Carlos Calderón - Academia.edu (original) (raw)
Papers by Carlos Calderón
Gaceta Sanitaria, 2019
para la promoción comunitaria del ejercicio físico en personas mayores mediante rutas saludables ... more para la promoción comunitaria del ejercicio físico en personas mayores mediante rutas saludables en colaboración con ayuntamientos, asociaciones ciudadanas y atención primaria. Objetivo: Evaluar desde la perspectiva de los participantes la experiencia Ttipi-Ttapa en el periodo 2012-2017 para identificar los principales aciertos y carencias y compartir propuestas de continuidad y mejora. Método: Diseño mixto con investigación cualitativa central y encuesta suplementaria a todos los caminantes en salidas en 13 localidades. Test de ji al cuadrado para comparación de porcentajes. En el estudio cualitativo, muestreo intencional con diferentes perfiles de participantes mediante nueve grupos focales y 10 entrevistas individuales. Grabación en audio previo consentimiento. Análisis temático con ayuda de mapas conceptuales y el programa MAXQDA. Triangulación entre investigadores en un contexto de investigación-aprendizaje. Resultados: Se analizaron 464 cuestionarios; 64% mujeres y 36% hombres. Edad media 69,8 años y 75% mayores de 65 años. Satisfacción general de 9,05/10, con diferencias significativas a favor de las mujeres, los grupos de mayor edad y las personas viudas. En el estudio cualitativo participaron 43 mujeres y 37 hombres. Se identifican tres áreas temáticas principales a partir de las categorías codificadas y sus solapamientos: a) no solo es caminar; b) organización, valores y personas; y c) claves colaborativas y retos de futuro. Conclusiones: Los beneficios percibidos en salud desbordan el ejercicio físico con implicaciones importantes en la interacción y la cohesión social. La complejidad de los procesos evaluados conlleva exigencias metodológicas, organizativas y colaborativas.
Revista Facultad Nacional de Salud Pública, 2015
Resumen La investigación cualitativa (IC) posibilita la apertura de las ciencias de la salud al c... more Resumen La investigación cualitativa (IC) posibilita la apertura de las ciencias de la salud al conocimiento y transformación de realidades complejas como las que caracterizan la atención primaria (AP) y los servicios sanitarios. La ap representa el contexto idóneo para la prestación de una asistencia de calidad, integral, equitativa y orientada a las personas y a la comunidad, pero, a su vez, resulta especialmente vulnerable al actual cuestionamiento de los sistemas públicos y a la reducción de la ciencia y de la buena práctica al diseño experimental y a la cuantificación numérica de actividades. La justificación y los retos metodológicos del desarrollo de la ic en la ap requieren discutirse atendiendo a dichas particularidades. Desde esa perspectiva, se comparten algunas reflexiones sobre las exigencias y dificultades de la labor asistencial, v33s1a19la implantación de sistemas de registro e información inadecuados y los efectos paradójicos de la difusión de la medicina basada en ...
Revista Facultad Nacional de Salud Pública, 2015
Una mirada ética y de justicia social en el medio sanitario no puede quedar reducida al ámbito de... more Una mirada ética y de justicia social en el medio sanitario no puede quedar reducida al ámbito de lo retórico ni a los factores macroeconómicos, sociológicos y políticos que condicionan los sistemas sanitarios y las estrategias dominantes de desarrollo de la investigación y del conocimiento en salud. Las prácticas en salud son cuestiones sociales complejas, condicionadas por ámbitos de escala mayor, pero en las que también intervienen dimensiones de escala menor en el ejercicio de la labor cotidiana, bien sea como profesionales, investigadores, docentes o como ciudadanos. En este trabajo se recogen algunas reflexiones compartidas entre estudiantes, académicos, investigadores y docentes interesados en la investigación cualitativa para tratar de identificar posibles vías de respuesta a los principales problemas éticos y de justicia social que se presentan en la práctica de la investigación cualitativa en el medio sanitario.
Revista Facultad Nacional de Salud Pública, 2009
Objetivo: profundizar en las percepciones de los medicos de familia y de los pacientes acerca las... more Objetivo: profundizar en las percepciones de los medicos de familia y de los pacientes acerca las actividades de promocion ante el tabaco, ejercicio, alcohol y dieta. Metodologia: metodologia cualitativa. Obtencion de la informacion mediante dos grupos de discusion de medicos y dos de pacientes que habian participado en intervenciones previas. Como modelo de analisis se utilizo el analisis sociologico del discurso. Validada mediante triangulacion entre los investigadores. Resultados: las actividades de promocion de la salud en AP son percibidas de modo diferente por los medicos y los pacientes en funcion de sus correspondientes contextos sanitarios y sociales. Dichas perspectivas y contextos pueden representarse en torno a dos ejes: uno, de interrelacion profesionales sanitarios-pacientes, y otro entre el polo de orientacion mas biomedica, parcelar y orientado a la enfermedad y el polo que representa las visiones mas integrales y orientadas a la salud. Conclusiones: los resultados d...
espanolToda investigacion requiere rigor metodologico y una actitud de revision continua de lo re... more espanolToda investigacion requiere rigor metodologico y una actitud de revision continua de lo realizado y sus efectos. Desde la experiencia de la investigacion cualitativa “Percepciones, actitudes y conductas del personal medico de atencion primaria del Pais Vasco ante las consultas sagradas”, en el presente articulo se analizan los requisitos eticos de la practica investigadora y se reflexiona sobre los retos acontecidos en el proceso de dicha investigacion. La etica atraviesa y abarca todo el proceso investigador: desde lo practico y reflexivo, a las decisiones metodologicas y de procedimiento, hasta los posicionamientos epistemologicos. En esta tarea es necesaria la actitud reflexiva del equipo investigador respecto a los principios y requisitos eticos mas alla de su mero cumplimiento formal. Han de considerarse los condicionantes contextuales del equipo investigador, de las personas investigadas y del objeto de estudio, situando a la etica de la investigacion en un necesario y ...
International Journal of Integrated Care, 2019
Bitarte Revista Cuatrimestral De Humanidades, 1996
Bitarte: Revista cuatrimestral de Humanidades, 1999
... En español. Resultado de la búsqueda, 1-1/1, Seleccionar todos Título: Médicos y pacientes:al... more ... En español. Resultado de la búsqueda, 1-1/1, Seleccionar todos Título: Médicos y pacientes:algo más que una simple relación Autores: Calderon, Carlos Revista: Bitarte : Revista cuatrimestral de Humanidades, 1999 ABR; (17) Página(s): 67-78 ISSN: 11336110. ...
BMC Health Services Research, 2009
Background: The philosophy of evidence-based medicine (EBM) was introduced in the early 90s as a ... more Background: The philosophy of evidence-based medicine (EBM) was introduced in the early 90s as a new approach to the practice of medicine, using the best available evidence to make decisions about health care. Despite ongoing controversy, EBM has developed enormously and physicians' attitude towards it is generally positive. Nevertheless, in Spain little is known about this topic. We will therefore undertake a study to explore perceptions, attitudes and knowledge about EBM among primary care physicians. Methods and design: A mixed-method study combining qualitative and quantitative designs will target family practitioners in Spain with the objective of evaluating current attitudes and perceptions about evidence-based medicine. The project will consist of two phases: a first phase running focus groups to identify perceptions and attitudes of participants, and a second phase assessing their attitudes and knowledge about EBM by means of a survey. Both phases will explore these issues in three different subgroups: family practitioners, with or without previous formal education in EBM; members of working groups that formulate healthcare recommendations; and physicians in charge of training family practice residents. Additionally, we will undertake a systematic review to identify and synthesize the available evidence on this topic. Discussion: The study will identify and gain insight into the perceived problems and barriers to the practice of evidence-based medicine among general practitioners in Spain. The project will also evaluate the main knowledge gaps and training needs, and explore how evidence-based medicine is being taught to family medicine residents, the medical practitioners of the future. Our results will aid researchers and health care planners in developing strategies to improve the practice of evidence-based medicine in our country.
BMC Family Practice, 2011
Background: Evidence based medicine (EBM) has made a substantial impact on primary care in Spain ... more Background: Evidence based medicine (EBM) has made a substantial impact on primary care in Spain over the last few years. However, little research has been done into family physicians (FPs)' attitudes related to EBM. The present study investigates FPs' perceptions of EBM in the primary care context. Methods: This study used qualitative methodology. Information was obtained from 8 focus groups composed of 67 FPs from 47 health centers in 4 autonomous regions in Spain. Intentional sampling considered participants' previous education in EBM, and their experience as tutors in family medicine or working groups' members of the Spanish Society of Family Practice. Sociological discourse analysis was used with the support of the MAXqda software. Results were validated by means of triangulation among researchers and contrast with participants. Results: Findings were grouped into three main areas: 1) The tug-of-war between the "science" of EBM and "experience" in the search for good clinical practice in primary care; 2) The development of EBM sensemaking as a reaction to contextual factors and interests; 3) The paradox of doubt and trust in the new EBM experts. The meaning of EBM was dynamically constructed within the primary care context. FPs did not consider good clinical practice was limited to the vision of science that EBM represents. Its use appeared to be conditioned by several factors that transcended the common concept of barriers. Along with concerns about its objectivity, participants showed a tendency to see EBM as the use of simplified guidelines developed by EBM experts. Conclusions: The identification of science with EBM and its recognition as a useful but insufficient tool for the good clinical practice requires rethinking new meanings of evidence within the primary care reality. Beyond the barriers related to accessing and putting into practice the EBM, its reactive use can determine FPs' questions and EBM development in a direction not always centred on patients' needs. The questioning of experts' authority as a pillar of EBM could be challenged by the emergence of new kinds of EBM texts and experts to believe in.
BMC health services research, Jan 23, 2006
The GRADE method represents a new approach to grading the quality of evidence and strength of rec... more The GRADE method represents a new approach to grading the quality of evidence and strength of recommendations in the preparation of Clinical Practice Guidelines (CPG). In the context of a pilot study to assess the implementability of the system in Spain, we considered it relevant to gain an insight into the significance of the perceptions and attitudes expressed by the actual experts participating in the system try-out. Qualitative research with an ethnographic approach, through non-participant observation and focus groups within the context of a consensus workshop in which 19 CPG experts participated to evaluate the GRADE proposal using 12 evidence tables taken from hypertension, asthma and arthritis CPGs. The interventions were recorded, under a guarantee of confidentiality. The transcriptions and field notes were analyzed, based on a sociological discourse analysis model, and the provisional findings were re-sent to participants in order to improve their validity. 1) Certain prob...
Atencion primaria / Sociedad Espanola de Medicina de Familia y Comunitaria, Jan 29, 2015
To implement and assess a collaborative experience between Primary Care (PC) and Mental Health (M... more To implement and assess a collaborative experience between Primary Care (PC) and Mental Health (MH) in order to improve the care of patients with depression. Pilot collaborative project from a participatory action research approach during 2013. Basque Country. Osakidetza (Basque Health Service). Bizkaia and Gipuzkoa. The study included 207 professionals from general practice, nursing, psychiatry, psychiatric nursing, psychology and social work of 9 health centres and 6 mental health centres of Osakidetza. Shared design and development of four axes of intervention: 1) Communication and knowledge between PC and MH professionals, 2) Improvement of diagnostic coding and referral of patients, 3) Training programmes with meetings and common Clinical Practice Guidelines, and 4) Evaluation. Intervention and control questionnaires to professionals of the centres on the knowledge and satisfaction in the PC-MH relationship, joint training activities, and assessment of the experience. Osakidetz...
Revista Española de Salud Pública
The importance of gaining further knowledge as to the health-related needs and expectations of in... more The importance of gaining further knowledge as to the health-related needs and expectations of individuals, as well as of the factors involved in the effectiveness of health care activities, particularly of the professionals proper, make it possible to anticipate a boom in Qualitative Research in fields such as Public Health and Health Service Research. Such an increase should go hand in hand with a progressive improvement in the quality of the outcomes of research, to which end tools for assessing said quality are required. However, the epistemological implications of the qualitative focus contribute to the setting of the bounds of these tolls having been a source of controversy at both the conceptual level as well as with regard to the methods and techniques to be employed, although without hardly any involvement on the part of the health sciences in our country. This article provides a brief review of the main points of reference of said debate and, after stressing the importance of the theoretical development and of precision in practice, as well as the function of the guides with regard thereto, the epistemological adaptation, relevance, validity and reflexivity as possible basic criteria for the assessment of the quality of Qualitative Research are proposed.
Ciência & saúde coletiva, 2012
Qualitative research constitutes a necessary perspective of knowledge within the field of health ... more Qualitative research constitutes a necessary perspective of knowledge within the field of health services. Healthcare always occurs in complex contexts and its enhancement requires research methodologies that address this complexity. Nevertheless, the knowledge and use of qualitative research in health services is still very limited. Among the different factors that affect its development, the teaching and learning of qualitative research proves to be fundamental, even beyond undergraduate education. Healthcare professionals and health services present certain specific aspects that must be considered in the design and development of the teaching and learning of qualitative research. Based on an eight-year online training experience with Primary Healthcare professionals, the main challenges are indentified and discussed.
Journal of Epidemiology & Community Health, 2010
Social values and the political context have an influence on the use and spread of health impact ... more Social values and the political context have an influence on the use and spread of health impact assessment (HIA). In Spain, there is little experience in HIA but some regional governments are already introducing it. The aim of this article is to describe the health impacts of a local regeneration project to improve accessibility in a neighbourhood of Bilbao (Spain), and discuss the main difficulties, opportunities and challenges of the process, considering the specificities of the social and political context. A concurrent and prospective assessment, based on a broad model of health, was carried out following the Merseyside guidelines. A literature review, community profiling and qualitative data collection were undertaken. Profound involvement of members of the community and key informants was judged as essential in the HIA process. The overall expected effect of the new lifts, roads, park and the rainwater collection system was positive. Uncertain or negative impacts were identified in some of those areas, and also concerning the burying of four high-voltage power lines. Historical and current characteristics of the community were highly influential on the way local people perceived the project and its impacts. Likewise, the way in which processes of planning and implementation were developing also played an important role. The spread of HIA in southern European countries will depend on the progressive introduction of values underlying HIA, as well as on the promotion of intersectoral work, a better knowledge of the social model of health and community's participation in policy making.
Hacia la promoción de la salud
Atención primaria de salud: por qué, dónde y cómo Poco se puede añadir, en unas breves líneas, a ... more Atención primaria de salud: por qué, dónde y cómo Poco se puede añadir, en unas breves líneas, a lo mucho que se ha publicado en relación a la importancia de la atención primaria de salud-APS-. No obstante, la realidad de su desigual desarrollo y de sus graves carencias y amenazas en gran parte de los países, permite señalar al menos tres ámbitos de reflexión y debate tanto en el plano teórico como en el compromiso práctico de impulsar la APS como servicio público imprescindible.
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 16, 2015
To classify and identify the main characteristics of the tools used in practice to assess the imp... more To classify and identify the main characteristics of the tools used in practice to assess the impact of elderly caregiving on the informal carers' life. A systematic review of literature was performed searching in Embase, MEDLINE, PsycINFO, CINAHL, IBECS, LILACS, SiiS, SSCI and Cochrane Library from 2009 to 2013 in English, Spanish, Portuguese and French, and in reference lists of included papers. The review included 79 studies, among them several in languages other than English. Their inclusion increased the variety of identified tools to measure this impact (n = 93) and allowed a wider analysis of their geographical use. While confirming their overlapping nature, instruments were classified according to the degree of integration of dimensions they evaluated and their specificity to the caregiving process: caregiver burden (n = 20), quality of life and well-being (n = 11), management and coping (n = 21), emotional and mental health (n = 29), psychosocial impact (n = 10), physic...
Gaceta Sanitaria, 2019
para la promoción comunitaria del ejercicio físico en personas mayores mediante rutas saludables ... more para la promoción comunitaria del ejercicio físico en personas mayores mediante rutas saludables en colaboración con ayuntamientos, asociaciones ciudadanas y atención primaria. Objetivo: Evaluar desde la perspectiva de los participantes la experiencia Ttipi-Ttapa en el periodo 2012-2017 para identificar los principales aciertos y carencias y compartir propuestas de continuidad y mejora. Método: Diseño mixto con investigación cualitativa central y encuesta suplementaria a todos los caminantes en salidas en 13 localidades. Test de ji al cuadrado para comparación de porcentajes. En el estudio cualitativo, muestreo intencional con diferentes perfiles de participantes mediante nueve grupos focales y 10 entrevistas individuales. Grabación en audio previo consentimiento. Análisis temático con ayuda de mapas conceptuales y el programa MAXQDA. Triangulación entre investigadores en un contexto de investigación-aprendizaje. Resultados: Se analizaron 464 cuestionarios; 64% mujeres y 36% hombres. Edad media 69,8 años y 75% mayores de 65 años. Satisfacción general de 9,05/10, con diferencias significativas a favor de las mujeres, los grupos de mayor edad y las personas viudas. En el estudio cualitativo participaron 43 mujeres y 37 hombres. Se identifican tres áreas temáticas principales a partir de las categorías codificadas y sus solapamientos: a) no solo es caminar; b) organización, valores y personas; y c) claves colaborativas y retos de futuro. Conclusiones: Los beneficios percibidos en salud desbordan el ejercicio físico con implicaciones importantes en la interacción y la cohesión social. La complejidad de los procesos evaluados conlleva exigencias metodológicas, organizativas y colaborativas.
Revista Facultad Nacional de Salud Pública, 2015
Resumen La investigación cualitativa (IC) posibilita la apertura de las ciencias de la salud al c... more Resumen La investigación cualitativa (IC) posibilita la apertura de las ciencias de la salud al conocimiento y transformación de realidades complejas como las que caracterizan la atención primaria (AP) y los servicios sanitarios. La ap representa el contexto idóneo para la prestación de una asistencia de calidad, integral, equitativa y orientada a las personas y a la comunidad, pero, a su vez, resulta especialmente vulnerable al actual cuestionamiento de los sistemas públicos y a la reducción de la ciencia y de la buena práctica al diseño experimental y a la cuantificación numérica de actividades. La justificación y los retos metodológicos del desarrollo de la ic en la ap requieren discutirse atendiendo a dichas particularidades. Desde esa perspectiva, se comparten algunas reflexiones sobre las exigencias y dificultades de la labor asistencial, v33s1a19la implantación de sistemas de registro e información inadecuados y los efectos paradójicos de la difusión de la medicina basada en ...
Revista Facultad Nacional de Salud Pública, 2015
Una mirada ética y de justicia social en el medio sanitario no puede quedar reducida al ámbito de... more Una mirada ética y de justicia social en el medio sanitario no puede quedar reducida al ámbito de lo retórico ni a los factores macroeconómicos, sociológicos y políticos que condicionan los sistemas sanitarios y las estrategias dominantes de desarrollo de la investigación y del conocimiento en salud. Las prácticas en salud son cuestiones sociales complejas, condicionadas por ámbitos de escala mayor, pero en las que también intervienen dimensiones de escala menor en el ejercicio de la labor cotidiana, bien sea como profesionales, investigadores, docentes o como ciudadanos. En este trabajo se recogen algunas reflexiones compartidas entre estudiantes, académicos, investigadores y docentes interesados en la investigación cualitativa para tratar de identificar posibles vías de respuesta a los principales problemas éticos y de justicia social que se presentan en la práctica de la investigación cualitativa en el medio sanitario.
Revista Facultad Nacional de Salud Pública, 2009
Objetivo: profundizar en las percepciones de los medicos de familia y de los pacientes acerca las... more Objetivo: profundizar en las percepciones de los medicos de familia y de los pacientes acerca las actividades de promocion ante el tabaco, ejercicio, alcohol y dieta. Metodologia: metodologia cualitativa. Obtencion de la informacion mediante dos grupos de discusion de medicos y dos de pacientes que habian participado en intervenciones previas. Como modelo de analisis se utilizo el analisis sociologico del discurso. Validada mediante triangulacion entre los investigadores. Resultados: las actividades de promocion de la salud en AP son percibidas de modo diferente por los medicos y los pacientes en funcion de sus correspondientes contextos sanitarios y sociales. Dichas perspectivas y contextos pueden representarse en torno a dos ejes: uno, de interrelacion profesionales sanitarios-pacientes, y otro entre el polo de orientacion mas biomedica, parcelar y orientado a la enfermedad y el polo que representa las visiones mas integrales y orientadas a la salud. Conclusiones: los resultados d...
espanolToda investigacion requiere rigor metodologico y una actitud de revision continua de lo re... more espanolToda investigacion requiere rigor metodologico y una actitud de revision continua de lo realizado y sus efectos. Desde la experiencia de la investigacion cualitativa “Percepciones, actitudes y conductas del personal medico de atencion primaria del Pais Vasco ante las consultas sagradas”, en el presente articulo se analizan los requisitos eticos de la practica investigadora y se reflexiona sobre los retos acontecidos en el proceso de dicha investigacion. La etica atraviesa y abarca todo el proceso investigador: desde lo practico y reflexivo, a las decisiones metodologicas y de procedimiento, hasta los posicionamientos epistemologicos. En esta tarea es necesaria la actitud reflexiva del equipo investigador respecto a los principios y requisitos eticos mas alla de su mero cumplimiento formal. Han de considerarse los condicionantes contextuales del equipo investigador, de las personas investigadas y del objeto de estudio, situando a la etica de la investigacion en un necesario y ...
International Journal of Integrated Care, 2019
Bitarte Revista Cuatrimestral De Humanidades, 1996
Bitarte: Revista cuatrimestral de Humanidades, 1999
... En español. Resultado de la búsqueda, 1-1/1, Seleccionar todos Título: Médicos y pacientes:al... more ... En español. Resultado de la búsqueda, 1-1/1, Seleccionar todos Título: Médicos y pacientes:algo más que una simple relación Autores: Calderon, Carlos Revista: Bitarte : Revista cuatrimestral de Humanidades, 1999 ABR; (17) Página(s): 67-78 ISSN: 11336110. ...
BMC Health Services Research, 2009
Background: The philosophy of evidence-based medicine (EBM) was introduced in the early 90s as a ... more Background: The philosophy of evidence-based medicine (EBM) was introduced in the early 90s as a new approach to the practice of medicine, using the best available evidence to make decisions about health care. Despite ongoing controversy, EBM has developed enormously and physicians' attitude towards it is generally positive. Nevertheless, in Spain little is known about this topic. We will therefore undertake a study to explore perceptions, attitudes and knowledge about EBM among primary care physicians. Methods and design: A mixed-method study combining qualitative and quantitative designs will target family practitioners in Spain with the objective of evaluating current attitudes and perceptions about evidence-based medicine. The project will consist of two phases: a first phase running focus groups to identify perceptions and attitudes of participants, and a second phase assessing their attitudes and knowledge about EBM by means of a survey. Both phases will explore these issues in three different subgroups: family practitioners, with or without previous formal education in EBM; members of working groups that formulate healthcare recommendations; and physicians in charge of training family practice residents. Additionally, we will undertake a systematic review to identify and synthesize the available evidence on this topic. Discussion: The study will identify and gain insight into the perceived problems and barriers to the practice of evidence-based medicine among general practitioners in Spain. The project will also evaluate the main knowledge gaps and training needs, and explore how evidence-based medicine is being taught to family medicine residents, the medical practitioners of the future. Our results will aid researchers and health care planners in developing strategies to improve the practice of evidence-based medicine in our country.
BMC Family Practice, 2011
Background: Evidence based medicine (EBM) has made a substantial impact on primary care in Spain ... more Background: Evidence based medicine (EBM) has made a substantial impact on primary care in Spain over the last few years. However, little research has been done into family physicians (FPs)' attitudes related to EBM. The present study investigates FPs' perceptions of EBM in the primary care context. Methods: This study used qualitative methodology. Information was obtained from 8 focus groups composed of 67 FPs from 47 health centers in 4 autonomous regions in Spain. Intentional sampling considered participants' previous education in EBM, and their experience as tutors in family medicine or working groups' members of the Spanish Society of Family Practice. Sociological discourse analysis was used with the support of the MAXqda software. Results were validated by means of triangulation among researchers and contrast with participants. Results: Findings were grouped into three main areas: 1) The tug-of-war between the "science" of EBM and "experience" in the search for good clinical practice in primary care; 2) The development of EBM sensemaking as a reaction to contextual factors and interests; 3) The paradox of doubt and trust in the new EBM experts. The meaning of EBM was dynamically constructed within the primary care context. FPs did not consider good clinical practice was limited to the vision of science that EBM represents. Its use appeared to be conditioned by several factors that transcended the common concept of barriers. Along with concerns about its objectivity, participants showed a tendency to see EBM as the use of simplified guidelines developed by EBM experts. Conclusions: The identification of science with EBM and its recognition as a useful but insufficient tool for the good clinical practice requires rethinking new meanings of evidence within the primary care reality. Beyond the barriers related to accessing and putting into practice the EBM, its reactive use can determine FPs' questions and EBM development in a direction not always centred on patients' needs. The questioning of experts' authority as a pillar of EBM could be challenged by the emergence of new kinds of EBM texts and experts to believe in.
BMC health services research, Jan 23, 2006
The GRADE method represents a new approach to grading the quality of evidence and strength of rec... more The GRADE method represents a new approach to grading the quality of evidence and strength of recommendations in the preparation of Clinical Practice Guidelines (CPG). In the context of a pilot study to assess the implementability of the system in Spain, we considered it relevant to gain an insight into the significance of the perceptions and attitudes expressed by the actual experts participating in the system try-out. Qualitative research with an ethnographic approach, through non-participant observation and focus groups within the context of a consensus workshop in which 19 CPG experts participated to evaluate the GRADE proposal using 12 evidence tables taken from hypertension, asthma and arthritis CPGs. The interventions were recorded, under a guarantee of confidentiality. The transcriptions and field notes were analyzed, based on a sociological discourse analysis model, and the provisional findings were re-sent to participants in order to improve their validity. 1) Certain prob...
Atencion primaria / Sociedad Espanola de Medicina de Familia y Comunitaria, Jan 29, 2015
To implement and assess a collaborative experience between Primary Care (PC) and Mental Health (M... more To implement and assess a collaborative experience between Primary Care (PC) and Mental Health (MH) in order to improve the care of patients with depression. Pilot collaborative project from a participatory action research approach during 2013. Basque Country. Osakidetza (Basque Health Service). Bizkaia and Gipuzkoa. The study included 207 professionals from general practice, nursing, psychiatry, psychiatric nursing, psychology and social work of 9 health centres and 6 mental health centres of Osakidetza. Shared design and development of four axes of intervention: 1) Communication and knowledge between PC and MH professionals, 2) Improvement of diagnostic coding and referral of patients, 3) Training programmes with meetings and common Clinical Practice Guidelines, and 4) Evaluation. Intervention and control questionnaires to professionals of the centres on the knowledge and satisfaction in the PC-MH relationship, joint training activities, and assessment of the experience. Osakidetz...
Revista Española de Salud Pública
The importance of gaining further knowledge as to the health-related needs and expectations of in... more The importance of gaining further knowledge as to the health-related needs and expectations of individuals, as well as of the factors involved in the effectiveness of health care activities, particularly of the professionals proper, make it possible to anticipate a boom in Qualitative Research in fields such as Public Health and Health Service Research. Such an increase should go hand in hand with a progressive improvement in the quality of the outcomes of research, to which end tools for assessing said quality are required. However, the epistemological implications of the qualitative focus contribute to the setting of the bounds of these tolls having been a source of controversy at both the conceptual level as well as with regard to the methods and techniques to be employed, although without hardly any involvement on the part of the health sciences in our country. This article provides a brief review of the main points of reference of said debate and, after stressing the importance of the theoretical development and of precision in practice, as well as the function of the guides with regard thereto, the epistemological adaptation, relevance, validity and reflexivity as possible basic criteria for the assessment of the quality of Qualitative Research are proposed.
Ciência & saúde coletiva, 2012
Qualitative research constitutes a necessary perspective of knowledge within the field of health ... more Qualitative research constitutes a necessary perspective of knowledge within the field of health services. Healthcare always occurs in complex contexts and its enhancement requires research methodologies that address this complexity. Nevertheless, the knowledge and use of qualitative research in health services is still very limited. Among the different factors that affect its development, the teaching and learning of qualitative research proves to be fundamental, even beyond undergraduate education. Healthcare professionals and health services present certain specific aspects that must be considered in the design and development of the teaching and learning of qualitative research. Based on an eight-year online training experience with Primary Healthcare professionals, the main challenges are indentified and discussed.
Journal of Epidemiology & Community Health, 2010
Social values and the political context have an influence on the use and spread of health impact ... more Social values and the political context have an influence on the use and spread of health impact assessment (HIA). In Spain, there is little experience in HIA but some regional governments are already introducing it. The aim of this article is to describe the health impacts of a local regeneration project to improve accessibility in a neighbourhood of Bilbao (Spain), and discuss the main difficulties, opportunities and challenges of the process, considering the specificities of the social and political context. A concurrent and prospective assessment, based on a broad model of health, was carried out following the Merseyside guidelines. A literature review, community profiling and qualitative data collection were undertaken. Profound involvement of members of the community and key informants was judged as essential in the HIA process. The overall expected effect of the new lifts, roads, park and the rainwater collection system was positive. Uncertain or negative impacts were identified in some of those areas, and also concerning the burying of four high-voltage power lines. Historical and current characteristics of the community were highly influential on the way local people perceived the project and its impacts. Likewise, the way in which processes of planning and implementation were developing also played an important role. The spread of HIA in southern European countries will depend on the progressive introduction of values underlying HIA, as well as on the promotion of intersectoral work, a better knowledge of the social model of health and community's participation in policy making.
Hacia la promoción de la salud
Atención primaria de salud: por qué, dónde y cómo Poco se puede añadir, en unas breves líneas, a ... more Atención primaria de salud: por qué, dónde y cómo Poco se puede añadir, en unas breves líneas, a lo mucho que se ha publicado en relación a la importancia de la atención primaria de salud-APS-. No obstante, la realidad de su desigual desarrollo y de sus graves carencias y amenazas en gran parte de los países, permite señalar al menos tres ámbitos de reflexión y debate tanto en el plano teórico como en el compromiso práctico de impulsar la APS como servicio público imprescindible.
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Jan 16, 2015
To classify and identify the main characteristics of the tools used in practice to assess the imp... more To classify and identify the main characteristics of the tools used in practice to assess the impact of elderly caregiving on the informal carers' life. A systematic review of literature was performed searching in Embase, MEDLINE, PsycINFO, CINAHL, IBECS, LILACS, SiiS, SSCI and Cochrane Library from 2009 to 2013 in English, Spanish, Portuguese and French, and in reference lists of included papers. The review included 79 studies, among them several in languages other than English. Their inclusion increased the variety of identified tools to measure this impact (n = 93) and allowed a wider analysis of their geographical use. While confirming their overlapping nature, instruments were classified according to the degree of integration of dimensions they evaluated and their specificity to the caregiving process: caregiver burden (n = 20), quality of life and well-being (n = 11), management and coping (n = 21), emotional and mental health (n = 29), psychosocial impact (n = 10), physic...