Ana Delgado

Influence of the doctor's gender in the satisfaction of the users.

This study was carried out in the framework of a wider research project concerning the degree of patient satisfaction with the various types of primary health care. We have studied the relationship among the gender of the doctor, the gender of the patient and the type of primary health care center involved. In 1 type of primary care center (health centers) the medical staff work as a team, whereas in the other (ambulatory care services), the doctor works alone. The survey was conducted among 86 doctors and 860 patients from urban areas in Andalusia, Spain. The degree of patient satisfaction was tested on Likert scales. Both male and female patients attended by female doctors were more satisfied than those attended by male doctors (P < 0.005). Both male and female patients were attended in equal proportions by both male and female doctors (P > 0.20). Overall patient satisfaction values were not affected by the patients gender (P > 0.40). In comparing overall satisfaction among patients according with the doctors gender and type of primary health care center, there was a greater degree of satisfaction with female doctors working in health centers (P < 0.01) and no difference existed in ambulatory care services in this area.

Validity of self reported utilisation of primary health care services in an urban population in Spain

STUDY OBJECTIVE To assess the validity and factors related with the validity of self reported numbers of visits to a primary health care centre, in comparison with the recorded number. DESIGN Cross sectional study. SETTING The urban area served by the Zaidín-Sur Primary Health Care Centre (Granada, Spain). PARTICIPANTS Two population samples (236 high users and 420 normal users) who were seen at the centre from 1985 to 1991 were interviewed in 1993. MAIN RESULTS A net tendency to overreport the actual number of visits was observed. Absolute concordance between self reported and recorded utilisation decreased as time interval lengthened, although this mainly reflected the increase in maximum variability both with time interval length and with the number of recorded visits. Corrected Spearman ρ coefficients obtained between the number of self reported and recorded visits ranged from 0.602 for the two weeks before the interview to 0.678 for the year before. Regression slopes of self reported utilisation upon recorded utilisation did not change between periods. In multiple regression analyses the actual number of visits was the main factor associated with both underreporting and overreporting. Older age was also significantly associated with underreporting. Poor health status and high satisfaction with health care were significantly associated with overreporting. CONCLUSIONS There was a substantial degree of inaccuracy in self reported utilisation, with a net tendency to overreport the number of visits. In relative terms, however, accuracy of self reports did not seem to decrease appreciably as the recall time lengthened. To compare the accuracy of different measures, it is important to take into account the maximum variability of each one. Otherwise, contradictory results may be obtained.

Patient expectations are not always the same

Objective: To validate a scale that measures patients’ expectations when seeking advice for health problems of different types. Methods: 360 patients who had consulted their general practitioner (GP) during the previous 12 months were randomly selected from the lists of 30 GPs. A questionnaire, including a 13-item expectation scale, was administered by interview in the patient’s home to assess expectations in relation to five health problems, three biomedical (strong chest pain, genital discharge and the common cold) and two psychosocial (depression/sadness and serious family problem), repeating the expectation scale for each one. The frequency distribution of items was analysed, multi-level factorial analysis was performed and the reliability of the expectation scale was tested for each hypothetical clinical condition. Results: The response rate was 90%. Mean age of patients was 47.3 years (SD 16.5); 51% were women. Expectations were high but varied according to the nature and severity of the condition. The percentage of patients wanting the doctor alone to make decisions ranged from 50% for “family problem” to 68% for “chest pain”. The five factorial structures differed and explained 49.3–63.9% of the variance. Similarities were observed depending on the type of problem. “Communication” and “Experience of disease” were thus separate dimensions for the biomedical diseases but mixed for the psychosocial conditions. Conclusions: The factorial structure of expectations varied, indicating that expectations are not homogeneous in all clinical situations. The desire of the patient to participate in decision-making also differs according to the type of health problem.

Gender and the professional career of primary care physicians in Andalusia (Spain)

BackgroundAlthough the proportion of women in medicine is growing, female physicians continue to be disadvantaged in professional activities. The purpose of the study was to determine and compare the professional activities of female and male primary care physicians in Andalusia and to assess the effect of the health center on the performance of these activities.MethodsDescriptive, cross-sectional, and multicenter study. Setting: Spain. Participants: Population: urban health centers and their physicians. Sample: 88 health centers and 500 physicians. Independent variable: gender. Measurements: Control variables: age, postgraduate family medicine specialty (FMS), patient quota, patients/day, hours/day housework from Monday to Friday, idem weekend, people at home with special care, and family situation. Dependent variables: 24 professional activities in management, teaching, research, and the scientific community. Self-administered questionnaire. Descriptive, bivariate, and multilevel logistic regression analyses.ResultsResponse: 73.6%. Female physicians: 50.8%. Age: female physicians, 49.1 ± 4.3 yrs; male physicians, 51.3 ± 4.9 yrs (p < 0.001). Female physicians with FMS: 44.2%, male physicians with FMS: 33.3% (p < 0.001). Female physicians dedicated more hours to housework and more frequently lived alone versus male physicians. There were no differences in healthcare variables. Thirteen of the studied activities were less frequently performed by female physicians, indicating their lesser visibility in the production and diffusion of scientific knowledge. Performance of the majority of professional activities was independent of the health center in which the physician worked.ConclusionsThere are gender inequities in the development of professional activities in urban health centers in Andalusia, even after controlling for family responsibilities, work load, and the effect of the health center, which was important in only a few of the activities under study.

Diferencias de género en la percepción del logro profesional en especialistas de medicina familiar y comunitaria

BACKGROUND The concept of achievement is important to study the professional development. In medicine there are gender inequalities in career. The purpose was to know and compare the professional achievements perceptions and attributions of female and male primary care physicians in Andalusia. METHOD Qualitative study with 12 focus groups (October 2009 to November 2010). POPULATION primary care physicians. SAMPLE intentionally segmented by age, sex and health care management. Were conducted by sex: two groups with young physicians, two groups with middle aged and two with health care management. TOTAL: 32 female physician and 33 male physicians. Qualitative content analysis with Nuddist Vivo. RESULTS Female and male physicians agree to perceive internal achievements and to consider aspects inherent to the profession as external achievements. The most important difference is that female physician related professional achievement with affective bond and male physician with institutional merit. Internal attributions are more important for female physician who also highlight the importance of family, the organization of working time and work-family balance. Patients, continuing education, institutional resources and computer system are the most important attributions for male physician. CONCLUSIONS There are similarities and differences between female and male physicians both in the understanding and the attributions of achievement. The differences are explained by the gender system. The perception of achievement of the female physicians questions the dominant professional culture and incorporates new values in defining achievement. The attributions reflect the unequal impact of family and organizational variables and suggest that the female physicians would be changing gender socialization.

Adaptación y validación al español del cuestionario 4CornerSAT para la medida de la satisfacción profesional del personal médico de atención especializada

BACKGROUND Satisfaction of physicians is a concern in the healthcare sector, and it requires a multi-dimensional questionnaire in Spanish which studies their high-order needs. The objectives of this study are to adapt the 4CornerSAT Questionnaire to measure career satisfaction of physicians and to evaluate its validity in our context. METHOD The 4CornerSAT Questionnaire was adapted into Spanish, validating it among physicians of hospitals in Andalusia, Spain. A confirmatory factor analysis (CFA) was performed to corroborate the a priori model, and it was evaluated the internal consistency and the construct validity through the Cronbachs alpha and the correlation between the scale and the global item, respectively. RESULTS The adapted questionnaire was administrated to 121 specialist physicians. The CFA corroborated the four dimensions of the questionnaire (χ2=114.64, df=94, p<0.07; χ2/df=1.22; RMSEA=0.04). The internal consistency obtained an α=0.92 and the correlation between the summed scale and the global item verified the construct validity (r=0.77; p<0.001). CONCLUSIONS The 4CornerSAT questionnaire was adapted to Spanish, identifying an adequate construct validity and internal consistency.Fundamentos: La satisfaccion de los profesionales de la medicina es una preocupacion en el sector sanitario y su medida requiere un cuestionario multidimensional en espanol que estudie sus necesidades de alto nivel. Los objetivos de este estudio son adaptar el cuestionario 4CornerSAT para la medida de la satisfaccion profesional del personal medico y evaluar su validez en nuestro contexto. Metodo: Se adapto el cuestionario al espanol, validandolo en profesionales medicos de hospitales de Andalucia, Espana. Se realizo un analisis factorial confirmatorio (AFC) para corroborar el modelo a priori y se evaluo la consistencia interna y la validez de constructo mediante el alfa de Cronbach y la correlacion entre la escala y el item global, respectivamente. Resultados: El cuestionario adaptado se administro a 121 especialistas. El AFC corroboro las cuatro dimensiones del cuestionario (χ²=114,64, df=94, p<0,07; χ²/df=1,22; RMSEA=0,04). La consistencia interna obtuvo un α=0,92 y la correlacion entre la suma de la escala y el item global verifico la validez de constructo (r=0,77; p<0,001). Conclusiones: Se adapto al espanol el cuestionario 4CornerSAT, evidenciado una adecuada validez de constructo y consistencia interna.

Derivaciones en los centros de salud de Andalucía según el sexo de profesionales y pacientes: un análisis de género

Fundamentos: En atencion primaria se han identificado diferencias de practica segun sexo del profesional y, simultaneamente, existen desigualdades de genero en la asignacion de recursos sanitarios, aspectos ambos que suscitan un interes creciente en la gestion y provision de servicios de salud. El objetivo del estudio es conocer si existen diferencias de practica en las derivaciones sanitarias realizadas por medicas y medicos de familia (MF) de centros de salud de Andalucia, si existen desigualdades en las derivaciones recibidas por hombres y mujeres, y si existe interaccion sexo de profesional sexo de paciente. Metodos: Estudio transversal y multicentrico. Poblacion: MF de 4 distritos sanitarios (DDSS). Muestra: 382 MF. Variables: tasa de derivaciones por visita (TDxV), tasa de derivaciones por cupo (TDxC), sexo de paciente; sexo, edad, y formacion postgraduada en medicina familiar de MF, tamano del cupo por sexo, media de visitas/paciente por sexo, edad media del cupo por sexo, y proporcion de hombres en el cupo; centro de salud urbano/rural, tamano del equipo, poblacion adscrita y acreditacion docente. Fuentes: bases de datos de los DDSS. Analisis estadistico: descriptivo. Bivariante y multivariante mediante analisis multinivel de la TDxV con modelo mixto de Poisson. Resultados: En 2010 los/as 382 MF realizaron 129.161 derivaciones a especialistas. La TDxC fue 23,47 y la TDxV es 4,92. Las TDxC de las medicas fue 27,23 en mujeres y 19,78 en hombres y las de los medicos 27,37 en mujeres y 19,51 en hombres. La TDxV de las medicas fueron 4,92 en mujeres y 5,48 en hombres y para los medicos 4,54 y 4,93 respectivamente. Conclusiones: No existen diferencias en las derivaciones segun sexo de MF, sin embargo, existen indicios de que las mujeres son menos derivadas. No existe interaccion sexo profesional-sexo paciente.

Género y trayectorias profesionales de las médicas de familia en Andalucía, España, a comienzos del siglo XXI

The purpose of this article was to study, from a feminist perspective, the diversity and homogeneity in the career paths of female primary care physicians from Andalusia, Spain in the early 21st century, by analyzing the meanings they give to their careers and the influence of personal, family and professional factors. We conducted a qualitative study with six discussion groups. Thirty-two female primary care physicians working in urban health centers of the public health system of Andalusia participated in the study. The discourse analysis revealed that most of the female physicians did not plan for professional goals and, when they did plan for them, the goals were intertwined with family needs. Consequently, their career paths were discontinuous. In contrast, career paths oriented towards professional development and the conscious planning of goals were more common among the female doctors acting as directors of health care centers.The purpose of this article was to study, from a feminist perspective, the diversity and homogeneity in the career paths of female primary care physicians from Andalusia, Spain in the early 21st century, by analyzing the meanings they give to their careers and the influence of personal, family and professional factors. We conducted a qualitative study with six discussion groups. Thirty-two female primary care physicians working in urban health centers of the public health system of Andalusia participated in the study. The discourse analysis revealed that most of the female physicians did not plan for professional goals and, when they did plan for them, the goals were intertwined with family needs. Consequently, their career paths were discontinuous. In contrast, career paths oriented towards professional development and the conscious planning of goals were more common among the female doctors acting as directors of health care centers.

Factors identified with higher levels of career satisfaction of physicians in Andalusia, Spain

The satisfaction of physicians is a worldwide issue linked with the quality of health services; their satisfaction needs to be studied from a multi-dimensional perspective, considering lower- and higher-order needs. The objectives of this study were to: i) measure the career satisfaction of physicians; ii) identify differences in the dimensions of career satisfaction; and iii) test factors that affect higher- and lower-order needs of satisfaction among physicians working in Andalusian hospitals (Spain). Forty-one percent of 299 eligible physicians participated in a study conducted in six selected hospitals. Physicians reported higher professional, inherent, and performance satisfaction than personal satisfaction. Foreign physicians reported higher levels of personal and performance satisfaction than local physicians, and those who received non-monetary incentives had higher professional and performance satisfaction. In conclusion, physicians in the selected Andalusian hospitals reported low levels of personal satisfaction. Non-monetary incentives were more relevant to influence their career satisfaction. Further investigations are recommended to study differences in the career satisfaction between foreign and local physicians.

Healthcare integration strategy implementation based on distance education and communication for health professionals in São Paulo City, Brazil: study protocol

The Brazilian healthcare system aims for universal access for the whole population, equity to prioritize health actions, and integrality in all assistance levels. The purpose of this research project is to promote and to evaluate intervention based on capacitation in clinical management focused on diseases that are part of the Brazilian list of ambulatory care sensitive conditions (ACSC). It will be delivered throughout a distance education course to health professionals who are based in a public hospitals and to 85 Family Health Strategy teams spread out over 18 Primary care Units (PCU), covering around 300,000 people, in the southern zone of Sao Paulo City. It will evaluate the use of communication tools, as a free internet-based platform and telemedicine, that will be made available to the health providers that can afford continuity and integrality of care to the patients who are followed by both health services. Also, health professionals learning and application of knowledge in the clinical practice as well as patient outcomes, will be evaluated. Quasi-experimental cohort design with historical controls study of adult patients hospitalized by ACSC and will be followed up 1 year after the hospital discharge. Data collection will be performed on hospital and PCU patient’s health records and will be applied the Primary Care Attention Tool, the World Health Organization Quality of Life, and Sociodemographic questionnaires, to patients and health professionals, for social and environmental characterization, treatment plan adherence, disease monitoring and access to the health services. Data analysis will evaluate as outcomes the hospital readmissions of the followed patients, the use of the communication tools by the health providers, demographic, social and environmental variables, and hospitalization rates, patient’s time of hospitalization and mortality rates related to the patients. This project is funded by the Brazilian Ministry of Health and Sao Paulo State Research Agency.