Implantación de una Unidad de Enlace Centralizada de Vacunación contra la COVID-19 gestionada por farmacéuticos-farmacólogos de Atención Primaria / Implementation of a Centralized COVID-19 Vaccination Liaison Unit managed by Primary Care pharmacist-pharmacologists

Introducción: La Unidad de Enlace Centralizada de Vacunación contra la COVID19 (UECeV) de la Dirección de Atención Primaria Metropolitana Nord del Institut Català de la Salut se creó para resolver las consultas de usuarios y/o profesionales sa-nitarios relacionadas con la vacunación contra el virus SARS-CoV-2. El objetivo principal del presente análisis fue describir la actividad de la UECeV.Método: Realizamos un estudio observacional retrospectivo a partir del registro de consultas aten-didas desde la UECeV entre 31 de abril y 31 de oc-tubre de 2021. Población de referencia: 1.139.411 habitantes adultos asignados. La UECeV se creó en tres sedes territoriales atendidas cada una por dos farmacéuticos/farmacólogos de Atención Primaria (FAP) y un administrativo. La atención telefónica fue a jornada completa adaptable según actividad. Variable principal del análisis: número y tipos de consultas atendidas. Se calculó valores absolutos y porcentajes, medianas y desviación estándar para las variables cuantitativas y para las variables cuali-tativas se realizó un análisis descriptivo.Resultados: 3.103 consultas gestionadas de 3.030 usuarios; 2.180 (70,25%) contestadas por el FAP. Consulta más frecuente: compatibilidad vacuna según patología/medicación de base 1.008 (32,5%). 2.830 (93,4%) usuarios se vacunaron después de la intervención (2.210 consultaron antes de la primera dosis y 618 antes de la segunda). La vacuna mayo-ritaria fue la Comirnaty®. Conclusiones: Las UECeV coordinadas por el FAP con atención directa a los usuarios y/o profesiona-les sanitarios constituyen un elemento de apoyo a los equipos de vacunación de atención primaria para la gestión experta de las consultas de vacuna-ción contra la COVID19. (AU)

Introduction: The North Metropolitan Primary Care Direction of the Institut Català de la Salut crea-ted the Centralized Liaison Unit for anti-COVID19 vaccination (UECeV) to solve queries from users and/or health professionals related to vaccination against the SARS-CoV-2 virus. The main objective of the present analysis was to describe the activity of UECeV.Method: We carried out a retrospective observa-tional study based on the registry of consultations attended from the UECeV between April 31st and October 31, 2021. We have an equal or above 18 years old reference population of 1,139,411 inha-bitants. The UECeV was set up in three territorial offices, each attended by two Primary Care phar-macists/pharmacologists (FAP) and one adminis-trative staff member. The telephone service was full-time and could be adapted according to activity. The main variable of the analysis was the number and types of queries attended. Absolute values and percentages, medians and standard deviation were calculated for the quantitative variables and a descriptive analysis was performed for qualitative variables.Results: 3,103 queries were managed out of 3,030 users; 2,180 (70.25%) were answered by the FAP. Most frequent consultation was: vaccine compa-tibility according to pathology/basic medication 1,008 (32.5%). 2,830 (93.4%) users were vaccinated after the consultation (2,210 consulted before the first dose and 618 before the second). The majority vaccine was Comirnaty® Conclusions: The UECeV coordinated by the FAP with direct attention to users and/or health profes-sionals constitutes a support element for primary care vaccination teams for the expert management of AntiCOVID19 vaccination consultations. (AU)

The interplay between infection risk factors of SARS-CoV-2 and mortality: a cross-sectional study from a cohort of long-term care nursing home residents.

BACKGROUND: Covid-19 pandemic has particularly affected older people living in Long-term Care settings in terms of infection and mortality. METHODS: We carried out a cross-sectional analysis within a cohort of Long-term care nursing home residents between March first and June thirty, 2020, who were ≥ 65 years old and on whom at least one PCR test was performed. Socio-demographic, comorbidities, and clinical data were recorded. Facility size and community incidence of SARS-CoV-2 were also considered. The outcomes of interest were infection (PCR positive) and death. RESULTS: A total of 8021 residents were included from 168 facilities. Mean age was 86.4 years (SD = 7.4). Women represented 74.1%. SARS-CoV-2 infection was detected in 27.7% of participants, and the overall case fatality rate was 11.3% (24.9% among those with a positive PCR test). Epidemiological factors related to risk of infection were larger facility size (pooled aOR 1.73; P < .001), higher community incidence (pooled aOR 1.67, P = .04), leading to a higher risk than the clinical factor of low level of functional dependence (aOR 1.22, P = .03). Epidemiological risk factors associated with mortality were male gender (aOR 1.75; P < .001), age (pooled aOR 1.16; P < .001), and higher community incidence (pooled aOR 1.19, P = < 0.001) whereas clinical factors were low level of functional dependence (aOR 2.42, P < .001), Complex Chronic Condition (aOR 1.29, P < .001) and dementia (aOR 1.33, P <0.001). There was evidence of clustering for facility and health area when considering the risk of infection and mortality (P < .001). CONCLUSIONS: Our results suggest a complex interplay between structural and individual factors regarding Covid-19 infection and its impact on mortality in nursing-home residents.

Evaluation of a support system for health professionals confined by COVID-19.

OBJECTIVE: To evaluate the implementation of a telephone system in a department of Primary Care in Barcelona, Spain, supporting health professionals confined by COVID-19. METHODS: We conducted an observational, descriptive, cross-sectional study with confined professionals, between March 11 and May 31, 2020. We emailed a questionnaire with 18 closed-ended questions and one open-ended question and performed a descriptive analysis of the closed-ended answers and an analysis of the thematic content of the open-ended question. RESULTS: Thirty-nine hundred and ninety-eight professionals evaluated the system overall with a score of 6.54 on a scale of 1 to 10. The evaluation of the format of calls made in the support system had higher scores, while the psychological support unit and the coordination of the different groups had lower scores. The content analysis of the open-ended question provides explanatory arguments for the quantitative results. CONCLUSIONS: The study allowed a valid and reliable evaluation of the implementation of a support system for confined professionals, in addition to recognizing areas for improvement.

Evaluation of a support system for health professionals confined by COVID-19 / Evaluación de un circuito de apoyo a profesionales sanitarios confinados por COVID-19

ABSTRACT OBJECTIVE To evaluate the implementation of a telephone system in a department of Primary Care in Barcelona, Spain, supporting health professionals confined by COVID-19. METHODS We conducted an observational, descriptive, cross-sectional study with confined professionals, between March 11 and May 31, 2020. We emailed a questionnaire with 18 closed-ended questions and one open-ended question and performed a descriptive analysis of the closed-ended answers and an analysis of the thematic content of the open-ended question. RESULTS Thirty-nine hundred and ninety-eight professionals evaluated the system overall with a score of 6.54 on a scale of 1 to 10. The evaluation of the format of calls made in the support system had higher scores, while the psychological support unit and the coordination of the different groups had lower scores. The content analysis of the open-ended question provides explanatory arguments for the quantitative results. CONCLUSIONS The study allowed a valid and reliable evaluation of the implementation of a support system for confined professionals, in addition to recognizing areas for improvement.

RESUMEN OBJETIVOS Evaluar la implementación de un circuito telefónico de apoyo a profesionales sanitarios confinados por COVID-19 en una dirección de Atención Primaria de Barcelona, en España. MÉTODOS Estudio observacional, descriptivo y transversal, realizado con profesionales confinados en domicilio entre el 11 de marzo y el 31 de mayo de 2020. Se envió por correo electrónico un cuestionario con 18 preguntas cerradas y una abierta. Se realizó un análisis descriptivo de las respuestas cerradas y un análisis del contenido temático de la pregunta abierta. RESULTADOS 398 profesionales puntuaron globalmente el circuito con 6,54 en una escala de 1 a 10. El formato de las llamadas realizadas en el circuito de apoyo se estimó con las puntuaciones máximas, la unidad de apoyo psicológico y la coordinación por diferentes colectivos se evaluaron con las puntuaciones más bajas. El análisis del contenido de la pregunta abierta ofrece argumentos explicativos de los resultados cuantitativos. CONCLUSIONES El estudio permitió evaluar de manera válida y fiable la implementación de un circuito de apoyo a profesionales confinados, además de reconocer áreas de mejora.

Estudio descriptivo de los trabajadores de servicios sanitarios de una dirección de atención primaria confinados por Covid-19 / Descriptive study of the health service workers of a Primary Care Department confined by Covid-19

OBJETIVO: La pandemia de la Covid-19 está poniendo a prueba la resistencia de los sistemas sanitarios. La preservación de los profesionales sanitarios es prioritaria siempre y especialmente ante situaciones de este tipo. La exposición de los profesionales frente a contactos sospechosos obliga en muchas ocasiones a su confinamiento. El objetivo fue conocer las características epidemiológicas de los profesionales de atención primaria que han precisado confinamiento. MÉTODOS: La investigación se llevó a cabo en el área de atención primaria Metropolitana Nord de Barcelona, desde el 17 de febrero al 3 de mayo de 2020. Participaron 1.418 profesionales que requirieron confinamiento debido a la epidemia por la Covid-19. Se registraron los motivos de confinamiento, sintomatología, tiempo de confinamiento y resultados de las pruebas PCR. Se realizó análisis descriptivo univariante. RESULTADOS: El 78,8% de los profesionales eran mujeres y la edad media de fue 45,2 años. El 67,8% fueron facultativos y enfermeras, en el 32,2% restante había diferentes profesionales asistenciales y no asistenciales. El 64,1% de la muestra presentó sintomatología compatible con Covid-19. Los participantes describieron múltiples síntomas durante el confinamiento. Se realizaron 1.050 pruebas diagnósticas RT-PCR resultando positivas en 323 casos, de los que 33 fueron en personas asintomáticas. CONCLUSIONES: El impacto de la epidemia por Covid-19 se adelanta en el personal sanitario respecto a la población general. La distribución de síntomas en profesionales sanitarios es similar a la de otros estudios en población general. Del total de profesionales que precisan confinamiento en el 22,7% se confirma el diagnóstico

OBJECTIVE: The Covid-19 pandemic is testing the resistance of health systems, the preservation of health professionals is a priority in processes of this type. The professionals' exposure to suspicious contacts often requires their confinement. The objective was to know the epidemiological characteristics of the primary care professionals who required confinement. METHODS: The research was carried out in the North Metropolitan Primary Care Area of Barcelona, from February 17 to May 3, 2020. 1,418 professionals who required confinement due to the epidemic by Covid-19 participated. The reasons for confinement, symptomatology, the confinement time and the results of PCR tests results were recorded. Univariate descriptive analysis was performed. RESULTS: 78.8% of the professionals were women and the mean age was 45.2 years. 67.8% were doctors and nurses, in the remaining 32.2% there were different healthcare and non-care professionals. 64.1% of the sample presented symptoms compatible with Covid-19. Participants described multiple symptoms during confinement. 1,050 diagnostic RT- PCR tests were performed, being positive in 323 cases, of which 33 were in asymptomatic people. CONCLUSIONS: The impact of the epidemic by Covid-19 is anticipated in health personnel compared to the general population. The distribution of symptoms in healthcare professionals is similar to that of other studies in the general population. Of the total number of professionals requiring isolation, 22.7% confirmed the diagnosis

Intervention to improve social and family support for caregivers of dependent patients: ICIAS study protocol.

BACKGROUND: Despite the existence of formal professional support services, informal support (mainly family members) continues to be the main source of eldercare, especially for those who are dependent or disabled. Professionals on the primary health care are the ideal choice to educate, provide psychological support, and help to mobilize social resources available to the informal caregiver.Controversy remains concerning the efficiency of multiple interventions, taking a holistic approach to both the patient and caregiver, and optimum utilization of the available community resources. .For this reason our goal is to assess whether an intervention designed to improve the social support for caregivers effectively decreases caregivers burden and improves their quality of life. DESIGN: CONTROLled, multicentre, community intervention trial, with patients and their caregivers randomized to the intervention or control group according to their assigned Primary Health Care Team (PHCT). STUDY AREA: Primary Health Care network (9 PHCTs). STUDY PARTICIPANTS: Primary informal caregivers of patients receiving home health care from participating PHCTs. SAMPLE: Required sample size is 282 caregivers (141 from PHCTs randomized to the intervention group and 141 from PHCTs randomized to the control group. INTERVENTION: a) PHCT professionals: standardized training to implement caregivers intervention. b) Caregivers: 1 individualized counselling session, 1 family session, and 4 educational group sessions conducted by participating PHCT professionals; in addition to usual home health care visits, periodic telephone follow-up contact and unlimited telephone support. CONTROL: Caregivers and dependent patients: usual home health care, consisting of bimonthly scheduled visits, follow-up as needed, and additional attention upon request.Data analysisDependent variables: Caregiver burden (short-form Zarit test), caregivers' social support (Medical Outcomes Study), and caregivers' reported quality of life (SF-12)INDEPENDENT VARIABLES: a) Caregiver: sociodemographic data, Goldberg Scale, Apgar family questionnaire, Holmes and Rahe Psychosocial Stress Scale, number of chronic diseases. b) Dependent patient: sociodemographic data, level of dependency (Barthel Index), cognitive impairment (Pfeiffer test). DISCUSSION: If the intervention intended to improve social and family support is effective in reducing the burden on primary informal caregivers of dependent patients, this model can be readily applied throughout usual PHCT clinical practice. TRIAL REGISTRATION: Clinical trials registrar: NCT02065427.

Intervention for control of hypertension in Catalonia, Spain (INCOTECA Project): results of a multicentric, non-randomised, quasi-experimental controlled intervention study.

OBJECTIVE: The purpose of this study was to assess the effectiveness of a quality improvement (QI) plan aimed at primary healthcare teams (PHCTs) to optimise hypertension control and to compare it with standard clinical care. METHODS: Design Multicentric, non-randomised, quasi-experimental controlled intervention study. Setting 5 PHCTs in the intervention and 13 in the standard care group in the province of Barcelona, Catalonia, Spain. Participants This is a population-based study in which all patients over 18 years of age with a diagnosis of hypertension before 1 January 2006 were included (n=9877 in the intervention group and n=21 704 in the control group). Intervention A QI plan that targeted primary care professionals. The plan included training sessions, implementation of recommended clinical practice guidelines for the management of hypertensive patients and audit and feedback to health professionals. Main outcome measure Prevalence of hypertensive patients with an adequate blood pressure (BP) control. RESULTS: The adjusted difference between intervention and standard care groups in the odds of BP control was 1.3 (95% CI 1.1 to 1.6, p=0.003). Results of the mixed model on repeated measures showed that, on average, an individual in the intervention group had an increase of 92% in the odds of BP control (OR 1.9, 95% CI 1.7 to 2.1). CONCLUSIONS: The implementation of a QI plan can improve BP control. This strategy is potentially feasible for up-scaling within the existing PHCTs. TRIAL REGISTRATION: ClinicalTrials.gov MS: 1998275938244441.