José Joaquín Mira

A Spanish Pillbox App for Elderly Patients Taking Multiple Medications: Randomized Controlled Trial

Background Nonadherence and medication errors are common among patients with complex drug regimens. Apps for smartphones and tablets are effective for improving adherence, but they have not been tested in elderly patients with complex chronic conditions and who typically have less experience with this type of technology. Objective The objective of this study was to design, implement, and evaluate a medication self-management app (called ALICE) for elderly patients taking multiple medications with the intention of improving adherence and safe medication use. Methods A single-blind randomized controlled trial was conducted with a control and an experimental group (N=99) in Spain in 2013. The characteristics of ALICE were specified based on the suggestions of 3 nominal groups with a total of 23 patients and a focus group with 7 professionals. ALICE was designed for Android and iOS to allow for the personalization of prescriptions and medical advice, showing images of each of the medications (the packaging and the medication itself) together with alerts and multiple reminders for each alert. The randomly assigned patients in the control group received oral and written information on the safe use of their medications and the patients in the experimental group used ALICE for 3 months. Pre and post measures included rate of missed doses and medication errors reported by patients, scores from the 4-item Morisky Medication Adherence Scale (MMAS-4), level of independence, self-perceived health status, and biochemical test results. In the experimental group, data were collected on their previous experience with information and communication technologies, their rating of ALICE, and their perception of the level of independence they had achieved. The intergroup intervention effects were calculated by univariate linear models and ANOVA, with the pre to post intervention differences as the dependent variables. Results Data were obtained from 99 patients (48 and 51 in the control and experimental groups, respectively). Patients in the experimental group obtained better MMAS-4 scores (P<.001) and reported fewer missed doses of medication (P=.02). ALICE only helped to significantly reduce medication errors in patients with an initially higher rate of errors (P<.001). Patients with no experience with information and communication technologies reported better adherence (P<.001), fewer missed doses (P<.001), and fewer medication errors (P=.02). The mean satisfaction score for ALICE was 8.5 out of 10. In all, 45 of 51 patients (88%) felt that ALICE improved their independence in managing their medications. Conclusions The ALICE app improves adherence, helps reduce rates of forgetting and of medication errors, and increases perceived independence in managing medication. Elderly patients with no previous experience with information and communication technologies are capable of effectively using an app designed to help them take their medicine more safely. Trial Registration Clinicaltrials.gov NCT02071498; http://clinicaltrials.gov/ct2/show/NCT02071498 (Archived by WebCite at http://www.webcitation.org/6OJjdHVhD).

Adverse events in hospitals: the patient's point of view

Background The publication of the report “To err is human: building a safer system” by the Institute of Medicine incited a profuse research addressing improvements in healthcare safety. However, there is still little acknowledgement of the key role of the patient in preventing adverse events of medical care. The aim of this review is to analyse and compare studies about patients perception and opinion about care safety in hospitals. Methods We searched 10 databases (EMBASE, MEDLINE, PsychINFO, SCOPUS, Science Citation Index Expanded, Social Science Citation, IME, Sociological Abstracts, LILACS and The Cochrane Library) to identify articles and reports on patients safety perception published between 1989 and 2006. Results From the 699 articles, 18 were selected: eight determined the frequency of experiences related to adverse events and the safety perception reported by patients, seven focused on the impact of the adverse events regarding the communication to the patient, and three included patients opinions about the management and disclosure of adverse events and proposals to prevent them. Conclusions The incidence of adverse events reported by patients was similar to that estimated by other procedures. The patients concept of adverse events was different from that of the physician. The quality of communication from the physician influenced the patients perception of adverse events, and the majority wanted adverse events to be disclosed. Patients emphasised emotional consequences of the adverse events. The majority supported system modifications to prevent adverse events and to sanction the physicians when an adverse event occurs.

Causas de satisfacción y de insatisfacción de los pacientes en hospitales y atención primaria

Resumen Introduccion En el sector sanitario se utilizan diferentes aproximaciones metodologicas (tanto cuantitativas como cualitativas) para identificar los aspectos de la atencion sanitaria mas importantes para los pacientes. Estos estudios han sido utilizados para disenar instrumentos de evaluacion de la satisfaccion del paciente, identificando las dimensiones que debian ser evaluadas para conocer mejor sus opiniones. Objetivo Identificar los aspectos que los pacientes senalan como causa de satisfaccion e insatisfaccion en diferentes servicios medicos. Metodo Diseno cualitativo combinando las tecnicas de grupo focal y grupo nominal. En total creamos 20 grupos de trabajo, colaborando 10 hospitales y 4 centros de salud. Sujetos Participo un total de 171 pacientes que habian sido atendidos en diferentes servicios sanitarios: medicina y cirugia, obstetricia, pediatria, consultas externas y urgencias y centros de atencion primaria. Resultados Los pacientes, independientemente del grupo en el que participaban, consideraron como causas de satisfaccion: el trato humano y personalizado, la empatia, la capacidad de respuesta, la calidad de la informacion recibida y el confort de las instalaciones. Por otro lado, consideraron como causas de insatisfaccion: la falta de coordinacion del personal sanitario cuando sucedia, las listas de espera y los retrasos en la atencion, en obtener los resultados de las diferentes pruebas o en comunicar el diagnostico. Conclusiones Empatia, trato y confort son los motivos mas frecuentes de “buenas experiencias”, mientras que la accesibilidad y ciertos aspectos organizativos son los motivos mas citados como causas de insatisfaccion.

¿Qué opinan los pacientes de los hospitales públicos? Análisis de los niveles de calidad percibida en cinco hospitales

Objetivo: Analizar las opiniones de pacientes atendidos en cinco hospitales publicos. Diseno: Estudio descriptivo basado en encuesta por correo. Instrumentos: Cuestionario SERVQHOS. Sujetos: 930 sujetos. Tasa de respuesta del 35%. Resultados: Un 19% de los pacientes no recomendaria el hospital. El 59,2% se mostro satisfecho y un 3,1% muy insatisfecho. Conocer el nombre del medico y enfermera/o son predictores del nivel de calidad percibida. La frecuencia con que el paciente dijo haber sido informado no predijo el nivel de calidad atribuido al hospital. Edad y sexo no mostraron relacion con el nivel de calidad percibida. Conclusion: Los pacientes valoran positivamente los hospitales aunque existe un porcentaje de insatisfechos importante.

Barriers for an effective communication around clinical decision making: an analysis of the gaps between doctors' and patients' point of view

There are doubts on whether patients feel that they have sufficient information for actively participating in clinical decisions.

Análisis de las condiciones en las que los pacientes toman decisiones responsables

1. Nuevas perspectivas en la relacion medico-paciente han visto la luz en la ultima decada, siendo un elemento comun de todas ellas la «emancipacion» de este ultimo 2 . El paciente recibe mas informacion que antes, participa en las decisiones en mayor medida, condiciona con sus preferencias las opciones terapeuticas y organizativas de los recursos sanitarios y es ahora mas probable que busque activamente esa informacion medica que cree necesitar para tomar sus propias decisiones. Las formas en que un paciente interactua con el sistema sanitario se han diversificado, y la tecnologia ha ampliado las posibilidades. El uso de las tecnologias de la informacion para informar y educar a los pacientes constituye, en la actualidad, un recurso en ascenso dia a dia, y ya hay quien identifica un nuevo perfil de paciente caracterizado por hacer gala de una mayor confianza en Internet que en su medico

Sexual behaviour and contraception in people under the age of 20 in Alicante, Spain.

Objective To describe and to analyse the relationship between patterns of sexually-risky behaviour and emergency contraception among young females attending a Family Planning Centre (FPC). Methods Data was obtained from a systematic analysis of 384 health records. Results Mean age of the sample subjects was 18.24 years (SD 1.47, range 13–20). Of these, 92% were single, 60% students and 83% were with the same partner. Age at first intercourse was 16.5 years (SD 1.52, range 11–20). Those who used condoms systematically totalled 72%. Mean number of sexual partners was 1.85 (SD 2.91, range 1–50). A total of 9% had become pregnant and 2% had had an abortion. Emergency contraception was resorted to by 26% of the young women on at least one occasion. Emergency contraception was related to younger age at first sexual intercourse (p < 0.001) and to a great number of partners (p = 0.011). Of the total number of subjects, 48.4% demonstrated sexually-risky behaviour. This behaviour was related to alcohol consumption (p < 0.0001) and to the existence of dysfunction (p < 0.001). Conclusions Spanish youngsters have enough knowledge regarding contraception. Condoms are mostly used on the occasion of a first sexual intercourse. However, the frequency of sexually-risky behaviour is still high due to the limited use of condoms in successive sexual relations with the same partner. Sexually-risky behaviour is also related to a high number of partners and to alcohol consumption on weekends.

Quality of websites in Spanish public hospitals

The objectives were to assess the quality of websites in Spanish public hospitals by means of a validated system, also including measures of readability and accessibility. A scale was designed and validated to assess the quality (citizen-orientated) of the websites of hospitals. The quality of the of public hospital websites was evaluated by means of the results of the above evaluation scale, analysis of the readability of their contents, and the results of the accessibility test. The validated scale contains 73 elements or attributes. Analysis of the concordance of website evaluations shows average assessment values of between 0.80 and 0.81, which confirms a high degree of agreement among jurors. Twenty per cent of the attributes do not appear on any websites, and 14% are present on all of them. The average mark of the hospitals is 43%. The marks given for readability of tests show that it is satisfactory for 64% hospitals. None of the websites visited fulfilled the requirements necessary to be considered as accessible. The quality of the websites analysed by means of this scale varies from 23% to 62%. Differences in the size or location of the hospitals do not explain this high level of variability. The results suggest that the readability of websites should be improved and that such sites should be accessible to people with disabilities.

La investigación cualitativa: una alternativa también válida

Objetivo Describir las principales tecnicas de investigacion cualitativa mediante la revision sistematica de los trabajos espanoles publicados en los ultimos 5 anos Diseno Revision sistematica. Fuentes de datos Busqueda en el Indice Medico Espanol y busqueda sistematica en las revistas Atencion primaria, Gaceta Sanitaria y Revista de Calidad Asistencial Seleccion de estudios Se incluyeron los trabajos realizados mediante tecnicas de investigacion cualitativa en cualquiera de sus modalidades. Se incluyeron tambien los trabajos que hacian una revision de las tecnicas de investigacion cualitativa. Se excluyeron las investigaciones que, aunque aplican alguna tecnica cualitativa, estan basadas fundamentalmente en tecnicas de investigacion cuantitativa. La revision se realizo entre abril de 1997 y abril de 2002 Resultados La mayor parte de los trabajos revisados emplearon una unica tecnica (80,5%). En los casos en que se combinaron varias (19,5% de los articulos revisados), habitualmente se empleaban los grupos focales y la entrevista. Las tecnicas empleadas fueron: grupo focal (utilizadas en el 34% de los trabajos revisados), entrevista (24%), Delphi (10%), analisis de contenido (8%), grupo nominal (8%), Metaplan (2%) y Philips 6/6 (2%) Conclusiones La investigacion cualitativa es una alternativa tambien valida y, utilizada con el rigor metodologico apropiado, puede resultar de gran interes para los profesionales del ambito de la salud.

A systematic review of patient medication error on self-administering medication at home

Introduction: Medication errors have been analyzed as a health professionals’ responsibility (due to mistakes in prescription, preparation or dispensing). However, sometimes, patients themselves (or their caregivers) make mistakes in the administration of the medication. The epidemiology of patient medication errors (PEs) has been scarcely reviewed in spite of its impact on people, on therapeutic effectiveness and on incremental cost for the health systems. Areas covered: This study reviews and describes the methodological approaches and results of published studies on the frequency, causes and consequences of medication errors committed by patients at home. A review of research articles published between 1990 and 2014 was carried out using MEDLINE, Web-of-Knowledge, Scopus, Tripdatabase and Index Medicus. Expert opinion: The frequency of PE was situated between 19 and 59%. The elderly and the preschooler population constituted a higher number of mistakes than others. The most common were: incorrect dosage, forgetting, mixing up medications, failing to recall indications and taking out-of-date or inappropriately stored drugs. The majority of these mistakes have no negative consequences. Health literacy, information and communication and complexity of use of dispensing devices were identified as causes of PEs. Apps and other new technologies offer several opportunities for improving drug safety.