Opinion on the benefits of nurse prescribing in Catalonia. Consensus of health professionals and managers.

OBJECTIVE: To study the level of agreement among health professionals and managers in Catalonia on the benefits of nurse prescribing (NP). METHOD: An online Real Time Delphi was conducted to collect the level of agreement of health professionals and managers. Participants voted in a 6-point scale (1 low benefit and 6 high benefit) for 12 items describing benefits of NP. A total of 1332 professionals participated. The level of consensus was calculated applying interquartile ranges of scores and standardized mean differences among subgroups using effect sizes (ES) and their corresponding 95% confidence intervals. RESULTS: The scores indicate a general agreement on the perceived benefits of NP among participants. Standardized differences among scores on the perceived benefits among professionals were small to high (ES range between 0.2 and 1.2) between nurses and medical doctors and high between nurses and pharmacists (ES range: 1.2 and 2.4). Differences between scores of nurses and those of managers or other professionals in the present study were smaller for most voted benefits. CONCLUSIONS: The study shows an agreement on the benefits of NP. Nevertheless, when standardized scores are taken into consideration, differences among professionals' perceptions emerged, and aligned with documented barriers identified in the literature such as corporative aspects, cultural limitations, institutional and organisational inertia, beliefs and unawareness of what NP implies.

Opinion on the benefits of nurse prescribing in Catalonia. Consensus of health professionals and managers / Opinión sobre los beneficios de la prescripción enfermera en Cataluña. Consenso de profesionales de la salud y gestores

Objective: To study the level of agreement among health professionals and managers in Catalonia on the benefits of nurse prescribing (NP). Method: An online Real Time Delphi was conducted to collect the level of agreement of health professionals and managers. Participants voted in a 6-point scale (1 low benefit and 6 high benefit) for 12 items describing benefits of NP. A total of 1332 professionals participated. The level of consensus was calculated applying interquartile ranges of scores and standardized mean differences among subgroups using effect sizes (ES) and their corresponding 95% confidence intervals. Results: The scores indicate a general agreement on the perceived benefits of NP among participants. Standardized differences among scores on the perceived benefits among professionals were small to high (ES range between 0.2 and 1.2) between nurses and medical doctors and high between nurses and pharmacists (ES range: 1.2 and 2.4). Differences between scores of nurses and those of managers or other professionals in the present study were smaller for most voted benefits. Conclusions: The study shows an agreement on the benefits of NP. Nevertheless, when standardized scores are taken into consideration, differences among professionals’ perceptions emerged, and aligned with documented barriers identified in the literature such as corporative aspects, cultural limitations, institutional and organisational inertia, beliefs and unawareness of what NP implies.(AU)

Objetivo: Estudiar el nivel de consenso entre profesionales de salud y gestores en Cataluña sobre los beneficios de la prescripción enfermera (PE). Método: Se realizó un Delphi en tiempo real en línea para recoger el nivel de acuerdo de profesionales de la salud y gestores. Las personas participantes votaron en una escala de 6 puntos (1 bajo beneficio y 6 alto beneficio) en 12 ítems que describen los beneficios de la PE. Participaron 1332 profesionales. El nivel de consenso se calculó aplicando rangos intercuartílicos de puntuaciones y diferencias de medias estandarizadas entre subgrupos a partir de tamaños del efecto (ES) y sus correspondientes intervalos de confianza del 95%. Resultados: Las puntuaciones indican un acuerdo general sobre los beneficios percibidos de la PE entre las personas participantes. Las diferencias estandarizadas entre las puntuaciones sobre los beneficios percibidos entre profesionales fueron de pequeñas a altas (rango ES: 0,2 a 1,2) entre enfermeras y médicos, y altas entre enfermeras y farmacéuticos (rango ES: 1,2 a 2,4). Las diferencias entre las puntuaciones de profesionales de enfermería y gestión clínica u otros profesionales en el presente estudio fueron menores para los beneficios más votados. Conclusiones: El estudio muestra un acuerdo sobre los beneficios de la PE. Sin embargo, cuando se tienen en cuenta las puntuaciones estandarizadas se encontraron algunas diferencias entre las percepciones de profesionales y se alinearon con las barreras documentadas identificadas en la literatura, como aspectos corporativos, limitaciones culturales, inercia institucional y organizativa, creencias y desconocimiento de lo que implica la PE.(AU)

Swallowing muscle training for oropharyngeal dysphagia: A non-inferiority study of online versus face-to-face therapy.

INTRODUCTION: The purpose of this study is to show the non-inferiority of the telemedicine therapy versus face-to-face using the exercise therapy of oropharyngeal muscles in 183 patients treated consecutively from 2010 to 2020. METHOD: We conducted a retrospective study comparing two dysphagia treatment groups: online versus face-to-face. Patients were distributed in a non-random way but according to patient's preferences. All patients followed the same pathway and were evaluated at the beginning and at the end of the study using the dysphagia outcome and severity scale and the functional oral intake scale. A non-inferiority analysis approximation was done with delta = 1 in both variables. RESULTS: Within a total of 183 patients, 114 (62.3%) used the online treatment and 69 (37.7%) the face-to-face one. The main cause of dysphagia was neurological in the total sample (60.7%) and within both groups. When we evaluate the clinical response, we find that both groups improved regardless of the type of therapy. The confidence interval of the difference between the beginning and the end of treatment did not reach the inferior limit of the delta defined, therefore supporting the no inferiority of online versus presential. DISCUSSION: This study shows the no inferiority of the online therapy versus the face-to-face one for the oropharyngeal training of the swallow muscles.

Design and customization of telemedicine systems.

In recent years, the advances in information and communication technology (ICT) have resulted in the development of systems and applications aimed at supporting rehabilitation therapy that contributes to enrich patients' life quality. This work is focused on the improvement of the telemedicine systems with the purpose of customizing therapies according to the profile and disability of patients. For doing this, as salient contribution, this work proposes the adoption of user-centered design (UCD) methodology for the design and development of telemedicine systems in order to support the rehabilitation of patients with neurological disorders. Finally, some applications of the UCD methodology in the telemedicine field are presented as a proof of concept.