Convivencia entre usuarios y profesionales de la salud en los centros de atención primaria

Abstract

This doctoral thesis explores user violence towards health personnel within Primary Care in the Murcian Health Service. The consequences in the health care setting and the increase in prevalence in recent years, especially after the global pandemic caused by the COVID-19, makes it a topic of concern and research interest. In hostile situations between users and professionals, it is possible to identify several elements that cause this: factors that depend on the professionals, factors that depend on the organization of the system and factors that depend on the user. Research has focused on studying professional and system factors from the point of view of healthcare personnel. There are very few studies that involve the user and explore their opinion. The objectives of this study focus on identifying the sources of conflict and their proposed solutions from the user’s point of view in Primary Care and reviewing the literature in order to search preventive measures or proposals that involve the user in the health care setting. Subsequently, based on the results obtained, another objective is to elaborate a set of interventions, aimed at provoking attitudinal changes in the user, to implement in the Primary Care centers of the Murcian Health Service and to pre-evaluate these measures again from the user’s perception. To carry out this study, a qualitative study was conducted, in a first phase, through focus groups (Krueger, 1991) and a constructivist inductive thematic analysis (Edmonds and Kennedy, 2017) to 80 users of the Murcian Health Service. The main sources of conflict collected in 4 topics and 13 subtopics were identified. Likewise, the participants provided proposals for solutions from which 5 topics and 10 subtopics were concluded. Next, a literature review was conducted according to PRYSMA protocol (Page et al., 2021) in four databases: EBSCOHOST, Web of Science, ProQuest and Cochrane. The aim was to detect work on intervention plans implemented in the health care setting or that included proposals to minimize violence by users against health care professionals. From these results, 30 preventive measures or actions involving the user were obtained. The results of both studies were the basis for the elaboration of a set of measures aimed at the user classified in different thematic blocks: measures aimed at improving communication between users and professionals, measures aimed at reducing the burden of care and measures aimed at generating new competencies within Primary Care. Finally, a qualitative study was carried out with pre-test users to gather their opinion on the proposals and their possible improvements. Thirty-eight users participated in 5 focus groups of 6-8 participants. The recommendations of the COREQ guide for focus groups were followed (Tong et al., 2007). In general, the proposals were very well received, highlighting the need for information and training for the users. The feasibility of implementing some of them was also questioned. In conclusion, it is necessary to introduce changes that promote the inclusion of the perpetrator oriented to the detected conflict hotspots and following the new models of prevention based on the scientific literature. Users demand their involvement, better communication channels, improved humane treatment, more training and information, and changes in the organization. It seems essential to sensitize the scientific and professional community to work on these premises, in order to bring about improvements in the coexistence between users and professionals in Primary Care.