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Colonoscopy services working in colorectal cancer screening programs must perform periodic controls to improve the quality based on patients' experiences. However, there are no validated instruments in this setting that include the two core dimensions for optimal care: satisfaction and safety. The aim of this study was to design and validate a specific questionnaire for patients undergoing screening colonoscopy after a positive fecal occult blood test, the Colonoscopy Satisfaction and Safety Questionnaire based on patients' experience (CSSQP). The design included a review of available evidence and used focus groups to identify the relevant dimensions to produce the instrument (content validity). Face validity was analyzed involving 15 patients. Reliability and construct and empirical validity were calculated. Validation involved patients from the colorectal cancer screening program at two referral hospitals in Spain. The CSSQP version 1 consisted of 15 items. The principal components analysis of the satisfaction items isolated three factors with saturation of elements above 0.52 and with high internal consistency and split-half readability: Information, Care, and Service and Facilities features. The analysis of the safety items isolated two factors with element saturations above 0.58: Information Gaps and Safety Incidents. The CSSQP is a new valid and reliable tool for measuring patient' experiences, including satisfaction and safety perception, after a colorectal cancer screening colonoscopy.

Background: This study aims to synthesize knowledge about the role of the public's participation in the definition, prioritization, rationalization, monitoring or control of policies, plans, governance, investment/disinvestment, and design of health services., Methods: Review of review articles (narrative or systematic) about consumer participation indexed in PubMed until August 2016., Results: Forty-two reviews were identified (eighteen systematic and twenty-four narrative). The extent of participation was provincial/regional or national. The issues addressed covered: What is public participation? What benefits are expected? Who participates in the representation of citizens? How and to what extent do citizens participate and with what outcomes? The impact of public participation has hardly been studied., Conclusions: There is moderate evidence in support of the argument that public participation legitimizes decisions of the Health Authorities, and improves outcomes of health policies. There is consensus on how participation techniques should be applied but there is a need to inquire more deeply into the level of impact of this participation.

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 < 0.001)., Conclusions: Many Spanish health organizations do not have a second and third victim support or a crisis management plan in place to respond to serious AEs.

Objective: To design and validate a questionnaire for assessing attitudes and knowledge about patient safety using a sample of medical and nursing students undergoing clinical training in Spain and four countries in Latin America., Methods: In this cross-sectional study, a literature review was carried out and total of 786 medical and nursing students were surveyed at eight universities from five countries (Chile, Colombia, El Salvador, Guatemala, and Spain) to develop and refine a Spanish-language questionnaire on knowledge and attitudes about patient safety. The scope of the questionnaire was based on five dimensions (factors) presented in studies related to patient safety culture found in PubMed and Scopus. Based on the five factors, 25 reactive items were developed. Composite reliability indexes and Cronbach's alpha statistics were estimated for each factor, and confirmatory factor analysis was conducted to assess validity. After a pilot test, the questionnaire was refined using confirmatory models, maximum-likelihood estimation, and the variance-covariance matrix (as input). Multiple linear regression models were used to confirm external validity, considering variables related to patient safety culture as dependent variables and the five factors as independent variables., Results: The final instrument was a structured five-point Likert self-administered survey (the "Latino Student Patient Safety Questionnaire") consisting of 21 items grouped into five factors. Compound reliability indexes (Cronbach's alpha statistic) calculated for the five factors were about 0.7 or higher. The results of the multiple linear regression analyses indicated good model fit (goodness-of-fit index: 0.9). Item-total correlations were higher than 0.3 in all cases. The convergent-discriminant validity was adequate., Conclusions: The questionnaire designed and validated in this study assesses nursing and medical students' attitudes and knowledge about patient safety. This instrument could be used to indirectly evaluate whether or not students in health disciplines are acquiring and thus likely to put into practice the professional skills currently considered most appropriate for patient safety.

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.

Objective: To design and validate a scale (CSR-Hospital-SP) to determine health professionals' views on the approach of management to corporate social responsibility (CSR) in their hospital., Methods: The literature was reviewed to identify the main CSR scales and select the dimensions to be evaluated. The initial version of the scale consisted of 25 items. A convenience sample of a minimum of 224 health professionals working in five public hospitals in five autonomous regions were invited to respond. Floor and ceiling effects, internal consistency, reliability, and construct validity were analyzed., Results: A total of 233 health professionals responded. The CSR-Hospital-SP scale had 20 items grouped into four factors. The item-total correlation was higher than 0.30; all factor loadings were greater than 0.50; 59.57% of the variance was explained; Cronbach's alpha was 0.90; Spearman-Brown's coefficient was 0.82., Conclusion: The CSR-Hospital-SP scale is a tool designed for hospitals that implement accountability mechanisms and promote socially responsible management approaches., (Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: Healthcare practices involve risks for patients, but there has been little research to date on the occurrence of adverse events (AE) in primary care (PC). The frequency of AE in PC in Spain, the factors that contribute to their occurrence, their severity and their preventability, were analysed., Methods: Observational cross-sectional study was carried out in 48 PC centres in 16 regions of Spain. PC professionals were asked to assess whether the AE was caused by the healthcare or if it was an expectable consequence of the patient's underlying condition. A total of 452 healthcare professionals who attended 96 047 consultations were involved., Results: A total of 773 AE were identified, so that the point prevalence of AE was 0.8% [95% confidence interval (CI) 0.76-0.85]. A majority of AE (64.3%) were considered preventable and only 5.9% were severe, usually related to medication [odds ratio (OR) = 4.6; 95% CI 2.1-10.3]. The most frequent causal factor of the AE was associated with medication (adverse drug reactions and medication errors), but problems in communication and management were at the root of many of the AE. Nurses reported more preventable AE (OR = 1.9; 95% CI 1.2-2.8)., Conclusion: In spite of an AE being less damaging in PC, large numbers of patients and professionals suffer their consequences each year. An awareness of the magnitude and impact of AE is the first step on the road to the cultural change necessary for achieving safer healthcare.

Objective: To report the precautions taken by diabetic patients to avoid treatment errors and to provide advice to increase their safety., Methods: A descriptive study of patients' behaviors to minimize errors and tips by professionals to improve safety. Ninety-nine insulin-treated patients were randomly recruited from 3 primary healthcare centers and 2 hospitals. An opportunity sample of 33 doctors and nurses was also surveyed., Results: Information of all prescriptions (p = 0.005), review of doubts before the visit (p = 0,009), and diet adherence (p = 0.02) were the only precautions reported by patients that related to a lower number of patient errors. Female patients better follow at home instructions for blood glucose monitoring (odds ratio 0.07; 95% confidence interval (CI) 0.1-0.6) and use pillboxes to avoid errors (odds ratio 0.23; 95% CI 0.1-0.6) more frequently than male patients. Male patients more commonly carry with them a card with information about allergies (odds ratio 5.03; 95% CI 1.4-17.5). Patients with a longer course of disease tend to withhold information about other treatments from their doctors (β -15.8; 95% CI -23.2-8.4). For healthcare professionals, safety may increase if patients: play a more active role in their treatment (91%), and inform their doctors about their different treatments (88%)., Conclusions: Promotion of patient autonomy, improved communication to patients, and systematic information about the most common medication errors may contribute to patient safety., (Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.)

Background: Diabetes and kidney disease are risk factors for adverse events (AE). There are no other studies on the perception of risk in these patients. This study analyzes the frequency of adverse event triggers reported by diabetic and renal patients and their perception of the risk., Material and Methods: Descriptive study based on interviews with randomly selected patients. Field study conducted between February and May 2010 in three health centers and two hospitals in Alicante and Madrid., Results: A total of 199 patients answered, 98 diabetic patients and 101 renal patients. Renal patients accumulated more AE triggers (21.8% referred to an AE trigger, 17.8% two AE triggers and 3% referred to > 3 AE triggers) than diabetic patients (16.3% referred to one AE trigger, 7.1% to two AE triggers and 7.1% referred to > 3 AE triggers). During the last year 6/98 diabetic patients and 10/101 renal patients required additional treatment due to a clinical error. The probability of the patient being the victim of a clinical error with serious consequences was 1:10. Women with renal illness believed themselves to have a greater probability of suffering an error (Chi2=12.7, p=0.002). Errors were attributed to a lack of time to attend to all patients and a lack of means and resources, without statistically significant differences between the subsamples. Interviewed patients considered that the risks of suffering a traffic accident or robbery were similar to the risk of an error with serious consequences., Conclusion: Information provided by patients can help improve safety procedures.

Objectives: To analyze hospital and primary care physicians' knowledge of certain patients' rights recently modified by Spanish Law 41/2002 (law of patient autonomy)., Material and Methods: We performed a voluntary survey of hospital and primary care physicians who were presented with three problem situations drawn from court decisions and the law of patient autonomy., Results: Among interviewed physicians, 78% were familiar with the law of patient autonomy. Fifty-three percent knew how to explain what advance wills are. Eighty-eight percent responded correctly to the problem situation concerning the right to privacy. Fifty-seven percent knew the legal age of consent for healthcare. Seventy percent correctly applied patients' right not to be informed. Only 38% responded correctly to all three problem situations. Correct responses were more frequent (odds ratio: 2.4-3.4) among physicians who were familiar with the law of patient autonomy., Conclusions: At least one out of every 10 physicians could be legally compromised by lack of knowledge of the law of patient autonomy. Patients' rights were most likely to be jeopardized in patients aged between 16 and 18 years old. Prior information on the law of patient autonomy contributes to greater compliance., (Copyright 2009 SESPAS. Published by Elsevier Espana. All rights reserved.)

Background: Approximately 10% of hospitalized patients suffer an adverse event during their hospital stay. An important proportion of subjects also feel that they have a high risk of suffering such an event during an eventual hospitalization., Aim: To determine the perception on clinical safety among patients discharged from a hospital., Material and Methods: A questionnaire about hospital safety was mailed to 1300 patients discharged from a hospital. The questionnaire was analyzed using construct validity predictive validity and Cronbach Alpha for internal consistency., Results: The questionnaire was answered by 384 patients, yielding a response rate of 29%. Of these, 77 incomplete answers were discarded. Thirty-one subjects (10%) reported a possible adverse event. In 19 cases (5.8%), it was due to medication errors and in 19 (6.1%), to surgical procedures. In seven cases (2.3%), both errors coincided (2.3%). According to the predictive validity of the questionnaire, if a patient reports an adverse event, the confidence in the hospital and in the professionals is reduced (p <0.001), communication with the physician is considered inappropriate (p =0.0001) and risk perception increases (p =0.003). Unsatisfied patients are those that believe that they have higher risks of suffering a medical error (p =0.005)., Conclusions: Risk perception for adverse events increases after having suffered such an event. Patient satisfaction minimizes the effects of adverse events on their confidence and attitude.

Objective: To describe the main qualitative research techniques through systematic review of Spanish studies published during the previous 5 years., Design: Systematic review., Data Sources: The Indice Médico Español (bibliographic database of items published in Spanish health sciences journals) was searched, and systematic searches of the journals Atención Primaria, Gaceta Sanitaria, and Revista de Calidad Asistencial were done. Study selection. We included studies carried out with any type of qualitative research technique. Also included were studies that reviewed qualitative research techniques. We excluded studies that used a qualitative technique but were based mainly on quantitative research techniques. The review was done during the period from April 1997 to April 2002., Results: Most of the studies we reviewed used only one technique (80.5%). When more than one technique was used in combination (19.5% of the articles we reviewed), focus groups and interviews were usually used. The techniques identified were focus group (used in 34% of the articles reviewed), interview (24%), the Delphi technique (10%), content analysis (8%), nominal group (8%), metaplan (2%), and Philips 6/6 (2%)., Conclusions: Qualitative research is a valid alternative, and if used with appropriate methodological rigor it can be of considerable use to health care professionals.

Objective: To identify the best way to inform patients about centers and services so that they can make a responsible choice, and to identify which factors determine patients' decisions., Subjects and Methods: Data on three illnesses (breast cancer, benign prostatic hypertrophy, and cataracts) in three fictitious hospitals were shown to patients. The data were presented to 1,259 subjects through four different means: a brochure including a table, a brochure with a bar graph, three brochures with tables, and three brochures with bar graphs. Data on each of the hospitals included: professional profiles, medical and surgical outcomes, side effects, patients' and relatives' satisfaction, and hospital complaints. The subjects completed a questionnaire evaluating the information received., Results: Most patients (88%) preferred to receive full information and to share decision-making with their physician. Sixty-four percent of the patients chose the hospital with the best medical or surgical outcomes. Patients preferred the data presented through a brochure with a table (p < 0.001). Three factors were identified with severe illness (satisfaction, outcomes and complaints) and two factors with non-severe illness (satisfaction and outcomes). Men paid more attention to medical and surgical outcomes (p < 0.001), relapses (p < 0.001), and side effects (p < 0.001). When performing comparisons, health professionals paid greater attention to medical and surgical outcomes than to patients' and relatives' satisfaction (t range between 0.40 and 0.90, p < 0.01)., Conclusions: Differences were found in the need for information and in comprehension depending on the way information was presented and on the type of disease. Gender and health knowledge seem to be predictors of patients' information needs when choosing a hospital.

Objective: To compare the opinions of patients assisted in 5 hospitals., Design: Descriptive study based in a survey by mail has been used in all cases., Instruments: The SERVQHOS questionnaire., Subjects: 930 patients. Answer rate around 35%., Results: 19% of the patients would not recommend the hospital. 59.2% was shown satisfied and 3.1% very unsatisfied. To know the doctor's and nurse's name were related to perceived quality. The frequency with which the patients said to have been correctly informed was not related to quality. Neither age nor patient's sex showed a relationship with perceived quality., Conclusion: The patients value the hospital positively although there are an important number of unsatisfied patients.