[Research and the recent evolution of primary health care]

Cumulative advantages and social capabilities in scientific mobility in the Health Sciences: The Spanish case

BACKGROUND

The big problem in global public health, arising from the international migration of physicians from less-developed to more-developed countries, increases if this migration also affects scientists dedicated to health areas. This article analyzes critical variables in the processes of Spanish scientific mobility in Health Sciences to articulate effective management policies for the benefit of national public health services and the balance between local and global science.

METHODS

This study develops a survey to measure and analyze the following crucial variables: research career, training, funding, working with a world-class team, institutional prestige, wages, facilities/infrastructure, working conditions in the organization of the destination country, fringe benefits in the organization of the destination country and social responsibility in the organization of the departure country. A total of 811 researchers have participated in the survey, of which 293 were from the health sector: Spanish scientists abroad (114), scientists that have returned to Spain (32) and young researchers in Spain (147).

RESULTS

The most crucial variables for Spanish scientists and young researchers in Spain in Health Sciences moving abroad are the cumulative advantages (research career, training, funding and institutional prestige) plus wages. On the other hand, the return of Spanish scientists in the Health Sciences is influenced by cumulative variables (working with a world-class team, research career and institutional prestige) and also by other variables related to social factors, such as working conditions and fringe benefits in the destination country. Permanent positions are rare for these groups and their decisions regarding mobility depend to a large extent on job opportunities.

CONCLUSIONS

Spanish health organizations can influence researchers to return, since these decisions mainly depend on job opportunities. These organizations can complement the cumulative advantages offered by the wealthier countries with the intensification of social factors.

An analysis of national collaboration with Spanish researchers abroad in the health sciences

Background

The establishment of scientific collaborations with researchers abroad can be considered a good practice to make appropriate use of their knowledge and to increase the possibilities of them returning to their country. This paper analyses the collaboration between Spanish researchers abroad devoted to health sciences and national science institutions.

Methods

We used the Fontes’ approach to perform a study on this collaboration with Spanish researchers abroad. We measured the level of national and international cooperation, the opportunity provided by the host country to collaborate, the promotion of collaboration by national science institutions, and the types of collaboration. A total of 88 biomedical researchers out of the 268 Spanish scientists who filled up the survey participated in the study. Different data analyses were performed to study the variables selected to measure the scientific collaboration and profile of Spanish researchers abroad.

Results

There is a high level of cooperation between Spanish health science researchers abroad and international institutions, which contrasts with the small-scale collaboration with national institutions. Host countries facilitate this collaboration with national and international scientific institutions to a larger extent than the level of collaboration promotion carried out by Spanish institutions.

Conclusions

The national collaboration with Spanish researchers abroad in the health sciences is limited. Thus, the practice of making appropriate use of the potential of their expertise should be promoted and the opportunities for Spanish health science researchers to return home should be improved.

Electronic supplementary material

The online version of this article (doi:10.1186/s12961-015-0055-2) contains supplementary material, which is available to authorized users.

[Teaching and learning the science of qualitative research in the health area]

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.

[Research lines proposed by Andalusian Association of Community Nursing]

OBJECTIVE

To define and prioritise the future research lines of the Andalusian Association of Community Nursing (ASANEC).

METHOD

Application of the Delphi technique within the members of the Working Group of the Research area of ASANEC, consisting of Community nurses from clinical and educational settings, as regards research in seven Andalusian provinces. Three rounds of participation were performed, with the last one being prioritised using a Linear Scale. Averages and standard deviations have been calculated.

RESULTS

The total number of participants on this technique was 13 professionals (54.16%). The main research lines finally agreed and prioritised, were the following, in decreasing order: «care management», «quality of life», «lifestyles and health education in children and adolescent population», «design and validation of nursing assessment tools», «patient safety», «accessibility to healthcare services and development of self-care capacity».

CONCLUSIONS

Research on the new model of care management introduced into Andalusian primary care was given priority, although there are more emerging research lines related to Health Promotion and Prevention of Health problems in the general population, children, young people and vulnerable populations. These results have been the deciding factors in the choice of the current research lines developed by the ASANEC Research Group.

[Promotion of research in primary care]

OBJECTIVE

To identify what can be done to promote research and development (R+D) in primary care. To find the main lines of primary care R+D in the Community of Valencia, Spain.

DESIGN

Qualitative research based on consensus group. Concretely, the Phillips technique, modified for the number attending, was employed.

SETTING

Primary care.

PARTICIPANTS

Twenty-four primary care professionals in the Community of Valencia (75% of 32 invited): physicians, pharmacists, teaching or research unit professionals, medical managers, and researcher-doctors leading primary care R+D projects.

MAIN MEASUREMENTS

Four questions were asked: concerning barriers to research, how to make it easier to take part in competitive R+D contests, how to disseminate results and what topics are of most interest today.

RESULTS

Problems identified were: lack of time, need for technical support, and need for day-schools and prizes to promote investigation. It was suggested that research should be given value in job contests, it should be made a requirement to finish training (MIR), funds for projects in health areas should be created and finance for emerging groups should be provided.

CONCLUSIONS

In summary, it was proposed to create research units in every department/area with professionals given time off to lead projects and with administrative support to gain resources. Doctors should be encouraged to take part by the recognition of research for job contests, in their professional careers and in productivity indicators.

[Attitudes of family doctors to patients' rights]

OBJECTIVES

To examine the attitudes of family doctors to patients' rights and to ascertain the social and professional variables that influence these views.

DESIGN

Descriptive, cross-sectional study based on a questionnaire.

SETTING

Primary care, Murcia, Spain.

PARTICIPANTS

Two-hundred and twenty-seven family physicians, who filled in a postal questionnaire.

INTERVENTIONS

The questionnaire included social and professional variables, evaluation of job satisfaction (by Likert scale 1-5), evaluation of patients' rights (Likert scale 1-5).

MAIN MEASUREMENTS AND RESULTS

The most valued right in the overall view of the doctors questioned was the right to suitable health care within a humane framework (4.86; 95% CI, 4.81-4.91), while the least valued right was the access to medical records (3.91; 95% CI, 3.76-4.05). Mean job satisfaction was 2.79 (95% CI, 2.71-2.87). We found: statistically significant differences in the assessment of patients' rights, which depended on various social and professional factors; direct associations between doctors' satisfaction and their views on patients' rights; and a significant correlation between overall evaluation of rights and total satisfaction (P=.039).

CONCLUSIONS

Overall, family doctors attach a lot of importance to patients' rights. However, social and professional characteristics seem to have some influence on their attitudes: older doctors, those working in an urban context, those with few patients on their lists, in teaching centres, and those feeling the greatest professional satisfaction tend to attach greater importance to patients' rights.

[Primary Care research: attitudes and hindrances perceived by our doctors]

OBJECTIVES

To discover how much research doctors in our area do; to describe their attitudes to research; and to evaluate the hindrances to developing research that they found.

DESIGN

Cross-sectional, descriptive study.

SETTING

Area 7 of Primary Care, Madrid.

PARTICIPANTS

Area 7 doctors.

MAIN MEASUREMENTS

An anonymous self-administered questionnaire was designed in order to gather the following information: age, gender, professional details, training in research methodology, research activity, questions from a previously validated questionnaire for finding attitudes towards research (scores from 0 to 80), and a question for assigning a value to 6 hindrances to research.

RESULTS

174 were returned (49.4% response). 65.9% of the doctors were women, with an average age of 43.23+/-7.33 years; and 55.5% were specialists in Family and Community Medicine. Over the last 5 years, 49.4% had published a scientific paper and 38% had given reports at congresses. The mean score on attitudes to research was 53.49+/-10.59. Hindrances to research were given in the following order, from greatest to least: case-load, lack of time, structural deficiencies, absence of multi-centred research lines, lack of incentives, lack of training, no motivation.

CONCLUSIONS

The research activity of our doctors is similar to that found in other studies. Attitude to research is no better than "acceptable." The main hindrances stated were: case-load and lack of time.