Quality and safety actions in primary care practices in COVID-19 pandemic: the PRICOV-19 study in Spain.

BACKGROUND: Primary Health Care (PHC) has been key element in detection, monitoring and treatment of COVID-19 cases in Spain. We describe how PHC practices (PCPs) organized healthcare to guarantee quality and safety and, if there were differences among the 17 Spanish regions according to the COVID-19 prevalence. METHODS: Cross-sectional study through the PRICOV-19 European Online Survey in PCPs in Spain. The questionnaire included structure and process items per PCP. Data collection was due from January to May 2021. A descriptive and comparative analysis and a logistic regression model were performed to identify differences among regions by COVID-19 prevalence (low < 5% or high ≥5%). RESULTS: Two hundred sixty-six PCPs answered. 83.8% of PCPs were in high prevalence regions. Over 70% PCPs were multi-professional teams. PCPs attended mainly elderly (60.9%) and chronic patients (53.0%). Regarding structure indicators, no differences by prevalence detected. In 77.1% of PCPs administrative staff were more involved in providing recommendations. Only 53% of PCPs had a phone protocol although 73% of administrative staff participated in phone triage. High prevalence regions offered remote assessment (20.4% vs 2.3%, p 0.004) and online platforms to download administrative documents more frequently than low prevalence (30% vs 4.7%, p < 0.001). More backup staff members were hired by health authorities in high prevalence regions, especially nurses (63.9% vs 37.8%, p < 0.001. OR:4.20 (1.01-8.71)). 63.5% of PCPs provided proactive care for chronic patients. 41.0% of PCPs recognized that patients with serious conditions did not know to get an appointment. Urgent conditions suffered delayed care in 79.1% of PCPs in low prevalence compared to 65.9% in high prevalence regions (p 0.240). A 68% of PCPs agreed on having inadequate support from the government to provide proper functioning. 61% of high prevalence PCPs and 69.5% of low ones (p: 0.036) perceived as positive the role of governmental guidelines for management of COVID-19. CONCLUSIONS: Spanish PCPs shared a basic standardized PCPs' structure and common clinical procedures due to the centralization of public health authority in the pandemic. Therefore, no relevant differences in safety and quality of care between regions with high and low prevalence were detected. Nurses and administrative staff were hired efficiently in response to the pandemic. Delay in care happened in patients with serious conditions and little follow-up for mental health and intimate partner violence affected patients was identified. Nevertheless, proactive care was offered for chronic patients in most of the PCPs.

Effects of antidiabetic drugs on bone metabolism.

Objectives: The prevalence of diabetes mellitus type 2 (DMT2) is increasing exponentially worldwide. DMT2 patients have been found to be at a higher risk for bone fractures than the healthy population. Hence, improving our understanding of the impact of antidiabetic drugs on bone metabolism is crucial. Methods: A descriptive, retrospective study involving 106 patients receiving six groups of antidiabetic drugs: insulin; dipeptidylpeptidase four inhibitors (DPP4i); glucagon-like peptide type 1 receptor agonists (GLP1ra); sulfonylureas; sodium-glucose cotransporter two inhibitors (SGLT2i); and pioglitazone, in which osteocalcin (OC), bone alkaline phosphatase (BAP) and C-terminal telopeptide of collagen type 1 or beta-crosslaps (ß-CTx) were determined. Results: ß-CTx concentrations were higher in the patients treated with pioglitazone, as compared to patients treated with DPP4i (p=0.035), SGLT2i (p=0.020) or GLP1ra (p<0.001). The lowest ß-CTx concentrations were observed in the patients treated with GLP1ra. Conclusions: Bone remodeling is influenced by the type of antidiabetic drug administered to DMT2 patients. In our study, the patients who received pioglitazone showed higher ß-CTx concentrations, as compared to patients treated with other types of antidiabetic drugs. This finding highlights the convenience of avoiding these drugs, especially in postmenopausal women with DMT2. GLP1ra drugs were associated with the lowest ß-CTx concentrations, which suggests that these agents could exert beneficial effects on bone metabolism.

Polypharmacy in Older Patients: A Three-Year Longitudinal Analysis in Primary Care Settings of Aragón, Spain.

BACKGROUND: Challenges of polypharmacy and the impact of coronavirus disease 2019 (COVID-19) pandemic in older patients require further investigation. This retrospective study analyzed the progression of polypharmacy and anticholinergic burden in older patients in a primary care setting before, during, and after the COVID-19 pandemic. METHODS: This 3-year cross-sectional study (2019, 2020, and 2021) comprised a dynamic cohort of individuals aged ≥75 years, who attended the Arrabal Primary Care Center in Zaragoza, Spain. Older patients with polypharmacy (≥5 medications) were identified according to their electronic health records. We collected demographic and clinical data, including medication prescriptions, diagnoses, and anticholinergic risks, and performed descriptive and statistical analyses. RESULTS: This study included a total of 1,928 patients with a mean age of 83.52±0.30 years. Over the 3-year study period, the mean number of medications prescribed increased, from 9.4 in 2019 to 10.4 in 2021. The prevalence of excessive polypharmacy (≥10 medications) increased from 39% in 2019 to 45% in 2021. The most commonly prescribed drugs were anilides, proton pump inhibitors, benzodiazepine derivatives, and platelet aggregation inhibitors. Women had a higher prevalence of illnesses and anticholinergic drug prescriptions than men. CONCLUSION: The results of this study highlighted an upward trend in polypharmacy and excessive polypharmacy among older patients in primary care settings. Future research should focus on optimizing medication management and deprescribing strategies and minimizing the adverse effects of polypharmacy in this population.

[Attend, consult, involve: do we need to redefine the concept of community engagement?] / Asistir, consultar, involucrar: ¿es necesario redefinir el concepto de participación comunitaria?

OBJECTIVE: To describe how a sample of people working in community health promotion projects perceive and implement community engagement approaches. METHOD: Mixed qualitative-quantitative study. Data was collected through: semi-structured interviews with 10 people representing the projects, and workshops in which 53 people participated and responded to a questionnaire prepared ad hoc to identify levels of community engagement. Descriptive statistical analysis of the questionnaires and framework analysis of the interviews, observations and workshops recordings. RESULTS: Although the projects are described as highly participatory, community engagement appeared mainly in the form of attending events, with few examples of consultation or community involvement. CONCLUSIONS: This difference may be due to the lack of a culture of participation, both in individuals and institutions, and lack of training in community engagement. It is proposed to change the language from participation-attendance to using expressions such as consulting or involving people.

[Bone metabolism in patients evaluated for lung transplantation]. / Metabolismo óseo en pacientes valorados para trasplante pulmonar.

INTRODUCTION: the prevalence of osteoporosis among candidates for lung transplantation is high and its pathophysiology is multifactorial. OBJECTIVES: to evaluate differences in bone mineral density, risk of fractures and bone remodeling markers in patients with terminal lung disease, at the time they are evaluated for lung transplantation, comparing two types of pathologies. MATERIAL AND METHODS: fifty-nine subjects, proposed to receive a lung transplant due to advanced lung disease, were included in this study. They were divided into two groups according to their respiratory pathology: chronic obstructive pulmonary disease (COPD) and diffuse interstitial pulmonary disease (ILD). Demographic data were collected and bone densitometry, blood analysis with markers of bone remodeling, spirometry, six-minute walk test (6MWT), echocardiography and cardiac catheterization were performed Results: no differences were found between the groups, regarding their age, sex, BMI or exposure to tobacco. A higher prevalence of osteoporosis and a higher FRAX were observed in the group with COPD. Regarding bone remodeling markers, higher parathyroid hormone (PTH) and higher osteocalcin were found in the COPD group. Vitamin D was lower in COPD patients. CONCLUSIONS: two out of three of the patients evaluated for lung transplantation had osteopenia or osteoporosis. The prevalence of osteoporosis and FRAX is higher in COPD patients. Vitamin D supplementation should be considered in certain patients. Differences in bone remodeling markers may be useful for suspected osteoporosis and therapeutic management.

Evaluating the implementation of community engagement guidelines (EVALUA GPS project): a study protocol.

INTRODUCTION: The EVALUA GPS project aims to evaluate the impact of the implementation of the National Institute for Health Care and Excellence (NICE) guideline 'Community engagement: improving health and well-being and reducing health inequalities' adapted to the Spanish context. METHODS AND ANALYSIS: Phase I: A tool will be designed to evaluate the impact of implementing the recommendations of the adapted NICE guideline. The tool will be developed through a review of the literature on implementation of public health guidelines between 2000 and 2021 and an expert's panel consensus. PHASE II: The developed tool will be implemented in 16 community-based programmes, acting as intervention sites, and 4 controls through a quasi-experimental pre-post study. Phase III: A final online web tool, based on all previously collected information, will be developed to support the implementation of the adapted NICE guidelines recommendations in other contexts and programmes. DATA COLLECTION AND ANALYSIS: Data will be collected through surveys and semistructured interviews. Quantitative and qualitative data will be analysed to identify implementation scenarios, changes in community engagement approaches, and barriers and facilitators to the implementation of the recommendations. All this information will be further synthesised to develop the online tool. ETHICS AND DISSEMINATION: The proposed research has been approved by the Clinical Research Ethics Committee of Aragon. Results will be presented at national and international conferences and published in peer-reviewed open access journals. The interactive online tool (phase III) will include examples of its application from the fieldwork.

Asistir, consultar, involucrar: ¿es necesario redefinir el concepto de participación comunitaria? / Attend, consult, involve: do we need to redefine the concept of community engagement?

Objetivo: Describir qué entienden por participación comunitaria las personas que trabajan en 10 proyectos de promoción de la salud y cómo se implementa. Método: Estudio mixto cuali-cuantitativo. Se recopilaron datos mediante entrevistas semiestructuradas a 10 personas representantes de los proyectos, y se realizaron talleres presenciales en los que participaron 53 personas que contestaron a un cuestionario elaborado ad hoc para identificar los niveles de participación comunitaria. Análisis estadístico descriptivo de los cuestionarios y análisis de matriz de las entrevistas, observaciones y grabaciones de los talleres. Resultados: Aunque los proyectos se definen como muy participativos, la participación se manifiesta principalmente como asistencia, con escasos ejemplos de consulta o implicación real de la comunidad. Conclusiones: La discrepancia observada puede deberse a una falta de cultura de participación de individuos e instituciones, y a falta de formación. Se propone dejar de hablar de participación-asistencia y hacerlo de consultar o involucrar a las personas.(AU)

Objective: To describe how a sample of people working in community health promotion projects perceive and implement community engagement approaches. Method: Mixed qualitative–quantitative study. Data was collected through: semi-structured interviews with 10 people representing the projects, and workshops in which 53 people participated and responded to a questionnaire prepared ad hoc to identify levels of community engagement. Descriptive statistical analysis of the questionnaires and framework analysis of the interviews, observations and workshops recordings. Results: Although the projects are described as highly participatory, community engagement appeared mainly in the form of attending events, with few examples of consultation or community involvement. Conclusions: This difference may be due to the lack of a culture of participation, both in individuals and institutions, and lack of training in community engagement. It is proposed to change the language from participation-attendance to using expressions such as consulting or involving people.(UA)

Participación en grupos de empoderamiento: utilidad y cambios percibidos / Participation in empowerment groups: usefulness and perceived changes

OBJETIVO: Conocer los cambios percibidos por las mujeres participantes de un grupo de empoderamiento sobre su estado físico, psíquico y social. DISEÑO: Metodología cualitativa mediante grupos focales. EMPLAZAMIENTO: Centro de salud (CS) urbano. PARTICIPANTES Y7O CONTEXTOS: Mujeres incluidas en alguna edición del Programa de Grupo de Empoderamiento del CS, dirigido por la trabajadora social desde 2012. MÉTODO: Grupos focales audiograbados durante 60-70 minutos. Transcripción literal, codificación y triangulación de los datos, comprobando saturación de la información. Análisis con MaxQDA. RESULTADOS: Desde el punto de vista psicológico, la situación previa de las participantes presentaba una baja autoestima, sintiéndose por lo general relegadas al último lugar en la jerarquía familiar. Las herramientas adquiridas durante las sesiones les ha permitido reivindicar un papel de mayor protagonismo. Respecto a su estado de salud físico, no perciben cambios importantes, excepto la menor dependencia farmacológica y la mayor capacidad para afrontar sus problemas de salud. A su vez, este programa les ha proporcionado la oportunidad de crear nuevas relaciones fuera de su entorno habitual. En contraposición, se comprueba una gran dependencia a la pertenencia al grupo. CONCLUSIONES: Destaca que el aprendizaje y la adquisición de nuevas herramientas, la mejora y ampliación de la red social, así como los cambios en la percepción de su propio yo, han dotado a las mujeres de mayor autonomía y ha mejorado su autoestima globalmente. En los aspectos negativos destaca la gran dependencia del grupo hacia la figura dinamizadora, que dificulta su propia autonomía

OBJECTIVE: To ascertain the changes perceived by the women participating in an empowerment group on their physical, mental and social state. DESIGN: Qualitative methodology by means of focus groups. LOCATION: Urban Health Centre (HC). Participants and/or backgrounds. Female sex, included in an edition of the HS Empowerment Group Programme, which has been supervised by the social worker since 2012. METHOD: Audio-recorded focus groups 60-70 minutes long. Literal transcription, coding and triangulation of the data guaranteeing information saturation. Analysis with MaxQDA. RESULTS: From the psychological point of view, the previous situation of the participants presented a low self-esteem, feeling in general relegated to the last place in the family hierarchy. The tools acquired during sessions enabled them to claim a role of greater prominence. Regarding their state of physical health, they do not perceive important changes except lower pharmacological dependence and greater capacity to tackle their health problems. In turn, this programme has provided them with the opportunity to create new relationships outside their usual environment. In contrast, a major dependence on belonging to the group was revealed. CONCLUSIONS: It is notable that learning and the acquisition of new tools, improvement and expansion of the social network, as well as changes in the perception of their own selves, have given women greater autonomy and have improved their self-esteem globally. In terms of negative aspects, the major dependence of the group on the dynamic figure, which hinders its own autonomy, stands out

Resident Physicians as Patients: Perceptions of Residents and Their Teaching Physicians.

OBJECTIVE: This study aims to broaden understanding into the process by which resident physicians deal with illness and to identify areas for improvement regarding healthcare of residents and teaching physicians training to support them adequately. METHODS: A qualitative study of ten semi-structured interviews with residents who had suffered a serious illness and a focus group of teaching physicians were conducted. Analysis of the interview transcripts was performed using the grounded theory approach, with information divided into five categories: Differences between residents as patients and general patients; confidentiality; feelings and attitudes; learning from illness; and impact on work and training. RESULTS: There are differences between residents and the general population: In the initial stage, diagnosis is made promptly with preferential treatment shown by colleagues. Subsequently, the lack of clear guidelines can lead to poor follow-up. They accept a loss of confidentiality in the process. One of the most serious concerns felt by residents is the impact of their illness on their training as specialists, meaning that teaching physicians are charged with the important role of guaranteeing the resident's proper recovery, return to work, and readaptation to the training program. Teaching physicians demand their own training be reinforced in these aspects. CONCLUSION: There is a need to assess the great diversity observed in training-related decisions made by teaching physicians when residents fall ill. Given the differences observed, more research is required to improve the care provided to sick residents and particularly the teaching physicians training to handle them.

El proceso de enfermar de los médicos y sus consecuencias en el profesionalismo / The process of physicians falling ill and consequences for their professionalism / O processo de adoecimento dos médicos e as suas consequências acerca do profissionalismo

Resumen: La idiosincrasia de la profesión médica, los rasgos de personalidad característicos del médico y la falta de formación específica para reconocer y tratar adecuadamente la propia vulnerabilidad, predisponen a este colectivo a padecer más patología mental y, probablemente, un deficiente tratamiento de otras enfermedades. La mayoría de los estudios realizados hasta el momento se centran en la patología mental y adictiva del médico, desde el punto de vista del riesgo para la mala praxis y la seguridad de sus pacientes. La revisión narrativa de la literatura científica realizada (MEDLINE, EMBASE e IME 1985-2016) ha mostrado que, en el entorno hispanoparlante, apenas disponemos de información actualizada sobre el médico como paciente, a pesar de ser un tema de indudable relevancia desde el punto de vista de la seguridad asistencial, del profesionalismo y del propio bienestar de los profesionales. La situación del médico que enferma es compleja y poco conocida, con conflicto de roles y con repercusiones en la ética profesional y la calidad asistencial.

Abstract: The idiosyncrasy of the medical profession, the characteristic personality traits of the physician and the lack of specific training to properly recognize and treat one's own vulnerability dispose this group to suffer more mental pathology and probably worse control of other medical diseases. Most of the studies promoted so far focus on the psychiatric and addictive concerns of the physician, from the point of view of the sick doctor as being at risk for malpractice and to guarantee the safety of their patients. The narrative review of scientific literature (MEDLINE, EMBASE and IME 1985-2016) has shown that we do not have in the Spanish-speaking environment updated information about the doctor as a patient, despite being a topic of incipient media repercussion and undoubtedly relevant from the point of view of patient safety, professionalism and medical ethics and as well as the welfare of professionals. The characteristic of a sick doctor are more complex than the rest of patients with a conflict of roles and repercussions on professional ethics and the quality of care.

Resumo: A idiossincrasia da profissão médica, as características de personalidade característica do médico e a falta de formação específica para reconhecer e, corretamente, tratar a própria vulnerabilidade, predispõem esse grupo a sofrer mais patologias mentais, e provavelmente tratamento deficiente de outras doenças. A maioria dos estudos realizados até agora tem como foco a patologia mental e o comportamento aditivo do médico, do ponto de vista do risco por negligência e segurança de seus pacientes. A revisão narrativa da literatura científica realizada (MEDLINE, EMBASE e IME 1985-2016) tem mostrado que no ambiente de idioma hispânico temos apenas informações atualizadas sobre o médico como paciente, apesar de ser uma questão de relevância inquestionável do ponto de vista da segurança assistencial, do profissionalismo e do próprio bem-estar dos profissionais. A situação do médico enfermo é complexa e pouco conhecida, com conflito de papéis e impacto sobre a ética profissional e a qualidade dos cuidados médicos. São necessários mais estudos, tanto quantitativos como qualitativos, que permitam compreender o processo do adoecimento dos médicos em cada um dos seus estágios profissionais (desde a graduação até a aposentadoria) para ser capaz de considerar estratégias para a melhoria na atenção da saúde desses profissionais.