[Are occupation and education interchangeable as social indicators in community health? A study in an employed population]

[Perceptions and expectations on primary health care: a new form of identifying improvements in the care system]

OBJECTIVE

To analyse the opinions of the users of primary care on the care that they receive and to identify the principal areas of satisfaction.

DESIGN

Qualitative study using discussion groups and open interviews during the period January-May 2003.

SETTING

Health areas of Valladolid, Spain.

PARTICIPANTS

The inclusion criteria were: to have attended a primary care clinic at sometime and to be between 35 and 80 years old. Recruitment was carried out through key informants, using the snowball technique.

METHOD

6 discussion groups and interviews with representatives of 3 nursing and 1 residents association were carried out. Structural sampling was carried out as regards the variables that influenced satisfaction. The conversations were recorded using tape recorders and literally transcribed on paper. The analysis of the texts was carried out by 2 investigators and concordance was sought between them.

RESULTS

The principal areas related to satisfaction were: the treatment received from the professionals, which is considered a fundamental part of care, combined with the technical quality, continuity of the care, the admission services, the bureaucratic procedures, the barriers for accessing specialised services, and waiting lists.

CONCLUSIONS

Personalized care, the time dedicated by the professional, the continuity of care, and waiting lists are the principal areas related to the perceived satisfaction of the patients. The possible responses to improve this situation are: the implementation of changes in the care management and organisation which would simplify the procedures, investment of resources (human and economic), changes in the model of the professional-patient relationship, and improvements in undergraduate and postgraduate training.

[Education and occupational social class: their relationship as indicators of socio-economic position to study social inequalities in health using health interview surveys]

AIM

To analyse the relationship between social class based on occupation and level of education in the study of social inequalities in health and use of health services. DESSIGN: Cross-sectional study (health interview survey).

SETTING

General population of the city of Cornellà de Llobregat (Spain).

PARTICIPANTS

Representative sample of subjects aged 14 years old or over (1043 men and 1101 women) who personally answered the questionnaire.

MEASUREMENTS

We analyse the association between social class and level of studies and different independent variables (self-perceived health, smoking, medical visits) by means of logistic regression.

RESULTS

The proportion of men who declare their self-perceived health as poor is higher among those who have low education (45.4%) than among those who have primary education level or higher (25.9%). The prevalence of smoking shows a similar pattern (54.2% versus 41.5%), with a gradient effect, which is statistically non-significant. However, these differences are no longer evident if social class is used to group the individuals. No clear association is observed between the use of health services and socio economic level.

CONCLUSIONS

We need to use several indicators of socioeconomic position to evaluate social inequalities In this disadvantaged population, level of education seems to be a good indicator to study social inequalities in health.