Survey of safety climate in public hospitals in Costa Rica in 1997

In response to growing concern for occupational health and safety in the public hospital system in Costa Rica, a research program was initiated in 1995 to evaluate and improve the safety climate in the national healthcare system through regional training programs, and to develop the capacity of the occupational health commissions in these settings to improve the identification and mitigation of workplace risks. A cross-sectional survey of 1000 hospital-based healthcare workers was conducted in 1997 to collect baseline data that will be used to develop appropriate worker training programs in occupational health. The objectives of this survey were to: (1) describe the safety climate within the national hospital system, (2) identify factors associated with safety climate focusing on individual and organizational variables, and (3) to evaluate the relationship between safety climate and workplace injuries and safety practices of employees. Individual factors evaluated included the demographic variables of age, gender, education and profession. Organizational factors evaluated included training, psychosocial work environment, job-task demands, availability of protective equipment and administrative controls. Work-related injuries and safety practices of employees included the type and frequency of injuries experienced and reported, and compliance with established safety practices. Multivariate regression analyses demonstrated that training and administrative controls were the two most significant predictors of safety climate. None of the demographic variables were significant predictors of safety climate. Safety climate was inversely and significantly associated with workplace injuries and positively and significantly associated with safety practices. These results suggest that training and administrative controls should be included in future training efforts and that improving safety climate will decrease workplace injuries and increase safety practices. ^

Patients' compliance with physician's advice in Costa Rica

The penetration of the western-developed pharmaceutical industry in developing nations has had an impact not only on access to medicines but also on the value attached to medicines and the way they are consumed. People in developing countries have more faith in medicines than in doctors. Medicines constitute a large share of government health expenses but little emphasis has been placed on how medicines are being used. This dissertation includes a discussion on the penetration of pharmaceuticals in the Costa Rican society, a thorough literature review on patients' compliance with medical recommendations (including studies conducted in developed and developing countries, factors affecting adherence, issues involved in measuring compliance, treatment compliance models, and strategies to improve patients' recollection and compliance with medical recommendations), results of a compliance survey conducted in Costa Rica, and a presentation of a compliance model for developing societies.^ The Costa Rican survey includes observations on 505 medical encounters involving 13 general practitioners and 1 pediatrician in 1 urban and 2 rural clinics. Home visits yielded information on patients' adherence to medical recommendations on 404 patients and 988 medicines. The level of patients' adherence in Costa Rica is similar to what has been documented in developed societies but the strategies to improve adherence are different. Costa Ricans are prone to follow the behaviors advertised through the media or recommended by persons they consider knowlegeable in health matters and with whom they can have a personal relationship. Programs to improve adherence to medical regimens should include mass media campaigns, a re-organization of the way drugs are being dispensed, and educating health professionals to communicate and establish meaningful relationships with their patients. ^