Care Centres In Spain Research Articles

A trial-based cost-effectiveness analysis of antibiotic prescription strategies for non-complicated respiratory tract infections in children

BackgroundAntibiotic prescription for respiratory tract infections (RTIs) in children attending primary care centres is almost double that predicted according to bacterial prevalence. Delayed antibiotic prescription (DAP) is designed to deploy a more rational use of antibiotics. While studies have evaluated DAP efficacy and safety for children with RTIs, little research has been conducted on the economic implications.MethodsOur trial compared cost-effectiveness for DAP, immediate antibiotic prescription (IAP), and no antibiotic prescription (NAP) for children aged 2–14 years with acute uncomplicated RTIs attended to in 39 primary care centres in Spain. The main outcome was the incremental cost-effectiveness ratio (ICER), measured in euros per gained quality-adjusted life days (QALDs). Net monetary benefit (NMB) was also calculated as a tool for decision making. The analysis was performed from a societal perspective for a time horizon of 30 days, and included healthcare direct costs, non-healthcare direct and indirect costs, and the antimicrobial resistance (AMR) cost.ResultsDAP was the most cost-effective strategy, even when the cost of AMR was included. QALD values for the three strategies were very similar. IAP compared to DAP was more costly (109.68 vs 100.90 euros) and similarly effective (27.88 vs 27.94 QALDs). DAP compared to NAP was more costly (100.90 vs 97.48 euros) and more effective (27.94 vs. 27.82 QALDs). The ICER for DAP compared to NAP was 28.84 euros per QALD. The deterministic sensitivity analysis indicated that non-healthcare indirect costs had the greatest impact on the ICER. The cost-effectiveness acceptability curve showed that DAP was the preferred option in approximately 81.75% of Monte Carlo iterations, assuming a willingness-to-pay value of 82.2 euros per gained QALD.ConclusionsWhen clinicians are in doubt about whether an antibiotic is needed for children with RTIs attending PC centres, those treated with the DAP strategy will have slightly better efficiency outcomes than those treated with IAP because its costs are lower than those of IAP. DAP is also the most cost-effective strategy over a time horizon of 30 days if AMR is considered, despite higher short-term costs than NAP. However, if in the long term the costs of AMR are larger than estimated, NAP could also be an alternative strategy.Trial registrationThis trial has been registered at www.clinicaltrials.gov (identifier NCT01800747; Date: 28/02/2013 (retrospectively registered).

Adherence to the therapeutic guidelines recommendations among the people with type 2 diabetes mellitus and obesity, frailty, or recent diagnosis, attended in primary health care centers in Spain: A cross-sectional study.

Clinical practice guidelines are helpful for clinicians, and their proper implementation could improve the quality of care and management of participants with diabetes. This study aimed to evaluate the degree of adherence to the Clinical Practice Guidelines (CPG) recommendations among obese, frail, or recently diagnosed type 2 diabetes mellitus (T2DM) participants in primary care centers in Spain. We perform a cross-sectional study on a national level in two phases. In the first phase, study participants were recruited, and their clinical data were collected. In the second phase, data related to the participating physicians were collected. In total, 882 participants from 240 physicians were analyzed. According to the study questionnaire, most participants from all three clinical groups had adequate adherence to the CPG. This percentage was highest among the recently diagnosed T2DM (91.6%) and lowest percent of frail T2DM persons (74.7%). The inadequate adherence to the guidelines was observed mainly among the obese and frail participants with T2DM from medical doctors with low CPG knowledge (3.4% and 3.5%, respectively). Regarding the patient's characteristics and degree of adherence to the guidelines, the participants with inadequate adherence were generally older, with higher BMI, poorer HbA1c control, and fewer visits with primary care physicians. Most (57%) primary care physicians had moderate CPG knowledge. In our multivariable logistic model, we did not observe statistically significant odds ratios for different characteristics related to the physicians/consultation and low CPG knowledge. The results of our cross-sectional study observe adequate adherence to the clinical guidelines by the primary care physicians for the majority of the participants with obesity, frailty, or newly diagnosed with T2DM.

Adherence to antidiabetic treatment among patients managed in primary care centres in Spain: the INTENSE study

AimsTo determine the degree and factors related to non-insulin antidiabetic drug (NIAD) adherence in people with type 2 diabetes mellitus (DM2) treated in primary carecentres in Spain. Methods: We did a cross-sectional study. During the study visit, variables related todifferent clinical characteristics, Adherence to Refills and Medications Scale Spanishversion (ARMS-e) and usage of NIAD were collected. We estimated the adherence toNIADs using the proportion of days covered (PDC) equation. Results: In total, 515 participants were included in the study. The mean PDC ratio was70.6 ( ± 28.9), and 50.5% (260) were classified as good adherent (PDC ≥80). Good adherence was highest among users of metformin (67.3%) and lowest among the participants using thiazolidinedione (0.8%). The score for ARMS-e was higher in the poor adherence group. In the multivariable analysis, HbA1c and the use of GLP1-RA or SGLT-2i were negatively associated with good adherence (odds ratio [OR]: 0.67, 95% confidence interval [CI]: 0.54, 0.82, OR: 0.20, 95%CI: 0.08, 0.46; OR: 0.56, 95%CI: 0.35, 0.89, respectively). Conclusions: Adherence to NIADs observed in our study is far from optimal. HbA1c and ARMS-e items could be used as adherence indicators to encourage treatment changes to improve T2DM control.

Writing reports in social work: Characteristics, correctness and style

This research analyses the characteristics of a sample of social work reports issued at a social care centre in Spain. The research involved three assumptions: (1) drafting reports is a demanding task; (2) social workers are poorly trained in report writing; and (3) procedures for drafting reports are inadequate. The research involved two phases: (1) social workers (N = 8) were interviewed; (2) the content and writing style of 250 reports were analysed. The results show that the social work reports analysed stand out for their relevance. However, they need to be more systematic, concise and reliable.

P-69 Anal squamous cell carcinoma (ASCC) outcomes in clinical practice: From localized to metastatic setting

Anal cancer is an infrequent neoplasm, usually diagnosed at localized stages. A multidisciplinary approach involving chemoradiotherapy (CRT) and surgery is necessary. Real-world data in both locally advanced and metastatic setting is needed to support therapeutic decisions. Patients with ASCC diagnosis between 2004 and 2022 in three tertiary care centers in Spain were reviewed. Demographic, clinical, pathological, and therapeutic variables were collected. Comparative analyses have been performed by Chi-squared tests. Survival estimates have been calculated by Kaplan-Meier method and comparations have been made using Cox proportional hazards model. 111 patients were included (45.9% males, median age 61y, 9.9% metastatic at initial diagnosis). Preferred treatment in localized stage was CRT (88.1%) with 5-fluorouracil and mytomicin-C (5FU-MMC) (55%) or 5FU-Cisplatin (33%). Response in patients treated with CRT was assessed by MRI at 3 and/or 6 months after CRT in 60.4% and 53.1% respectively. 19.6% of patients needed surgical intervention due to persistent or progressive disease after CRT. There were no significant differences between 5FU-MMC or 5FU-Cisplatin in terms of complete radiological response (45,28% vs. 51,61%; p = 0.58), need of surgical rescue (18,85% vs. 19,35%; p = 0.96), distant or localized relapse (30,18% vs. 25,80%; p = 0.67), median disease-free survival (DFS) (50,00 months vs. non reached (NR); p = 0.24) or overall survival (117,26 months vs. NR; p = 0.45). OS was significantly improved in patients who achieved a complete radiological response vs. patients who not (117,26 months vs. 29,01 months p 42,57% of all patients treated with curative intent relapsed locally (44.2%) or distant (55.8%), being regional nodes most common place of recurrence. The median OS of metastatic patients at diagnosis was 14,75 months. Considering all metastatic patients (de novo or relapsed), no significant differences in OS were found between patients who received treatment with curative intent (surgery, CRT) and patients only candidate to palliative chemotherapy 15,97 months vs. 13,11 months; p = 0.072). Median progression-free survival (PFS) of Carboplatin-Paclitaxel was 4,76 months. 62,85% of metastatic patients received a 2nd line of treatment. 48,57% of metastatic patients received immunotherapy. PD-(L)1 was only determined in 11,42% of metastatic patients. PFS of immunotherapy was 2,27 months. One patient receiving immunotherapy achieved a complete response and two patients achieved a PFS > 12 months. Other regimens used in latter lines included oxaliplatin (5,71%) and irinotecan-based (14,28%) regimens. Real world data in ASCC population reveals a complex scenario with significant heterogeneity in response to treatments and outcomes. Multidisciplinary collaboration is essential. Role of immunotherapy in ASCC patients in clinical practice is still unknown. More research is needed in the refractory setting after Carboplatin-Paclitaxel to increase OS.

Working Environment, Personal Protective Equipment, Personal Life Changes, and Well-Being Perceived in Spanish Nurses during COVID-19 Pandemic: A Cross-Sectional Study.

During the COVID-19 pandemic, nurses have had to face logistical problems related to critical changes in their work environment, the supply of personal protective equipment (PPE), and hard personal life decisions. This study aimed to investigate the changes in the working environment, PPE use, personal lives, and well-being as perceived by nurses in hospitals and primary care centers in Spain, during the COVID-19 pandemic. A descriptive cross-sectional survey study was conducted in April 2020, including 61 public and private hospitals, and 852 primary care centers. A total of 1296 nurses participated. The redeployment practice for organizational or vulnerability reasons was used by 26.4% of the participants. A total of 61.9% of the nurses doubled the time they used masks, and 8.3% of them could only replace the mask once a week. A total of 11.2% (n = 145) of the nurses left home to avoid infecting their family. Finally, 60.97% of the participants stated that their well-being was reduced compared to the state before the pandemic. Changes in the work environment, the use of PPE, and personal life may be related to the decrease in personal well-being perceived by the nurses.

The Influence of Doing Shift Work on the Lifestyle Habits of Primary Care Nurses.

Nurses’ lifestyle habits play a key role in promoting healthy lifestyles; although, they may not always be entirely healthy and can be influenced by working conditions. This paper aims to analyze the influence of doing shift work on nurses’ lifestyle habits. Participants (n = 219) were recruited from 27 primary health care centres in Spain. Data were collected on socio-demographic characteristics, working conditions and lifestyle behaviour, assessed by use of an adhoc questionnaire including validated measures. Descriptive analysis and logistic regression models were performed. A total of 95% of the nurses reported having an adequate diet; 45.2% did not engage in any type of physical activity; and 85.8% did not smoke, especially women. A total of 60.3% did shift work, especially the younger ones (80.8%; p < 0.001), these nurses being the ones with the worst food habits (81.8%). In contrast, nurses who did shift work, exercised more days a week (69.5%; p < 0.001). The dietary habits of the nurses were adequate. Low tobacco consumption and low adherence to physical activity were observed, especially among women. Shift work harmed eating habits and obesity rates, but was a protective factor in terms of adherence to physical exercise.

Management of burnout among the staff of primary care centres in Spain during the pandemic caused by the SARS-CoV-2

BackgroundThe provision of healthcare during the pandemic caused by the SARS-CoV-2 virus represented a challenge for the management of the resources in the primary care centres. We proposed assessing burnout among the staff of those centres and identifying factors that contributed to its appearance and those that limited it.MethodsAn observational study which, by means of anonymous questionnaires, collected information about: (i) demographic variables; (ii) the characteristics of each position; (iii) the measures implemented by the medical decision-makers in order to provide care during the pandemic; and (iv) the Burnout Clinical Subtype Questionnaire (BCSQ-36). We performed a descriptive analysis of the burnout mentioned by the staff, and, by means of a multivariate analysis, we identified the factors which influenced it. Using logit models, we analysed whether receiving specific training in COVID-19, feeling involved in decision-making processes, and/or working within different healthcare systems had effects on the development of burnout.ResultsWe analysed the replies of 252 employees of primary care centres in Spain with an average age of 45 (SD = 15.7) and 22 (SD = 11.4) years of experience. 68% of the participants (n = 173) indicated burnout of the frenetic subtype. 79% (n = 200) of the employees had high scores in at least one burnout subtype, and 62% (n = 156) in at least two. Women older than 45 had a lower probability of suffering burnout. Receiving specific training (OR = 0.28; CI95%: 0.11–0.73) and feeling involved in decision-making (OR = 0.32; CI95%:0.15–0.70) each reduced the probability of developing burnout. Working in a different department increased the likelihood of developing burnout of at least one clinical subtype (OR = 2.85; CI95%: 1.38–5.86).ConclusionsThe staff in primary care centres have developed high levels of burnout. Participation in decision-making and receiving specific training are revealed as factors that protect against the development of burnout. The measures taken to contain the adverse effects of a heavy workload appear to be insufficient. Certain factors that were not observed, but which are related to decisions taken by the healthcare management, appear to have had an effect on the development of some burnout subtypes.

Economic Impact of Low Adherence to COPD Management Guidelines in Spain.

ObjectiveThe objective of this study was to assess the non-adherence level of Spanish clinical practice to guideline recommendations for the treatment of chronic obstructive pulmonary disease (COPD) and to estimate the potential impact on pharmaceutical expenditure resulting from transitioning current treatment patterns according to guidelines.MethodsA model was developed to compare current prescribing patterns with two alternative scenarios: the first aligned with the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2020) recommendations, and the second with the Spanish Guidelines for COPD (GesEPOC 2017). Current treatment practice was obtained from publications that describe treatment patterns by pulmonology departments in Spain. The economic impact between patterns was calculated from the perspective of the Spanish National Health System (NHS), considering the annual pharmacological costs of COPD inhaled maintenance therapy. Two additional analyses were performed: one that included current prescribing patterns of patients managed by pulmonology and primary care centers in Spain (published aggregated data); and another that only considered the appropriate use of inhaled corticosteroids (ICS) treatment according to guidelines.ResultsIt was estimated that 54% and 38% of patients were not treated in line with GOLD and GesEPOC recommendations, respectively, mainly due to a broader use of ICS-based therapies. Adapting treatment to recommendations could provide a potential annual cost-saving of €17,792,022 (according to GOLD) and €5,881,785 (according to GesEPOC). In scenario analysis 1, a 26% of non-adherence to GesEPOC guideline was observed with a potential annual pharmacological cost-saving of €2,707,554. In scenario analysis 2, considering only inappropriate use of ICS treatment, an annual cost-saving of €17,863,750 (according to GOLD) and €9,904,409 (according to GesEPOC) was calculated.ConclusionMore than a third of treatments for COPD patients in Spain are not prescribed in accordance with guideline recommendations. The adaptation of clinical practice to guideline recommendations could provide important cost-savings for the Spanish NHS.

Use of heuristics during the clinical decision process from family care physicians in real conditions.

The available evidence on the use of heuristics and their relationship with diagnostic error in primary care is very limited. The aim of the study is to identify the use of unknown thought and specifically the possible use of Representativeness, Availability and overconfidence heuristics in the clinical practice of primary care physicians in cases of dyspnoea and to analyse their possible relationship with diagnostic error. A total of 371 patients consulting with new episodes of dyspnoea in Primary Care centres in Spain were registered. Based on specific operational definitions, the use of unconscious thinking and the use of heuristics during the diagnostic process were assessed. Subsequently, the association between their use and diagnostic error was analysed. In 49.6% of cases, the confirmatory diagnosis coincided with the first diagnostic impression, suggesting the use of the representativeness heuristic in the diagnostic decision process. In 82.3% of the cases, the confirmatory diagnosis was among the three diagnostic hypotheses that were first identified by the general physicians, suggesting a possible use of the availability heuristic. In more than 50% of the cases, the physicians were overconfident in the certainty of their own diagnosis. Finally, a diagnostic error was identified in 9.9% of the recorded cases and no statistically significant correlation was found between the use of some unconscious thinking tools (such as the use of heuristics) and the diagnostic error. Unconscious thinking manifested through the acceptance of the first diagnostic impression and the use of heuristics is commonly used by primary care physicians in the clinical decision process in the face of new episodes of dyspnoea; however, its influence on diagnostic error is not significant. The proposed explicit and reproducible methodology may inspire further studies to confirm these results.

Improving Therapeutic Adherence of Oral Antidiabetics in Insulin-Dependent Patients with Type 2 Diabetes Mellitus: the Combination of a Fixed-Dose

Objective: To assess whether the combination of fixed-dose Oral Antidiabetic drugs (OA) in a single tablet compared to OA separated into 2 or more tablets is an effective strategy to improve adherence in insulin-dependent patients with Type 2 Diabetes Mellitus (DM2). Methods: This was a prospective, longitudinal, multi-center study, carried out in 3 primary care centers in Spain. One hundred and twenty patients treated with OA and insulin prescribed for insulin-dependent DM2 were included. A cluster randomization was performed based on two groups: (1) Control Group (CG): Sixty patients treated with two OA prescribed separately in different tablets, and (2) an Intervention Group (IG): Sixty patients treated with OA were with 2 drugs in combination at a fixed dose, in a single tablet. Three visits took place. AO Adherence was measured by using electronic monitors (MEMS). Average adherence percentage (%; Average AP) and daily compliance (%; Daily AP) was calculated. A patient was considered adherent when AP was 80–100%. Insulin adherence was measured by counting. Results: One hundred and ten patients completed the study (79 in the IG and 31 in the CG). Global adherence was 92,59% and 79,62% in IG and 82,85% and 48,21% in CG at 6 and 12 months, respectively (p&lt;0.05 by groups). Daily adherence was 79,62% and 62,96% in IG and 17,85% and 10,71% in CG at 6 and 12 months, respectively (p&lt;0.05). Global adherence with insulin by count was 77,78% and 70,37% in IG and 57,14% and 60,71% in CG at 6 and 12 months, respectively with significant differences. In the non-adherent group, the number of concomitant medications and glucemia and haemoglobin A glycosylate levels at 6 and 12 months, were significantly higher than in the adherent population. The NNT was 4,42 patients to prevent one non-adherence. Conclusions: The combination of fixed-dose OA in a single tablet compared to OA separated into 2 or more tablets is an effective strategy to improve AO therapeutic adherence in patients with insulin-dependent DM2.

Interventions Incorporating Interdisciplinary Teaming to Improve Chronic Pain Management in Primary Care: A Systematic Review

Current chronic pain management recommendations emphasize leveraging interdisciplinary care models, which rely on communication, coordination, and collaboration among multiple providers. We aimed to identify key features of interdisciplinary teamwork and teaming processes that facilitate improved pain outcomes for patients experiencing chronic pain in primary care settings. We searched PubMed, EMBASE, CINAHL, and the Cochrane Library for English language, randomized studies published after 2009. Included studies had to report patient-reported pain outcomes (i.e. BPI total pain), include primary care as an intervention setting, and involve interactions between at least two providers and the patient over time. We assessed study quality with the Cochrane Risk of Bias tool. We qualitatively synthesized findings on intervention characteristics related to teamwork and teaming processes and patient pain outcomes. PROSPERO Registration: CRD42020191467. We included 13 randomized studies with 14 total interventions in our review, of which 7 reported one or more significantly improved pain outcome compared to controls over 6 to 12 months of observation. Most studies involved multiple primary care practices in the USA or Canada. Five studies were evaluated either within the Indianapolis Veterans Affairs Medical Center (VAMC) or the Portland VAMC. Other studies took place in primary care centers in Spain, Finland, the UK, and the Netherlands. Interventions with positive pain outcomes often described regularly scheduled patient contact, but there were few identified similarities about the communication, coordination, and collaboration processes among clinical intervention members. Care management and patient follow-up schedules were identified as key characteristics of teamwork or teaming in the interventions associated with improved pain outcomes. Despite widespread emphasis on interdisciplinary teams for pain management, high quality evidence about relevant team structures and teamwork and teaming processes remains limited. Care management and patient follow-up characterized primary care-based interventions involving teaming associated with improved pain outcomes.

Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data.

We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men.

Higher Accuracy of Lung Ultrasound over Chest X-ray for Early Diagnosis of COVID-19 Pneumonia.

Background: The COVID-19 pandemic rapidly strained healthcare systems worldwide. The reference standard for diagnosis is a positive reverse transcription polymerase chain reaction (RT-PCR) test, but results are not immediate and sensibility is variable. Aim: To evaluate the diagnostic accuracy of lung ultrasound compared to chest X-ray for COVID-19 pneumonia. Design and Setting: A retrospective analysis of symptomatic patients admitted into one primary care centre in Spain between March and September 2020. Method: Patients’ chest X-rays and lung ultrasounds were categorized as normal or pathologic. RT-PCR confirmed COVID-19 infection. Pathologic lung ultrasound images were further categorized as showing either local or diffuse interstitial disease. McNemar and Fisher tests were used to compare diagnostic accuracy. Results: Most of the 212 patients presented fever at admission, either as a standalone symptom (37.74% of patients) or together with others (72.17% of patients). The positive predictive value of the lung ultrasound was 90% for the diffuse interstitial pattern and 46.92% for local pattern. The lung ultrasound had a significantly higher sensitivity (82.75%) (p < 0.001), but lower specificity (71%) than the chest X-ray (54.02% and 86%, respectively) (p = 0.008) for identifying interstitial lung disease. Moreover, sensitivity of the lung ultrasound for severe interstitial disease was 100%, and was significantly higher than the chest X-ray (58.33%) (p = 0.002). Conclusion: The lung ultrasound is more accurate than the chest X-ray for identifying patients with COVID-19 pneumonia and it is especially useful for those presenting diffuse interstitial disease.

Анализ антитромботической терапии у пожилых людей во врачебной клинической практике центров семейной медицины Кыргызской Республики

Введение. Риски тромбоза и кровотечения с возрастом увеличиваются одновременно, при этом пожилой контингент извлекает больше пользы от антитромботической терапии, чем лица молодого возраста. Цель исследования: изучить ситуацию с назначением антикоагулянтной терапии у пациентов пожилого и старческого возраста с фибрилляцией предсердий (ФП) при центрах семейной медицины южных регионов Кыргызской Республики. Материалы и методы. Из 2000 амбулаторных карт медицинского наблюдения отобрано 470 пациентов с неклапанной ФП, которые имели показания для назначения антитромботической терапии: 187 (39,8%) мужчин, 283 (60,2%) женщины, из них 212 (45,1%) городских жителей и 258 (54,9%) сельских жителей. Средний возраст обследованных составил 69,5 ± 10,2 лет. Результаты. Из 377 (80,2%) пациентов должная антикоагулянтная терапия была назначена 162 (42,9%), антиагрегантная терапия — 191 (50,6%), и терапия не была назначена 24 (6,4%) больным при наличии абсолютных показаний. В качестве антикоагулянтной терапии 148 больным был назначен варфарин, адекватная антикоагуляция к концу года составила всего 12,2%. Новый оральный антикоагулянт — ривароксабан был назначен 14 (8,6%) пациентам. Врачами-терапевтами сельской местности 50% больным при необходимости антикоагулянтов была назначена антиагрегантная терапия. Заключение. В южных регионах республики наблюдается неблагоприятная ситуация с назначением антикоагулянтной терапии и ведением пациентов пожилого и старческого возраста. Необходимо продолжить исследования по другим регионам страны для получения полноценной и реальной картины по проблеме и выработки единой и соответствующей рекомендации. Background. The risks of thrombosis and bleeding increase simultaneously with age. At the same time, the elderly population derives more benefit from antithrombotic therapy than young individuals. Objectives: to study the current state of the anticoagulant therapy prescription for elderly and senile patients with atrial fibrillation (AF) at the centers of family medicine in the southern regions of the Kyrgyz Republic. Patients/Methods. From 2000 outpatient medical records, 470 patients with nonvulvar AF were selected who had indications for prescribing antithrombotic therapy: 187 (39.8%) men, 283 (60.2%) women; 212 (45.1%) were urban residents and 258 (54.9%) were village residents. The average age was 69.5 ± 10.2 years. Results. From among 377 (80.2%) patients, needful anticoagulant therapy was prescribed to 162 (42.9%), 191 (50.6%) patients received antiplatelet therapy and therapy was not prescribed to 24 (6.4%) patients in the presence of absolute indications. Warfarin as anticoagulant therapy was prescribed to 148 patients; adequate anticoagulation by the end of the year was only 12.2%. A new oral anticoagulant — rivaroxaban was prescribed to 14 (8.6%) patients. In non-urban area primary care physicians prescribed antiplatelet therapy to 50% of patients who needed anticoagulants. Conclusions. An unfavorable situation is observed with the prescription of anticoagulant therapy and management of elderly and senile patients in the southern regions of the republic. It is necessary to continue study in other regions of the country in order to obtain a complete and real picture of the problem, and to develop a unified and relevant recommendation.

Cross-Cultural Adaptation, Validation, and Piloting of the Patient Reported Experiences and Outcomes of Safety in Primary Care Questionnaire for Its Use in Spain.

This study aimed to cross-culturally adapt, validate, and pilot the Patient Reported Experiences and Outcomes of Safety in Primary Care questionnaire for its use in Spain. After setting up an expert panel to determine its content validity, the questionnaire was translated and back-translated, and subjected to cognitive testing. The questionnaire was piloted in a cross-sectional study in 10 primary health care centers in Spain. Fifty patients per center completed the questionnaire while waiting for an appointment. We estimated (i) the acceptability of the questionnaire (response rate), (ii) scores distribution (floor and ceiling effects), (iii) internal consistency (Cronbach α), and (iv) construct validity (exploratory factor analyses and correlation between scales). To examine patients' evaluations of patient safety, we followed a mixed-methods approach: (i) statistical analyses at the scale and item levels based on responses to standardized items and (ii) qualitative content analysis based on responses to open-ended questions. Complete data were collected from 493 patients (participation rate, 77%). A ceiling effect was observed for 3 scales ("safety problems," "harm severity," "harm needs"). The internal consistency was adequate (α > 0.7) for the majority of scales. Exploratory factor analysis and correlation between scales suggested an appropriate construct validity. Two hundred twenty-six (45.8%) respondents experienced at least 1 safety problem, and 109 (23.2%) reported harm in the previous 12 months. The multidimensional primary health care patient safety instrument Patient Reported Experiences and Outcomes of Safety in Primary Care is now available for its use in Spain. Initial testing demonstrates its potential for use in primary care. Future developments will further address its use in actual clinical practice.

Transdiagnostic group cognitive behavioural therapy for emotional disorders in primary care: the results of the PsicAP randomized controlled trial.

Emotional disorders are highly prevalent in primary care. We aimed to determine whether a transdiagnostic psychological therapy plus treatment-as-usual (TAU) is more efficacious than TAU alone in primary care adult patients. A randomized, two-arm, single-blind clinical trial was conducted in 22 primary care centres in Spain. A total of 1061 adult patients with emotional disorders were enrolled. The transdiagnostic protocol (n = 527) consisted of seven 90-min sessions (8-10 patients) delivered over a 12-14-week period. TAU (n = 534) consisted of regular consultations with a general practitioner. Primary outcome measures were self-reported symptoms of anxiety, depression, and somatizations. Secondary outcome measures were functioning and quality of life. Patients were assessed at baseline, post-treatment, and at 3, 6, and 12 months. Intention-to-treat and per-protocol analyses were performed. Post-treatment primary outcomes were significantly better in the transdiagnostic group compared to TAU (anxiety: p < 0.001; Morris's d = -0.65; depression: p < 0.001; d = -0.58, and somatic symptoms: p < 0.001; d = -0.40). These effects were sustained at the 12-month follow-up (anxiety: p < 0.001; d = -0.44; depression: p < 0.001; d = -0.36 and somatic symptoms: p < 0.001; d = -0.32). The transdiagnostic group also had significantly better outcomes on functioning (d = 0.16-0.33) and quality of life domains (d = 0.24-0.42), with sustained improvement at the 12-month follow-up in functioning (d = 0.25-0.39) and quality of life (d = 0.58-0.72). Reliable recovery rates showed large between-group effect sizes (d > 0.80) in favour of the transdiagnostic group after treatment and at the 12-month follow-up. Adding a brief transdiagnostic psychological intervention to TAU may significantly improve outcomes in emotional disorders treated in primary care. isrctn.org identifier: ISRCTN58437086.

Benefits of Dog-Assisted Therapy in Patients with Dementia Residing in Aged Care Centers in Spain.

(1) Background: Currently, the scientific evidence on the benefits of assisted therapy with dogs in dementia is not clear. In this study, we want to evaluate such benefits through a randomized controlled clinical trial in multiple centers across the country. (2) Methods: The participants were people over 65 years old with dementia, residing in senior centers in Spain (n = 334). The experimental group underwent assisted therapy with dogs based on the Comprehensive Cognitive Activation Program in Dementia, for 8 months, with weekly sessions of 45 min. Data were collected at the commencement, middle, and end of the program, to evaluate the aspects using the Mini-Examination Cognitive, the modified Bartell Index, the Cornell Scale for Depression in Dementia and the Neuropsychiatric Inventory. (3) Results: The results show significant improvements in the experimental group versus the control group in the affective (T1 = p 0.000; T2 = p 0.000) and behavioral (T1 = p 0.005; T2 = p 0.000) aspects, with the affective aspect displaying greater progress in participants with additional depressive (p = 0.022) or anxiety (p = 0.000) disorders, shorter institutionalization periods (r = −0.222, p = 0.004), and those undergoing complementary psychotherapy (p = 0.033) or alternative therapy (p = 0.011). (4) Conclusions: Dog therapy is effective in improving the affective and behavioral aspects of institutionalized patients with dementia.

Maternal Education Level and Excessive Recreational Screen Time in Children: A Mediation Analysis.

There is increasing recognition of the adverse health consequences of excessive recreational screen time (RST) in children and adolescents. Early interventions that aim to reduce RST are crucial, but there are some controversies about which individual and parental variables affect RST in children. The aim of this study was to determine the relationship of parental education level with RST in children and early adolescents and to identify mediators of these relationships. This cross-sectional study examined a sample of children (2–14 year-old) who attended routine childcare visits in primary health care centers in Spain (n = 402; 53.7% males; mean age: 7 ± 4 year-old). A self-reported questionnaire was given to the parents to assess sociodemographic data, parental education, the home media environment, and RST in children. Separate analysis was performed for two age groups (2–6 year-old and 6–14 year-old). Path analysis, an application of structural equation modeling, was used to analyze the data. Fitty three percent of the children had excessive RST (≥2 h/day). The maternal education level, eating lunch/dinner in front of a TV, presence of a background TV, and the amount of parental TV viewing had significant associations with excessive RST in both age groups. For the younger group, the maternal education level had direct and indirect effects on RST (total effect: β = −0.29, p < 0.01). For the older group, maternal education level only had a significant indirect effect on RST, and this was mediated by the presence of a background TV and the time of parental TV viewing (total indirect effect: β = −0.11, p < 0.01). A higher maternal education level appears to be associated with certain environmental factors or habits that prevent excessive RST.

Chronic kidney disease in Spain: analysis of patient characteristics, incidence and direct medical costs (2011–2017)

Objectives To review the characteristics of patients with chronic kidney disease (CKD) who attended primary and specialized care centers in Spain, and to analyze patients’ use of medical resources and direct medical costs of specialized care. Methods Records of patients with CKD admitted to primary and specialized healthcare centers in Spain between 2011 and 2017 from two national discharge databases were analyzed in a retrospective multicenter observational study. Records were classified into one-to-five CKD stages plus a 5b stage, indicating end-stage renal disease. Results Most of the patients registered in hospital settings were in stage 5. Registered secondary conditions included hypertensive chronic kidney, diabetes, anemia, hypercholesterolemia, and hypertension. The number of cases registered in primary care settings increased over time, whereas in specialized care centers incidence decreased; hospital incidence of CKD in 2017 was 10.72 per 10,000 persons. Mean in-hospital mortality was 5.90%, which remained stable during the study period. Mortality was associated with respiratory and heart failure. Mean length of hospital stay was 8.19 days, decreasing over the study period, whilst increasing with CKD progression. Mean annual direct medical cost of specialized care was €10,436 per patient. Complications of a transplant and bacterial infections were responsible for major increases in medical costs, that otherwise decreased over the study period. Conclusions The costs of specialized care decreased with the length of hospital stay reduction. Cardiovascular risk factors were crucial in in-hospital mortality. This study provides population-based data to assist decision-makers at the national level and to contribute to worldwide evaluations and disease surveillance.