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Díaz-González Á, Fontanillas N, Gil-Hernández E, Guilabert M, Londoño MC, Noguerol M, Pérez Escanilla F, Mira JJ, Santiñá M. Recommendations and quality criteria to improve the early diagnosis of primary biliary cholangitis. GASTROENTEROLOGIA Y HEPATOLOGIA 2023:S0210-5705(23)00492-2. [PMID: 38109994 DOI: 10.1016/j.gastrohep.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 11/08/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE The study aimed to establish recommendations and quality criteria to enhance the healthcare process of PBC. PATIENTS AND METHODS It was conducted using qualitative techniques, preceded by a literature review. A consensus conference involving five specialists in the field was held, followed by a Delphi process developed in two waves, in which 30 specialist physicians in family and community medicine, digestive system and internal medicine were invited to participate. RESULTS Seven recommendations and 15 sets of quality criteria, indicators and standards were obtained. Those with the highest consensus were «Know the impact on the patient's quality of life. Consider their point of view and agree on recommendations and care» and «Evaluate possible fibrosis at the time of diagnosis and during PBC follow-up, assessing the evolution of factors associated with poor disease prognosis: noninvasive fibrosis (elastography > 2.1 kPa/year), GGT, ALP and bilirubin annually», respectively. CONCLUSIONS The implementation of the consensus recommendations and criteria would provide better patient care. The need for multidisciplinary follow-up and an increased role of primary care is emphasized.
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Affiliation(s)
- Álvaro Díaz-González
- Servicio de Gastroenterología y Hepatología, Hospital Universitario Marqués de Valdecilla, Santander, España; Grupo de Investigación Clínica y Traslacional en Enfermedades Digestivas, Instituto de Investigación Valdecilla (IDIVAL), Santander, España
| | - Noelia Fontanillas
- Medicina Familiar y Comunitaria, Centro de Salud Bezana, Cantabria, España; Grupo de Trabajo en Aparato Digestivo, Sociedad Española de Médicos de Atención Primaria (SEMERGEN), Madrid, España
| | - Eva Gil-Hernández
- Grupo ATENEA Investigación, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Sant Joan d'Alacant, España.
| | - Mercedes Guilabert
- Departamento de Psicología de la Universidad Miguel Hernández, Elche, España; Sociedad Española de Calidad Asistencial, Oviedo, España
| | - Maria-Carlota Londoño
- Servicio de Hepatología, Hospital Clínic de Barcelona, Fundació de Recerca Clínic Barcelona-Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBEREHD, Barcelona, España
| | - Mar Noguerol
- Medicina Familiar y Comunitaria, Centro de Salud Cuzco, Madrid, España; Grupo de Patología digestiva y hepática de la Sociedad Española de Medicina Familiar y Comunitaria (semFYC), Madrid, España
| | | | - José J Mira
- Grupo ATENEA Investigación, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana, Sant Joan d'Alacant, España; Departamento de Psicología de la Universidad Miguel Hernández, Elche, España; Sociedad Española de Calidad Asistencial, Oviedo, España
| | - Manuel Santiñá
- Sociedad Española de Calidad Asistencial, Oviedo, España; Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, España
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Talens A, LÓpez-Pintor E, Guilabert M, Cantó-Sancho N, Aznar MT, Lumbreras B. Validation of a scale to assess adherence to oral chemotherapy based on the experiences of patients and healthcare professionals (EXPAD-ANEO). Front Pharmacol 2023; 14:1113898. [PMID: 36969861 PMCID: PMC10033971 DOI: 10.3389/fphar.2023.1113898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Lack of adherence to Oral antineoplastic agents (OAAs) treatment has important clinical, social and economic consequences.Objective: To develop and validate a novel instrument for assessing adherence to OAAs, based on the reported experiences of people with cancer in relation to their treatment and the opinions of the healthcare professionals who care for them.Methods: We performed a multicenter validation study of a scale designed to assess adherence to OAAs. First, a steering committee developed the items for an initial scale, based on the results of a qualitative study that evaluated patients’ and professionals’ experiences with this treatment. We then assessed the validity and reliability of the initial scale in a sample of 268 outpatients with cancer who received their OAAs from four Spanish hospitals.Results: The mean age of the sample of 268 outpatients was 64.1 (standard deviation [SD] 12.4) years, and 47% of participants were women. With the results of this analysis, we developed the EXPAD-ANEO scale, which has 2 factors, one for beliefs and expectations and another for behavior. Both factors explain 52% of the explained common variance. Good reliability was obtained, with a McDonald’s omega of 0.7 for the first factor and 0.6 for the second factor. The fit indices were optimal (Root Mean Square Error of Approximation = 0.02, Comparative Fit Index = 0.99, Tucker Lexis Index = 0.99 and Standardized Root Mean Squared Residual = 0.03), which verifies the appropriateness of the items to the model. We measured EXPAD-ANEO criterion validity against pill count, obtaining a specificity of 80%. We measured convergent validity with the Morisky-Green test and found a significant association (p < 0.001). We measured divergent validity with questions on health literacy from the 16-item European Health Literacy Survey and found no correlation (p = 0.153).Conclusion: EXPAD-ANEO is the first validated instrument for evaluating patients’ experiences with and adherence to OAAs, providing valuable information that can help health professionals to establish individual strategies or collective programs for improving therapeutic results and reducing healthcare costs.
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Affiliation(s)
- Amparo Talens
- Pharmacy Department, Elda General University Hospital, Elda, Spain
- Department of Engineering, Area of Pharmacy and Pharmaceutical Technology, Miguel Hernandez University, Alicante, Spain
| | - Elsa LÓpez-Pintor
- Department of Engineering, Area of Pharmacy and Pharmaceutical Technology, Miguel Hernandez University, Alicante, Spain
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- *Correspondence: Elsa LÓpez-Pintor,
| | - Mercedes Guilabert
- Department of Health Psychology, Miguel Hernandez University, Elche, Spain
| | - Natalia Cantó-Sancho
- Department of Optics, Pharmacology and Anatomy University of Alicante, Alicante, Spain
| | - María Teresa Aznar
- Pharmacy Department, Hospital Universitario de San Juan de Alicante, Alicante, Spain
| | - Blanca Lumbreras
- Center for Biomedical Research in Epidemiology and Public Health Network (CIBERESP), Madrid, Spain
- Department of Public Health, History of Science and Gynecology, Miguel Hernandez University, Alicante, Spain
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Mora Capín A, Rivas García A, Marañón Pardillo R, Ignacio Cerro C, Díaz Redondo A, Vázquez López P. [Impact of a strategy to improve the quality of care and risk management in a paediatric emergency department]. J Healthc Qual Res 2019; 34:78-85. [PMID: 30638906 DOI: 10.1016/j.jhqr.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/24/2018] [Accepted: 10/13/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Emergency departments are a high risk area for the occurrence of adverse events. The aim of this study is to analyse the impact of a strategy to improve the quality assurance and risk management in the notification of incidents in our Unit, and describe the improvement actions developed from the reported incidents. MATERIAL AND METHODS A retrospective observational study was developed during one year, divided into two periods: P1 (Start: training session and implementation of the risk management process), and P2 (Start: feed-back session of incidents reported in P1 and improvement actions developed). In each period, the number of reported incidents in relation to the number of emergencies attended (‰) and the descriptive data of each incident were recorded. The improvement actions developed from the incidents reported in P1 were described. RESULTS The number of notifications from P1 (4.1‰; 95%CI 3.2-5.0‰) increased in P2 (10.9‰; 95%CI 9.8-10.2‰, P<.001). The most frequent incidents in P1 were medication (33.3%), and identification errors (25.9%): both were significantly reduced in P2 (16.9%, P=.001 and 9.3%, P<.001, respectively). In P2, prescription errors of the P1 were reduced (35.9% vs 62.9%, P=.02). The factors of "Knowledge and training" (23.5%) were the most frequent in P1, decreasing in P2 (7.4%, P<.001). CONCLUSION It is considered that the implementation of a risk management process, and the promotion of a safety culture, through training and feed-back sessions to all professionals, contributed to increase the volume of notifications in our Unit. The voluntary and anonymous reporting of incidents is useful to identify risks, and plan corrective measures, contributing to improve quality assurance and patient safety.
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Affiliation(s)
- A Mora Capín
- Unidad de Urgencias de Pediatría, Hospital Gregorio Marañón, Madrid, España.
| | - A Rivas García
- Unidad de Urgencias de Pediatría, Hospital Gregorio Marañón, Madrid, España
| | - R Marañón Pardillo
- Unidad de Urgencias de Pediatría, Hospital Gregorio Marañón, Madrid, España
| | - C Ignacio Cerro
- Unidad de Urgencias de Pediatría, Hospital Gregorio Marañón, Madrid, España
| | - A Díaz Redondo
- Servicio de Medicina Preventiva y Gestión de Calidad, Unidad Funcional de Gestión de Riesgos, Hospital Gregorio Marañón, Madrid, España
| | - P Vázquez López
- Unidad de Urgencias de Pediatría, Hospital Gregorio Marañón, Madrid, España
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Safety incidents in airway and mechanical ventilation in Spanish ICUs: The IVeMVA study. J Crit Care 2018; 47:238-244. [PMID: 30056219 DOI: 10.1016/j.jcrc.2018.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 07/12/2018] [Accepted: 07/13/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess incidence, related factors and characteristics of safety incidents associated with the whole process of airway management and mechanical ventilation (MV) in Spanish ICUs. MATERIALS AND METHODS Observational, prospective, 7 days cross-sectional multicenter study. Airway and MV related incidents were reported using structured questionnaire. Type, characteristics, severity, avoidability and contributing factors of the incidents were assessed. RESULTS Participant ICUs: 104. Inclusion of 1267 patients; 745 (59%) suffered one or more incidents. Incidents reported: 2492 (59% non-harm-events, 41% adverse events). Individual risk of suffering at least one incident: 66.6%. Incidence ratio (median) of incidents: 2 per 100 patient-hours. 73.7% of incidents were related to MV process, 9.5% to tracheostomy, 6.2% to non-invasive MV, 5.4% to weaning/extubation, 4.4% to intubation and 0.8% to prone position. Temporary damage was produced in 12% incidents, while 0.8% was related to permanent injuries, risk to the patient's life or contributed to death. Incidents were considered avoidable in 73.5% of cases. 98% of all incidents had 1 or more contributing factors. CONCLUSIONS MV is a risk process in critical patients. Although most incidents did not harm patients, some caused damage and a few were related to the patient's death or permanent damage. Preventability is high.
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Mira JJ, Lorenzo S, Carrillo I, Ferrús L, Silvestre C, Astier P, Iglesias-Alonso F, Maderuelo JA, Pérez-Pérez P, Torijano ML, Zavala E, Scott SD. Lessons learned for reducing the negative impact of adverse events on patients, health professionals and healthcare organizations. Int J Qual Health Care 2018; 29:450-460. [PMID: 28934401 DOI: 10.1093/intqhc/mzx056] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 05/05/2017] [Indexed: 12/21/2022] Open
Abstract
Purpose To summarize the knowledge about the aftermath of adverse events (AEs) and develop a recommendation set to reduce their negative impact in patients, health professionals and organizations in contexts where there is no previous experiences and apology laws are not present. Data sources Review studies published between 2000 and 2015, institutional websites and experts' opinions on patient safety. Study selection Studies published and websites on open disclosure, and the second and third victims' phenomenon. Four Focus Groups participating 27 healthcare professionals. Data extraction Study characteristic and outcome data were abstracted by two authors and reviewed by the research team. Results of data synthesis Fourteen publications and 16 websites were reviewed. The recommendations were structured around eight areas: (i) safety and organizational policies, (ii) patient care, (iii) proactive approach to preventing reoccurrence, (iv) supporting the clinician and healthcare team, (v) activation of resources to provide an appropriate response, (vi) informing patients and/or family members, (vii) incidents' analysis and (viii) protecting the reputation of health professionals and the organization. Conclusion Recommendations preventing aftermath of AEs have been identified. These have been designed for the hospital and the primary care settings; to cope with patient's emotions and for tacking the impact of AE in the second victim's colleagues. Its systematic use should help for the establishment of organizational action plans after an AE.
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Affiliation(s)
- Jose Joaquin Mira
- Alicante-Sant Joan Health Department, Alicante, Spain.,Miguel Hernández University, Elche, Spain
| | | | | | - Lena Ferrús
- Integrated Health Organisation, L'Hospitalet de Llobregat, Spain
| | | | - Pilar Astier
- Family and Community Medicine, Tauste Health District, Aragon Health Service (SALUD), Zaragoza, Spain
| | | | - Jose Angel Maderuelo
- Salamanca Primary Care Management, Castilla y León Health Service (SACYL), Salamanca, Spain
| | - Pastora Pérez-Pérez
- Patient Safety Observatory, Andalusian Agency for Healthcare Quality, Seville, Spain
| | | | | | - Susan D Scott
- University of Missouri Health System, Columbia, MO, USA
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Mira JJ, Ferrús L, Silvestre C, Olivera G. What, who, when, where and how to inform patients after an adverse event: a qualitative study. ENFERMERIA CLINICA 2016; 27:87-93. [PMID: 27209159 DOI: 10.1016/j.enfcli.2016.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To explore suggestions and recommendations for conducting open disclosure with a patient after an adverse event in a setting without professionals' legal privileges. METHOD Qualitative study conducting focus groups/Metaplan. This study was conducted with physicians and nurses from Primary Care and Hospitals working in the public health system in Spain. RESULTS Twenty-seven professionals were involved 8-30 years of experience, 15 (56%) medical and 12 (44%) nurses, 13 (48%) worked in hospitals. Consensus was obtained on: how (honesty and open and direct language), where (avoid corridors, with privacy), and when to disclose (with agility but without precipitation, once information is obtained, and after reflecting on the most suitable according to the nature of the AE). There was controversy as to what to say to the patient when the AE had serious consequences and doubts about what type of incidents must be reported; who should be required to disclose (the professional involved in the AE or other professional related to the patient, the role of the staff and the management team); and in which cases an apology can be a problem. CONCLUSIONS The severity of the AE determines who should talk with the patient in both hospital and primary care. The most appropriate way to convey an apology to the patient depends of the AE. An early, direct, empathetic and proactive action accompanied by information about compensation for the harm suffered could reduce the litigation intention.
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Affiliation(s)
- José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan, Alicante, España; Universidad Miguel Hernández, Elche, España.
| | - Lena Ferrús
- Consorcio Sanitario Integral, L'Hospitalet de Llobregat, Barcelona, España
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Mira JJ, Lorenzo S. Algo no estamos haciendo bien cuando informamos a los/las pacientes tras un evento adverso. GACETA SANITARIA 2015; 29:370-4. [DOI: 10.1016/j.gaceta.2015.04.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 04/17/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
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Mira JJ, Lorenzo S, Carrillo I, Ferrús L, Pérez-Pérez P, Iglesias F, Silvestre C, Olivera G, Zavala E, Nuño-Solinís R, Maderuelo-Fernández JÁ, Vitaller J, Astier P. Interventions in health organisations to reduce the impact of adverse events in second and third victims. BMC Health Serv Res 2015; 15:341. [PMID: 26297015 PMCID: PMC4546284 DOI: 10.1186/s12913-015-0994-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 08/10/2015] [Indexed: 01/12/2023] Open
Abstract
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. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0994-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- José Joaquín Mira
- Departamento de Salud Alicante-Sant Joan, Alicante, Spain. .,Universidad Miguel Hernández, Altamira Building, Avd Universidad s/n, 03202, Elche, Spain.
| | - Susana Lorenzo
- Hospital Universitario Fundación Alcorcón, Madrid, Spain.
| | - Irene Carrillo
- Universidad Miguel Hernández, Altamira Building, Avd Universidad s/n, 03202, Elche, Spain.
| | - Lena Ferrús
- Consorcio Sanitario Integral, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Pastora Pérez-Pérez
- Observatorio para la Seguridad del Paciente, Agencia de Calidad Sanitaria de Andalucía, Sevilla, Spain.
| | | | | | | | - Elena Zavala
- Hospital Universitario Donostia, Donostia, Spain.
| | | | | | - Julián Vitaller
- Universidad Miguel Hernández, Altamira Building, Avd Universidad s/n, 03202, Elche, Spain. .,Inspección Médica, Elche, Spain.
| | - Pilar Astier
- Medicina de Familia y Comunitaria, Centro de Salud Caspe, Sector Alcañiz, Servicio Aragonés de Salud (SALUD), Zaragoza, Spain.
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