La Encuesta Nacional de Salud como instrumento de investigación para la planificación y evaluación de políticas en salud pública

Abstract

ABSTRACT Introduction: Health surveys are instruments designed by epidemiology to study the frequency and distribution of health and disease events, and they are of great scientific importance because they are used to explore and generate research hypotheses. In addition, they provide policy makers and managers the ability to monitor health outcomes and thus adjust their policies, strategies and programs if necessary. Objective: To analyze, through the national health surveys, the relationship of socio-economic factors with health indicators and patient satisfaction as measures of health outcomes for the evaluation and planning of health policies. Methods: This work was carried out through three studies elaborated between November 2013 and January 2017, which included the following analyzes: A first analysis, based on the national health surveys (ENS) of Spain 2006/2007, 2011/2012 from which the association of the current economic recession with the probability of developing a mental disorder (through the GHQ-12 included in the ENS), with the consumption of anxiolytics and sleeping pills, and with the self-perception of Health status of the Spanish population, was studied through models of multiple logistic regression. Based on the European Health Survey (EES) conducted in Spain in 2009, two additional studies were carried out. The second analysis evaluated, through a Poisson regression, the socioeconomic characteristics related to patient satisfaction regarding the care provided by the PHC physician and its geographical variability. The third study identified socioeconomic and health variables, associated to patient satisfaction with the health services received in: hospitals, specialized medicine and primary care physicians, and their variability according to the geographical area of residence, through a multilevel analysis. Results: The first analysis showed that consumption of anxiolytic and sleeping pills in men (OR = 2.3, CI95% 1.8-2.8) and women (OR = 1.7, CI95% 1.4-1.9) increased in the years 2011/2012. Mental dysfunction increased during the period of economic crisis in the male population (OR = 1.2, 95% CI 1.1-1.3). Regarding the analysis of patient satisfaction with the primary care physician, approximately one in three users considered that the care provided had been excellent, while 6.7% were dissatisfied. There was a wide variability in satisfaction among the different regional health services, prevalences ranging from 10.9 to 55.2%. On the other hand, this assessment was closely related to age, self-perceived health level, mental health, previous hospital admissions, chronic disease status and limitations in daily activities. The study of patient satisfaction with the services received in: Hospitals, specialized medicine and primary care physicians was associated with variables such as female sex, older age, better mental health level and subjects born in different countries from Maghreb or the EU besides Spain. The hierarchical analysis showed a significant association between satisfaction and per capita GDP (OR = 2.53, 95% CI: 1.18-5.42) or per capita spending on health services (OR = 2.54, 95% CI, : 1.07-6.02). Dissatisfaction was related to illiteracy rates, short- and long-term unemployment rates, GVA% in the services sector, and the number of inhabitants /doctor's office ratio. Conclusions: The economic recession showed a variable relationship with mental and general health of the population, and coincided with an increase in mental health disorders, such as anxiety. Satisfaction with the care provided by the PHC physician is relatively high. However, it presents a heterogeneous distribution among the autonomous communities and the sociodemographic characteristics and the health status of the user. Almost 11% of the population studied perceived as "excellent" the care received in hospitals, specialist medical consultations and primary care physicians. Factors such as sex, age, mental health or country of birth are related to patient satisfaction. Similarly, there are differences in satisfaction according to socio-economic determinants such as GDP per capita, illiteracy rates, unemployment rates or number of inhabitants /doctor's office ratio. Factors such as sex, age, positive mental health or country of birth are related to patient satisfaction. Similarly, there are differences in satisfaction according to socio-economic determinants such as GDP per capita, illiteracy rates, unemployment rates or number of inhabitants /doctor's office ratio.