Andalusian Hospitals Research Articles

Revolving door and human resources in a community mental health system

Background and aims:Andalusia is the most highly populated (7,849,799 hab.) region of the Spanish State. It has all the sanitary domains under its own Health Service (Consejeria de Salud), and it has undertaken a deep reorganization of the psychiatric services, establishing a new model based on the mental health communitarian alternative that is already completely implanted. Rates of readmission are a method to assess the quality of care and an important tool in the planning of services of mental health.The aim of this study is to establish if readmission rates are influenced by Human Resources in Psychiatric Community Devices.Part of FIS Project PI05/90061 ‘Patterns of General Hospital Psychiatric Units Overuse’.Method:MBDS is a system of hospital register that gathers all the discharges produced in the andalusian hospitals. It is totally trustworthy from 1995, and we have processed data up to 2004.Our Data Set register 101234 hospital admissions of psychiatric patients.Results:The number of admissions from patients who enter three times or more throughout the year has been: 22.66%(1995); 24.66% (1996); 31.01%(1997); 30.72%(1998); 34.07%(1999); 35.35%(2000); 36.92%(2001); 32.93%(2002); 31.20%(2003) and 29.36%(2004).On the other hand, it has been an increase in Mental Health Human Resources Rates: 24.23-100.000 inhab-(1998); 24.19 (1999); 26.01(2000); 28.04(2001); 29.83(2002); 29.16(2003); 29.34(2004) and 29.90(2005).Conclusion:Increasing human resources in psychiatric community devices do not change revolving-door rates in general hospital acute psychiatric units in a community mental health system.

Implantación de la guía para la incorporación de nuevos fármacos (GINF) en los hospitales andaluces

To measure the level of implementation of the GINF (guidelines for the introduction of new drugs) in Andalusian hospitals, describe the characteristics of this implementation and analyse if any of the hospital s dependent variables could influence these characteristics. A telephone survey was carried out in the hospitals included in the Department of Health list. The survey consisted of 11 closed questions on different variables in the hospital and the GINF use profile, and an open question about the improvements carried out and proposals for improvement. The results were analysed according to the type of hospital (category, training, geographical location) in order to detect possible differences. A target population of 31 hospitals was identified. The survey was carried out in 29 of these; the level of implementation was 96.5% in the responding hospitals. 23 hospitals used the GINF for 100% of drugs, 6 had carried out local modifications and 80% made proposals for improvement. Significant differences were found in the implementation of the GINF according to resident/intern pharmacist training (p = 0.049), the geographical location (p = 0.004) and the hospital category (p < 0.001). The GINF have been implemented in almost all public Andalusian hospitals as the guidelines for requesting new drugs. Very few local modifications have been carried out to the guidelines, although numerous proposals for improvement have been made. Differences in use have been identified (No. of drugs, different versions) according to the hospital characteristics (location, training and complexity classification). They are considered a useful tool and influence the drug selection process, in particular in training hospitals with a higher classification.

Impacto de los factores demográficos y psicosociales en la no adherencia a los fármacos antirretrovirales

Antiretroviral efficacy is closely related to the degree of adherence. The aim of this study is to assess the association between psychosocial and demographic variables and adherence to antiretroviral treatment. A cross-sectional survey of 320 patients under antiretroviral treatment was conducted in four Andalusian hospitals, using a semi-structured questionnaire given by health care professionals. Median age was 39.7 years. Nearly 12% of the sample was considered non-compliant to antiretroviral treatment. An interaction was observed between psychological morbidity and mental health quality of life scores. Among patients who presented psychological morbidity, a higher mental quality of life score was associated with a lower risk of non-compliance (P = 0.04). This association was not found among patients without psychological morbidity. Older age, homosexual or bisexual status and the use of injecting drugs for a shorter period of time was associated with non-compliance. Demographic and psychological factors have an influence on adherence to antiretroviral treatment.

Oncology care planning. Elements for care quality and management improving

The improvement of care quality depends on the education and skills of the professional team as well as on an adequate work method, which uses the right instruments of clinical management such as medical history, registers or protocols. Defining standardized criteria related to the oncology care quality and applying them to a group of hospitals within the framework of continuous improvement establishing comparisons among them. Information taken from 14 Andalusian public hospitals, in 2003 and first semester of 2004. A total of 35 variables were collected from official sources, validated studies and surveys as a starting point, grouped in four main issues (medical history, protocols, central commission and tumour sub-commissions), delays (diagnostic, treatment and early diagnostic), variability (cytostatics and radiotherapy), research (clinical trials and financed projects) and work loads. In 3 out of 14 centers medical histories are unique for each patient. In average, 3 of the 6 most frequent tumor locations have joint protocols. The delays for the diagnostic test vary from 1 to 23 days and from 11 to 29 days for treatments. The consumption increase of 12 cytostatics was of 71.8% (average of 602,413 euro per hospital). The average rate of patients undergoing irradiation was of 34 %. 109 clinical trials were approved (a centre performes 26) and 20 projects were financed (Health Department, Consejería de Salud). The attendance pressure was of 140 patients per specialist in MO and RO (maximum of 241 and 214 respectively and minimum of 85 and 69). The information gathered in this study shows a diverse nature, and meets items not always taken into consideration, in a global way, but with a clearly complementary nature. No doubt, they offer a scenery that deepens into the complexity of which today means the improvement of the quality of the non-monographic hospital centres that attend patients suffering from cancer. It finally offers instruments for the improvement of the clinical management which we understand it is of certain usefulness.

Calidad del registro de quimioterapia en los servicios de farmacia hospitalaria de Andalucía

To analyze registry quality in centralized cytostatic therapy units in Andalusian hospitals, and the availability of data to analyze the use of these drugs. An ad hoc questionnaire was designed using variables related to information coverage on patients and their treatments, data processing extent, and organization. Questionnaires were completed in September 2005 by surveying people responsible for chemotherapy in all 19 pharmacy departments in Andalusian hospitals that treat oncologic patients. Response rate was 100%, but one department had no centralized cytostatic therapy unit. Centralized preparation coverage was 89% for the day hospital, 84% for inpatients, 79% for hematologic patients, and 69% for pediatric patients. Registries are computerized in only 13 hospitals (68%) with a variety of software programs. Temozolamide and capecitabine dispensation has a separate registry in 68% and 42% of cases, respectively. Patient name, and cytostatic name and dosage are the only data recorded in all instances, while protocol name is only recorded in 47%, and diagnosis, staging, and TNM categorization in 58%, 31%, and 16% of cases, respectively. There is great variability regarding information systems for cytostatic use management, and a relevant shortage of patient data available for prescription use and adaptation studies.

De gestoras de recursos a gestoras de cuidados: opiniones y expectativas de las supervisoras sobre su nuevo rol profesional

Aim To determine the opinions and expectations of nursing supervisors in Andalusian hospitals (Spain) regarding the introduction of a new healthcare management model in hospitals and how it will affect their role, which will change from resource management to care management. Method A qualitative study based on the use of focus groups was carried out. The study was performed in 2 University Hospitals of the Andalusian Health Service, with between 700 and 1100 beds, situated in 2 different provinces, in 2003. In each of the hospitals, 8 focus groups (16 in total) were carried out, in which all the centres’ nursing supervisors participated (132 persons). Results The results revealed an unequal degree of implantation of the new model in the distinct services, a lack of clear definition of contents, and the predominantly structural character of professional expectations. Mid-level managers reported that to make the transition from one model to another they needed to have a clearer idea of what exactly was expected of them, greater professional autonomy, greater participation in the decision-making process, more training opportunities, and increased support from upper-level managers. Conclusions The professional role of nursing supervisors is currently undergoing a process of transformation. The majority of supervisors show a positive attitude toward this change. Internal communication and participation are essential elements for the model’s progress.

Estado clínico, adherencia al TARGA y calidad de vida en pacientes con infección por el VIH tratados con antirretrovirales

Quality of life is one of the most frequently used subjective measures in chronic health problems. The aim of this study is to analyze the association between clinical and therapeutic parameters, and 11 quality of life domains in HIV-infected patients.A cross-sectional survey of 320 patients on antiretroviral treatment was conducted in four Andalusian hospitals (Spain). A semi-structured questionnaire was administered by health care professionals. Health-related quality of life was assessed with the MOS-HIV questionnaire, an instrument designed specifically for HIV-infected patients.Almost three-quarters of the population were men (73.4%); 35.6% had developed aids, and 88.1% were considered adherent to treatment. Patients with greater viral load presented lower quality of life scores for all the domains, except cognitive functioning. Patients who had developed aids showed poorer quality of life for 10 of the 11 domains. Patients with adequate adherence to antiretroviral treatment showed better quality of life for 10 domains. No statistically significant differences in the domain scores except for quality of life were found between patients with a treatment regimen including protease inhibitors and those without.The patient's clinical status and adherence affect not only survival, but also quality of life.

Prevalencia de mutaciones primarias en el virus de la inmunodeficiencia humana que confieren resistencia a análogos de nucleósidos en pacientes de Andalucía no tratados previamente

To analyze the frequency of HIV primary mutations to nucleosides analogues in Andalusia. Genotype study (LiPA) of mutations in codons M41L, T69D, K70R, L74V, M184V, T215Y/F and RT75G-S was performed in 106 HIV-naive patients from 12 Andalusian hospitals, with viral load over 5000 copies of RNA/ml. Reliable results were obtained in 96 patients; 11 of them (11.45%) showed 12 mutations: two in codon 41, four in codon 70, three in codon 184 and three in codon 215. One patient showed two mutations (41 and 215). The presence of mutations only was related to having sex partner and sexual transmission of HIV infection. a) The primary mutations to nucleosides in HIV patients from Andalusia was 11.45%; b) mainly involved drugs were AZT and 3Tc, and c) mutations regarding resistance to ddC, ddI o D4T were not found.