated with those variables., Methods: Descriptive, cross-sectional study. The data was collected with a questionnaire. The sample size was 450 inmates, 90.4% of whom were males., Results: Seventy-two percent of those taking part in the study considered their health to be good or very good, 32.7% stating having seen the doctor once a month or more often. A total 43.1% of the participants stated having chronic illnesses, mainly HIV (19.1%) and hepatitis C (18.2%); 40.9% stating that they take medication. Worse health was perceived among the older inmates, those who have to serve longer than a five-year sentence, those who are repeat offenders and those not having pending trials. Those perceiving their health to have deteriorated over the past year have chronic illnesses and take medication. The regression model for the use of healthcare services shows that they are used to a greater extent by those who are serving a longer than a 5-year sentence, those who have been in prison for less than a year and those who take medication., Conclusions: The results show the importance of increasing the monitoring of possible addictive disorders upon entering prison and of the trend and treatment of chronic diseases.

Objectives: To analyse ongoing education within primary care teams from managers' perspective., Design: Cross-sectional descriptive study., Setting: The Mother-Infant Health Programme of Andalusia in primary care., Intervention: The views of health centre professionals were obtained through 8 groups. The type of health district and the number of years in operation were used as criteria for division. The views of the area managers were collected through a self-filled questionnaire from all the managers in the autonomous community., Measurements and Main Results: Professionals believed it necessary to keep up to date and train in new technology. They thought that training activities should focus on questions such as evaluation of programmes, focus of risk, counselling and communication, and certain techniques such as IUD insertion. Both managers and professionals coincided in recognising the effect of training on the development of mother-child services. There was consensus among professionals in affirming that training increases the quality of care delivered. Access to training was the main incentive element used by most area managers and one of those most highly valued by professionals. The professionals affirmed that in recent years there had been obstacles to their education by attending scientific events outside their areas. Many professionals stated that the economic assistance of the pharmaceutical industry for courses caused inequalities between doctors and nurses in access to training. Professionals were very critical of training combined with specialist training., Conclusions: Professionals think they have sufficient training for mother-child health care. It is generally recognised that family doctors are better trained for working on health programmes than other professionals at the centres. Ongoing training was rated very highly by both professionals and directors, as it was seen as a motivating element and thought to be an activity almost solely carried out at health centres.

Regarding the debate on the existence of two current focuses on health science research (qualitative and quantitative), the paper states the need for complementing the techniques which contribute to a better knowledge of populations and communities, and the need for offering effective solutions to different problems. The article analyses the usefulness of qualitative methods, describes the techniques and procedures more frequently used to guarantee the validity and reliability of research findings and ends bringing up the need for using qualitative and quantitative approaches. This way of working together or learning from each other will enrich research and interventions on public heath and health management fields. Qualitative methods are useful for sound understanding of a given issue that is being investigated or evaluated taking into account the point of view of the participants under research. Key techniques, listed from the most structured to the less structured are among others: structured interview, Delphi, nominal group, case study, semistructured interview, focal group, brainstorming, discussion group, in depth interview, life story and participant observation.