Mercedes Guilabert

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.

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 The most common were: incorrect dosage, forgetting, mixing up medications, failing to recall indications and taking out-of-date or inappropriately stored drugs.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.

Use of QR and EAN-13 codes by older patients taking multiple medications for a safer use of medication.

BACKGROUND Older persons following a prolonged complex drug regimen often make mistakes when taking their medication. Currently, the widespread use of tablets and smartphones has encouraged the development of applications to support self-management of medication. OBJECTIVE The aim of this study was to design, develop and assess an app that transforms medication-associated ean-13 (barcodes) and Quick Response codes (QR) into verbal instructions, to enable safer use of medication by the elderly patients taking multiple medications. METHODS Meetings were held in which participated a total of 61 patients. RESULTS The results showed that patients appreciated the application and found it useful for safer use of medicines. CONCLUSIONS The study results support the use of such technology to increase patient safety taking multiple medications safety.

Frecuencia de errores de los pacientes con su medicación

OBJETIVO: Analizar la frecuencia de errores de medicacion que son cometidos e informados por los pacientes. METODOS: Estudio descriptivo basado en encuestas telefonicas a una muestra aleatoria de pacientes adultos del nivel primario de salud del sistema publico espanol. Respondieron un total de 1 247 pacientes (tasa de respuesta, 75%). El 63% eran mujeres y 29% eran mayores de 70 anos. RESULTADOS: Mientras 37 pacientes (3%, IC 95%: 2-4) sufrieron complicaciones asociadas a la medicacion en el curso del tratamiento, 241 (19,4%, IC 95%: 17-21) informaron haber cometido algun error con la medicacion. Un menor tiempo de consulta (P < 0,01) y una peor valoracion de la informacion proporcionada por el medico (P < 0,01) se asociaron al hecho de que en la dispensacion en la farmacia le indicaran al paciente que el tratamiento prescrito no era apropiado. CONCLUSIONES: A los riesgos conocidos de sufrir un evento adverso, fruto de la intervencion sanitaria por error del sistema o del profesional, hay que sumar los asociados a los errores de los pacientes en la autoadministracion de la medicacion. Los pacientes insatisfechos con la informacion proporcionada por el medico informaron un mayor numero de errores.

Patient Satisfaction with Pre-Hospital Emergency Services. A Qualitative Study Comparing Professionals’ and Patients’ Views

Objective: To describe patient satisfaction with pre-hospital emergency knowledge and determine if patients and professionals share a common vision on the satisfaction predictors. Methods: A qualitative study was conducted in two phases. First, a systematic review following the PRISMA protocol was carried out searching publications between January 2000 and July 2016 in Medline, Scopus, and Cochrane. Second, three focus groups involving professionals (advisers and healthcare providers) and a total of 79 semi-structured interviews involving patients were conducted to obtain information about what dimensions of care were a priority for patients. Results: Thirty-three relevant studies were identified, with a majority conducted in Europe using questionnaires. They pointed out a very high level of satisfaction of callers and patients. Delay with the assistance and the ability for resolution of the case are the elements that overlap in fostering satisfaction. The published studies reviewed with satisfaction neither the overall care process nor related the measurement of the real time in responding to an emergency. The patients and professionals concurred in their assessments about the most relevant elements for patient satisfaction, although safety was not a predictive factor for patients. Response capacity and perceived capacity for resolving the situation were crucial factors for satisfaction. Conclusions: Published studies have assessed similar dimensions of satisfaction and have shown high patient satisfaction. Expanded services resolving a wide number of issues that can concern citizens are also positively assessed. Delays and resolution capacity are crucial for satisfaction. Furthermore, despite the fact that few explanations may be given due to a lack of face-to-face attention, finding the patient’s location, taking into account the caller’s emotional needs, and maintaining phone contact until the emergency services arrive are high predictors of satisfaction.

Indicadores de calidad en el tratamiento de pacientes con depresión, trastorno bipolar o esquizofrenia. Estudio de consenso

OBJECTIVE To define a set of indicators for mental health care, monitoring quality assurance in schizophrenia, depression and bipolar disorders in Spain. MATERIAL AND METHOD Qualitative research. Consensus-based study involving 6 psychiatrists on the steering committee and a panel of 43 psychiatrists working in several health services in Spain. An initial proposal of 44 indicators for depression, 42 for schizophrenia and 58 for bipolar disorder was elaborated after reviewing the literature. This proposal was analysed by experts using the Delphi technique. The valuation of these indicators in successive rounds allowed those with less degree of consensus to be discarded. Feasibility, sensitivity and clinical relevance were considered. The study was carried out between July 2015 and March 2016. RESULTS Seventy indicators were defined by consensus: 17 for major depression, 16 for schizophrenia, 17 for bipolar disorder and 20 common to all three pathologies. These indicators included measures related to adequacy, patient safety, exacerbation, mechanical restraint, suicidal behaviour, psychoeducation, adherence, mortality and physical health. CONCLUSIONS This set of indicators allows quality monitoring in the treatment of patients with schizophrenia, depression or bipolar disorder. Mental health care authorities and professionals can use this proposal for developing a balanced scorecard adjusted to their priorities and welfare objectives.

Quality Assurance and Patient Safety Measures: A Comparative Longitudinal Analysis

Objective: To analyze whether the results on quality assurance and safety culture in a healthcare organization are related to and affected by the actions implemented. Setting: Health Insurance of Work-related Accidents and Occupational Diseases. Methods: The study was conducted as a longitudinal observational study that analyzed the relationship of the Safety Culture and Quality Assurance measurements. Participants who were involved came from small centers with less than eight workers (N = 52), big centers (eight and more workers) (N = 707), and those centers with quality coordinators (N = 91). Data were collected during the years 2015 and 2016. Results: A total of 595 healthcare professionals responded in 2015 and 491 in 2016. The scores showed a positive progression both in Quality Assurance (T-test = 3.5, p = 0.001) and in Safety Culture (T-test = 5.6, p < 0.0001). Hence, the gradient of improvement in quality (average 5.5%) was greater compared to that of the safety culture (2.1%). Conclusions: The assessments of the quality assurance goals were consistent with the safety culture assessment. Hence, the results on Safety Culture were observed to be more stable over time.

The Measure of the Family Caregivers’ Experience

Objective: Design and validate a measure of the experience of family caregivers with the integrated care that receive the persons they care for. Methods: The new instrument for measuring the experience of caregivers is based on the Instrument to Evaluate the EXperience of PAtients with Chronic Diseases (acronym in Spanish: IEXPAC) scale instrument. With the qualitative technique of the discussion group, nine professionals and eight caregivers assessed the face validity of the instrument and they advised on issues to explore and the measuring scale to use. The instrument’s items were analyzed individually, as well as its consistency, reliability, and construct and empirical validity. Results: 235 caregivers responded, of which 186 (79%) were women. The average age of the persons under their care was 83.9 years (SD 9.7). The scale’s score when eliminating its items one by one ranged between 38.6 and 41.1. The factorial saturations of the items ranged between 0.53 and 0.82. Cronbach’s alpha (12 elements) was 0.88 and the Kuder-Richardson coefficient was 0.91. The factorial solution explained 64.3% of the total variance and allowed isolating two factors (with 11 items with saturations greater than 0.65): care for the patient, and care for the caregiver. The internal consistency of both factors was greater than 0.80. The scale’s score was 41.1 (SD 9.7). Conclusions: The Caregivers Experience Instrument combines acceptability, ease of comprehension, and perceived usefulness for the caregivers. It has adequate internal consistency, reliability, and construct and empirical validity.

IEXPAC website for measuring advances in People-Centred and Integrated Care in healthcare organizations

Introduction : Systematic assessment of patient experience (PE) might contribute to transform the patient-professional interaction model and to improve outcomes. This type of assessments stems from the recognition of the person’s rights and, therefore, of his/her active role in their wellbeing. It is a promising alternative to the fruitless efforts of the traditional approaches to achieve patient’s participation in the design of care processes. Patient Experience describes results from the patient viewpoint when receiving care in relation to the interaction with professionals (relational aspects) and to the care process in which the person is involved (functional aspects). PE measure allows the assessment of how health and social care providers are organized to satisfy patient needs in each moment adequately. In this type of measurements, elements such as integrated care, personalized care plans, recognition of patient’s role in their own health (co-production) or communication adapted to patient’s needs and personal circumstances are crucial. IEXPAC (Instrumento de Evaluacion de la eXperiencia del Paciente Cronico in Spanish, (see www.iemac.org/iexpac) is a 12 structured items scale with a 0-10 points-scale response that allows to assess the experience of a chronic patient. It has been validated in Spain considering ceiling and floor effects, reliability and face and construct validity. IEXPAC converged into 3 factors exploring: (1) the type and scope of patient and professionals interactions oriented to patient activation; (2) the patient’s self-management capacity of his/her wellbeing thanks to the interventions received and (3) new relational model of the patient with the system through internet or with partners in group interventions. This scale has its origin in the instrument IEMAC/ARCHO (Assessment of Readiness for Chronicity of Health Care Organizations, see www.iemac.org), designed to monitor progress of health and social care organizations towards an integrated, person-centered chronic care model. To facilitate the introduction of patient experience assessment in the evaluation procedures of health and social care organizations, a website was designed. IEXPAC website is accessible to patients from different profiles of users, as healthcare institutions, providers, patients’ associations or research’s teamwork. The objective of the current study was to evaluate the usefulness and user friendliness of the IEXPAC website, and the use of IEXPAC scale. Methods : The IEXPAC website (http://www.iemac.es/iexpac/default.asp) was designed for Chrome, Explorer, Safari, Firefox, Edge and to allow the introduction and recovery of data regarding one or several evaluations. Comparisons inter and intra evaluations are available so users obtain useful information to introduce changes to improve care. This website suggests recommendations about how to conduct studies in several contexts. The IEXPAC website was assessed exploring its friendliness, usefulness, and impact to introduce changes. Assessments were performed with self-assessed, online, standardized questionnaires. The number of users and downloads were also considered. Results : Preliminary results render an average rating in the IEXPAC scale of 5.7 points (SD 0.7, IC95% 3.0-3.2). Average rating for each factor is: 7.7 (SD 0.9) for factor 1; 7 (SD 0.9) for factor 2, 2.5 (SD 0.9) for factor 3. New integrated care models incorporate people’s needs, preferences and expectations. IEXPAC participates of this approach emphasizing, for instance, the need to improve patient’s active participation in their therapeutic and care plan by agreeing health targets with his/her professionals (item 6, rated 6.85, SD 1.4); facilitating information of the different health and social resources available in patient’s environment to improve their health and wellbeing (item 10, rated 5.72, SD 1.6). Capture of friendliness’ and usefulness’ data is being performed and should be finished in January 2016. Discussion : IEXPAC website is a tool that allows the assessment of Patient experience and from this measure, promoting changes in chronic care approach. The active participation of patients and the integration of all care they receive are objectives of the person-centered care that professionals and organizations strive to achieve. The new evaluative frameworks look for the integration of measures of effectiveness and efficiency together with the experience of patients. This study aims in this direction. Conclusion : The IEXPAC scale facilitates the reorientation towards person-centered care. A useful and user-friendly framework has been designed to introduce the PE measure in several health and social contexts.

News items about clinical errors and safety perceptions in hospital patients

OBJECTIVE: To analyze how news items about clinical errors are treated by the press in Spain and their influence on patients. METHODS: We performed a quantitative and qualitative study. Firstly, news items published between April and November 2007 in six newspapers were analyzed. Secondly, 829 patients from five hospitals in four autonomous regions were surveyed. RESULTS: We analyzed 90 cases generating 128 news items, representing a mean of 16 items per month. In 91 news items (71.1%) the source was checked. In 78 items (60.9%) the author could be identified. The impact of these news items was -4.86 points (95% confidence interval [95%CI]: -4.15-5.57). In 59 cases (57%) the error was attributed to the system, in 27 (21.3%) to health professionals, and in 41 (32.3%) to both. Neither the number of columns (p=0.702), nor the inclusion of a sub-header (p=0.195), nor a complementary image (p=0.9) were found to be related to the effect of the error on safety perceptions. Of the 829 patients, 515 (62.1%; 95%CI: 58.8-65.4%) claimed to have recently seen or heard news about clinical errors in the press, on the radio or on television. The perception of safety decreased when the same person was worried about being the victim of a clinical error and had seen a recent news item about such adverse events (chi(2)=15.17; p=0.001). CONCLUSIONS: Every week news items about clinical errors are published or broadcast. The way in which newspapers report legal claims over alleged medical errors is similar to the way they report judicial sentences for negligence causing irreparable damage or harm. News about errors generates insecurity in patients. It is advisable to create interfaces between journalists and health professionals.