Necesidades de información de los usuarios de Atención Primaria desde la perspectiva de los profesionales sanitarios. Un estudio Delphi

[Information needs of the health and diseases in users of healthcare services in Primary Care at Salamanca, Spain]

Objetivo

Conocer, interpretar y comprender las necesidades de información sobre salud y enfermedad en usuarios de servicios sanitarios de atención primaria urbana de Salamanca.

Diseño

Investigación cualitativa. Diseño exploratorio desde la perspectiva cualitativa-estructural.

Emplazamiento

Atención primaria. Área urbana de Salamanca en 2007.

Participantes y/o contextos

Diez grupos de discusión: 2 integrados por miembros de asociaciones relacionadas con la salud y 8 por usuarios de atención primaria, participando un total de 83 personas. Las variables estructurales consideradas son: género, edad, nivel de estudios y pertenencia o no a asociaciones.

Método

Generar información hasta alcanzar la saturación informativa en los grupos de discusión. Previo compromiso de confidencialidad y consentimiento informado, se procedió a la grabación y transcripción literal de la conversación grupal. Cuatro investigadores categorizaron los contenidos, la intencionalidad del discurso y elaboraron el mapa conceptual. Después de triangular los resultados y codificar los párrafos se analizaron con el programa Nudist6.0.

Resultados

Los contenidos informativos señalan 4 necesidades de información: salud y prevención, diagnóstico precoz, primeros auxilios y enfermedad. Se detectan diferentes intencionalidades (necesidad, observación, reivindicación y mejora) y perfiles según las variables estructurales analizadas. Las principales necesidades informativas se refieren al diagnóstico, pronóstico y opciones terapéuticas del motivo de consulta. Existe concordancia entre los grupos en que la información transmitida al paciente debe ser inteligible, actualizada y coordinada entre los diferentes profesionales y niveles asistenciales.

Conclusiones

Los participantes demandan información de carácter clínico para ejercer su derecho de autonomía traduciendo la tendencia al empoderamiento de los usuarios como parte del cambio social.

Selection of tools for reconciliation, compliance and appropriateness of treatment in patients with multiple chronic conditions

BACKGROUND

The healthcare models developed for patients with multiple chronic diseases agree on the need for improving drug therapy in these patients. The issues of patient compliance, appropriateness of prescriptions and the reconciliation process are of vital importance for patients receiving multiple drug treatment.

OBJECTIVE

To identify and select the most appropriate tools for measuring treatment compliance and appropriateness in multiple-disease patients, as well as the best reconciliation strategy.

METHODS

The study used the Delphi methodology. We identified compliance and appropriateness questionnaires and scales, as well as functional organisation models for reconciliation that had been used in patients with multiple chronic conditions. Based on the strength of the evidence, their usefulness in these patients and ease of use, the panel selected the most appropriate ones.

RESULTS

We selected 46 indications for the panel: 5 on compliance, 20 on appropriateness, and 31 on reconciliation. The tool considered most appropriate and with a high degree of agreement was the "Adherence to Refills and Medication Scale" questionnaire. For appropriateness, the Medication Appropriateness Index questionnaire was considered appropriate. The STOPP/START criteria were the most appropriate. The greatest degree of agreement regarding reconciliation was on the information that needed to be collected and the variables considered as discrepancies.

CONCLUSIONS

The "Adherence to Refills and Medication Scale" questionnaire for compliance, the STOPP/START criteria, the Medication Appropriateness Index questionnaire for appropriateness and the development of a specific strategy for reconciliation were considered appropriate for the assessment of drug therapy in patients with multiple chronic conditions.

[The end of life in the intensive care unit from the nursing perspective: a phenomenological study]

INTRODUCTION

Intensive Care Units do not adapt to the social and health reality regarding the phenomenon of death and this results in a high degree of dissatisfaction among professional, relatives and patients. The special characteristics of these units give the nursing staff a main roll as carers of critical dying patients. The principal aim of this study is to know the nursing staffs' experiences and attitudes towards the phenomenon of death in the intensive care units.

PARTICIPANTS AND METHOD

A descriptive qualitative study of phenomenological character was performed. Constant comparison and progressive incorporation of participants was made, using intentional sampling up to data saturation (n=16). The data collection technique used was a semi-structured in-depth interview, which were recorded and literally transcribed. The data collected was verified by the informants and analyzed according to the steps proposed by Taylor-Bogdan.

RESULTS

The analysis shows 5 thematic categories: death and beliefs, emotional work, environmental factors, decision-making management of death in intensive care units and relationships with relatives.

CONCLUSIONS

The management model of death in intensive care units focuses on medical intervention and overlooks the opinions of the nurses, relatives and patients. This study shows the contributions that can be provided by the nursing staff in decision making and in the care of the dying patients in these wards.