RESUMEN
Objetivo. Comparar la atención prestada por los Servicios de Urgencias de Atención Primaria durante el confinamiento por COVID19 (marzo-junio de 2020) y el mismo periodo de 2019. Diseño. Estudio descriptivo retrospectivo. Emplazamiento. Zona básica de Salud de la ciudad de Granada. Participantes. 10.790 registros de urgencias, 3.319 en 2020 y 7.471 en 2019. Mediciones principales. Edad, sexo, servicio, franjas horarias, derivación al alta, niveles de prioridad, tiempos de espera, procesos previos y motivos de consulta. Se emplearon T-Student y Chi-cuadrado para variables continuas y categóricas. Se calcularon el tamaño del efecto (d de Cohen) y OR junto con el IC al 95%. Resultados. Las urgencias disminuyeron en 2020 con respecto a 2019, aumentó el porcentaje de las urgencias Prioridad V (p<0,01), derivaciones al alta al domicilio (p=0,01) y traslados al hospital (p<0,01), en detrimento de las derivaciones a los médicos de familia (p<0,01). Aumentaron en 2020 las urgencias en horario nocturno (p<0,01) y en barrios de renta baja (p<0,01). El tiempo de espera para clasificación disminuyó (p<0,01), pero el total de asistencia aumentó en 2020 (p<0,01). Los pacientes atendidos en 2020 fueron de mayor edad (p<0,01), y con un mayor número de procesos previos (p<0,01), destacando los pacientes con ansiedad, depresión o somatizaciones (p<0,01) y diabetes (p=0,041). Aumentaron las consultas relacionadas con diversos síntomas de COVID19, problemas de salud mental y patologías crónicas. Conclusiones. Los Servicios de Urgencias de Atención Primaria ofrecen ventajas adicionales ante situaciones como la pandemia COVID19, dado que permiten canalizar parte de la demanda sanitaria.
RESUMEN
OBJECTIVE: To compare the care provided by primary care emergency services during the COVID19 lockdown (March-June 2020) and the same period in 2019. DESIGN: Retrospective descriptive study. SETTING: Basic Health Area of Granada. POPULATION: 10.790 emergency reports, 3.319 in 2020 and 7.471 in 2019. OUTCOMES: Age, sex, service, shifts, referrals, priority levels, care times, previous processes, and reasons for consultation. T-Student and Chi Square were used for continuous and categorical variables. Effect size (Cohen's d) and OR along with 95% CI were calculated. RESULTS: The patients attended by primary care emergency services decreased in 2020 compared to 2019, but the percentage of Priority V cases (p<0.01), home discharges (p=0.01) and hospital transfers (p<0.01) increased, and referrals to family doctors (p<0.01) decreased. In 2020, the percentage of emergencies at night (p<0.01) and in low-income neighborhoods (p<0.01) increased. Waiting time for classification decreased (p<0.01), but total care time increased in 2020 (p<0.01). The patients seen in 2020 were older (p<.001), and with a greater number of previous processes (p<0.01), highlighting patients with anxiety, depression, or somatization (p<0.01) and diabetes (p=0.041). Consultations related to various symptoms of COVID19, mental health problems and chronic pathologies increased. CONCLUSIONS: Primary care emergency services offer additional advantages in situations such as the COVID19 pandemic, as they allow channeling part of the health demand.
Asunto(s)
COVID-19 , Humanos , COVID-19/epidemiología , Pandemias , Estudios Retrospectivos , Control de Enfermedades Transmisibles , Atención Primaria de Salud , Servicio de Urgencia en HospitalRESUMEN
The Nursing Homes End-of-life Programme (NUHELP) was developed in 2017 and is based on quality standards of palliative care, but it was not implemented due to the outbreak of the COVID-19 pandemic. OBJECTIVES: To describe perceptions among staff at nursing homes and primary health care (PHC) centres regarding the relevance, feasibility, and degree of achievement of quality standards for palliative care in nursing homes and to determine the differences in these perceptions before and after the pandemic. METHODOLOGY: Cross-sectional descriptive study. Professionals at eight nursing homes and related PHC centres who participated in NUHELP development assessed 42 palliative care standards at two time points (2018 and 2022). The Mann-Whitney U test was applied to analyse differences in the scores between these two times and between perceptions at nursing homes and at PHC centres. RESULTS: The study population consisted of 58 professionals in 2018 and 50 in 2022. The standard regarding communication with persons affected by the death of a family member was considered less relevant (p = 0.05), and that concerning the culturally sensitive and dignified treatment of the body was less fully achieved (p = 0.03) in 2022 than in 2018. Social support (p = 0.04), sharing information among the care team (p = 0.04), patient participation (p = 0.04) and information about the treatment provided (p = 0.03) were all more poorly achieved in 2022 than in 2018. The perceptions of nursing home and PHC workers differed in several respects. CONCLUSIONS: Professional intercommunication and social support should be reinforced, and residents should be more actively involved in decision-making.
RESUMEN
BACKGROUND: There is inconclusive evidence regarding congenital, intrapartum, and postnatal maternal-fetal-neonatal SARS-CoV-2 infections during the COVID-19 pandemic. A narrative review was conducted with the aim of guiding clinicians on the management of pregnant women with respect to congenital, intrapartum, and postnatal maternal-fetal-neonatal SARS-CoV-2 infections and breastfeeding during the COVID-19 pandemic. METHODS: Searches were conducted in Web of Science, PubMed, Scopus, Dialnet, CUIDEN, Scielo, and Virtual Health Library to identify observational, case series, case reports, and randomized controlled trial studies assessing the transmission of SARS-CoV-2 from mother to baby and/or through breastfeeding during the COVID-19 pandemic. RESULTS: A total of 49 studies was included in this review, comprising 329 pregnant women and 331 neonates (two pregnant women delivered twins). The studies were performed in China (n = 26), USA (n = 7), Italy (n = 3), Iran (n = 2), Switzerland (n = 1), Spain (n = 1), Turkey (n = 1), Australia (n = 1), India (n = 1), Germany (n = 1), France (n = 1), Canada (n = 1), Honduras (n = 1), Brazil (n = 1), and Peru (n = 1). Samples from amniotic fluid, umbilical cord blood, placenta, cervical secretion, and breastmilk were collected and analyzed. A total of 15 placental swabs gave positive results for SARS-CoV-2 ribonucleic acid (RNA) on the fetal side of the placenta. SARS-CoV-2 RNA was found in seven breastmilk samples. One umbilical cord sample was positive for SARS-CoV-2. One amniotic fluid sample tested positive for SARS-CoV-2. CONCLUSIONS: This study presents some evidence to support the potential of congenital, intrapartum, and postnatal maternal-fetal-neonatal SARS-CoV-2 infections during the COVID-19 pandemic. Mothers should follow recommendations including wearing a facemask and hand washing before and after breastfeeding.