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      Estándares de calidad en Atención Primaria para pacientes con espondiloartritis axial. Una revisión de la literatura Translated title: Quality standards in Primary Care for patients with axial spondyloarthritis. A literature review

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          Abstract

          RESUMEN Introducción: la espondiloartritis axial (Esp-Ax) es una enfermedad inflamatoria crónica del esqueleto axial. Su inicio insidioso y baja prevalencia dificultan un diagnóstico temprano. Por eso cada vez más el involucramiento de la Atención Primaria y el médico de familia gana más relevancia para una adecuada coordinación para el control de la enfermedad y la detección oportuna de comorbilidades. El objetivo de este estudio fue identificar estándares de calidad para la atención de pacientes con Esp-Ax con especial énfasis en la Atención Primaria. Métodos: se hizo una revisión de la literatura en las siguientes bases de datos: MEDLINE, EMBASE y Cochrane Library para la identificación de publicaciones y literatura gris que validen o reporten estándares de calidad para la atención de pacientes con Esp-Ax, con especial énfasis en la Atención Primaria. No se aplicaron restricciones de idioma, fecha ni de tipología de documentos para obtener una búsqueda más amplia. Resultado: fueron identificados 161 documentos, de los cuales 3 cumplieron con los criterios de inclusión. Los estándares fueron agrupados siguiendo el modelo de Donabedian, 7 estándares de estructura, 3 estándares de proceso y 10 estándares de resultado. Conclusiones: la mejora de la práctica clínica depende de la identificación de oportunidades de mejora. Los estándares de calidad persiguen este objetivo, para disminuir la variabilidad clínica, mejorar los resultados y aumentar la satisfacción de las personas con la atención prestada.

          Translated abstract

          ABSTRACT Introduction: axial spondyloarthritis is a chronic inflammatory disease of the axial skeleton. Its insidious onset and low prevalence make early diagnosis difficult. Therefore, the involvement of primary care and family physicians is becoming more relevant for adequate coordination for control of the disease and the timely detection of comorbidities. The aim of this study was to identify quality standards for the care of Sp-Ax patients with a special emphasis on primary care. Methods: a literature review was performed in the following databases: MEDLINE, EMBASE, and Cochrane Library to identify publications and grey literature that validate or report quality standards for the care of Sp-Ax patients with a special emphasis on primary care. No language, date or document type restrictions were made to obtain a broader search. Result: a total of 161 documents were identified of which three met the inclusion criteria. The standards were grouped according to the Donabedian model, seven structure standards, three process standards, and 10 outcome standards. Conclusions: improving clinical practice depends on identifying opportunities for improvement. Quality standards pursue this objective to reduce clinical variability, improve outcomes and increase people's satisfaction with the care provided.

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          Most cited references22

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          Axial spondyloarthritis.

          The term axial spondyloarthritis covers both patients with non-radiographic and radiographic axial spondyloarthritis, which is also termed ankylosing spondylitis. The disease usually starts in the third decade of life with a male to female ratio of two to one for radiographic axial spondyloarthritis and of one to one for non-radiographic axial spondyloarthritis. More than 90% heritabilty has been estimated, the highest genetic association being with HLA-B27. The pathogenic role of HLA-B27 is still not clear although various hypotheses are available. On the basis of evidence from trials the cytokines tumour necrosis factor (TNF)-α and interleukin-17 appear to have a relevant role in pathogenesis. The mechanisms of interaction between inflammation and new bone formation is still not completely understood but clarification will be important for the prevention of long-term structural damage of the bone. The development of new criteria for classification and for screening of patients with axial spondyloarthritis have been crucial for the early indentification and treatment of such patients, with MRI being the most important existing imaging method. Non-steroidal anti-inflammatory drugs and TNF blockers are effective therapies. Blockade of interleukin-17 is a new and relevant treatment option.
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            Evaluating the quality of medical care.

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              Development and Validation of an Instrument for Assessing Patient Experience of Chronic Illness Care

              Introduction: The experience of chronic patients with the care they receive, fuelled by the focus on patient-centeredness and the increasing evidence on its positive relation with other dimensions of quality, is being acknowledged as a key element in improving the quality of care. There are a dearth of accepted tools and metrics to assess patient experience from the patient’s perspective that have been adapted to the new chronic care context: continued, systemic, with multidisciplinary teams and new technologies. Methods: Development and validation of a scale conducting a literature review, expert panel, pilot and field studies with 356 chronic primary care patients, to assess content and face validities and reliability. Results: IEXPAC is an 11+1 item scale with adequate metric properties measured by Alpha Chronbach, Goodness of fit index, and satisfactory convergence validity around three factors named: productive interactions, new relational model and person’s self-management. Conclusions: IEXPAC allows measurement of the patient experience of chronic illness care. Together with other indicators, IEXPAC can determine the quality of care provided according to the Triple Aim framework, facilitating health systems reorientation towards integrated patient-centred care.
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                Author and article information

                Journal
                albacete
                Revista Clínica de Medicina de Familia
                Rev Clin Med Fam
                Sociedad Española de Medicina de Familia y Comunitaria (Barcelona, Cataluña, Spain )
                1699-695X
                2386-8201
                2022
                : 15
                : 3
                : 143-146
                Affiliations
                [7] Elche Valencia orgnameUniversidad Miguel Hernández de Elche Spain
                [3] Sabadell orgnameCentro de Atención Primaria Gracia-Merinales España
                [6] Alicante orgnameDepartamento de Salud Alicante-Sant Joan España
                [8] Alicante orgnameRed de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC) España
                [5] Barcelona orgnameHospital Universitari de Bellvitge Spain
                [1] Cádiz Andalucía orgnameUniversidad de Cádiz Spain
                [2] Sant Joan d'Alacant orgnameFundación para el Fomento de la Investigación Sanitaria y Biomédica (FISABIO) orgdiv1Grupo de Investigación Atenea España
                [4] Alcorcón Madrid orgnameHospital Universitario Fundación Alcorcón España
                Article
                S1699-695X2022000300004 S1699-695X(22)01500300004
                cec835b8-4b8e-48ea-bc81-8fbbd7fbeedc

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 03 July 2022
                : 16 February 2022
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 22, Pages: 4
                Product

                SciELO Spain

                Categories
                Originales

                Quality of Care,Primary Care,calidad asistencial,Atención Primaria,espondiloartritis,Spondyloarthritis

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