Andalusian Public Health Service Research Articles

Medication Errors Detected in Primary Health Care after Hospital Discharge

Background: Medication conciliation allows finding discrepancies and medication errors in healthcare transitions, but there are few studies performed after hospital discharge, in the context of primary health care. Therefore, the main aim of this research was to evaluate the process of medication conciliation in primary health care, after hospital discharge. We further sought to analyze some demographic aspects of the patients that could be associated with potential discrepancies. Methods: A cross-sectional study was performed using the database which contained the records generated by the medication reconciliations performed by the physicians of the Andalusian Public Health Service, in Spain. Results: A total of 6115 medication conciliations were analyzed, and discrepancies were found in 73.7% of them. A total of 50.6% were medication errors, the most frequent being medication omission. Medication errors were more prevalent in women of 65 years and older. Conclusions: After hospital discharge, most patients show medication discrepancies in their records, particularly older women. To prevent this, primary health care plays an essential role in the conciliation process, therefore more research is needed in this context.

Cost and potential savings generated by a paediatrics e-Health web site for parents

IntroductionThere are few studies on e-Health interventions directed at parents that analyse their costs and any potential savings that may occur. The aims of this study consisted of calculating the costs of the development and maintenance of a paediatric web site for parents, including the costs per visit and per visitor, and the potentially savings made as regards medical visits avoided as a result of its use. MethodsThe technology costs as well as the work of the professionals were considered as costs of the web site. The calculation of the cost of the professionals and the potential savings were based on the official fees and public prices of the Andalusian Public Health Service. ResultsDuring 5 years and 6 months of the study, the total cost of the web site was €45,201.56. The cost per visit received was €0.0155€, and €0.0186 for each single visitor. Among the 516 users that took part in the study, face-to-face visits to Primary Care paediatric clinics were avoided, as well as those to Paediatric Emergency Department, at a savings of €22,263.89. ConclusionsThe costs of developing a paediatric e-Health website for parents written in Spanish, using existing and free technologies, are low compared to other forms of e-Health development. Furthermore, the costs are considerably low if they are divided by the total number of visits or the number of visitors. There is also a considerable potential financial saving on contributing to avoid face-to-face visits.

Costs analysis of a training intervention for the reduction of preanalytical errors in primary care samples.

Background:To perform a cost-error analysis based on a quasi-experimental pre-post study of the preanalytical errors in 2 hospital laboratories. The real cost and theoretical cost are defined as the cost resulting from errors with or without the training intervention. The real impact associated to the training program was estimated, calculated as the total associated to the preanalytical errors cost difference. The costs were measured using Andalusian Public Health Service fees. Cost analysis of an educational intervention presented in a previous study from 2017. Preanalytical errors were detected in the laboratories of the University Hospital Virgen de la Victoria (Málaga, Spain) and in the University Hospital Juan Ramón Jiménez (Huelva, Spain).Methods:The founded errors were divided into blood and urine samples. Univariate sensitivity analysis was used to assess how parameter uncertainty impacted on overall results. Variations of parameters between 0% and 5% were substituted into the base case.Results:The real impact associated with educational intervention in LAB1 was an increase of €16,961.378, and the expected impact was an increase €78,745.27 (difference of €61,783.9). In LAB2, the real impact in the same period amounted to €260,195.37, and the expected impact was €193,905.83 (difference of −€66,289.54). The results were different in the 2 laboratories, proving the intervention in only one of them to be more effective.Conclusions:Costs analysis determined that this training intervention can provide saves in the costs, as the effectiveness of the educational sessions in reducing preanalytical errors currently results in a significant decrease of the costs associated with these errors.

The Sustainability of Public Social Services: A Qualitative Study

The 2008 global economic crisis heightened social inequality and drastically reduced equal opportunities for many people. It had negative consequences for social regulation in many European countries, which have dismantled their public social policies. The objective of the study was to describe social workers’ perceptions of their lived experiences in different areas of the public social services system. A qualitative study was developed, based on a hermeneutic approach. Six in-depth interviews and two focus groups were conducted with 20 social workers employed by community social services and the Andalusian public health service (Spain). The professionals agreed that the public social services system has been eroded, that the lack of resources has consequences for workers and the general public alike, and that the public authorities and the administration are responsible for this situation. Social services have become distributors of scarce resources rather than a social protection system that empowers and accompanies the most vulnerable. The system must provide the necessary resources and structures so that they can escape the situation of poverty, exclusion and social injustice.

A Multicentre Study of Psychological Variables and the Prevalence of Burnout among Primary Health Care Nurses.

Nurses in primary health care (PHC) have multiple responsibilities but must often work with limited resources. The study’s aim was to estimate burnout levels among PHC nurses. A Quantitative, observational, cross-sectional, multicentre study of 338 nurses working in PHC in the Andalusian Public Health Service (Spain) is presented. A total of 40.24% of the nurses studied had high levels of burnout. The dimensions of emotional exhaustion and depersonalisation were significantly associated with anxiety, depression, neuroticism, on-call duty and seniority-profession and inversely related to agreeableness. In addition, depersonalisation was significantly associated with gender, and emotional exhaustion correlated inversely with age. Personal achievement was inversely associated with anxiety and depression and positively correlated with agreeableness, extraversion and responsibility. There is a high prevalence of burnout among nurses in PHC. Those most likely to suffer burnout syndrome are relatively young, suffer from anxiety and depression and present high scores for neuroticism and low ones for agreeableness, responsibility and extraversion.

Intercultural Sensitivity on the Websites of the Hospitals Belonging to the Andalusian Public Health Service (SSPA), Spain

Abstract Attention to interculturality in hospital web services should be considered as an aspect to take into account as an indicator of quality, especially given that little evidence is available about it in the general literature. Accordingly we undertook a study among the Andalusian hospitals of the Andalusian Public Health Service (SSPA), which are committed to provide the citizens with a quality service (considered for our purposes to be the services related to web pages). We undertook a cross-sectional, observational study to assess intercultural contact between immigrants and the hospital via web pages. We used a test to determine the presence or absence of certain intercultural attributes grouped into 3 sections composed of different items: languages, corporate values and content, and information content for immigrants on the web pages of the SSPA hospitals. The results indicate that the web pages of the SSPA hospitals are not designed for intercultural relations with immigrants, given the lack of translation of these attributes to different languages on the hospital web pages. In conclusion, we found a complete lack of linguistic diversity, and little interest in this aspect by the managers of these hospitals or the Andalusian Ministry of Health. On the other hand however, the notice concerning the rights and obligations of the citizens has been translated into 7 different languages. Very little consideration was given to translations of food menus or information about religious services. The Andalusian Health Ministry has preferred to use a telephone translation service rather than having permanent translators available in the hospitals. More information for immigrants should be provided on the web pages, such as manuals and guides as well as cross-border health information.

¿Son efectivos nuestros centros de reconocimiento médico valorando la aptitud psicofísica para permisos de conducción y licencias de armas?

ObjectivesThis article aimed to evaluate the effectiveness of medical centres in the assessment of medical fitness for driving and gun licences, as well as describing the differences between them. MethodUsing a crossover design and a representative sample of holders of driving and firearms licences in the province of Malaga during 2014 (363 reports for driving licenses and 626 for firearms licenses), an assessment was made of fitness report issued by the centres by comparing it with the records of the Andalusian public health service. The proportion of those that would not meet the legal eligibility requirements was calculated. An analysis was made of the origin of the disagreements as regards the information made available by the centres. ResultsThe discordance in the assessment of fitness to drive was estimated as 15.4% (95% CI: 12.0 to 19.4), while for firearms licenses it was 2.7 times higher (41.4%). The origin of the discordance is related to the information provided to the centres, rather than the assessment made by them. ConclusionsThe limited effectiveness of the centres in the assessment of fitness for driving and, especially, for firearms licenses, could be improved by increased monitoring of their activity, providing health workers with adequate training and access to healthcare records of applicants.

Cuestionario ISMP-España y estrategia de mejora en el uso seguro del medicamento dentro del Servicio Andaluz de Salud

ObjectiveTo describe the strategy employed by Andalusian public health service hospitals to foster safe medication use. The self-evaluation questionnaire on drug system safety in hospitals, adapted by the Spanish Institute for Safe Medication Practices was used as a fundamental tool to that end. Material and methodThe strategy is developed in several phases. We analyse the report evaluating drug system safety in Andalusian public hospitals published by the Spanish Ministry of Health and Consumption in 2008 and establish a grading system to assess safe medication practices in Andalusian hospitals and prioritise areas needing improvement. We developed a catalogue of best practices available in the web environment belonging to the Andalusian health care quality agency's patient safety observatory. We publicised the strategy through training seminars and implemented a system allowing hospitals to evaluate the degree of compliance for each of the best practices, and based on that system, we were able to draw up a map of centres of reference. ResultsWe found areas for improvement among several of the questionnaire's fundamental criteria. These areas for improvement were related to normal medication procedures in daily clinical practice. We therefore wrote 7 best practice guides that provide a cross-section of the assessment components of the questionnaire related to the clinical process needing improvement. ConclusionsThe self-evaluation questionnaire adapted by ISMP-Spain is a good tool for designing a systematic, rational intervention to promote safe medication practices and intended for a group of hospitals that share the same values.

Professional involvement in the design of accreditation manuals

This paper aims to describe the participation of health professionals as key agents for the successful definition of skills manuals supporting professional accreditation in Andalusia (Spain). The increasing extent to which different stakeholders are recognized reflects the importance they hold in all decision-making processes. The Andalusian Agency for Healthcare Quality's commitment to this process has facilitated the healthcare professionals' participation when professional skills manuals are designed for their respective specialities. The process involved over 400 healthcare professionals from 58 disciplines between March 2005 and January 2008. Results were conditioned by several factors, some acting as drivers while others represented a barrier. The experience relates to a specific geographical context. Healthcare professionals eligible to participate had to be in active employment and working for the Andalusian Public Health Service. There was an overrepresentation of members from scientific associations. Co-operation based on mutual trust is the essential ingredient accounting for the success of participative involvement. The paper incorporates all categories of personnel and specialities in a regional healthcare system that covers eight million inhabitants and employs over 90,000 professionals, includes 33 public hospitals, more than 1,500 primary care centres and other healthcare units.

Estudio de pacientes polimedicados mayores de 65 años en un centro de asistencia primaria urbano

Objective To identify and characterise the polymedicated population over 65 years-old; and to determine the prevalence of drugs and the diseases in this population subgroup. Design Cross-sectional study. Setting A primary care centre Zaidín-Centro in Granada. Andalusian Public Health Service. Participants A total of 305 patients over 65 years-old taking polypharmacy (defined as use of five or more drugs, during a period equal to or greater than six months by any route) selected by stratified sampling by sex, age and number of drugs consumed. Principal measurements The analysed variables were sex, age, number of diseases, number of drugs and medical doctor. Results The prevalence of polypharmacy in patients over 65 years-old was 33.77%. These patients were using an average number of drugs of 8.7 ± 2.5 and had an average number of diseases of 5.56 ± 1.89. The prevalence of polypharmacy was greater among women, but differences decreased in people more than 85 years old. The antihypertensive pharmacological group was the most commonly used, in accordance with the most frequent disease, arterial hypertension. We found a strong relationship between the number of drugs and the number of diseases (p = 0.05). Conclusions Chronic use of drugs in the elderly is of considerable magnitude, affecting one out of every three. Polypharmacy in the elderly is a common and serious problem that needs to be reviewed and evaluated continuously.

La anatomía de la satisfacción del paciente

To analyze how the overall satisfaction of users of the Andalusian Public Health Service varies according to their level of satisfaction with the different dimensions and specific aspects of the service. Data stem from the Primary Care Services User Survey conducted in 2005 as part of a larger research project regarding user satisfaction with the Andalusian Public Health Service. The methodology was to establish a compound variable for Global satisfaction from three initial satisfaction measurements found in the survey and to reduce 23 indicators for partial satisfaction to three satisfaction dimensions in order to analyze the existing relationship between them. The level of satisfaction with the dimension called the "organizational aspects of the service" best reflects the increase or decrease in the users' Global satisfaction level. Users' satisfaction with "medical services received" as well as the "state of the amenities" has less of an impact on the level of Global satisfaction. Once a high level of satisfaction with the medical services is attained, the organization is the dimension that most determines the level of Global satisfaction with Primary Care services because this dimension contains factors that reflect the highest levels of dissatisfaction.

The impact of generic reference pricing interventions in the statin market

Objectives The objective of this study was to evaluate the intended and unintended impact on pharmaceutical use and sales of three public reimbursement reforms applied to the prescription of statins: a Spanish generic reference pricing system, and two competing policies introduced by the Andalusian Public Health Service. Methods This study is designed as an interrupted time series analysis with comparison series of 46 monthly drug use and sales figures from January 2001 to October 2004 for each active ingredient. Results The mean monthly saving for the year after the introduction of reference pricing was 16.7% of total lovastatin sales, representing only 1.1% of total statins sales. Mean monthly savings for the 10 months after reference pricing being applied to simvastatin were 51.8% of simvastatin sales, and 13.9% of statin sales. Over the 46 months of the study, all analysed public interventions resulted in a 2.2% average monthly decrease in statin sales in the rest of Spain and savings non-significantly different from zero in Andalusia. Conclusion RP has been effective at reducing the volume of sales growth of the off-patent statins, yet its overall impact on sales of all statins has been relatively modest.

The Impact of Generic Reference Pricing Interventions in the Statin Market

The objective of this study was to evaluate the intended and unintended impact on pharmaceutical use and sales of three public financing reforms applied to the prescription of statins: a Spanish generic reference pricing (RP) system for lovastatin and simvastatin, and two competing policies introduced by the Andalusian Public Health Service (APHS) for all statins, first a maximum consumer price (MCP) and then a so called quality prescribing incentive for general practitioners (MCP plus PI). This study is designed as an observational, retrospective, interrupted time series analysis with comparison series (APHS and the rest of Spain) of 46 monthly drug use and sales ratios from January 2001 to October 2004 for each active ingredient in the group of statins. RP has been effective at reducing the volume of sales growth of the off-patent statins, yet its overall impact on sales of all statins has been relatively modest. The quantity and volume of sales impact heavily depends on regulatory RP details such as when the system is introduced, how often it is updated, and how the reference price is calculated.

Argumentos para las unidades de gestión clínica

Background The application of clinical management provides a managerial style that prioritizes the human factor and encourages each individual to lend his or her best personal and professional qualities to the organization. In the last few decades the culture of health care organizations has undergone a change that is transforming the roles of the actors in the healthcare process. Objectives The present article aims to: a) define the conceptual and legislative framework that promotes responsibility, autonomy, and decentralization of management and decision making; b) establish the bases that enable the development of clinical management units, and c) present the possible benefits of clinical management for the actors involved: health professionals, managers and citizens. Methodology The conceptual elements that determine clinical management and the benefits for the actors involved in the healthcare process (citizens, health professionals and managers) are defined in the Andalusian Public Health Service.