[ROWING AGAINST THE CURRENT]. / REMANDO A CONTRACORRIENTE.

At Lalonde we know that the determinants that most influence the health of the population are lifestyle, genetics and the environment. Health represents only 10% and is the determinant that consumes the most resources. It has been shown that a salutogenic approach focused on the social determinants of health and the support of public policies to improve the environment are more efficient in the long term than medicine focused on hospitals, technology and super-specialization. Primary Care (PC) that has an approach centered on the person and families with a community vision, is the ideal level to provide health care, and to influence lifestyles. However it is not invested in PC. In this article we review the socioeconomic and political factors that globally influence the lack of interest in the development of PC.

Remando a contracorriente / Rowing against the current

At Lalonde we know that the determinants that most influence the health of the population are lifestyle, genetics and the environment. Health represents only 10% and is the determinant that consumes the most resources. It has been shown that a salutogenic approach focused on the social determinants of health and the support of public policies to improve the environment are more efficient in the long term than medicine focused on hospitals, technology and super-specialization. Primary Care (PC) that has an approach centered on the person and families with a community vision, is the ideal level to provide health care, and to influence lifestyles. However it is not invested in PC. In this article we review the socioeconomic and political factors that globally influence the lack of interest in the development of PC.(AU)

Desde Lalonde sabemos que los determinantes que más influyen en la Salud de la población son el estilo de vida, la genética y el entorno. La sanidad representa solo el 10% y es el determinante que más recursos consume. Está demostrado que un enfoque salutogénico centrado en los determinantes sociales de la salud y el apoyo de políticas públicas para mejorar el entorno, son más eficientes a largo plazo que la medicina centrada en los hospitales, la tecnología y la superespecialización. La Atención Primaria (AP) que tiene un enfoque centrado en la persona y las familias con una visión comunitaria, es el nivel idóneo para proveer atención sanitaria, y para influir en los estilos de vida. Sin embargo no se invierte en AP. En este artículo revisamos los condicionantes socioeconómicos y políticos que influyen de manera global en la falta de interés en el desarrollo de la AP.(AU)

Prevalence and comorbidities of Sjogren's syndrome patients in the Community of Madrid: A population-based cross-sectional study.

OBJECTIVES: To estimate the prevalence, sociodemographic characteristics and comorbidities of Sjogren's syndrome (SS) patients in the Community of Madrid. METHODS: A population-based cross-sectional cohort of SS patients was derived from the information system for rare diseases in the Community of Madrid (SIERMA) and confirmed by a physician. The prevalence per 10,000 inhabitants among people aged ≥18years in June 2015 was calculated. Sociodemographic data and accompanying disorders were recorded. Univariate and bivariate analyses were performed. RESULTS: A total of 4,778 SS patients were confirmed in SIERMA; 92.8% were female, with a mean age of 64.3 (standard deviation=15.4) years. A total of 3,116 (65.2%) patients were classified as primary SS (pSS), and 1,662 (34.8%) as secondary SS (sSS). The prevalence of SS among people aged ≥18 years was 8.4/10,000 (95%Confidence interval [CI]=8.2-8.7). The prevalence of pSS was 5.5/10,000 (95%CI=5.3-5.7), and that of sSS was 2.8/10,000 (95%CI=2.7-2.9), with rheumatoid arthritis (20.3%) and systemic lupus erythematosus (8.5%) being the most prevalent associated autoimmune diseases. The most common comorbidities were hypertension (40.8%), lipid disorders (32.7%), osteoarthritis (27.7%) and depression (21.1%). The most prescribed medications were nonsteroidal anti-inflammatory drugs (31.9%), topical ophthalmic therapies (31.2%) and corticosteroids (28.0%). CONCLUSION: The prevalence of SS in the Community of Madrid was similar to the overall prevalence worldwide observed in previous studies. SS was more frequent in women in their sixth decade. Two out of every three SS cases were pSS, while one-third were associated predominantly with rheumatoid arthritis and systemic lupus erythematosus.

Sex differences in social support perceived by polymedicated older adults with multimorbidity. MULTIPAP study.

The beneficial effects of social support on morbidity, mortality, and quality of life are well known. Using the baseline data of the MULTIPAP study (n = 593), an observational, descriptive, cross-sectional study was carried out that analyzed the sex differences in the social support perceived by polymedicated adults aged 65 to 74 years with multimorbidity. The main outcome variable was social support measured through the Duke-UNC-11 Functional Social Support (DUFSS) questionnaire in its two dimensions (confident support and affective support). For both sexes, the perception of functional social support was correlated with being married or partnered and having a higher health-related quality of life utility index. In women, it was correlated with a higher level of education, living alone, and treatment adherence, and in men with higher monthly income, prescribed drugs and fewer diagnosed diseases.

Identification of the multimorbidity training needs of primary care professionals: Protocol of a survey.

Current epidemiological situation has prompted the consideration of multimorbility (MM) as a prevalent condition, influenced by age, educational level and social support, related to unfavorable social and health determinants. Primary Care (PC) has a key role in its approach but further training of professionals in MM is required. The evidence on the effectiveness of training interventions in MM is still limited. Knowing the experiences, opinions and training needs of professionals is essential to enhance training interventions. OBJECTIVES: Identify perceived training needs by PC health professionals (doctors and nurses) in MM and polypharmacy. METHODS: Design: Cross-sectional study based on an online survey (anonymous-ad hoc questionnaire). Participants and recruitment: 384 doctors and nurses working in healthcare centers and out-of-hospital emergencies of the Spanish National Health System. Non-probabilistic convenience sampling via email addressed to Health Institutions, and social networks. DATA: Demographic characteristics and professional profile data (close-ended and multiple-choice questions) will be collected. Open-ended questions will be used to identify training needs, difficulties and resources about MM; required skills to care patients with MM will be assessed using a 4-item ordinal scale. ANALYSIS: Coding of data prior to analysis. Descriptive statistical analysis, participation and completion rates of the questionnaire and estimation of absolute and relative frequencies and 95% confidence intervals in close-ended questions. Content analysis with inductive methodology in open-ended questions. Ethics: Ethical approval, Online informed consent. CONCLUSIONS: The identification of training needs of health professionals who care for patients with MM will be necessary data for developing highly effective training activities.

Implementación de recomendaciones y guías de práctica clínica por residentes: el papel de las unidades docentes multiprofesionales de atención familiar y comunitaria en España / Implementation of Recommendations and Clinical Practice Guidelines by residents: the role of the Multiprofessional Family and Community Care Teaching Units in Spain

Objetivo: Analizar el papel de las unidades docentes (UD) de atención familiar y comunitaria como agentes facilitadores de la implementación de guías de práctica clínica (GPC) y los factores asociados a un mayor esfuerzo en esta tarea. Material y métodos: Diseño: estudio descriptivo transversal con enfoque analítico. Participantes: UD en España (n=94). Mediciones principales: Variables recogidas mediante encuesta autocumplimentada en 5 dominios: características de las UD, actividad formativa dirigida a la práctica clínica basada en pruebas, importancia atribuida a esta actividad, responsabilidad sobre implementación de GPC y percepción sobre barreras y facilitadores para su uso. Análisis descriptivo y multivariante siendo la variable dependiente el esfuerzo percibido de las UD para implementar GPC. Resultados: Respondieron 45 UD (47,9%). El 42,2% (IC 95%: 27,8-56,6) de sus responsables ha dirigido proyectos de investigación y el 31,1% (IC 95%:17,6- 44,6) ha participado en elaborar GPC. Organizaban una media de 51horas (DE 47,2) de formación en práctica clínica basada en pruebas. El 97,7% (IC 95%:93,3-100) consideraba fundamental que los residentes conozcan y apliquen GPC y el 93,3% (IC 95%: 86,0-100) consideran los tutores responsables de implementarlas. Se relacionaron con un mayor esfuerzo de las UD la participación del responsable en GPC (coef.: 0,58; IC 95%: 0,00-1,16), la importancia dada a que los residentes las conozcan (coef.: 0,89; IC 95%: 0,24-1,54) y que estas parezcan aplicables (coef.: 0,35; IC 95%: –0,01-0,70). Conclusiones: Las UD reconocen la importancia de las GPC y consideran a los tutores responsables de su implementación. El esfuerzo de las UD para implementar GPC se relacionó con la experiencia previa de los responsables, la percepción de aplicabilidad y de necesidad de los residentes.(AU)

Objective: To analyze the role of Family and Community Care Trainig Units as facilitators of the implementation of Clinical Practice Guidelines (CPG) and the factors associated with a greater effort in this task. Material and methods: Design: Cross-sectional descriptive study with analytical approach. Participants: Training Units in Spain (N=94). Main measurements: Variables were collected through a self-completed survey into five domains: characteristics of Training Units, training activity directed at evidence-based clinical practice (EBPP), importance attributed to this activity, responsibility for EBPP implementation, perception of barriers and facilitators to its use. Descriptive and multivariate analysis with the dependent variable being the perceived effort of the training unit to implement CPG. Results: 45 Training Units responded (47.9%). 42.2%(CI 95%: 27.8-56.6) of their coordinators have directed research projects and 31.1% (CI 95%:17.6-44.6) have participated in elaborating CPG. They organized an average of 51hours (SD 47.2) of training in PCBP. 97.7% (CI95%:93.3-100) considered it fundamental that the residents ow and apply PCBP and 93.3% (CI95%:86.0-100) considered that tutors are responsible for the implementation. The participation of the coordinator in CPG (coef: 0.58; IC 95%: 0.00-1.16), awareness of how important is that residents know about CPG (coef: 0.89; IC 95%: 0.24-1.54) and that CPG appear to be widely applicable. applicable (coef: 0.35; IC 95%: -0.01-0.70) were related to a greater effort by the training units. Conclusions: The training units recognize the importance of CPGs and consider that tutors are responsible for their implementation. Training Units effort to implement CPG was related to unit coordinators previous experience, the perception of applicability and residents needs.(AU)

[Implementation of Recommendations and Clinical Practice Guidelines by residents: the role of the Multiprofessional Family and Community Care Teaching Units in Spain]. / Implementación de recomendaciones y guías de práctica clínica por residentes: el papel de las unidades docentes multiprofesionales de atención familiar y comunitaria en España.

OBJECTIVE: To analyze the role of Family and Community Care Trainig Units as facilitators of the implementation of Clinical Practice Guidelines (CPG) and the factors associated with a greater effort in this task. MATERIAL AND METHODS: Design: Cross-sectional descriptive study with analytical approach. PARTICIPANTS: Training Units in Spain (N=94). MAIN MEASUREMENTS: Variables were collected through a self-completed survey into five domains: characteristics of Training Units, training activity directed at evidence-based clinical practice (EBPP), importance attributed to this activity, responsibility for EBPP implementation, perception of barriers and facilitators to its use. Descriptive and multivariate analysis with the dependent variable being the perceived effort of the training unit to implement CPG. RESULTS: 45 Training Units responded (47.9%). 42.2%(CI 95%: 27.8-56.6) of their coordinators have directed research projects and 31.1% (CI 95%:17.6-44.6) have participated in elaborating CPG. They organized an average of 51hours (SD 47.2) of training in PCBP. 97.7% (CI95%:93.3-100) considered it fundamental that the residents ow and apply PCBP and 93.3% (CI95%:86.0-100) considered that tutors are responsible for the implementation. The participation of the coordinator in CPG (coef: 0.58; IC 95%: 0.00-1.16), awareness of how important is that residents know about CPG (coef: 0.89; IC 95%: 0.24-1.54) and that CPG appear to be widely applicable. applicable (coef: 0.35; IC 95%: -0.01-0.70) were related to a greater effort by the training units. CONCLUSIONS: The training units recognize the importance of CPGs and consider that tutors are responsible for their implementation. Training Units effort to implement CPG was related to unit coordinators previous experience, the perception of applicability and residents needs.

Training primary care professionals in multimorbidity management: Educational assessment of the eMULTIPAP course.

Multimorbidity (MM) is a widespread problem and it poses unsolved issues like the healthcare professionals' training. A training curriculum has been proposed, but it has not been sufficiently explored in a clinical context. The eMULTIPAP course is part of the MULTIPAP complex intervention, applied through a pragmatic controlled, cluster randomized clinical trial to general practitioners (GP) and his/her patients with MM with 12 months follow-up. The eMULTIPAP course is based on problem-based learning, constructivism and Ariadne principles. It has been assessed according to the Kirkpatrick model and has shown knowledge improvement and high applicability of learning with more motivation to consider MM in the clinical practice. It has also improved the Medication Appropriateness Index at 6-months and at 12- months. We conclude that the eMULTIPAP course generates significant changes in GP's learning, enhancing clinical practice in multimorbidity scenarios.

Multimorbilidad en medicina de familia y los principios Ariadne. Un enfoque centrado en la persona / Multimorbidity in general practice and the Ariadne principles. A person-centred approach

La multimorbilidad, definida como la presencia de dos o más enfermedades crónicas en un mismo individuo, conlleva consecuencias negativas para la persona e importantes retos para los sistemas sanitarios. En atención primaria, donde recae esencialmente la atención de este grupo de pacientes, la consulta es más compleja que la de un paciente con una única enfermedad debido, entre otros, al hecho de tener que manejar mayor cantidad de información clínica, disponer de poca evidencia científica para abordar la multimorbilidad, y tener que coordinar la labor de múltiples profesionales para garantizar la continuidad asistencial. Además, para poder implementar correctamente los planes de tratamiento en estos pacientes es necesario un proceso de toma de decisiones compartida médico-paciente. Entre las distintas herramientas disponibles para apoyar dicho proceso, recientemente se ha desarrollado una dirigida específicamente a pacientes con multimorbilidad en atención primaria y que se describe en el presente artículo: los principios Ariadne

Multimorbidity, defined as the coexistence of two or more chronic conditions in one same individual, has negative consequences for people suffering from it and it poses a real challenge for health systems. In primary care, where most of these patients are attended, the clinical management of multimorbidity can be a complex task due, among others, to the high volume of clinical information that needs to be handled, the scarce scientific evidence available to approach multimorbidity, and the need for coordination among multiple health providers to guarantee continuity of care. Moreover, the adequate implementation of the care plan in these patients requires a process of shared decision making between patient and physician. One of the available tools to support this process, which is specifically directed to patients with multimorbidity in primary care, is described in the present article: the Ariadne principles

[Multimorbidity in general practice and the Ariadne principles. A person-centred approach]. / Multimorbilidad en medicina de familia y los principios Ariadne. Un enfoque centrado en la persona.

Multimorbidity, defined as the coexistence of two or more chronic conditions in one same individual, has negative consequences for people suffering from it and it poses a real challenge for health systems. In primary care, where most of these patients are attended, the clinical management of multimorbidity can be a complex task due, among others, to the high volume of clinical information that needs to be handled, the scarce scientific evidence available to approach multimorbidity, and the need for coordination among multiple health providers to guarantee continuity of care. Moreover, the adequate implementation of the care plan in these patients requires a process of shared decision making between patient and physician. One of the available tools to support this process, which is specifically directed to patients with multimorbidity in primary care, is described in the present article: the Ariadne principles.