[The acceptability of the health services contract by the primary care health professionals in Madrid: a qualitative research].
BACKGROUND
The objective of this paper is to study whether the Contrato Programa-based management formula between INSALUD and Primary Care Managerships (CP) is known by INSALUD-Madrid primary care physicians and nurses, as well as which factors are influencing its acceptability.


METHODS
Qualitative-based analysis and interpretation of the discussion had in five health personnel groups was used.


RESULTS
The Health Service Contract is known by primary care health personnel as "self-management". This word induces them to think in the management of teams by their physicians themselves. Based on this self-management, physicians would plan staffs with minimal representation of nurses personnel, in exchange for increasing medical and administrative personnel, which in fact would solve their main problems, i.e. attendance pressure and bureaucracy, in addition to relationships with nurses. Determinants of this response relate to the satisfaction level with the Primary Care Reform attained by these collectives. This Reform has produced a "subjective equality" in both collectives, conditioned by fault in authority by physicians, which is desired by nurses and rejected by physicians.


CONCLUSIONS
Health Service Contract in Primary Care is generally accepted by physicians, except for pediatricians, and rejected by nurses. Reasons are related to the ability from both collectives to recuperate the difference between them.
Pérez Andrés
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Subdirección General de Epidemiología, Promoción y Educación para la Salud, Madrid.
D003284:Contract Services; D005194:Family Practice; D006282:Health Personnel; D006296:Health Services; D006801:Humans; D009726:Nurses; D011320:Primary Health Care; D011634:Public Health / Q000592:standards; D013030:Spain; D000078329:Workforce
Aceptación del contrato programa por el personal sanitario de la atención primaria de Madrid: un estudio cualitativo.