Spanish Healthcare Research Articles

Contributions of nursing students during their clinical practice in primary care: Adaptation and validation of a scale

AimTo adapt the ‘Nursing Student Contributions to Clinical Settings’ scale (CEEEC, Spanish acronym), designed for specialized care and to evaluate the validity and reliability of a measure in the primary health care setting. Additionally, a description of the contributions of nursing students to primary health care in Spain is presented, based on the perception of preceptor nurses. MethodsA multicenter cross-sectional study was conducted in Spain, involving a committee of nursing experts who participated in a Delphi panel (n = 5) and cognitive interviews (n = 5) and a sample of nursing preceptors (n = 300) from 57 primary health care centers (2019–2020). The CEEEC was reviewed by experts for the conceptual semantic adequacy of the 24 items for its application in primary health care. Nurse preceptors’ responses to the CEEEC scale were used to study the validity and reliability of the measure, including factor analysis, convergent validity with the Health Sciences-Evidence Based Practice scale and a matched test-retest over a three-week interval. ResultsAccording to the consensus of experts, the CEEEC scale is valid for primary health care with minimal modifications (change "patient" to "user"). Based on the analysis of responses to the scale, the corrected item-total correlations of the 24 items were ≥ 0.40 and were grouped into a single factor, explaining 46.3% of the variance. The Cronbach's alpha value was 0.95. Regarding convergent validity, there was a positive correlation between the CEEEC scale and the score of the Health Sciences-Evidence Based Practice scale (Pearson’s coefficient= 0.33; p < 0.001). The overall intraclass correlation coefficient was 0.91. Finally, the mean CEEEC score was 61.9 points (range 0–96). The two most positive contributions were ‘Nursing students enable nursing professionals to perform their teaching role’ and ‘Nursing students become future professionals who know the healthcare facility’. ConclusionsThe CEEEC scale provides a valid and reliable measure of nursing students' contributions to primary health care. Nursing students’ contributions to Spanish primary health care were positive, especially towards the nursing profession and healthcare organizations.

Long-term Effectiveness and Predictors of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy for Emotional Disorders in Specialized Care: Secondary Analysis of a Randomized Controlled Trial.

Transdiagnostic internet-delivered cognitive behavioral therapy (iCBT) for emotional disorders has been shown to be effective in specialized care in the short term. However, less is known about its long-term effects in this specific setting. In addition, predictors of long-term effectiveness may help to identify what treatments are more suitable for certain individuals. This study aimed to analyze the long-term effectiveness of transdiagnostic iCBT compared with that of treatment as usual (TAU) in specialized care and explore predictors of long-term effectiveness. Mixed models were performed to analyze the long-term effectiveness and predictors of transdiagnostic iCBT (n=99) versus TAU (n=101) in public specialized mental health care. Outcomes included symptoms of depression and anxiety, health-related quality of life (QoL), behavioral inhibition and behavioral activation, comorbidity, and diagnostic status (ie, loss of principal diagnosis) from baseline to 1-year follow-up. Sociodemographic characteristics (sex, age, and education) and clinical variables (principal diagnosis, comorbidity, and symptom severity at baseline) were selected as predictors of long-term changes. Compared with baseline, transdiagnostic iCBT was more effective than TAU in improving symptoms of depression (b=-4.16, SE 1.80, 95% CI -7.68 to -0.67), health-related QoL (b=7.63, SE 3.41, 95% CI 1.00-14.28), diagnostic status (b=-0.24, SE 0.09, 95% CI -1.00 to -0.15), and comorbidity at 1-year follow-up (b=-0.58, SE 0.22, 95% CI -1.00 to -0.15). From pretreatment assessment to follow-up, anxiety symptoms improved in both transdiagnostic iCBT and TAU groups, but no significant differences were found between the groups. Regarding the predictors of the long-term effectiveness of transdiagnostic iCBT compared with that of TAU, higher health-related QoL at follow-up was predicted by a baseline diagnosis of anxiety, male sex, and the use of psychiatric medication; fewer comorbid disorders at follow-up were predicted by older age and higher baseline scores on health-related QoL; and fewer depressive symptoms at follow-up were predicted by baseline diagnosis of depression. However, this pattern was not observed for baseline anxiety diagnoses and anxiety symptoms. The results suggest that transdiagnostic iCBT is more effective than TAU to target depressive symptoms among patients with emotional disorders. Anxiety symptoms remained stable at 1-year follow-up, with no differences between the groups. Results on predictors suggest that some groups of patients may obtain specific gains after transdiagnostic iCBT. Specifically, and consistent with the literature, patients with baseline depression improved their depression scores at follow-up. However, this pattern was not found for baseline anxiety disorders. More studies on the predictor role of sociodemographic and clinical variables in long-term outcomes of transdiagnostic iCBT are warranted. Future studies should focus on studying the implementation of transdiagnostic iCBT in Spanish public specialized mental health care. ClinicalTrials.gov NCT02345668; https://clinicaltrials.gov/ct2/show/NCT02345668.

Toxic Habits and Well-Being Measures in Spanish Healthcare University Students during the COVID-19 Pandemic.

Background: Unhealthy lifestyles are strongly entrenched in healthcare universities and have sometimes been linked to stress or lack of sleep. This study investigated the prevalence of toxic habits (smoking, patterns of harmful alcohol use, and illicit drug use), stress levels, perceived health status, and sleep duration and assessed the connections between toxic habits and said well-being measures, as well as healthcare students’ perception of the influence of the COVID-19 pandemic on these health-related behaviors. Methods: In a cross-sectional study, healthcare students from Alfonso X University (Spain) completed a health survey composed of Alcohol Use Disorders Identification Test (AUDIT-C), Perceived Stress Scale (PSS-10), self-perceived health status, and the number of hours of sleep. Results: A total of 997 healthcare students completed the survey, of which 982 were analyzed. Being a smoker (32.2%) was associated with worse health status and insufficient sleep. Risk drinkers (33.2%) were associated with being female, and the consumption of cannabinoids (6.7%), with being male. These three toxic habits were related to each other. High levels of stress (28.2%) were correlated with worse ratings in the perception of health status (29.2%) and with insufficient sleep (45.8%), and all of them were associated with the female sex. Respectively, 49.3% and 44.2% of students recognized a worsening in their perception of stress and their sleep habits during the pandemic. Conclusion: Healthcare universities must carry out health promotion programs for stress management, sleep habits, and unhealthy lifestyles.

A socio-ecological approach to reduce the physical activity drop-out ratio in primary care-based patients with type 2 diabetes: the SENWI study protocol for a randomized control trial

BackgroundPhysical activity (PA) is a key behaviour for patients with type 2 diabetes (T2DM). However, healthcare professionals’ (HCP) recommendations (walking advice), which are short-term and individually focused, did not reduce the PA drop-out ratio in the long run. Using a socio-ecological model approach may contribute to reducing patient dropout and improving adherence to PA. The aim of this study is threefold: first, to evaluate the effectiveness of a theory-driven Nordic walking intervention using a socio-ecological approach with T2DM patients in Spain; second, to explore the feasibility on the PA adherence process in T2DM patients while participating in the SENWI programme; and third, to understand the HCPs’ opinion regarding its applicability within the Spanish healthcare system.MethodsA three-arm randomized control trial (n = 48 each group) will assess the efficacy of two primary care-based PA interventions (Nordic walking vs. Nordic walking plus socio-ecological approach; two sessions per week for twelve weeks) compared to a control group (usual HCPs’ walking advice on PA). Inclusion criteria will include physically inactive patients with T2DM, older than 40 years and without health contraindications to do PA. PA levels and drop-out ratio, quality of life and metabolic and health outcomes will be assessed at baseline, post-intervention and at 9- and 21-month follow-ups. The effect of the different interventions will be assessed by a two-factor analysis of variance: treatment group vs time. Also, a two-factor ANOVA test will be performed with linear mixed models for repeated measures.A qualitative analysis using focus groups will explore the reasons for the (in)effectiveness of the new PA interventions. Qualitative outcomes will be assessed at post-intervention using thematic analysis.DiscussionCompared with the general PA walking advice and Nordic walking prescriptions, integrating a socio-ecological approach into Spanish primary care visits could be an effective way to reduce the PA drop-out ratio and increase PA levels in patients with T2DM. Such interventions are necessary to understand the role that multiple socio-complex process in day-to-day PA behaviour has in patients with T2DM in the Spanish context.Trial registrationClinicalTrials.gov NCT05159089. Physical Activity Drop-out Ratio in Patients’ Living with Type 2 Diabetes. Prospectively registered on 15 December 2021.

Litigation in cardiology and cardiovascular surgery: A cross-sectional observational study of liability in the Spanish public healthcare system

IntroductionThe overestimation by physicians of the risk of a lawsuit has, among other consequences, the stepped-up of defensive medicine. To analyse the characteristics of medical liability rulings in Spain in public health care in the specialties of cardiology and cardiovascular surgery. Materials and methodsCross-sectional observational study analysing the rulings handed down in the contentious-administrative jurisdiction by the High Courts of Justice in the period 2008–2020, in the specialties of cardiology and cardiovascular surgery. The variables were administrative, clinical, judicial, and compensatory. ResultsA total of 1015 rulings were analysed; 47 (4.63%) involved to the specialties of cardiology and cardiovascular surgery. Both obtained similar frequency percentages, cardiology 22 (2.2%) and cardiovascular surgery 25 (2.5%). A total of 74.1% of the rulings were dismissed in the first instance and 75% in the second instance. The 2 grounds for finding against the defendent were loss of chance 6 (42.85%) and diagnostic and/or therapeutic malpractice 5 (35.71%). Damages were usually claimed: death 21 (44.68%) and sequelae 26 (55.32%). The median award was 30 000 euros. ConclusionsThe low frequency of claims in cardiology and cardiovascular surgery indicates that these are "low risk" specialties for litigation. The vast majority of the rulings are, moreover, dismissive of the patients' claims. The data help to structure the role of lawsuits and to increase professionals' knowledge of the medical–legal dimension of health care.

Cultural Adaptation and Validation of the Premature Infant Pain Profile-Revised (PIPP-R) Pain Measurement Scale: Research Protocol.

Introduction: The main objective of this study is to validate the PIPP-R scale (Premature Infant Pain Profile-Revised) for measuring neonatal pain in the Spanish hospital setting. Materials and Methods: The original scale will be translated from English into Spanish and a consensus translation will be prepared by the research team, which will be back-translated from Spanish into English. The content validity of the Spanish version of the scale will be measured using the Delphi method. Subsequently, a multicenter observational study will be conducted to assess construct validity, internal consistency, and intra-observer and inter-observer agreement. Pain will be assessed by comparing scores for a specific non-painful procedure with those for a specific painful procedure. The sample will include 300 subjects in intensive care and intermediate care units, who will be equally distributed among the participating hospitals. The subjects will be stratified into three groups by gestational age. Discussion: The original version of the PIPP-R scale is useful for objectively assessing neonatal acute and procedural pain from a gestational age of 25 weeks and over. It is important to culturally adapt the original validated scale and to test its validity and reliability in the Spanish healthcare context. The results of this study may represent significant progress in pain management.

Evaluation of consent forms for clinical practice in Spanish Public Hospitals

ObjectiveTo evaluate the access, development, and quality of consents forms for clinical practice within the Spanish Public Hospitals. MethodA cross-sectional study was conducted in a two-stage process (January 2018–September 2021). In stage 1, A nationwide survey was undertaken across all public general hospitals (n=223) in the Spanish Healthcare System. In stage 2, Data was taken from the regional health services websites and Spanish regulations. Health Regional Departments were contacted to verify the accuracy of the findings. Data was analyzed using a descriptive and inferential statistics (frequencies, percentages, Chi-square & Fisher's exact tests). ResultsThe response rate was 123 (55.16%) of Spanish Public Hospitals. The results revealed a range of hospital departments involved in the development of consent documents and the absence of a standardized approach to consent forms nationally. Consent audits are undertaken in 43.09% hospitals and translation of written consents into other languages is limited to a minority of hospitals (35.77%). The validation process of consent documentation is not in evidence in 13% of Spanish Hospitals. Regional Informed Consent Committees are not place in the majority (70.7%) of hospitals. Citizens can freely access to consent documents through the regional websites of Andalusia and Valencia only. ConclusionVariability is found on access, development and quality of written consent across the Spanish Public Hospitals. This points to the need for a national informed consent strategy to establish policy, standards and an effective quality control system. National audits at regular intervals are necessary to improve the consistency and compliance of consent practice.

Concern about contagion and distress in intensive care unit (ICU) nurses during the COVID-19 pandemic. Motherhood as moderator

ABSTRACT The aim of this research is to analyze the role that children play between fear of contagion and distress in intensive care unit (ICU) nurses during the COVID-19 pandemic, taking into account possible work stressors. Cross-sectional study using an online survey. The selection of the sample was carried out by means of a non-probabilistic sampling for convenience, sending the link to professionals of the Spanish healthcare system who had been in contact with COVID-19 patients. Social networks were also used. Data was collected from May to July 2020. Mothers were selected from among the female nurses for participation in this study. The sample was composed of 283 female nurses working in critical care during the COVID-19 pandemic. Distress levels were significantly lower (F = 2.372, p = .048) in women with children over the age of 16 (M = 8.26, SD = 4.44) than in those without them (M = 10.30;DT = 3.75) (cohabitants). No differences were observed in worries about contagion between nurses with children (either under or over 16 years of age) and without children at home. The regression analysis found significant direct positive contributions of worries about contagion (p = .025) and the presence of children living at home (p = .033) on distress levels. We found a moderating effect of having children over 16 years old living at home in this relationship (β = 2.198, t = 2.422, p = .016, 95 percentCI = .406–3.992). Our results suggest higher levels of distress in ICU nurses who are working-mothers during COVID-19 pandemic. Living at home with children over 16 years of age has a moderating effect. Our study results point to the need to create action protocols that prepare the health system for outbreaks including early care actions with special emphasis on higher risk groups.

Mental health assessment of Spanish frontline healthcare workers during the SARS-CoV-2 pandemic

Background and objectiveThe Covid-19 pandemic continues challenging health systems globally, exposing healthcare workers to constant physical and psychological stressors. To date, several studies have already shown the catastrophic impact on the mental health of medical personnel during the early period of the pandemic. Nevertheless, literature evidences the dearth of works that evaluate the effect over time, understanding the pandemic as a sustained extreme stressor. The present study examines the effect of the pandemic on the mental health of Covid-19 frontline healthcare workers at six months follow-up. Material and methodsA total of 141 frontline healthcare workers from two tertiary hospitals were recruited between July and November 2020. Healthcare workers were evaluated psychologically at baseline and six months follow-up (January to May 2021) using psychometric tests for the assessment of acute stress (VASS, PSS-10, PCL-5), anxiety (STAI) and depression (PHQ-2) ResultsOverall, there was a general worsening of the mental health between the two psychological assessments, especially regarding depression and predisposition to perceiving the situations as a threat. Nurses and nurse aides showed poorer mental health while physicians improved over time. Reduced working hours and higher physical exercise resulted in better mental health among healthcare workers. Women and nursing staff were the most affected by psychological distress at baseline and six months follow-up. ConclusionReduced working hours, adequate resting periods, physical exercise, and efficient intervention strategies are of utmost importance in preventing, controlling, and reducing psychological distress among healthcare workers when coping with critical scenarios such as the current pandemic.

The Spanish and Italian Healthcare Professionals' Contribution to the Safety Attitudes Questionnaire Short Form in the Operating Room: Construct Validity and Reliability.

The aims of the study are to determine the construct validity and reliability of the Spanish and Italian versions of the Safety Attitudes Questionnaire Short Form and to study the capability of this scale of distinguishing between different countries, types of healthcare professionals, and attitudes around patient safety. This was a cross-sectional study of the scale among registered nurses, surgeons, and anesthetists providing direct patient care at surgical inpatient units within public health services in Spain (Sistema Nacional de Salud) and Italy (Servizio Sanitario Nazionale). Construct validity, in both countries, was firstly assessed by exploratory factor analysis. Then, a confirmatory factor analysis was conducted, and finally an assessment was performed by means of hypothesis testing. The reliability of the scale was calculated using Cronbach α coefficient. A total of 499 healthcare professionals completed the questionnaire (Spain, n = 183; Italy, n = 316). The questionnaire showed excellent internal consistency (α = 0.85). An exploratory factor analysis identified a new factor model of the scale. The confirmatory factor analysis performed on this new model reflected the fair dimensionality of the construct (χ2 = 1193.63, root mean square error of approximation &lt; 0.05, standardized root mean square residual &lt; 0.08; nonnormed fit index, comparative fit index, incremental fit index, and goodness of fit index values = 0.90, indicating a good fit). This study provides scientific evidence of the construct validity and reliability of the Safety Attitudes Questionnaire Short Form in both Spain and Italy, showing the capability of this scale of distinguishing between different countries, types of healthcare professionals, and attitudes around patient safety.

An Economic Evaluation of the Adjuvanted Quadrivalent Influenza Vaccine Compared with Standard-Dose Quadrivalent Influenza Vaccine in the Spanish Older Adult Population.

Standard-dose quadrivalent influenza vaccines (QIV) are designed to provide protection against all four influenza strains. Adjuvanted QIV (aQIV), indicated for individuals aged 65+ years, combines MF59® adjuvant (an oil-in-water emulsion of squalene oil) with a standard dose of antigen, and is designed to produce stronger and longer immune response, especially in the elderly where immunosenescence reduces vaccine effectiveness. This study evaluated the cost-effectiveness of aQIV vs. egg-based standard-dose QIV (QIVe) in the elderly population, from the payer and societal perspective in Spain. A dynamic transmission model, which accounts for herd protection, was used to predict the number of medically attended infections in Spain. A decision tree structure was used to forecast influenza-related costs and benefits. Influenza-related probabilities of outpatient visit, hospitalization, work absenteeism, mortality, and associated utilities and costs were extracted from Spanish and European published literature. Relative vaccine effectiveness (rVE) was sourced from two different meta-analyses: the first meta-analysis was informed by laboratory-confirmed influenza studies only, resulting in a rVE = 34.6% (CI95% 2–66%) in favor of aQIV; the second meta-analysis included real world evidence influenza-related medical encounters outcomes, resulting in a rVE = 13.9% (CI95% 4.2–23.5%) in benefit of aQIV. All costs were expressed in 2021 euros. Results indicate that replacing QIVe with aQIV in the Spanish elderly population would prevent on average 43,664 influenza complicated cases, 1111 hospitalizations, and 569 deaths (with a rVE = 34.6%) or 19,104 influenza complicated cases, 486 hospitalizations, and 252 deaths (with a rVE = 13.9%). When the rVE of aQIV vs. QIVe is 34.6%, the incremental cost per quality adjusted life years (QALY) gained was €2240 from the payer; from the societal perspective, aQIV was cost saving compared with QIVe. If the rVE was 13.9%, the incremental cost per QALY was €6694 and €3936 from the payer and societal perspective, respectively. Sensitivity analyses validated the robustness of these findings. Results indicate that replacing QIVe with aQIV in the Spanish elderly population is a cost-effective strategy for the Spanish healthcare system.

Obstetric Complications in Women from Sub-Saharan Africa-A Cross-Sectional Study.

Aim: The aim of this study was to identify and compare birthing complications in women originating from countries where they are at risk (may become victims) of FGM with those of Spanish women, all having given birth from 2012 to 2015 at the “Virgen de la Arrixaca” University Clinical Hospital in Murcia, Spain. Methods: A transversal, observational, quantitative study was carried out, retrospectively, comparing 245 sub-Saharan women originating from countries where FGM is practiced with 490 Spanish women, in terms of obstetric complications. Data collection was performed via electronic clinical records. Results: The sub-Saharan women presented higher rates of intrapartum and emergency caesareans, intense postpartum haemorrhages, concurrent episiotomies and tears (2nd and 3rd degree), failed inductions, and non-progressive labours, and a more severe risk of foetal distress when compared with Spanish women. Conclusions: The fact that the sub-Saharan women originating from countries where FGM is practiced presented a greater number of birthing complications than the Spanish women proves the need for Spanish healthcare professionals to receive training towards cultural competency acquisition, in order to provide a multidisciplinary approach, with standardized action protocols focused fundamentally on prevention.

Factor structure of the Maslach Burnout Inventory Human Services Survey in Spanish urgency healthcare personnel: a cross-sectional study

BackgroundThe Maslach Burnout Inventory (MBI) is an instrument commonly used to evaluate burnout syndrome. The goal of the present study was to assess the internal reliability and the performance of the items and the subscales of the MBI-HSS (the version for professionals working in human services) by validating its factorial structure in Spanish urgency healthcare personnel.MethodsCross-sectional study including 259 healthcare emergency professionals (physicians and nurses) in the Spanish health region of Lleida and the Pyrenees. Burnout was measured using the Spanish validated version of the MBI-HSS. Internal reliability was estimated using Cronbach’s alpha coefficient. The sampling adequacy was assessed using the Kaiser-Meyer-Olkin measure along with the Bartlett’s test of sphericity. A principal axis exploratory factor analysis with an oblique transformation of the solution and a confirmatory factor analysis with maximum likelihood estimation were performed. Goodness-of-fit was assessed by means of the chi-square ratio by the degrees of freedom, the standardized root mean square residual (SRMR), the root mean square error of approximation (RMSEA), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI).ResultsThe three subscales showed good internal reliability with Cronbach’s alpha coefficients exceeding the critical value of 0.7. Exploratory factor analysis revealed five factors with eigenvalues greater than 1. Nevertheless, confirmatory factor analysis showed a relatively satisfactory fit of the three-factor structure (χ2/df = 2.6, SRMR = 0.07, RMSEA = 0.08, TLI = 0.87, CFI = 0.89), which was improved when several items were removed (χ2/df = 1.7, SRMR = 0.04, RMSEA = 0.05, TLI = 0.97, CFI = 0.98).ConclusionsAlthough it is necessary exploring new samples to get to more consistent conclusions, the MBI-HSS is a reliable and factorially valid instrument to evaluate burnout syndrome in health professionals from the Spanish emergency services.

Burnout, psychopathology and purpose in life in healthcare workers during COVID-19 pandemic.

BackgroundThe COVID-19 pandemic has led to a significant increase in the workload of healthcare workers that, together with the risks associated with exposure to this new virus, has affected their mental health.ObjectivesThe objective of the current study was to determine the prevalence of psychopathology and burnout syndrome in healthcare workers and the predictive role of purpose in life and moral courage in this relationship.MethodsA cross-sectional study was carried out in 115 Spanish healthcare workers.ResultsParticipants with burnout had higher anxiety (p = 0.001), depression (p < 0.001), post-traumatic stress (p = 0.01) and alcohol consumption (p = 0.03) levels. The different components of burnout (emotional fatigue and despersonalization) were associated with the occurrence of anxiety (OR = 0.31) and depression (OR = 0.26), respectively. A strong purpose in life decreased emotional fatigue (OR = −0.39) depersonalization (OR = −0.23) scores, increased personal accomplishment (OR = 0.52), subsequently reducing burnout levels (OR = −0.45).ConclusionsPurpose in life was most strongly related to decreased levels of burnout. Furthermore, an association between anxiety, depression and the components of burnout was found.

Experiences with obstetric violence among healthcare professionals and students in Spain: A constructivist grounded theory study

BackgroundObstetric violence appears to be a worldwide concern and is defined as a type of gender-based violence perpetrated by health professionals. This violence undermines and harms women’s autonomy. In Spain, 38.3 % of women have identified themselves as victims of this type of violence. AimTo explore current information and knowledge about obstetric violence within the Spanish healthcare context, as well as to develop a theoretical model to explain the concept of obstetric violence, based on the experiences of healthcare professionals (midwives, registered nurses, gynaecologists and paediatricians) and nursing students. MethodsA constructivist grounded theory study was conducted at Jaume I University in Spain between May and July 2021, including concurrent data collection and interpretation through constant comparison analysis. An inductive analysis was carried out using the ATLAS.ti 9.0 software to organise and analyse the data. ResultsTwenty in-depth interviews were conducted, which revealed that healthcare professionals and students considered obstetric violence a violation of human rights and a serious public health issue. The interviews allowed them to describe certain characteristics and propose preventive strategies. Three main categories were identified from the data analysis: (i) characteristics of obstetric violence in the daily routine, (ii) defining the problem of obstetric violence and (iii) strategies for addressing obstetric violence. Participants identified obstetric violence as structural gender-based violence and emphasised the importance of understanding its characteristics. Our results indicate how participants’ experiences influence their process of connecting new information to prior knowledge, and they provide a connection to specific micro- and macro-level strategic plans. DiscussionDespite the lack of consensus, this study resonates with the established principles of women and childbirth care, but also generates a new theoretical model for healthcare students and professionals to identify and manage obstetric violence based on contextual factors. The term ‘obstetric violence’ offers a distinct contribution to the growing awareness of violence against women, helps to regulate it through national policy and legislation, and involves both structural and interpersonal gender-based abuse, rather than assigning blame only to care providers. ConclusionsObstetric violence is the most accurate term to describe disrespect and mistreatment as forms of interpersonal and structural violence that contribute to gender and social inequality, and the definition of this term contributes to the ongoing awareness of violence against women, which may help to regulate it through national policy and legislation.

Moral distress among healthcare professionals working in intensive care units in Spain.

To assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). Cross-sectional, prospective study. ICUs in Spain. HCPs currently working in Spanish ICUs. A 55-item questionnaire was electronically distributed. The questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). In total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40-135) than for nurses (61, IQR 35-133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46-163 vs. 61, IQR 32-117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=-0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. In the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job.

FRI504 - A cost-effectiveness evaluation of the GORE® VIATORR® TIPS Endoprosthesis versus large volume paracentesis in the management of portal hypertension complications in the Spanish healthcare system

FRI504 - A cost-effectiveness evaluation of the GORE® VIATORR® TIPS Endoprosthesis versus large volume paracentesis in the management of portal hypertension complications in the Spanish healthcare system

Analysis of Patient Satisfaction through the Effect of Healthcare Spending on Waiting Times for Consultations and Operations.

In recent years, public authorities have invested large amounts of public money in trying to reduce waiting times for consultations and operations with the aim of improving the quality of the healthcare system. Our research aims to analyze the effect of these investments on patient satisfaction through the mediating relationship of waiting times for consultations and operations, as well as from a gender perspective. By studying a series of key indicators of the Spanish healthcare system and applying partial least squares structural equation modelling (PLS-SEM), the findings show that the model explains 12.10% of the variance in consultant waiting times, 51.90% in operation waiting times, and 27.00% in patient satisfaction. We found that increased public spending leads to increased patient satisfaction by reducing waiting times. However, no gender-based differences were found. The results provide exciting implications for theory and practice, indicating how policymakers can orient their strategies towards improving patient satisfaction.

Moral distress among healthcare professionals working in intensive care units in Spain

ObjectiveTo assess moral distress (MD) among Spanish critical care healthcare professionals (HCPs). DesignCross-sectional, prospective study. SettingICUs in Spain. ParticipantsHCPs currently working in Spanish ICUs. InterventionsA 55-item questionnaire was electronically distributed. Main variablesThe questionnaire included work-related and socio-demographic characteristics, the Spanish version of the Measure of Moral Distress for Health Care Professionals (MMD-HP-SPA), and the Hospital Ethical Climate Survey (HECS). ResultsIn total, 1065 intensive care providers completed the questionnaire. Three out of four validity hypotheses were supported. MD was significantly higher for physicians (80, IQR 40–135) than for nurses (61, IQR 35–133, p=0.026). MD was significantly higher for those clinicians considering leaving their position (78, IQR 46–163 vs. 61, IQR 32–117; p<0.001). The MMD-HP-SPA was inversely correlated with the HECS (r=−0.277, p<0.001). An exploratory factor analysis revealed a four-factor structure, evidencing the patient, team, and system levels of MD. ConclusionsIn the study sample, Spanish intensivists report higher MD than nurses. Strategies to improve ICU ethical climate and to correct other related factors in order to mitigate MD at a patient, team, and system level should be implemented. Both groups of HCPs manifest a relevant intention to leave their position due to MD. Further studies are needed to determine the extent to which MD influences their desire to leave the job.

Cost-effectiveness of direct oral anticoagulants compared to low-molecular-weight-heparins for treatment of cancer associated venous thromboembolism in Spain

Aim Recent studies have compared the efficacy and safety of direct-acting oral anticoagulants (DOAC) and low-molecular-weight heparin (LMWH) for cancer-associated venous thromboembolism (VTE). However, there is no available cost-effectiveness analysis comparing DOAC and LMWH. The study aimed to conduct a cost-effectiveness analysis of DOAC (apixaban, edoxaban, and rivaroxaban) vs. LMWH for the treatment of cancer-associated VTE in Spain from the Spanish healthcare system perspective. Methods We developed a Markov model with a 12-month time horizon. The states included pulmonary embolism, deep vein thrombosis, major and non-major bleeding, chronic thromboembolic pulmonary hypertension, post-thrombotic syndrome, and death. The use of medical resources and drug costs were obtained from the 2021 Spanish Ministry of Health database, and the main references for obtaining the outcomes were derived from Caravaggio, Hokusai VTE Cancer, ADAM VTE, and SELECT-D trials. We performed a deterministic and probabilistic sensitivity analysis to validate the robustness. The Incremental Cost-Effectiveness Ratio (ICER) scores cost per life-year (€/LY) gained and cost per quality-adjusted life-year (€/QALY) gained. Results The 12-month cost of DOAC was 1,994€ (apixaban 1,944€, edoxaban 1,968€, rivaroxaban 2,122€) and 2,152€ for LMWH. The amount of QALY for DOAC was 0.54 (apixaban 0.55, rivaroxaban 0.53, and edoxaban 0.52) and 0.53 for LMWH. We observed similar results for LYs. ICER scores in terms both of €/LY and €/QALY show that DOAC is dominant over LMWH and apixaban showed the best profile. Limitations Our research is based on an indirect comparison of a short-term clinical trial. Conclusion Our results suggest that DOAC is cost-effective and cost-saving compared to LMWH in treating VTE.