Innovative Health and Social Integrated Care Model Effectiveness to Improve Quality Care for Chronic Patients: A Single Group Assignment Clinical Trial.

Background: Patients with chronic disease have become one of the major challenges for health and social protection systems in developed countries. Integrated care models (ICM) have demonstrably improved the quality of care of chronic patients. However, new models of integration need further evaluation of its effectiveness and outcomes. Methods: The ICM studied promoted coordination between the health and social sectors during a 6-month period, through an ad hoc developed application (app) that enabled a constant flow of communication between professionals from both sectors. Patients' quality of life, treatment adherence, chronic patient experience and caregiver overload were assessed by questionnaires at baseline, at the end of the intervention and 6 months post-intervention. Results: The implementation of the new health and social ICM permitted new case detection and medical and social services offered to chronic patients. Furthermore, the quality of life and treatment adherence of patients and caregiver overload were significantly improved. These positive effects lasted at least 6 months after the intervention. Conclusions: Integrated care may facilitate access to care services, increase perceived patient quality of life and treatment adherence. Enhanced access to medical and social services from complex chronic patients may have important implications for caregivers and the care systems who are struggling to adapt to an expanding demand.

Integrated Care Model Salut+Social Assessment by Professionals, Informal Caregivers and Chronic or Social Dependent Patients: A Qualitative Study.

We explored the views of the professionals (from primary care and social services) and users (caregivers and patients) who participated in the clinical trial of the Salut+Social integrated care model to identify the implementation barriers and facilitators, to assess the impact on health and wellbeing and to obtain an assessment of the program. A qualitative descriptive study with a pragmatic, utilitarian approach was performed. Participants were recruited by purposive and convenience sampling. A focus group (FG) and in-depth interviews were conducted with professionals and users, respectively. Thematic content analysis was employed. A total of 11 professionals and 8 users participated in the FG and interviews, respectively. Seven themes were identified: (1) contextualizing the previous scenario; (2) achievements of the program from the professionals' perspective; (3) facilitators and barriers of the integrated care model; (4) proposals for improving the integrated care model; (5) users' assessment of the care received within the program framework; (6) users' perception of the impact on health and wellbeing; (7) users' demands for better care. Professionals reported improved coordination between services and highlighted the need for a protocol for emergencies and to strengthen community orientation. Users proposed more frequent home visits. This study shows the acceptability of the new model by professionals and the users' satisfaction with the care received.

The impact of COVID-19 pandemic on pulmonary hypertension: What have we learned?

The coronavirus 2019 disease (COVID-19) pandemic threatened the Spanish health-care system. Patients with demanding conditions such as precapillary pulmonary hypertension (PH) faced a potentially severe infection, while their usual access to medical care was restricted. This prospective, unicentric study assessed the impact of COVID-19 on PH patients' outcomes and the operational changes in the PH network. Sixty-three PH patients (41 pulmonary arterial hypertension [PAH]; 22 chronic thromboembolic pulmonary hypertension [CTEPH]) experienced COVID-19. Overall mortality was 9.5% without differences when stratifying by hemodynamics or PAH-risk score. Patients who died were older (73.6 ± 5 vs. 52.2 ± 15.4; p = 0.001), with more comorbidities (higher Charlson index: 4.17 ± 2.48 vs. 1.14 ± 1.67; p = 0.0002). Referrals to the PH expert center decreased compared to the previous 3 years (123 vs. 160; p = 0.002). The outpatient activity shifted toward greater use of telemedicine. Balloon pulmonary angioplasty activity could be maintained after the first pandemic wave and lockdown while pulmonary thromboendarterectomy procedures decreased (19 vs. 36; p = 0.017). Pulmonary transplantation activity remained similar. The COVID-19 mortality in PAH/CTEPH patients was not related to hemodynamic severity or risk stratification, but to comorbidities. The pandemic imposed structural changes but a planned organization and resource reallocation made it possible to maintain PH patients' care.

Efectividad de un programa comunitario de apoyo a cuidadores de pacientes con demencia: escuela del cuidar / Effectiveness of a community support program for caregivers of patients with dementia: school of care

Objetivo: conocer las necesidades que expresan los cuidadores de pacientes con demencia en relación a aspectos formativos, de apoyo psicosocial, resolución de problemas y entrenamiento de habilidades. Diseñar, implementar y evaluar un programa comunitario de apoyo a cuidadores de pacientes con demencia que mejore su calidad de vida como cuidador y su experiencia de cuidar. Método: estudio de metodología mixta según la guía de la Medical Research Council sobre evaluación de intervenciones complejas, en tres fases. Fase 1: Modelización y operativización de la intervención (cualitativo). Fase 2: Estudio cuasi-experimental pre/post-intervención con medidas repetidas antes y después de la intervención y a los seis meses. Fase 3: Evaluación del programa de intervención (cualitativo).La población objeto de estudio son los cuidadores de pacientes no institucionalizados con diagnóstico de demencia, con grado de dependencia 1, 2 o pendientes de grado de las comarcas del Montsiá y Baix Ebre (Tarragona, España) en el ámbito de Atención Primaria, para el periodo 2020-2022. Conclusiones: realizar un estudio de metodología mixta desde la Atención Primaria y con colaboración ciudadana permitirá el diseño de una intervención adaptada la realidad de los sujetos de estudio. Su aplicación podría ser relevante ya que, si se confirman los objetivos propuestos, este estudio establecería una base para modificar el abordaje a los cuidadores y el apoyo que deben recibir, iniciándose desde el momento del diagnóstico del paciente, minimizando la sobrecarga del cuidador, mejorando su calidad de vida y su apoyo social.(AU)

Objectives: to understand the needs expressed by caregivers of patients with dementia regarding aspects of training, psychosocial support, solution of problems and training in skills. To design, implement and evaluate a community support program for caregivers of patients with dementia, which will improve their quality of life as caregivers and their caring experience. Method: a mixed methodology study according to the Medical Research Council guidelines on evaluation of complex interventions, in three stages. Stage 1: Modelling and implementation of the intervention (qualitative). Stage 2: Quasi-experimental pre-post intervention study with measurements repeated before and after the intervention and at six months. Stage 3: Evaluation of the intervention program (qualitative).The population object of the study are caregivers of non-institutionalized patients with diagnosis of dementia, with degree of dependence 1 or 2 or pending degree, in the Montsiá and Baix Ebre regions (Tarragona, Spain) in the Primary Care setting, for the 2020-2022 period. Conclusions: to conduct a mixed methodology study from Primary Care and with collaboration by citizens will allow to design an intervention adapted to the reality of the study subjects. Its application could be relevant, because if the objectives are confirmed, this study would establish the basis for modifying the way to address caregivers and the support they must receive, by being initiated since patient diagnosis, reducing caregiver overload to a minimum, and improving their quality of life and social support.(AU)

Effectiveness of the integrated care model Salut+Social in patients with chronic conditions: A mixed methods study protocol.

INTRODUCTION: Integrated care models aim to provide solutions to fragmentation of care by improving coordination. This study will evaluate the effectiveness of a new integrated care model (Salut + Social), which will promote the coordination and communication between social and healthcare services in southern Catalonia (Spain) to improve quality of life, adherence to treatment and access to medical services for patients with chronic conditions, and also to reduce caregiver burden. Additionally, we will evaluate the experience of caregivers, health professionals and social workers with the new model implemented. METHODS AND ANALYSIS: A clinical trial using mixed methodology will be carried out. The intervention consists of improving the coordination between the social and healthcare sectors during a 6-month period, by means of information and communication technology (ICT) tools that operate as an interface for the integrated care model. The study subjects are primary care patients with chronic health and social conditions that can benefit from a collaborative and coordinated approach. A sample size of 141 patients was estimated. Questionnaires that assess quality of life, treatment adherence, medical service and caregiver burden will be used at baseline and at 6, 9, and 12 months after the beginning of the study. The principal variable is quality of life. For statistical analysis, comparisons of means and proportions at different time points will be performed. A discussion group and semi-structured interviews will be conducted with the aim of improving the care model taking into account the opinions of professionals and caregivers. A thematic content analysis will be carried out. ETHICS AND DISSEMINATION: This study protocol has been approved by the Clinical Research Ethics Committee of the Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (code P17/100). Articles will be published in international, peer-reviewed scientific journals. TRIAL REGISTRATION: Clinical-Trials.gov: NCT04164160.

Real-life effect of a microcrystalline tyrosine adjuvanted mite immunotherapy in patients with allergic rhinitis.

Aim: Evaluate the effectiveness and safety of immunotherapy with Acarovac Plus® in a 1-year prospective multicentered real-life study. Methods: A total of 118 adults with allergic rhinitis sensitized to Dermatophagoides received subcutaneous immunotherapy with Acarovac Plus. Treatment outcomes were evaluated at baseline, 6 months and 1 year after treatment initiation. Primary end point was the evolution of the combined symptom and medication score. Secondary end points included other effectiveness outcomes and measurement of product tolerability. Results: Acarovac Plus induced significant improvements in primary and secondary end points after 6 months compared with baseline. These differences persisted after 1 year of treatment (p < 0.001; baseline vs 1 year): combined symptom and medication score (1.60 vs 0.79). No serious adverse events were recorded. Conclusion: Acarovac Plus for 1 year was effective and well tolerated in a real-life setting.

Oral immunotherapy with peach juice in patients allergic to LTPs.

INTRODUCTION: To assess the safety and efficacy of an oral immunotherapy regimen in patients with allergy to lipid transfer proteins (LTPs). MATERIALS AND METHODS: Prospective study of 24 patients allergic to LTP with positive skin test and a history of anaphylaxis. All patients underwent a desensitization protocol with commercial peach juice. Rising doses of peach juice were administered, starting with an initial dose of seven drops of a 1/1000 dilution and finishing with a dose of 5 ml at visit 17. At visit 18, all patients performed an open challenge with whole juice at a cumulative dose of 200 ml. All adverse reactions occurring during the administration of the different doses were recorded. Levels of rPru p 3 in the juice were quantified. RESULTS: There were no severe reactions during the desensitization process in the 24 patients. Seven patients (29%) reported mild oral symptoms, and two patients (8%) had urticaria associated with co-factors (one due to exercise and another due to non-steroidal anti-inflammatory drugs). Nineteen patients were able to swallow 5 ml of juice and five withdrew from the study. In two pregnant patients the final challenge was not performed. In all, 17/24 patients were able to consume 200 ml peach juice without developing symptoms. CONCLUSIONS: Oral immunotherapy with the regimen used in this study is an effective and safe short-term therapeutic option for patients with allergy to LTPs. Commercial peach juice appears to be suitable for this treatment.

Edad, dependencia y consecuencias sociosanitarias / Age, dependency and socio-sanitary consequences

El uso de recursos sanitarios viene condicionado por unaserie de factores que escapan a los tratados directamentepor el sistema sanitario, y que es necesario considerar enel avance hacia la eficiencia y eficacia del mismo, así comopara mejorar la prevención, la atención y la salud dela población. Esto es especialmente importante en uncontexto sociológico y demográfico en el que el sectorde población mayor y muy mayor está ganando cada vezmás peso específico. Este peso, y sus consecuencias,plantean asuntos clave no sólo en términos de eficienciay eficacia del sistema sociosanitario, sino también a nivelde valores y derechos sociales (AU)

The use of health resources is conditioned by several factors,that are not considered by health system. It is necesary toconsider that factors in order to improve the efficiency andeffectiveness, prevention, care and population health.This is especially important in a sociological and demographiccontext in which elderly and very elderly population isgetting more and more importance. This fact, and its consequences,raise key issues not only in terms of efficiencyand effectiveness of the health system, but also at the levelof values and social rights (AU)