Chagas disease presents bio-psycho-social and cultural determinants for infected patients, their family members, close friends, and society. For this reason, diagnosis and treatment require an active ...approach and an integral focus, so that we can prevent the disease from creating stigma and exclusion, as is actively promoting access to diagnosis, medical attention and social integration.
The study was conducted in the Metropolitan Area of Barcelona (Catalonia, Spain) from 2004 to 2017. After an increased detection rates of CHD in our region, the process of construction of community strategies started (2004-2013). Different community interventions with informational, educational, and communication components were designed, developed, implemented, and evaluated. The results of the evaluation helped to determine which intervention should be prioritized: 1) workshop; 2) community event; 3) in situ screening. Afterwards, those strategies were implemented (2014-2017).
Each of the three strategies resulted in a different level of coverage, or number of people reached. The in situ screening interventions reached the highest coverage (956 persons, 58.98%).Clear differences exist (p-value<0.001) between the three strategies regarding the percentage of screenings and diagnoses carried out. The largest number was in the in situ screening intervention, with a total of 830 persons screened despite the greatest number of diagnoses was among the workshop participants (33 persons, 20.75% of those screened). The prevalence of infection found is similar among the three strategies, ranging from 16.63% to 22.32% of the screened patients (p-value = 0.325).
The results of the study show that community interventions seem to be necessary to improve access to diagnosis and treatment of CHD in the area of Barcelona. They also show which strategy is the most appropriate based on the detected needs of the community, the proposed objectives of the intervention, and the given socio-temporal context.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Reducing ineffective practices is one way to ensure high-quality and efficient healthcare for the population. For this reason, several initiatives have been implemented worldwide to reduce low-value ...care. This article describes the experience of the Essencial project, a multifaceted deadoption strategy implemented in the Catalan primary care system. Lessons learnt from this project include the importance of considering the local context in deadoption strategies, providing adequate training and communication material to patients and clinicians and supporting the key role of clinical champions. Given the knowledge gaps regarding the conditions for successful deadoption strategies, the Catalan experience could provide enlightenment on how to implement, evaluate and sustain a large-scale collaborative deadoption strategy in primary healthcare.
In the European Union, around 5 million people are affected by psychotic disorders, and approximately 30%-50% of people with schizophrenia have treatment-resistant schizophrenia (TRS). Mobile health ...(mHealth) interventions may be effective in preventing relapses, increasing treatment adherence, and managing some of the symptoms of schizophrenia. People with schizophrenia seem willing and able to use smartphones to monitor their symptoms and engage in therapeutic interventions. mHealth studies have been performed with other clinical populations but not in populations with TRS.
The purpose of this study was to present the 3-month prospective results of the m-RESIST intervention. This study aims to assess the feasibility, acceptability, and usability of the m-RESIST intervention and the satisfaction among patients with TRS after using this intervention.
A prospective multicenter feasibility study without a control group was undertaken with patients with TRS. This study was performed at 3 sites: Sant Pau Hospital (Barcelona, Spain), Semmelweis University (Budapest, Hungary), and Sheba Medical Center and Gertner Institute of Epidemiology and Health Policy Research (Ramat-Gan, Israel). The m-RESIST intervention consisted of a smartwatch, a mobile app, a web-based platform, and a tailored therapeutic program. The m-RESIST intervention was delivered to patients with TRS and assisted by mental health care providers (psychiatrists and psychologists). Feasibility, usability, acceptability, and user satisfaction were measured.
This study was performed with 39 patients with TRS. The dropout rate was 18% (7/39), the main reasons being as follows: loss to follow-up, clinical worsening, physical discomfort of the smartwatch, and social stigma. Patients' acceptance of m-RESIST ranged from moderate to high. The m-RESIST intervention could provide better control of the illness and appropriate care, together with offering user-friendly and easy-to-use technology. In terms of user experience, patients indicated that m-RESIST enabled easier and quicker communication with clinicians and made them feel more protected and safer. Patients' satisfaction was generally good: 78% (25/32) considered the quality of service as good or excellent, 84% (27/32) reported that they would use it again, and 94% (30/32) reported that they were mostly satisfied.
The m-RESIST project has provided the basis for a new modular program based on novel technology: the m-RESIST intervention. This program was well-accepted by patients in terms of acceptability, usability, and satisfaction. Our results offer an encouraging starting point regarding mHealth technologies for patients with TRS.
ClinicalTrials.gov NCT03064776; https://clinicaltrials.gov/ct2/show/record/NCT03064776.
RR2-10.1136/bmjopen-2017-021346.
The Catalonian Expert Patient Programme on Chagas disease is a initiative, which is part of the Chronic Disease Programme. It aims to boost responsibility of patients for their own health and to ...promote self-care. The programme is based on nine sessions conducted by an expert patient. Evaluation was focusing in: habits and lifestyle/self-care, knowledge of disease, perception of health, self-esteem, participant satisfaction, and compliance with medical follow-up visits. Eighteen participants initiated the programme and 15 completed it. The participants were Bolivians. The 66.7 % of them had been diagnosed with chagas disease in Spain. The 100 % mentioned that they would participate in this activity again and would recommend it to family and friends. The knowledge about disease improve after sessions. The method used in the programme could serve as a key strategy in the field of comprehensive care for individuals with this disease.
Display omitted
Puntos clave•Las intervenciones en seguridad del paciente, como las prácticas seguras, buscan reducir el número de incidentes para la seguridad de los pacientes, particularmente el ...número de eventos adversos evitables.•El número de eventos adversos evitables en atención primaria en España se ha duplicado con respecto a los datos aportados por el estudio APEAS (Estudio de la Seguridad de los Pacientes en atención primaria de Salud) realizado en 2008.•Uno de cada 30 eventos adversos evitables supone un daño grave y permanente en el adulto.
Determinar la frecuencia de eventos adversos evitables (EAE) en atención primaria (AP).
Estudio retrospectivo de cohortes.
consultas de medicina de familia y pediatría de Andalucía, Aragón, Castilla La Mancha, Cataluña, Madrid, Navarra y Comunidad Valenciana.
Se determinó revisar un mínimo de 2.397 historias clínicas (nivel de confianza del 95% y una precisión del 2%). La muestra se estratificó por grupos de edad de forma proporcional a su frecuentación y con revisión paritaria de historias de hombres y mujeres.
Número y gravedad de los EAE identificados entre febrero de 2018 y septiembre de 2019.
Se revisaron un total de 2.557 historias clínicas (1.928, 75.4% de pacientes adultos y 629, 24.6% pediátricos). Se identificaron 182 EAE que afectaron a 168 pacientes (7,1%, IC 95% 6,1-8,1%); en adultos 7,6% (IC 95% 6,4-8,8%) y 5,7% (IC 95% 3,9-7,5%) en pacientes pediátricos. Las mujeres sufrieron más EAE que los hombres (p=0,004). La incidencia de EAE en niños y niñas fue similar (p = 0,3). 6 (4.1%) de los EAE supusieron un daño permanente en pacientes adultos.
Buscar fórmulas para incrementar la seguridad en AP, particularmente en pacientes mujeres, debe seguir siendo un objetivo prioritario incluso en pediatría. Uno de cada 24 EAE supone un daño grave y permanente en el adulto.
To determine the frequency of avoidable adverse events (AAEs) in Primary Care (PC).
Retrospective cohort study.
Family medicine and paediatric clinics in Andalusia, Aragon, Castilla-La Mancha, Catalonia, Madrid, Navarre, and Valencia.
A review was performed on a designated sample of 2,397 medical records (95% confidence level and 2% accuracy). The sample was stratified by age group as regards the frequency of physician consultations and considering equal distribution of male and female patients.
Number and severity of identified AAEs from February 2018 to September 2019.
A total of 2,557 medical records were reviewed (1,928, 75.4% of adult patients, and 629, 24.6% paediatrics). A total of 182 (7.1%, 95% CI 6.1-8.1%) AAEs that affected 168 patients were identified, which included 7.6% (95% CI 6.4-8.8%) in adults and 5.7% (95% CI 3.9-7.5%) in paediatric patients. The number of AAEs in women was higher than in men (P = 0.006). The incidence of AAEs in boys and girls was similar (P = 0.3). Permanent damage was caused by AAEs in 6 (4.1%) adult patients.
Seeking formulas to increase patient safety in PC should remain a priority objective, particularly in female patients and in paediatrics. One in 24 AAEs causes serious and permanent damage in adults.
In the European Union between 0.2 and 2.6% of the population suffer from psychotic disorders, and around 40% can be considered resistant to pharmacological treatment 1. Interventions based on ...m-Health solutions may be effective in increasing treatment adherence, relieving some of the symptoms of schizophrenia and thus, preventing relapses. Although smartphone ownership among people with schizophrenia is relatively high and increasing, to date, mHealth studies have not been performed in Treatment Resistant Schizophrenia (TRS) samples. In this study, we present the results of the m-RESIST feasibility project (www.mresist.eu), a new therapeutic program based on novel technology.). The aim of the m-RESIST study is to assess acceptability, usability and user experience, satisfaction and empowerment after using the m-RESIST solution. Thirty-nine TRS patients, 11 caregivers and 8 clinicians were recruited for the study, which was carried out in Gertner Institute (Tel-Aviv, Israel), Semmelweis University (Budapest, Hungary) and Hospital de la Santa Creu i Sant Pau (Barcelona, Spain). Acceptability was measured with an adapted version to TRS patients of TAM questionnaire (7-point Likert scale). 2. Satisfaction and empowerment was measured with CSQ-8 3 and BUES 4 scales respectively. In order to yield insights into user experience a questionnaire was developed and administered at the start, in the middle and at the end of the pilot. Results showed that patients’ acceptance of m-RESIST ranged from moderate to high, with a mean score for perceived use and ease of use 5.16 and 5.36, respectively. In general, patient’s satisfaction was good: 57% thought that the quality of service was good or excellent. 65% of patients reported having the services they wanted and 43% thought that the program met their needs. However, 19% did not get the kind of service they wanted and for 38% only few of their needs were met. 78% of the sample was overall satisfied with m-RESIST and 70% would come back again to it. In terms of user experience, patients indicated that m-RESIST solution permits an easier and a quicker communication with clinicians. Patients also reported that the feeling of having a clinical team involved and concerned din their wellbeing made them feel more protected. Caregivers reported that m-RESIST provided a better support for patients and a better follow-up, and also were unanimous about the sense of security. Clinicians indicated that the m-RESIST system was easy and intuitive to use and felt that it opened up a new communication pathway with their patients. Finally, the result of empowerment in our patients was 2.76, out of a possible score of 4, which indicates a high level of empowerment Mean for dropouts was 20%. To conclude, in terms of acceptability, usability and satisfaction, the m-RESIST solution was well accepted by patients, caregivers and clinicians. These results offer an encouraging starting point concerning the use of ICT tools in the treatment of TRS patients. m-RESIST project is founded by Horizon 2020 Framework Programme of the European Union. Co-financed with European Union ERDF Funds.
The frequency of low-value practices (LVPs) in the healthcare system is a worldwide challenge. This study aimed to evaluate the LVPs trend in Spanish primary care (PC), its frequency in both sexes, ...and estimate its related extra cost.
A multicentric, retrospective, and national research project was conducted. Ten LVPs highly frequent and potentially harmful for patients were analyzed (majority of them related to prescription). Algorithms were applied to collect the data from 28,872,851 episodes registered into national databases (2015-2017).
LVPs registered a total of 7,160,952 (26.5%) episodes plus a total of 259,326 avoidable PSA screening tests. In adults, a high frequency was found for inadequate prescription of paracetamol antibiotics, and benzodiazepines . Women received more jeopardizing practices (p ≤ 0.001). Pediatrics presented a downward of antibiotic and paracetamol-ibuprofen prescription combination. The estimated extra cost was close to €292 million (2.8% of the total cost in PC).
LVPs reduction during the analyzed period was moderate compared to studies following 'Choosing Wisely list' of LVPs and must improve to reduce patient risk and the extra related costs.
PDF
