[Health professionals' opinion of the Catalan Health Plan. Basis for a reflexion on the future]

OBJECTIVES

To know health professional's opinion of the Health Plan for Catalonia (Spain) in order to get news elements for the formulation and management of new plans.

DESIGN

Combination of quantitative and qualitative methodologies. Postal survey to doctors and nurses (multistage randomised sample). 3.223 questionnaires were obtained (response rate: 34,1%). Interview to a selected sample of 41 health care professionals and managers.

MEASUREMENTS AND MAIN RESULTS

78,8% (IC95%: 1,4) of health professionals are familiar with the Health Plan, and for most of them it is valued as important. 28,9% (IC95%: 1,7) of the professionals who know the Plan consider that it has repercussions in their daily work and 51,8% (IC95%: 1,9) declare that it doesn't have any repercussions. Different issues such as the planning process, the contents, the dissemination strategy, as well as a the poor impact on the health budget are critised. Differences by age group and sex, care setting and type of health professional are observed.

CONCLUSIONS

The implication of health professionals in the discussion, formulation and implementation of the Health Plan proposals needs to be improved. It will be necessary to make progress in identifying health problems and needs, in setting priorities and in the allocation of resources. To increase the multisectorial involvement and to develop marketing strategies directed to politicians, managers and health professionals will also be needed in order to increase the impact of the Health Plan on both the Health System and the other sectors involved in health. The role to be played by the Health Plan in the health system must be redefined and this will lead to redesigning the planning process and the implementation of health strategies.

[Detection of cardiovascular risk factors in the reformed primary care network in Catalonia. Comparison between the years 1995 and 2000]

OBJECTIVES

To know if much the detection and control of cardiovascular risk factors (FRCV) have been incorporated in primary care settings (PCS) on 2000 and compare them with 1995 results. Design and participants. A descriptive cross-sectional study of a random sample of 5,875 of clinical histories (CH) of patients aged 15 and over attended during 2000 in PCS, which had been in operation for over three years.

MEASUREMENTS AND MAIN RESULTS

Whether were recorded values, levels, diagnoses and control related to: blood pressure, cholesterol, glucose, weight, size, tobacco and alcohol consumption, in order to compare 1995 and 2000 results obtained with the same methodology. Cholesterol levels (57.3%), blood pressure values (52.9%) and glucose levels (51.3%) are the most recorded variables in CH. Obese diabetics and high blood pressure patients are the most studied with a mean of 3.6 records in the CH related others CRF. Smoking (41.7%) and hypertension (32.9%) are the most frequents diagnoses. The 32.3% of the high blood pressure patients have optimum control and 42.9% acceptable control. The 31.2% hyperlipaemia and the 34.1% diabetic patients are controlled. Compared with 1995, the main variations observed are: an increase of the records of cholesterol levels and glucose levels and a decrease of the others, especially in tobacco and alcohol consumption screening. Diabetes and obesity diagnosis decrease and smoking and excessive alcohol consumption increase have been also observed. Screening age and sex group differences are maintained.

CONCLUSIONS

The results suggest that may be a change in CRF screening performance is happening and the influencial factors would be study.

[Health self-perception in men and women among the elderly]

OBJECTIVES

To analyze the differences in health self-perception between men and women in the later stages of life and to assess their association with sociodemographic and health variables.

METHODS

Data on 1,459 men and 1,993 women aged 60 or older from the 1994 Catalan Health Survey, were collected and an analysis of health self-perception according to age, gender, social class, reporting of chronic disease and handicaps was performed. Multivariate logistic regression analysis was used, taking into account the survey design.

RESULTS

Of the women aged 60 and older, 57.3% reported poor health compared with 43.6% of men of the same age. The proportion of women with one or more handicaps was also greater (41.2%) than that of the men (28.7%), as was the case with chronic disease (92.2% in women and 85.6% in men). The multivariate model also revealed that health self-perception was poorer among women than among men. Other explanatory factors were the number of chronic diseases, having handicaps, and being a member of a lower social class. Age interacted with the number of chronic diseases to mitigate the effect of chronic diseases on perceived health status.

CONCLUSIONS

In the elderly population, poor health self-perception was greater among women, even when other significant explanatory variable (social class, age, handicaps and chronic disease) were adjusted for. The most important explanatory factors in health self-perception were having chronic disease and/or handicaps. The impact of chronic disease on poor health self-perception decreased in older age groups.

[Effect of sample design in the analysis of complex surveys. Application to the health survey of Catalonia]

OBJECTIVE

To illustrate the way in which a sample design can be easily incorporated into the statistical analysis of complex surveys to obtain correct estimates.

METHODS

A statistical program (STATA) was used to analyze the Catalan Health Survey (Spain) for the year 1994.

RESULTS

If the sample design is taken into account, the estimates are unbiased. If only the weights are taken into account, unbiased point estimates are obtained, but the standard errors tend to be underestimated.

CONCLUSIONS

The current availability of statistical programs that allow to incorporate easily the sample design should encourage researchers to better analyze their surveys.

Educational level, voluntary private health insurance and opportunistic cancer screening among women in Catalonia (Spain)

Health care services in Catalonia (Spain) are organized in a national health service with universal population coverage and include preventive services such as mammography and Pap tests. In addition to a national health service (NHS) coverage, 22% of the population is enrolled in a voluntary private health insurance (VPHI), leading to a double coverage. This situation offers an opportunity to study the impact of this organizational aspect of health care with regard to cancer screening access. The source of data was the Catalan Health Survey (CHS), a cross-sectional survey conducted in a random sample of non-institutionalized population carried out in 1994. Variables analysed were age, educational level and voluntary private health insurance (VPHI). Women were asked if they had ever had a mammography and Pap test for preventive purposes. Logistic regression was used to study the relationship between these variables and the mammography or Pap test participation. The study sample was 5865 women aged 20 years and older. A Pap test and mammography were carried out on 42% and 25% of women, respectively. Participation had a peak between the ages of 30 and 39 years in Pap test and between 40 and 49 years in mammography; it decreased in older women. The percentage of Pap test practice increases according to a higher educational level than it does in mammography. Women who had a VPHI showed a higher percentage of screening tests than the rest of the population. There is also an increase in the mammography practice related to the educational level in older groups, but this fact is not observed in women younger than 40 years . Multivariate logistic regression analysis showed an increase in the likelihood of ever had a mammography and a Pap test according to age and to educational level, although this situation is less pronounced in older age groups. Both variables (educational level and age) remained significant after introducing the VPHI into the model (women who reported having a VPHI were more likely to have had a Pap test and a mammography than the rest of the women). In conclusion the opportunistic screening is associated with age, educational level and VPHI. Educational level is also associated with participation in both screening tests after adjusting by age. Furthermore, screening for cervical cancer shows a higher educational gradient than for breast cancer screening. The influence of VPHI after adjusting by age and by educational level poses the question about the role of private health insurances with regard to preventive practices in the context of a national health service aimed at promoting equity of health care access.