Healthcare Professionals' Perceptions about the Implementation of Shared Decision-Making in Primary Care: A Qualitative Study from a Virtual Community of Practice.

Background: The incorporation of shared decision making (SDM) is a central part of empowerment processes, as it facilitates greater activation on the part of patients, increasing the likelihood of them gaining control over their healthcare and developing skills to solve their health problems. Despite these benefits, there are still difficulties in the implementation of SDM among healthcare professionals due to internal and external factors related to the context and health systems. Aim: To explore primary care professionals (PCPs)' perceptions of the SDM model, based on their preconceptions and experience in clinical practice. Methods: A framework analysis was conducted on qualitative data derived from a virtual community practice forum, within a cluster-randomized clinical trial developed in the e-MPODERA project. Results: The most important points in the opinions of the PCPs were: exploring the patients' values, preferences and expectations, providing them with and checking their understanding of up-to-date and evidence-based health information. The analysis revealed three themes: determinants of the implementation process of SDM, lack of consistency and dilemmas and benefits of PCP active listening, motivation and positive expectations of SDM. Discussion: In our initial analysis, we examined the connections between the categories of the TDC model and its application in the primary care context. The categories related to the model reflect the theoretical understanding of professionals, while those related to perceptions of its application and use show certain discrepancies. These discrepancies could indicate a lack of understanding of the model and its real-world implications or insufficient commitment on the part of professionals or the organization to ensure its effective implementation. Conclusions: Specific targeted training that addresses knowledge, attitudes and practice may resolve the aforementioned findings.

Antecedentes: La incorporación de la toma de decisiones compartida (TDC) es una parte central del empoderamiento del paciente, ya que facilita una mayor activación, ganar control sobre la atención que recibe y desarrollar habilidades para resolver sus problemas de salud. A pesar de estos beneficios, todavía existen dificultades para implementar la TDC entre los profesionales sanitarios debido a factores internos de los propios profesionales y externos, relacionados con el contexto y los sistemas sanitarios. Objetivo: Explorar en el foro de una comunidad virtual de práctica (CVdP) las percepciones de los profesionales de atención primaria (PAP) sobre el modelo de TDC en función de sus ideas preconcebidas y su experiencia en la práctica clínica. Métodos: Se realizó un análisis de marco desde un abordaje cualitativo de las intervenciones hechas por los PAP en el foro de una CVdP. Esta CVdP se implementó dentro de un ensayo clínico aleatorizado por grupos desarrollado en el proyecto e-MPODERA. Resultados: Los aspectos más importantes relacionados con la TDC desde la perspectiva de los PAP incluyeron: explorar los valores, preferencias y expectativas de los pacientes, proporcionarles información actualizada y basada en la evidencia, y comprobar su comprensión. En el análisis posterior, tres categorías emergieron como los temas más relevantes: determinantes de la implementación del TDC, falta de consistencia y dilemas, y beneficios de la escucha activa de los PAP, motivación y expectativas positivas de la TDC. Discusión: En nuestro análisis inicial, examinamos las conexiones entre las categorías del modelo de TDC y su aplicación en el contexto de atención primaria. Las categorías relacionadas con el modelo reflejan la comprensión teórica de los profesionales, mientras que las relativas a las percepciones de su aplicación y uso muestran ciertas discrepancias. Estas discrepancias podrían indicar una falta de comprensión del modelo y de sus implicaciones en el mundo real o un compromiso insuficiente por parte de los profesionales o de la organización para garantizar su aplicación efectiva. Conclusión: Una formación específica que aborde los conocimientos, las actitudes y la práctica puede resolver los hallazgos mencionados.

COVID-19 healthcare and social-related needs from the perspective of Spanish patients and healthcare providers: a qualitative analysis of responses to open-ended questions.

Introduction: Identifying stakeholders' needs is crucial to informing decisions and policy development. This study aims to identify healthcare and social-related needs and effective strategies associated with COVID-19 from the first-person perspectives of patients and healthcare providers. Methods: Cross-sectional online survey design including qualitative open-ended questions, conducted in primary care and hospital settings across Spain, with 12 out of 19 regions represented. Adults aged 18 years and older, who (a) resided in Spain and had a history of COVID-19 or (b) worked as healthcare providers delivering direct or indirect care for people with COVID-19 in Spanish primary care or hospitals during 2020 were eligible to participate. Recruitment was conducted via social-media networks (Twitter, LinkedIn, and WhatsApp) and communication channels of key organizations including patient and professional associations and groups. A total of 182 people were invited to complete the surveys and 76 people completed the surveys (71% women), of which 33 were home-isolated patients, 14 were hospitalized patients, 16 were primary care professionals, and 13 were hospital care professionals. Results: A total of 327 needs and 86 effective strategies and positive aspects were identified across surveys and classified into the following overarching themes: (i) Accessibility, (ii) Basic needs, (iii) Clinical care, (iv) Person-and-family centered care, (v) Caring for the healthcare professional, (vi) Protocolization, information, health campaigns, and education, (vii) Resource availability, (viii) and Organizational needs/strategies. Discussion: Findings indicate the Spanish health and social care systems were generally unprepared to combat COVID-19. Implications for research, practice, and policy focus on integrating first-person perspectives as best practice to identify, prioritize and address needs to increase health and social care systems capacity and preparedness, as well as providing well-co-coordinated responses across government, healthcare, and non-government sectors to promote and protect the physical and mental health of all.

Global Healthcare Needs Related to COVID-19: An Evidence Map of the First Year of the Pandemic.

The COVID-19 pandemic has exposed gaps and areas of need in health systems worldwide. This work aims to map the evidence on COVID-19-related healthcare needs of adult patients, their family members, and the professionals involved in their care during the first year of the pandemic. We searched the databases MEDLINE, Embase, and Web of Science. Two reviewers independently screened titles and abstracts and assessed full texts for eligibility. Disagreements were resolved by consensus. Descriptive data were extracted and inductive qualitative content analysis was used to generate codes and derive overarching themes. Thirty-six studies met inclusion criteria, with the majority reporting needs from the perspective of professionals (35/36). Professionals' needs were grouped into three main clusters (basic, occupational, and psycho-socio-emotional needs); patients' needs into four (basic, healthcare, psycho-socio-emotional, and other support needs); and family members' needs into two (psycho-socio-emotional and communication needs). Transversal needs across subgroups were also identified and grouped into three main clusters (public safety, information and communication, and coordination and support needs). This evidence map provides valuable insight on COVID-19-related healthcare needs. More research is needed to assess first-person perspectives of patients and their families, examine whether needs differ by country or region, and evaluate how needs have evolved over time.

A Virtual Community of Practice to Improve Primary Health Care Professionals' Attitudes Toward Patient Empowerment (e-MPODERA): A Cluster Randomized Trial.

PURPOSE: We aimed to evaluate the effectiveness of a virtual community of practice (vCoP) in improving primary health care professionals' (HCPs') attitudes toward empowering patients with chronic disease. METHODS: We conducted a cluster randomized controlled trial. Practices were units of randomization, and primary HCPs and patients were units of analysis. Sixty-three practices in Madrid, Catalonia, and the Canary Islands were randomly allocated to the intervention or control groups. Randominzation of practices was performed after HCP and patient recruitment. The patients and statistician were anonymized to group allocation; it was not possible to anonymize HCPs. The intervention was a 12-month multicomponent tailored vCoP built on the Web 2.0 concept and focused on skills toward patient empowerment. The primary outcome was Patient-Provider Orientation Scale (PPOS) score at baseline and at 12 months. The secondary outcome was the Patient Activation Measure (PAM) score. RESULTS: A total of 321 HCPs and 1,921 patients were assessed. The intervention had a positive effect on PPOS total score (0.14 points higher in the vCoP arm; 95% CI, 0.03-0.25; P = .011) and the PPOS Sharing subscale (0.3 points higher in the vCoP arm; 95% CI, 0.15-0.44; P < .001). No effect was found for the PPOS Caring subscale, and no significant differences were found for PAM scores. CONCLUSIONS: A vCoP led to a minor increase in the PPOS Sharing component and the total score but not in the Caring component. However, considerable uncertainty remains, given the observed attrition and other limitations of the study. Further research is needed on the effectiveness of the vCoP model and on how to improve HCP engagement.VISUAL ABSTRACT.

Cross-cultural validation of the patient-practitioner orientation scale among primary care professionals in Spain.

BACKGROUND: In recent decades, many self-report instruments have been developed to assess the extent to which patients want to be informed and involved in decisions about their health as part of the concept of person-centred care (PCC). The main objective of this research was to translate, adapt and validate the Patient-Practitioner Orientation Scale (PPOS) using a sample of primary care health-care professionals in Spain. METHODS: Baseline analysis of PPOS scores for 321 primary care professionals (general practitioners and nurses) from 63 centres and 3 Spanish regions participating in a randomized controlled trial. We analysed missing values, distributions and descriptive statistics, item-to-scale correlations and internal consistency. Performed were confirmatory factor analysis (CFA) of the 2-factor model (sharing and caring dimensions), scale depuration and principal component analysis (PCA). RESULTS: Low inter-item correlations were observed, and the CFA 2-factor model only obtained a good fit to the data after excluding 8 items. Internal consistency of the 10-item PPOS was acceptable (0.77), but low for individual subscales (0.70 and 0.55). PCA results suggest a possible 3-factor structure. Participants showed a patient-oriented style (mean = 4.46, SD = 0.73), with higher scores for caring than sharing. CONCLUSION: Although the 2-factor model obtained empirical support, measurement indicators of the PPOS (caring dimension) could be improved. Spanish primary care health-care professionals overall show a patient-oriented attitude, although less marked in issues such as patients' need for and management of medical information.

Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment: a qualitative pilot study.

BACKGROUND: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. METHODS: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. RESULTS: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. CONCLUSIONS: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02757781 . Registered on 25 April 2016.

Effectiveness of a virtual intervention for primary healthcare professionals aimed at improving attitudes towards the empowerment of patients with chronic diseases: study protocol for a cluster randomized controlled trial (e-MPODERA project).

BACKGROUND: Communities of practice are based on the idea that learning involves a group of people exchanging experiences and knowledge. The e-MPODERA project aims to assess the effectiveness of a virtual community of practice aimed at improving primary healthcare professional attitudes to the empowerment of patients with chronic diseases. METHODS: This paper describes the protocol for a cluster randomized controlled trial. We will randomly assign 18 primary-care practices per participating region of Spain (Catalonia, Madrid and Canary Islands) to a virtual community of practice or to usual training. The primary-care practice will be the randomization unit and the primary healthcare professional will be the unit of analysis. We will need a sample of 270 primary healthcare professionals (general practitioners and nurses) and 1382 patients. We will perform randomization after professionals and patients are selected. We will ask the intervention group to participate for 12 months in a virtual community of practice based on a web 2.0 platform. We will measure the primary outcome using the Patient-Provider Orientation Scale questionnaire administered at baseline and after 12 months. Secondary outcomes will be the sociodemographic characteristics of health professionals, sociodemographic and clinical characteristics of patients, the Patient Activation Measure questionnaire for patient activation and outcomes regarding use of the virtual community of practice. We will calculate a linear mixed-effects regression to estimate the effect of participating in the virtual community of practice. DISCUSSION: This cluster randomized controlled trial will show whether a virtual intervention for primary healthcare professionals improves attitudes to the empowerment of patients with chronic diseases. TRIAL REGISTRATION: ClicalTrials.gov, NCT02757781 . Registered on 25 April 2016. Protocol Version. PI15.01 22 January 2016.

Eficacia de las vías clínicas de cuidados integrados para adultos y niños en centros de práctica clínica / No disponible

No disponible

[Effectiveness of clinical counseling after increasing physical activity. A prospective randomized study]. / Efectividad del consejo sanitario en la promoción de la actividad física. Estudio prospectivo aleatorizado.

BACKGROUND AND OBJECTIVE: There is enough evidence about how physical activity decreases the risk of some chronic diseases; although there are few studies that value the effectiveness of clinical counseling on increase physical activity levels on the population. There is no information about the effectiveness of clinical counseling on decreasing other non-healthy habits, like smoking. PATIENTS AND METHOD: After measure the amount of physical activity on adult population, we selected the group with light level (< 143 Kcal/day), dividing them in two random groups: intervention, that received sanitary advice on increase physical activity on free time, and control, without this intervention. On both, we inquire about physical activity and healthy habits 12 months after the intervention. RESULTS: After twelve months, in the intervention group we observed a mean increase of 1,766 cal/week (95% confidence interval [CI], 1,400-2,132) vs 488 (95% CI, 295-520) in control group (p < .001). 69% of patients from intervention group made intense physical activity vs 15% from controls (p < .001). Control group also improved health-self perception and had a significant reduction on cigarettes consumption. CONCLUSIONS: Sanitary counseling is efficient on improving physical activity on leisure. An added benefit is to gain better self-perception health and smoking cessation.

Efectividad del consejo sanitario en la promoción de la actividad física. Estudio prospectivo aleatorizado / Efectiveness of clinical counseling after increasing physical activity. A prospective randomized study

Fundamento y objetivo: Hay suficiente evidencia acerca de que la actividad física disminuye el riesgo de experimentar determinadas enfermedades crónicas. Sin embargo, hay pocos estudios de calidad que valoren la efectividad del consejo sanitario en cuanto a incrementar el índice de actividad física de la población. Tampoco hay datos acerca de si este consejo sanitario puede ser eficaz para reducir otros hábitos no saludables, como el tabáquico. Pacientes y método: Tras cuantificar la actividad física en una muestra de población adulta, se seleccionó al grupo con actividad física ligera (< 143 kcal/día), y se aleatorizó a estos pacientes en dos grupos: a) intervención, al que se dio consejo sanitario para fomentar su actividad física en tiempo libre, y b) control, en el que no se realizó esta intervención. En ambos grupos, se realizó una encuesta de actividad física y hábitos saludables a los 12 meses de la intervención. Resultados: A los 12 meses, en el grupo intervención se produjo un incremento medio de calorías/semana de 1.766 (intervalo de confianza [IC] del 95%, 1.400-2.132) frente a 488 (IC del 95%, 295-620) en el grupo control (p < 0,001). Un 69% de los pacientes del grupo intervención realizaba una actividad física intensa, comparado con un 15% en el grupo control (p < 0,001). En el grupo intervención se produjo también una mejoría significativa de la autopercepción de salud y hubo una reducción significativa del consumo de cigarrillos. Conclusiones: El consejo sanitario es eficaz para aumentar el índice de actividad física en el tiempo libre. Como beneficio adicional, se obtiene una mejor percepción de salud y un mayor porcentje de abandono del hábito tabáquico

Background and objective: There is enough evidence about how physical activity decreases the risk of some chronic diseases; although there are few studies that value the efectiveness of clinical counseling on increase physical activity levels on the population. There is no information about the efectiveness of clinical counseling on decreasing other non-healthy habits, like smoking. Patients and method: After measure the amount of physical activity on adult population, we selected the group with light level (< 143 Kcal/day), dividing them in two random groups: intervention, that received sanitary advice on increase physical activity on free time, and control, without this intervention. On both, we inquire about physical activity and healthy habits 12 months after the intervention. Results: Affer twelve months, in the intervention group we observed a mean increase of 1,766 cal/week (95% confidence interval [CI], 1,400-2,132) vs 488 (95% CI, 295-520) in control group (p < .001). 69% of patients from intervention group made intense physical activity vs 15% from controls (p < .001). Control group also improved health-self perception and had a significant reduction on cigarettes comsumption. Conclusions: Sanitary counseling is efficient on improving physical activity on leisure. An added benefit is to gain better self-perception health and smoking cessation

Revisión de la literatura sobre lesiones por presión en personas de 65 años o más / Review of literature on pressure ulcers in people aged 65 or over

Se presentan los resultados de un estudio realizado con el objetivo de revisar la literatura científica publicada en los últimos siete años, sobre los aspectos epidemiológicos, los factores de riesgo y las medidas de prevención y de tratamiento de las lesiones por presión en personas de 65 años o más. La estrategia de búsqueda definida se utilizó en las bases de datos CINAHL, CUIDEN, COCHRANE y MEDLINE, durante los meses de mayo y junio de 2003. Los criterios de inclusión de los artículos fueron: publicados entre 1997 y 2003; ámbito geográfico del estudio: EE.UU., Canadá y Europa; idioma: inglés, francés y castellano; y sujetos de estudio de 65 años o más. De las 102 referencias identificadas, se eliminaron 85 por estar duplicadas en alguna de las bases de datos o no cumplir los criterios de la búsqueda, quedando 17 artículos para realizar la síntesis que se presenta. Los escasos estudios que se han encontrado sobre lesiones por presión en población mayor de 65 años, de los que una parte importante ha sido desarrollada en España, presentan una gran variabilidad y algunos tienen problemas metodológicos importantes

Findings of a survey performed to review scientific literature published in the last seven years on epidemiological aspects, risk factors and measures for the prevention and treatment of pressure ulcers in people aged 65 or over. The defined search strategy was used in the following databases: CINAHL, CUIDEN, COCHRANE and MEDLINE in May and June 2003. Inclusion criteria for articles were: articles published between 1997 and 2003; geographical area of the survey: USA, Canada and Europe; language of publication: English, French and Spanish; subjects of the survey aged 65 or over. Eighty five out of the 102 identified references were removed as they were present in more than one database or did not comply with the search criteria, so 17 articles were used to performed this review. The small amount of surveys on pressure ulcers in people aged 65 or over which have been found, a vast number of which have been performed in Spain, show a high degree of variability and some of them have significant methodological problems