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Biomedical subjects

J J Mira

Publications and source records attributed to J J Mira.

13 recordsLinked to original sources
PubMed2004

[Qualitative research: a valid alternative].

OBJECTIVE: To describe the main qualitative research techniques through systematic review of Spanish studies published during the previous 5 years. DESIGN: Systematic review. DATA SOURCES: The Indice Médico Español (bibliographic database of items published in Spanish health sciences journals) was searched, and systematic searches of the journals Atención Primaria, Gaceta Sanitaria, and Revista de Calidad Asistencial were done. Study selection. We included studies carried out with any type of qualitative research technique. Also included were studies that reviewed qualitative research techniques. We excluded studies that used a qualitative technique but were based mainly on quantitative research techniques. The review was done during the period from April 1997 to April 2002. RESULTS: Most of the studies we reviewed used only one technique (80.5%). When more than one technique was used in combination (19.5% of the articles we reviewed), focus groups and interviews were usually used. The techniques identified were focus group (used in 34% of the articles reviewed), interview (24%), the Delphi technique (10%), content analysis (8%), nominal group (8%), metaplan (2%), and Philips 6/6 (2%). CONCLUSIONS: Qualitative research is a valid alternative, and if used with appropriate methodological rigor it can be of considerable use to health care professionals.

Biomedical Research↗
PubMed2003

[Management by integrated care processes].

Processes management has a positive effect in both reducing the variability of clinical practice, and increasing therapeutic effectiveness and patients' satisfaction. In this article the different types of processes and the methods used to identify and define processes and subprocesses are described. The management by processes requires to combine information of patients' needs and expectations, and the recent evidence, describing the activities' sequence that the professionals would realize in order to obtain a positive outcome. Defining quality criteria of clinical practice and monitoring if standards are achieved are critical to obtain other of its characteristic: continuous improvement (PDCA cycle). The introduction of total quality ideas in the healthcare organizations in recent years has yielded the dissemination of the advantages of management processes in health care sector.

Delivery of Health Care, Integrated↗
PubMed2000

[Patient satisfaction as an outcome measure in health care].

In the last years an important change has taken place regarding doctor-patient relationships. One of its effects is that today healthcare results are measured in terms of effectiveness, efficiency, patient's perception of pain or autonomy, physical and mental well-being and, also, in terms of satisfaction with the achieved outcome. In literature it is easy to find studies on patient satisfaction with the conditions of hospitalization, emergencies, or visits. However, it is not usual, to find studies on patient satisfaction with medical outcomes, and this is the kind of information most relevant to clinical use. The concept of "patient-focused-care" obeys to this new position that is based on the recognition of patients' active role in the decision-making process and the notion that clinical decisions should take patients' views and perceptions into account. In this paper, the concept of patients' satisfaction is reviewed as a health outcome. The theories, instruments, methodological questions and implications of this measure are analysed in order to assess and improve the health care presently provided.

Humans↗
PubMed1999

[The variability in the care for diabetic and hypertensive patients as a function of the styles of a physician's practice].

OBJECTIVES: To analyse the variability of certain indicators of the procedure and outcome of medical care in the clinical records of diabetic and hypertense patients, and their relationship with the doctor's style of practice. DESIGN: An observational, descriptive study. SETTING: Seven health centres in the public network. PARTICIPANTS: 40 primary care doctors (all the doctors). MEASUREMENTS AND MAIN RESULTS: By means of stratified systematic random sampling, 20 clinical histories for each doctor were chosen (10 for patients diagnosed with diabetes mellitus and 10 with hypertension). The deviation ratio was used as the measurement of variability. Doctors' styles of medical practice were evaluated through the Australia questionnaire. Great variability was found in the frequency with which the different indicators of the two pathologies were recorded (deviation ratio: weight > 90.02% in DM, 81.37% in HT; height > 84.01% in DM, 77.10% in HT), and in the absolute figures (patients with HT, wide variability in all outcome indicators; patients with DM, in last figures, total and HDL cholesterol, and HbA1c). The styles of practice were shown to be related to the frequency of appearance of some indicators in the clinical records and with the quality of particular outcome indicators. The age of the doctor correlated significantly, and negatively, with the recording of almost all the indicators and their quality. CONCLUSIONS: Variability of medical practice in the care of the chronically ill seen in primary care does exist. The use of clinical practice guides is emphasised.

Adult↗
PubMed1998

[Validation of an instrument for identifying styles of the professional practice of the primary care doctor].

OBJECTIVE: To elaborate and validate a questionnaire for identifying common styles of Primary Care doctors' practice. SETTING: Primary Health Care. Public sector in Spain. DESIGN: This was a study to validate a questionnaire administered in two phases with different samples. In the first phase, the items (item-total correlation, using Alpha on eliminating item), validity of construction, empirical validity and internal consistency, were analysed. In the second, discriminatory validity and reliability of the questionnaire (test-retest) were calculated. MEASUREMENTS AND MAIN RESULTS: 81.5% of the doctors replied in the first phase; and 100% in the second. Two factors were isolated with the Principal Components procedure, which confirmed the validity of the questionnaire's construction (52% variance explained). Internal consistency (Alphas ranged between 0.55 and 0.75) and reliability (ranging between 0.50 and 0.95 in function of the time elapsed) were also demonstrated. CONCLUSIONS: This instrument could be used to differentiate two styles in practice, characterised by focusing on the physical illness vs the psycho-social aspects of the disease process. The instrument is also useful because it gives the feeling of control over the task.

Family Practice↗
PubMed1997

Assessing the impact of mental health programs upon community: the perspectives of primary caregivers and consumers.

Since 1985, there has been a significant movement in Spanish mental health services away from provision of care in psychiatric hospitals and toward a community mental health model (CMMH). This reform has ushered in changes not only for the patients but also for both their relatives and their primary caregivers. However, no survey has ever been carried out to obtain these parties' perceptions of the CMMH. Two studies have now been designed to describe the acceptability of the CMMH to these two key groups. The goals of the two projects were, firstly, to assess the opinions of primary care professionals about CMMH and, secondly, to sample the opinions of the patients' relatives regarding mental health care. In the first survey, 884 primary caregivers (general practitioners (GPs), pediatricians, nurses and social workers) filled out a 14-item questionnaire with a five-point response scale. Several aspects of care were evaluated: accessibility, referral facilities, therapeutic support, training or teaching activities, communication between primary care and mental health professionals for their mutual collaboration, and appropriateness of resources. Most of the primary caregivers reported that the community psychiatric model improved accessibility, treatment and communication between the different levels. Nurses and pediatricians reported dissatisfaction with the CMMH. In the second survey, the satisfaction of patients' relatives with the services provided by the therapists was assessed, using the Satisfaction with Therapist Questionnaire (STQ). The STQ consists of 15 items with a three-point response scale. Amount and adequacy of the information provided, accessibility, and style of conducting the appointment were assessed as measures of satisfaction. A sample of relatives of schizophrenic patients was surveyed by mail (76 relatives answered, a response rate of 31.13%). In summary, relatives were satisfied with therapists' competence but dissatisfied with their communication skills.

Adult↗
PubMed1994

[Job satisfaction and stress among general physicians in the public health system].

OBJECTIVE: To determine: 1) the level of job satisfaction and job stress among general practitioners of National Health Service, and 2) the most common sources of stress of their job. DESIGN: Descriptive study based in a meal survey with bivariate and multivariate analysis of data. SETTING: Primary Care Centers of the Valencian Health Service. SUBJECTS: 216 general practitioners were questioned. Of these 127 answered on time (102 male; age 39.55 years; response rate of 58.80%). MEASUREMENTS AND MAIN RESULTS: The Font Roja-AP Questionnaire (to evaluate job satisfaction and stress) and the Tabarca Inventory (to determine sources of stress) were used. Social relationship at work, intrinsic job satisfaction, job distension and variety at work were in hierarchy order the principal reasons of job satisfaction. On the other hand, interruptions of family life, emergency calls, monotony and practice administration and the doctor-patient communication aspects were in hierarchy order the principal reasons of job stress. CONCLUSIONS: The general practitioners work yield job satisfaction. Moderate job stress has been observed among general practitioners. The most important sources of stress were interruptions of family life and other conditions which disturb intimacy.

Adult↗
PubMed1993

[An evaluation study of a scale of diabetological education in primary care].

OBJECTIVE: To devise and evaluate a scale of measurement which would permit evaluation at primary care level, of the knowledge that diabetic patients have of diabetes. Secondly, to ascertain the level of knowledge of the sample of diabetic patients attending the Xixona Health Centre. DESIGN: Non-longitudinal, observational, descriptive study. SETTING: Primary health care (health centre). MEASUREMENTS AND MAIN RESULTS: The degree of internal consistency of the diabetes scale of knowledge (DISK) attained a Cronbach Alpha value of 0.87. The coefficients of correlation of each of the factors--defined a priori (general knowledge, diet, exercise, hygiene and self-regulation)--oscillated between 0.77 and 0.83. The Garret index of corrected difficulty was at 0.64. The homogeneity of each item with the questionnaire showed values above 0.31. The reliability measured by means of the KR20 index was 0.86. The odd-even coefficient of reliability was at 0.89. The mean level of correct answers was 70%. A relation was found between the level of knowledge and the variables age and years the patient had been subject to the condition. No relation was found with the treatment, sex, glycaemia or HbA1C level, nor educational level. CONCLUSIONS: The indices obtained by the scale can be considered to be judiciously acceptable, both in terms of their internal consistency and their ability to characterise. The DISK (ECODI) is, then, a valuable tool in the field of primary health care.

Diabetes Mellitus↗
PubMed1992

Absenteeism as a symptom of occupational ill-health in hospitals and its repercussion on quality assurance.

The purpose of the present study was to evaluate the importance of absenteeism due to illness in the hospital organization. A measurement of absenteeism due to illness among hospital professionals of the National Health System in the Alicante province (Spain) during the years 1988, 1989 and 1990 was carried out, as well as its repercussion on quality assurance in health care. The absenteeism index (frequency) was 5.39, 6.38 and 6.79 in 1988, 1989 and 1990, respectively. The extent of absenteeism (duration) in 1988 was 19.7 days per worker, and was 24.23 in 1989 and 26.45 in 1990. Hospitals with more than 400 beds presented during these periods poor absenteeism self-control. Maintenance personnel, nurses, administrative personnel and graduates had, in this order, the highest scores of days lost. We show that the dimension of Intrinsic Job Satisfaction, Extrinsic Job Satisfaction and Job Monotony are interrelated with absenteeism.

Absenteeism↗
PubMedDate not supplied

[What do patients think of public hospitals? Analysis of the perceived quality levels of 5 hospitals].

OBJECTIVE: To compare the opinions of patients assisted in 5 hospitals. DESIGN: Descriptive study based in a survey by mail has been used in all cases. INSTRUMENTS: The SERVQHOS questionnaire. SUBJECTS: 930 patients. Answer rate around 35%. RESULTS: 19% of the patients would not recommend the hospital. 59.2% was shown satisfied and 3.1% very unsatisfied. To know the doctor's and nurse's name were related to perceived quality. The frequency with which the patients said to have been correctly informed was not related to quality. Neither age nor patient's sex showed a relationship with perceived quality. CONCLUSION: The patients value the hospital positively although there are an important number of unsatisfied patients.

Adult↗