Commentary: The other view
Comentario: La otra perspectiva
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Spain. Preventive Medicine and Public Health Teaching Unit, University of Murcia, Spain." "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Preventive Medicine and Public Health Teaching Unit, University of Murcia, Spain." "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Comentario: La otra perspectiva" ] ] "textoCompleto" => "<p class="elsevierStylePara"> </p><p class="elsevierStylePara"><img src="27v30n07-13039047tab01.gif"></img></p><p class="elsevierStylePara">Avedis Donabedian described quality of care as that type of care which is expected to provide the patient with the greatest and most complete well-being, once the losses have been balanced against the gains in the outcomes.<span class="elsevierStyleSup">1</span> Using this definition as a starting point, we can define the concept of quality in the context of primary health care by answering the question «What requirements should services provided at primary health care centers meet to lead to the user´s well-being?» However, we must also inevitably consider who should answer this question.</p><p class="elsevierStylePara">Recent years have seen a change in the approach to this topic. Traditionally, we health care professionals have decided what is best for patients, on the basis of our experience and knowledge. Even today there are many professionals who believe that quality service ­understood broadly­ can only be provided if physicians' acts are based on the scientific and technical norms and standards of our profession. However, the view that this is only one of the dimensions of quality ­obviously necessary, but not always sufficient­ that can be used to fulfil the needs and expectations our patients feel is increasingly widespread.</p><p class="elsevierStylePara">From this new perspective it seem obvious that the user is the essential protagonist in providing information on characteristics of health care that influence the maximization of potential benefits to be obtained, among which is, undoubtedly, satisfaction with the care received. In fact, several studies have shown that research based on the opinions of professionals is limited in what it reveals about those aspects of health care that users most appreciate. For example, in the study in this issue by Hernán García et al, health professionals offer a wide-ranging yet partial description of the components of care perceived by the user. The information provided by the physician, a habitual and particularly relevant component of quality as it is perceived by users,<span class="elsevierStyleSup">2</span> is not identified as such by practitioners. Moreover, another study that investigated a similar issue found that primary care professionals identified their patients´ expectations-especially the most relevant ones such as continuity of care by the same physician and providing an effective solution to the problem that led the patient to seek medical advice ­more clearly than did their colleagues at hospitals. However, primary care practitioners were less adept at identifying other aspects of treatment and individual attention, which are less relevant for users but that also influence their satisfaction.<span class="elsevierStyleSup">3</span></p><p class="elsevierStylePara">As a result, it seems essential for health professionals to be aware of, understand and sympathize with the user´s point of view in order for the quality of health care to improve.<span class="elsevierStyleSup">3</span> The increasing frequency of efforts aimed at incorporating the user´s perspective into definitions and evaluations of quality of health care should therefore come as no surprise.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Some studies designed to this end have been limited to using a questionnaire as a quantitative approach to research. However, this procedure may be appropriate to determine the relative importance of a predetermined set of possible expectations and needs, but is in itself insufficient to identify the wider range of dimensions, components and factors that make up reality. In this regard, qualitative research methods are particularly useful, as illustrated by the study by Hernán García et al. Such studies shed light on the «what» and «why» of the phenomena under investigation.<span class="elsevierStyleSup">4</span> Although now being encouraged<span class="elsevierStyleSup">4</span>, and although they have been shown useful for designing surveys to measure satisfaction with primary care,<span class="elsevierStyleSup">5</span> this type of study has yet to be widely used in the Spanish setting.</p><p class="elsevierStylePara">Two other studies done in the primary care context are also noteworthy for their attempt to reconcile the viewpoints of the family physician and the user. The first study, of a theoretical nature, resulted in the publication by the Catalonian Society of Family and Community Medicine of a manual titled <span class="elsevierStyleItalic">On the other side of the table.</span> The book contains a series of narratives and commentaries that describe the experiences of different patients, and which form the basis for a description and analysis of the dimensions of perceived quality in the SERVQUAL model (responsiveness, reliability, tangibles, empathy and assurance).<span class="elsevierStyleSup">6</span> The second study, of a more practical nature, was done as part of course work for a doctoral program. Physicians visited their general practitioner as patients, and then completed a semistructured questionnaire on the quality of care and reported on characteristics that should be improved.<span class="elsevierStyleSup">7</span></p><p class="elsevierStylePara">To sum up, as noted by J.R. Vázquez, «an excellent doctor is a doctor who, in addition to possessing a great "clinical eye," possesses a great "human ear" which he or she uses to listen to the needs patients feel, and to identify, among them, their real care needs.»</p>" "pdfFichero" => "27v30n07a13039047pdf001.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:6 [ "identificador" => "tbl1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "tablaImagen" => array:1 [ 0 => array:4 [ "imagenFichero" => "27v30n07-13039047tab01.gif" "imagenAlto" => 240 "imagenAncho" => 353 "imagenTamanyo" => 8137 ] ] ] ] ] ] 1 => array:5 [ "identificador" => "tbl2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "referenciaCompleta" => "The definition of quality and its approaches to its assessment. 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| 2022 July | 26 | 11 | 37 |
| 2022 June | 14 | 11 | 25 |
| 2022 May | 19 | 14 | 33 |
| 2022 April | 28 | 17 | 45 |
| 2022 March | 29 | 16 | 45 |
| 2022 February | 13 | 11 | 24 |
| 2022 January | 13 | 13 | 26 |
| 2021 December | 25 | 17 | 42 |
| 2021 November | 13 | 13 | 26 |
| 2021 October | 21 | 14 | 35 |
| 2021 September | 16 | 16 | 32 |
| 2021 August | 13 | 8 | 21 |
| 2021 July | 24 | 12 | 36 |
| 2021 June | 20 | 9 | 29 |
| 2021 May | 12 | 8 | 20 |
| 2021 April | 17 | 14 | 31 |
| 2021 March | 15 | 10 | 25 |
| 2021 February | 18 | 6 | 24 |
| 2021 January | 21 | 6 | 27 |
| 2020 December | 17 | 7 | 24 |
| 2020 November | 12 | 9 | 21 |
| 2020 October | 7 | 8 | 15 |
| 2020 September | 15 | 7 | 22 |
| 2020 August | 18 | 11 | 29 |
| 2020 July | 14 | 9 | 23 |
| 2020 June | 16 | 9 | 25 |
| 2020 May | 21 | 3 | 24 |
| 2020 April | 16 | 3 | 19 |
| 2020 March | 19 | 7 | 26 |
| 2020 February | 22 | 5 | 27 |
| 2020 January | 22 | 6 | 28 |
| 2019 December | 29 | 8 | 37 |
| 2019 November | 15 | 13 | 28 |
| 2019 October | 8 | 0 | 8 |
| 2019 September | 12 | 7 | 19 |
| 2019 August | 15 | 3 | 18 |
| 2019 July | 21 | 5 | 26 |
| 2019 June | 44 | 16 | 60 |
| 2019 May | 167 | 26 | 193 |
| 2019 April | 18 | 7 | 25 |
| 2019 March | 11 | 4 | 15 |
| 2019 February | 11 | 4 | 15 |
| 2019 January | 11 | 3 | 14 |
| 2018 December | 14 | 2 | 16 |
| 2018 November | 8 | 10 | 18 |
| 2018 October | 11 | 8 | 19 |
| 2018 September | 13 | 5 | 18 |
| 2018 August | 8 | 1 | 9 |
| 2018 July | 7 | 2 | 9 |
| 2018 June | 6 | 1 | 7 |
| 2018 May | 5 | 1 | 6 |
| 2018 April | 3 | 3 | 6 |
| 2018 March | 3 | 0 | 3 |
| 2018 February | 1 | 2 | 3 |
| 2018 January | 1 | 1 | 2 |
| 2017 December | 2 | 5 | 7 |
| 2017 October | 2 | 2 | 4 |
| 2017 September | 6 | 5 | 11 |
| 2017 August | 2 | 1 | 3 |
| 2017 July | 1 | 1 | 2 |
| 2017 June | 12 | 4 | 16 |
| 2017 May | 18 | 4 | 22 |
| 2017 April | 11 | 4 | 15 |
| 2017 March | 18 | 3 | 21 |
| 2017 February | 16 | 3 | 19 |
| 2017 January | 6 | 3 | 9 |
| 2016 December | 16 | 3 | 19 |
| 2016 November | 17 | 4 | 21 |
| 2016 October | 47 | 2 | 49 |
| 2016 September | 17 | 2 | 19 |
| 2016 August | 12 | 1 | 13 |
| 2016 July | 17 | 2 | 19 |
| 2016 June | 27 | 12 | 39 |
| 2016 May | 8 | 13 | 21 |
| 2016 April | 9 | 2 | 11 |
| 2016 March | 11 | 2 | 13 |
| 2016 February | 14 | 4 | 18 |
| 2016 January | 12 | 3 | 15 |
| 2015 December | 13 | 4 | 17 |
| 2015 November | 15 | 1 | 16 |
| 2015 October | 25 | 7 | 32 |
| 2015 September | 22 | 3 | 25 |
| 2015 August | 13 | 1 | 14 |
| 2015 July | 8 | 5 | 13 |
| 2015 June | 4 | 1 | 5 |
| 2015 May | 4 | 1 | 5 |
| 2015 April | 7 | 7 | 14 |
| 2015 March | 13 | 2 | 15 |
| 2015 February | 6 | 1 | 7 |
| 2015 January | 19 | 2 | 21 |
| 2014 December | 41 | 6 | 47 |
| 2014 November | 28 | 0 | 28 |
| 2014 October | 28 | 3 | 31 |
| 2014 September | 22 | 0 | 22 |
| 2014 August | 26 | 1 | 27 |
| 2014 July | 25 | 1 | 26 |
| 2014 June | 21 | 4 | 25 |
| 2014 May | 17 | 1 | 18 |
| 2014 April | 16 | 0 | 16 |
| 2014 March | 19 | 0 | 19 |
| 2014 February | 21 | 0 | 21 |
| 2014 January | 10 | 2 | 12 |
| 2013 December | 16 | 0 | 16 |
| 2013 November | 14 | 2 | 16 |
| 2013 October | 16 | 1 | 17 |
| 2013 September | 14 | 2 | 16 |
| 2013 August | 19 | 3 | 22 |
| 2013 July | 10 | 1 | 11 |
| 2002 October | 273 | 0 | 273 |
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