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BACKGROUND: Research shows that feeding back patient-reported outcome information to clinicians and/or patients could be associated with improved care processes and patient outcomes. Quantitative syntheses of intervention effects on oncology patient outcomes are lacking. OBJECTIVE: To determine the effects of patient-reported outcome measure (PROM) feedback intervention on oncology patient outcomes. DATA SOURCES: We identified relevant studies from 116 references included in our previous Cochrane review assessing the intervention for the general population. In May 2022, we conducted a systematic search in five bibliography databases using predefined keywords for additional studies published after the Cochrane review. STUDY SELECTION: We included randomized controlled trials evaluating the effects of PROM feedback intervention on processes and outcomes of care for oncology patients. DATA EXTRACTION AND SYNTHESIS: We used the meta-analytic approach to synthesize across studies measuring the same outcomes. We estimated pooled effects of the intervention on outcomes using Cohen's d for continuous data and risk ratio (RR) with a 95% confidence interval for dichotomous data. We used a descriptive approach to summarize studies which reported insufficient data for a meta-analysis. MAIN OUTCOME(S) AND MEASURES(S): Health-related quality of life (HRQL), symptoms, patient-healthcare provider communication, number of visits and hospitalizations, number of adverse events, and overall survival. RESULTS: We included 29 studies involving 7071 cancer participants. A small number of studies was available for each metanalysis (median = 3 studies, ranging from 2 to 9 studies) due to heterogeneity in the evaluation of the trials. We found that the intervention improved HRQL (Cohen's d = 0.23, 95% CI 0.11-0.34), mental functioning (Cohen's d = 0.14, 95% CI 0.02-0.26), patient-healthcare provider communication (Cohen's d = 0.41, 95% CI 0.20-0.62), and 1-year overall survival (OR = 0.64, 95% CI 0.48-0.86). The risk of bias across studies was considerable in the domains of allocation concealment, blinding, and intervention contamination. CONCLUSIONS AND RELEVANCE: Although we found evidence to support the intervention for highly relevant outcomes, our conclusions are tempered by the high risk of bias relating mainly to intervention design. PROM feedback for oncology patients may improve processes and outcomes for cancer patients but more high-quality evidence is required.
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Neoplasias , Calidad de Vida , Humanos , Retroalimentación , Hospitalización , Medición de Resultados Informados por el Paciente , Neoplasias/terapiaRESUMEN
BACKGROUND: Although circadian, seasonal, and other cycles have been observed for a number of chronic conditions, their impact on patient reported outcomes measurements (PROMs) has not been systematically explored, rendering our understanding of the effect of time of measurement on PROM scores very limited. The aim was to conduct a scoping review to determine what is known about how intra-individual cyclical variation might affect the way individuals with chronic conditions respond to patient-reported outcome measures. METHODS: A protocol of a systematic scoping review was registered on PROSPERO (CRD42017058365). We developed a search strategy based on previous relevant reviews and implemented it in: MEDLINE, Embase, PsycINFO, and CINAHL. No restrictions were placed on article types and backward and forward citation searches were conducted. Screening and data extraction were independently completed by up to four reviewers. An adapted version of CASP criteria was used to appraise the quality of included articles. Concepts that were important in understanding the impact of cyclical variation on PROM scores were elicited from the papers and iteratively refined through discussion amongst the authors. RESULTS: 2420 references resulted from the searches, with 33 articles meeting the inclusion criteria. Most study designs included observational research (particularly ecological momentary assessment), 2 were RCTs and 2 were systematic reviews. Studies mainly focused on specific health conditions: mental health, respiratory and musculoskeletal. There was a lack of qualitative research and theoretical framework to explore these concepts more fully. Five overarching concepts emerged: variation in outcomes, variation of scores, psychological status, individual factors, and environmental/situational factors. A conceptual model was developed outlining the relationships between these concepts. CONCLUSIONS: There is empirical evidence that supports cyclical variation in PROM scores across different chronic conditions, with potential very significant implications for administration and interpretation of PROMs. The proposed conceptual model can support further research in this area.
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BACKGROUND: EQ-5D health state utilities (HSU) are commonly used in health economics to compute quality-adjusted life years (QALYs). The EQ-5D, which is country-specific, can be derived directly or by mapping from self-reported health-related quality of life (HRQoL) scales such as the PROMIS-29 profile. The PROMIS-29 from the Patient Reported Outcome Measures Information System is a comprehensive assessment of self-reported health with excellent psychometric properties. We sought to find optimal models predicting the EQ-5D-5L crosswalk from the PROMIS-29 in the United Kingdom, France, and Germany and compared the prediction performances with that of a US model. METHODS: We collected EQ-5D-5L and PROMIS-29 profiles and three samples representative of the general populations in the UK (n = 1509), France (n = 1501), and Germany (n = 1502). We used stepwise regression with backward selection to find the best models to predict the EQ-5D-5L crosswalk from all seven PROMIS-29 domains. We investigated the agreement between the observed and predicted EQ-5D-5L crosswalk in all three countries using various indices for the prediction performance, including Bland-Altman plots to examine the performance along the HSU continuum. RESULTS: The EQ-5D-5L crosswalk was best predicted in France (nRMSEFRA = 0.075, nMAEFRA = 0.052), followed by the UK (nRMSEUK = 0.076, nMAEUK = 0.053) and Germany (nRMSEGER = 0.079, nMAEGER = 0.051). The Bland-Altman plots show that the inclusion of higher-order effects reduced the overprediction of low HSU scores. CONCLUSIONS: Our models provide a valid method to predict the EQ-5D-5L crosswalk from the PROMIS-29 for the UK, France, and Germany.
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Medición de Resultados Informados por el Paciente , Calidad de Vida , Años de Vida Ajustados por Calidad de Vida , Adulto , Anciano , Femenino , Francia , Alemania , Humanos , Masculino , Persona de Mediana Edad , Psicometría/instrumentación , Reino UnidoRESUMEN
Multimorbidity, the simultaneous presence of multiple health conditions in an individual, is an increasingly common phenomenon globally. The systematic assessment of the quality of care delivered to people with multimorbidity will be key to informing the organization of services for meeting their complex needs. Yet, current assessments tend to focus on single conditions and do not capture the complex processes that are required for providing care for people with multimorbidity. We conducted a scoping review on quality of care and multimorbidity in selected databases in June 2018 and identified 87 documents as eligible for review, predominantly original research and reviews from North America, Europe and Australasia and mostly frequently related to primary care settings. We synthesized data qualitatively in terms of perceived challenges, evidence and proposed metrics. Findings reveal that the association between quality of care and multimorbidity is complex and depends on the conditions involved (quality appears to be higher for those with concordant conditions, and lower in the presence of discordant conditions) and the approach used for measuring quality (quality appears to be higher in people with multimorbidity when measured using condition/drug-specific process or intermediate outcome indicators, and worse when using patient-centred reports of experiences of care). People with discordant multimorbidity may be disadvantaged by current approaches to quality assessment, particularly when they are linked to financial incentives. A better understanding of models of care that best meet the needs of this group is needed for developing appropriate quality assessment frameworks. Capturing patient preferences and values and incorporate patients' voices in the form of patient-reported experiences and outcomes of care will be critical towards the achievement of high-performing health systems that are responsive to the needs of people with multimorbidity.
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Multimorbilidad , Evaluación de Procesos y Resultados en Atención de Salud , Calidad de la Atención de Salud , Indicadores de Salud , Humanos , Atención Dirigida al PacienteRESUMEN
The complexity and heterogeneity of patients with multimorbidity and polypharmacy renders traditional disease-oriented guidelines often inadequate and complicates clinical decision making. To address this challenge, guidelines have been developed on multimorbidity or polypharmacy. To systematically analyse their recommendations, we conducted a systematic guideline review using the Ariadne principles for managing multimorbidity as analytical framework. The information synthesis included a multistep consensus process involving 18 multidisciplinary experts from seven countries. We included eight guidelines (four each on multimorbidity and polypharmacy) and extracted about 250 recommendations. The guideline addressed (i) the identification of the target population (risk factors); (ii) the assessment of interacting conditions and treatments: medical history, clinical and psychosocial assessment including physiological status and frailty, reviews of medication and encounters with healthcare providers highlighting informational continuity; (iii) the need to incorporate patient preferences and goal setting: eliciting preferences and expectations, the process of shared decision making in relation to treatment options and the level of involvement of patients and carers; (iv) individualized management: guiding principles on optimization of treatment benefits over possible harms, treatment communication and the information content of medication/care plans; (v) monitoring and follow-up: strategies in care planning, self-management and medication-related aspects, communication with patients including safety instructions and adherence, coordination of care regarding referral and discharge management, medication appropriateness and safety concerns. The spectrum of clinical and self-management issues varied from guiding principles to specific recommendations and tools providing actionable support. The limited availability of reliable risk prediction models, feasible interventions of proven effectiveness and decision aids, and limited consensus on appropriate outcomes of care highlight major research deficits. An integrated approach to both multimorbidity and polypharmacy should be considered in future guidelines.
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Práctica Clínica Basada en la Evidencia/métodos , Multimorbilidad , Polifarmacia , Continuidad de la Atención al Paciente , Objetivos , Prioridades en Salud , Humanos , Conciliación de Medicamentos , Prioridad del Paciente , Atención Dirigida al Paciente , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/normas , AutomanejoRESUMEN
BACKGROUND: PROMIS-29 is a new generic standardized questionnaire measuring self-reported health status. It was developed as part of the Patient Reported Outcome Measurement Information System (PROMIS) in the United States. The objective of this study was to carry out the psychometric validation of a French-language version of PROMIS-29 and to establish general population reference values for France. METHODS: Quota sampling was conducted by an independent polling company (Ipsos) to obtain a general population sample (n=1,501) representative with regards to: gender, age, occupation, region, and population density of the place of residence. Data collected included the results of the questionnaires PROMIS-29 and Short Form Health Survey (SF-36), the presence of selected chronic diseases, and socio-demographic information. RESULTS: The French PROMIS-29 demonstrated excellent factorial validity, confirming the 7-factor model of the original PROMIS-29. The use of modern measurement methods indicated that the PROMIS-29 scales satisfy the important characteristics of unidimensionality and, for five of the seven composite scales, invariance across age, educational level and gender. Gender and age specific (10-year intervals) reference values were generated for PROMIS-29 use in France. CONCLUSION: The French version of PROMIS-29 is a valid and reliable measure of self-reported health status in the French population. The instrument's sensitivity to change needs to be evaluated before its use in longitudinal studies can be recommended.
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Lenguaje , Psicometría , Calidad de Vida , Autoinforme , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Francia/epidemiología , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Medición de Resultados Informados por el Paciente , Psicometría/métodos , Psicometría/normas , Valores de Referencia , Autoinforme/normas , Autoinforme/estadística & datos numéricos , Encuestas y Cuestionarios/normas , Adulto JovenRESUMEN
Migration is a growing phenomenon in Latin America influenced by several factors such as economic stability, employment, social welfare, education and health system. Currently Chile has a positive migration flow rate. Particularly, a significant number of Haitian immigrants has been observed du ring the last years, especially after earthquake of 2010. These immigrants present a different cultural background expressed in relevant aspects of living including parenting and healthcare. Knowing the Haitian culture and its health situation is relevant for a better understanding of their health needs. Haitian people come to Chile looking for a cordial reception and willing to find a place with better perspectives of wellbeing in every sense. Immigration represents a major challenge for Chilean health system that must be embraced. Integration efforts in jobs, health, education system and community living should be enhanced to ensure a prosper settlement in our country. A new immigration law is crucial to solving major problems derived from current law created in 1975.
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Servicios de Salud Comunitaria , Características Culturales , Emigrantes e Inmigrantes , Emigración e Inmigración , Evaluación de Necesidades , Salud Pública , Chile , Servicios de Salud Comunitaria/métodos , Servicios de Salud Comunitaria/organización & administración , Emigrantes e Inmigrantes/legislación & jurisprudencia , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Emigración e Inmigración/legislación & jurisprudencia , Emigración e Inmigración/estadística & datos numéricos , Emigración e Inmigración/tendencias , Haití , HumanosRESUMEN
Las migraciones constituyen un fenómeno creciente en América Latina, influido por factores económicos, laborales, búsqueda de bienestar social, educación y salud, entre otros. Chile presenta una tasa neta de migración positiva, y en el último tiempo ha destacado el gran número de inmigrantes haitianos que han llegado a nuestro país, especialmente luego del terremoto que le afectó el 2010. Provenientes de una cultura diferente, donde el estilo de crianza y las características de atención en salud, entre otros aspectos, difieren a la de nuestro país, conocer la cultura haitiana y su situación de salud es relevante para una mejor apreciación de sus necesidades y enfrentar de mejor forma la programación de la atención sanitaria de esta población que busca en Chile un lugar de acogida y mayor bienestar. Para profundizar los esfuerzos de integración en trabajo, salud, educación y en la comunidad parece aconsejable actualizar la legislación referente a migraciones, tal que permita abordar los problemas actuales a través de una ley migratoria que data de 1975.
Migration is a growing phenomenon in Latin America influenced by several factors such as economic stability, employment, social welfare, education and health system. Currently Chile has a positive migration flow rate. Particularly, a significant number of Haitian immigrants has been observed du ring the last years, especially after earthquake of 2010. These immigrants present a different cultural background expressed in relevant aspects of living including parenting and healthcare. Knowing the Haitian culture and its health situation is relevant for a better understanding of their health needs. Haitian people come to Chile looking for a cordial reception and willing to find a place with better perspectives of wellbeing in every sense. Immigration represents a major challenge for Chilean health system that must be embraced. Integration efforts in jobs, health, education system and community living should be enhanced to ensure a prosper settlement in our country. A new immigration law is crucial to solving major problems derived from current law created in 1975.
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Humanos , Salud Pública , Servicios de Salud Comunitaria/métodos , Servicios de Salud Comunitaria/organización & administración , Evaluación de Necesidades , Características Culturales , Emigración e Inmigración/legislación & jurisprudencia , Emigración e Inmigración/tendencias , Emigración e Inmigración/estadística & datos numéricos , Emigrantes e Inmigrantes/legislación & jurisprudencia , Emigrantes e Inmigrantes/psicología , Emigrantes e Inmigrantes/estadística & datos numéricos , Chile , HaitíRESUMEN
While the use of PROs in research is well established, many challenges lie ahead as their use is extended to other applications. There is consensus that health outcome evaluations that include PROs along with clinician-reported outcomes and administrative data are necessary to inform clinical and policy decisions. The initiatives presented in this paper underline evolving recognition that PROs play a unique role in adding the patient perspective alongside clinical (e.g., blood pressure) and organizational (e.g., admission rates) indicators for evaluating the effects of new products, selecting treatments, evaluating quality of care, and monitoring the health of the population. In this paper, we first explore the use of PRO measures to support drug approval and labeling claims. We critically evaluate the evidence and challenges associated with using PRO measures to improve healthcare delivery at individual and population levels. We further discuss the challenges associated with selecting from the abundance of measures available, opportunities afforded by agreeing on common metrics for constructs of interest, and the importance of establishing an evidence base that supports integrating PRO measures across the healthcare system to improve outcomes. We conclude that the integration of PROs as a key end point within individual patient care, healthcare organization and program performance evaluations, and population surveillance will be essential for evaluating whether increased healthcare expenditure is translating into better health outcomes.
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Evaluación del Resultado de la Atención al Paciente , Garantía de la Calidad de Atención de Salud , Mejoramiento de la Calidad , Atención a la Salud , Estado de Salud , Humanos , Evaluación de Programas y Proyectos de Salud , Calidad de VidaRESUMEN
Insulin secretion and insulin sensitivity indexes are related by hyperbolic functions, allowing the calculation of the disposition index (DI) as the product of the acute insulin response (AIR) and the insulin sensitivity index (Si) from intravenous glucose tolerance test (IVGTT). Our objective was to develop an oral-DI based on the oral glucose tolerance test (OGTT) and to assess its association with glucose tolerance status. This research is structured in three studies. Study 1: OGTT were performed in 833 non-diabetic Chilean women (18-60 years) without family history of diabetes mellitus. Study 2: an independent group of n = 57 non-diabetic (18-46 years) without family history of diabetes mellitus carried out an OGTT and an abbreviated IVGTT. Study 3: a sample of 1674 Chilean adults (18-60 years) with different glycaemic status performed an OGTT. An adequate statistical fit for a rectangular hyperbola was found between the area under the curve of insulin-to-glucose ratio (AUCI/G-R) and the Matsuda ISI-COMP index (study 1). The oral-DI derived as AUCI/G-R × ISI-COMP was previously termed insulin-secretion-sensitivity index-2 (ISSI-2). ISSI-2 significantly correlated with DI from IVGTT (rho = 0.34; p = 0.009) (study 2). ISSI-2 shows important differences across groups of subjects with different glycaemic status (study 3). We have confirmed that ISSI-2 replicates the mathematical properties of DI, showing significant correlations with DI from the abbreviated MM-IVGTT. These results indicate that ISSI-2 constitutes a surrogate measure of insulin secretion relative to insulin sensitivity and emphasizes the pivotal role of impaired insulin secretion in the development of glucose homeostasis dysregulation.
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Glucemia/análisis , Diabetes Mellitus Tipo 2/diagnóstico , Intolerancia a la Glucosa/diagnóstico , Resistencia a la Insulina , Células Secretoras de Insulina/metabolismo , Insulina/metabolismo , Estado Prediabético/diagnóstico , Adolescente , Adulto , Chile , Estudios Transversales , Diabetes Mellitus Tipo 2/sangre , Diabetes Mellitus Tipo 2/etnología , Diabetes Mellitus Tipo 2/metabolismo , Salud de la Familia/etnología , Femenino , Intolerancia a la Glucosa/sangre , Intolerancia a la Glucosa/etnología , Intolerancia a la Glucosa/metabolismo , Prueba de Tolerancia a la Glucosa , Humanos , Insulina/sangre , Resistencia a la Insulina/etnología , Secreción de Insulina , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Estado Prediabético/sangre , Estado Prediabético/etnología , Estado Prediabético/metabolismo , Sensibilidad y Especificidad , Adulto JovenRESUMEN
BACKGROUND: Multimorbidity is an intuitively appealing, yet challenging, concept for Family Medicine (FM). An EGPRN working group has published a comprehensive definition of the concept based on a systematic review of the literature which is closely linked to patient complexity and to the biopsychosocial model. This concept was identified by European Family Physicians (FPs) throughout Europe using 13 qualitative surveys. To further our understanding of the issues around multimorbidity, we needed to do innovative research to clarify this concept. The research question for this survey was: what research agenda could be generated for Family Medicine from the EGPRN concept of Multimorbidity? METHODS: Nominal group design with a purposive panel of experts in the field of multimorbidity. The nominal group worked through four phases: ideas generation phase, ideas recording phase, evaluation and analysis phase and a prioritization phase. RESULTS: Fifteen international experts participated. A research agenda was established, featuring 6 topics and 11 themes with their corresponding study designs. The highest priorities were given to the following topics: measuring multimorbidity and the impact of multimorbidity. In addition the experts stressed that the concept should be simplified. This would be best achieved by working in reverse: starting with the outcomes and working back to find the useful variables within the concept. CONCLUSION: The highest priority for future research on multimorbidity should be given to measuring multimorbidity and to simplifying the EGPRN model, using a pragmatic approach to determine the useful variables within the concept from its outcomes.
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Investigación Biomédica , Comorbilidad , Medicina Familiar y Comunitaria , Adulto , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , InvestigaciónRESUMEN
Introduction: mercury is a heavy metal widely dispersed in nature, occurring in three chemical forms. Exposure to mercury at work sites and even at home may be clinically significant. Objective: to update the knowledge about the risks of this toxic element. Case report: the case of a teenager and his family poisoned by elemental mercury is reported. The diagnostic process was difficult, mainly due to an initial presumption of probable infectious etiology, unavailability of key anamnestic data and unusual clinical behavior, with signs and symptoms of multisystem compromise (neurological, hepatic, renal and dermatological compromise). Discussion: the study was based on literature review of various clinical presentations regarding this poisoning and its management, emphasizing the need for dimercaptosuccinic acid chelator. As a major public health problem, the importance of education and implementation of public policies to have a mercury-free environment is discussed.
Introducción: el mercurio es un metal pesado ampliamente distribuido en el medio ambiente, en sus tres formas químicas. La exposición a dicho metal en recintos laborales e incluso en el hogar, puede llegar a ser clínicamente significativa. Objetivo: actualizar el conocimiento acerca de los riesgos de este tóxico. Caso clínico: se presenta el caso clínico de un adolescente y su familia intoxicados por mercurio elemental, cuyo proceso diagnóstico fue difícil, principalmente por la presunción inicial de una probable etiología infecciosa, falta de disponibilidad de datos anamnésticos claves y el inusual comportamiento clínico, con signos y síntomas de compromiso multisistémico (neurológico, hepático, renal y dermatológico). Discusión: se revisa la literatura en relación a las diversas formas de presentación clínica de esta intoxicación y su manejo, destacando la utilidad del quelante ácido dimercaptosuccínico. Por ser un importante problema de salud pública, se destaca la trascendencia de la educación e implementación de políticas públicas por un ambiente libre de mercurio.
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Humanos , Masculino , Adolescente , Intoxicación por Mercurio/diagnóstico , Intoxicación por Mercurio/tratamiento farmacológico , Exposición a Riesgos Ambientales , Intoxicación por Mercurio/etiología , Mercurio/efectos adversos , Quelantes/administración & dosificación , Succímero/administración & dosificaciónRESUMEN
The National Health Service in England is moving away from targets based on processes of care and focusing on patient outcomes. This vision is operationalised in the recently published NHS Outcomes Framework, which includes the generalised use of Patient Reported Outcomes (health status and quality of life) as measures of population health at the provider level. This is the first time that such a bold initiative is attempted in the UK and it is not without risks. In this article we elaborate on our experience on the use of Patient Reported Outcomes and identify challenges and likely implications of this approach and suggest less disruptive alternatives.
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Reforma de la Atención de Salud/normas , Indicadores de Salud , Programas Nacionales de Salud/normas , Evaluación de Procesos, Atención de Salud , Inglaterra , Estado de Salud , Humanos , Calidad de Vida , Resultado del TratamientoRESUMEN
Objetivos: Conocer cómo asumen y desempeñan los médicos de asistencia infantil en Cataluña los atributos de la atención primaria (AP) (coordinación, globalidad y longitudinalidad). Material y métodos: Estudio cualitativo basado en grupos de discusión y entrevistas individuales semiestructuradas con pediatras cuyo perfil había sido definido previamente según características sociodemográficas y de formación. Se llevaron a cabo 2 grupos de discusión (5 y 4 personas respectivamente) y 5 entrevistas individuales. Los participantes respondieron dos preguntas: ¿cómo explicaríais vuestra función como pediatras de AP? y ¿cuál es vuestra opinión sobre la relación entre los pediatras de AP y los especialistas a los que deriváis a los pacientes? Se llevó a cabo un análisis de contenido temático. Resultados: Los pediatras asumen que la AP debe ser integral y tener en cuenta el contexto del niño/a. El vínculo que se establece con las familias es una característica definitoria de su función. Detectan deficiencias en su propia formación y escaso reconocimiento social e institucional de su trabajo. La coordinación con la atención especializada y la transferencia de información entre niveles no son satisfactorias. Se identifican como factores facilitadores el conocimiento personal, la formación común y las sesiones clínicas. Conclusión: A pesar de su formación hospitalaria, los pediatras asumen los atributos de la AP. Se propone abordar los aspectos deficitarios, como la falta de formación en AP, y tener en cuenta el escaso reconocimiento institucional y social, así como las dificultades en la coordinación, para mantener un nivel de calidad elevado en la atención primaria a la población infantil (AU)
Objectives: Primary care (PC) paediatricians are trained mainly in the hospital setting, with little contact with PC. This study aimed to find out what perceptions and experiences they have on the attributes of PC (first contact, comprehensiveness and continuity of care) that are assumed and performed by PC paediatricians. Material and methods: A qualitative study was performed based on focus groups and semi-structured individual interviews with paediatricians with pre-defined sociodemographic and speciality training characteristics. Two focus groups (5 and 4 people each) and 5 interviews were made. Participants responded to two questions: how would you explain your function as a primary care paediatrician? and what is your opinion on the relationship between primary care paediatricians and the specialists to whom your patients are referred? The conversations of the groups and interviews were recorded and transcribed, and a content analysis was performed. Results: Paediatricians assume that PC must be comprehensive, and take into account the context of the child. Paediatricians declare a lack in their training and poor social and institutional recognition. Coordination with specialists and the transfer of information are not satisfactory. Helpful factors are personal knowledge, the shared training and the face-to-face clinical sessions. Conclusion: Despite their hospital-based training, paediatricians assume the attributes of PC. Difficulties in performing their function include poor adaptation of their training to PC, and little institutional and social recognition. Coordination with specialists is not satisfactory. Approaching these difficulties can help maintaining a high quality level in the care of the paediatric population (AU)
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Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Atención Primaria de Salud/métodos , Atención Primaria de Salud/tendencias , Atención a la Salud , Pediatría , Atención Primaria de Salud , Pediatría/métodos , Pediatría/normasRESUMEN
OBJECTIVES: Primary care (PC) paediatricians are trained mainly in the hospital setting, with little contact with PC. This study aimed to find out what perceptions and experiences they have on the attributes of PC (first contact, comprehensiveness and continuity of care) that are assumed and performed by PC paediatricians. MATERIAL AND METHODS: A qualitative study was performed based on focus groups and semi-structured individual interviews with paediatricians with pre-defined sociodemographic and speciality training characteristics. Two focus groups (5 and 4 people each) and 5 interviews were made. Participants responded to two questions: how would you explain your function as a primary care paediatrician? and what is your opinion on the relationship between primary care paediatricians and the specialists to whom your patients are referred? The conversations of the groups and interviews were recorded and transcribed, and a content analysis was performed. RESULTS: Paediatricians assume that PC must be comprehensive, and take into account the context of the child. Paediatricians declare a lack in their training and poor social and institutional recognition. Coordination with specialists and the transfer of information are not satisfactory. Helpful factors are personal knowledge, the shared training and the face-to-face clinical sessions. CONCLUSION: Despite their hospital-based training, paediatricians assume the attributes of PC. Difficulties in performing their function include poor adaptation of their training to PC, and little institutional and social recognition. Coordination with specialists is not satisfactory. Approaching these difficulties can help maintaining a high quality level in the care of the paediatric population.
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Actitud del Personal de Salud , Pediatría , Rol del Médico , Atención Primaria de Salud , Adulto , Femenino , Humanos , Relaciones Interprofesionales , Masculino , Persona de Mediana Edad , EspecializaciónRESUMEN
The Spanish KIDSCREEN follow-up study reassessed the Spanish baseline sample (n=840) of the European KIDSCREEN study 3 years later (2006). The aims of this paper were to describe the KIDSCREEN follow-up study and the pilot test, and to analyze participation rates and representativeness. Instruments included the KIDSCREEN-52 HRQoL measure and a set of scales including the possible explanatory variables. Focus groups and individual interviews were carried out in a pilot test. Participants were compared with non-participants at baseline, and also with Eurostat census data. Twenty-two out of 24 subjects were interviewed in the pilot test. Fifteen items needed to be modified after the pilot test. Participation rate reached 54% (n=454). Participants (mean age=12.71 years old) were on average 6 months younger than non-participants (p=0.03), and from more educated families. KIDSCREEN follow-up instrumentation seems adequate for collecting factors with potential influence on HRQoL. Follow-up respondents' representativeness seems to be acceptable.
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Estado de Salud , Calidad de Vida/psicología , Encuestas y Cuestionarios , Adolescente , Niño , Femenino , Estudios de Seguimiento , Humanos , Masculino , Proyectos Piloto , EspañaRESUMEN
OBJECTIVES: To assess changes in health-related quality of life (HRQoL) in children and adolescents over a 3-year period and to examine factors associated with change. METHODS: A representative sample of Spanish children and adolescents aged 8-18 years and their parents completed the KIDSCREEN-52 questionnaire at baseline and again after 3 years. Data were also collected on gender, pubertal development (PD), and family socio-economic status (SES). Change in HRQOL over time was evaluated using effect sizes (ES). Generalized estimating equations (GEE) were used to analyze associations among changes in KIDSCREEN scores, socio-demographic factors, and pubertal development. RESULTS: Response rate at follow-up was 54% (n = 454). Overall, HRQoL worsened in eight out of the ten KIDSCREEN dimensions, with ES ranging from -0.10 (Moods and Emotions) to -0.34 (Psychological Well-being). The decrease was most marked in the intermediate age group (13-17 years of age at follow-up) and in girls. In the GEE models, pubertal development more strongly impacted changes in girls than in boys. CONCLUSIONS: In this representative, population-based sample of children and adolescents, moderate decrements in HRQoL were observed after 3 years. Changes were particularly important among girls and in relation to pubertal development. These results could provide useful reference data for other longitudinal studies in population sub-groups.
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Indicadores de Salud , Calidad de Vida , Adolescente , Niño , Femenino , Estudios de Seguimiento , Humanos , Entrevistas como Asunto , Masculino , España/epidemiología , Encuestas y CuestionariosRESUMEN
AIMS: To obtain a conceptually and psychometrically equivalent Spanish version of the Coddington Life Events Scales (CLES) for children and adolescents and to test their psychometric properties. METHODS: Forward and backward translations were performed. Comprehension, acceptability, and alternative translations were tested in focus groups and semi-structured interviews. An expert panel and the copyright holders of the original version were actively involved. Test-retest reliability [Intraclass Correlation Coefficient (ICC)] was assessed by administering the questionnaire on two occasions 3 months apart to children aged 12-14 years (n = 30). Construct validity was assessed by comparing children's responses with those of their parents (n = 19). The methods replicated those of the validation of the original version. RESULTS: Of the 53 CLES items translated, ten were found to be difficult to understand. Following back-translation, seven items were modified and a final version was obtained. Test-retest ICC reliability for total scores was 0.63. The ICC between children and parents was 0.42. Both results were very similar to those reported for the original version. CONCLUSIONS: These preliminary findings suggest that the Spanish version of the CLES is understandable and acceptable and that it is similar to the original in terms of validity and reliability. Although further validation is needed, it is recommended for use in research settings in Spain.
Asunto(s)
Cultura , Lenguaje , Acontecimientos que Cambian la Vida , Psicometría , Adolescente , Factores de Edad , Niño , Preescolar , Comprensión , Femenino , Grupos Focales , Indicadores de Salud , Humanos , Entrevistas como Asunto , Masculino , Proyectos Piloto , Pruebas Psicológicas , EspañaRESUMEN
OBJECTIVE: The purpose of this paper is to summarize the best evidence regarding the impact of providing patient-reported outcomes (PRO) information to health care professionals in daily clinical practice. METHODS: Systematic review of randomized clinical trials (Medline, Cochrane Library; reference lists of previous systematic reviews; and requests to authors and experts in the field). RESULTS: Out of 1,861 identified references published between 1978 and 2007, 34 articles corresponding to 28 original studies proved eligible. Most trials (19) were conducted in primary care settings performed in the USA (21) and assessed adult patients (25). Information provided to professionals included generic health status (10), mental health (14), and other (6). Most studies suffered from methodologic limitations, including analysis that did not correspond with the unit of allocation. In most trials, the impact of PRO was limited. Fifteen of 23 studies (65%) measuring process of care observed at least one significant result favoring the intervention, as did eight of 17 (47%) that measured outcomes of care. CONCLUSIONS: Methodological concerns limit the strength of inference regarding the impact of providing PRO information to clinicians. Results suggest great heterogeneity of impact; contexts and interventions that will yield important benefits remain to be clearly defined.
Asunto(s)
Satisfacción del Paciente , Calidad de Vida , Retroalimentación , Indicadores de Salud , Humanos , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
BACKGROUND: Evidence about the impact of routine feedback of patient-reported outcomes is contradictory, and there is limited information regarding its use in the routine management of cataract patients. METHODS: The VF-14 Index was used to assess the visual function of 833 consecutive cataract patients, attending 19 ophthalmologists from public and private hospitals and primary care practices in Spain, in 1999-2000. In this before/after trial, the intervention included (1) an educational session, and (2) the provision of the VF-14 scores of all subsequent patients to the ophthalmologist. Mixed effects linear and logistic models were constructed to assess the effect on the process (correlation between patients' and physicians' assessments of visual function, appropriateness of surgery recommendation) and the outcome of care (satisfaction). RESULTS: The adjusted regression coefficient for the VF-14 score significantly increased after the intervention as a predictor of the ophthalmologist's assessment of visual function (beta coefficient: control 0.10 vs. intervention 0.35, p < 0.05). The intervention did not increase the probability of an appropriate medical decision (OR = 0.90; 95% CI: 0.42; 2,69) and it did not change patient satisfaction with care. CONCLUSIONS: Routine provision of education and feedback on the patient's VF-14 Index score significantly increases agreement between patients' and physicians' assessments of functional capacity. The lack of a beneficial effect on management or outcome suggests the need for a more intense intervention to change medical practice.