Primary Health Care Centers In Spain Research Articles

"Talking on the Phone Is Very Cold"-Primary Health Care Nurses' Approach to Enabling Patient Participation in the Context of Chronic Diseases during the COVID-19 Pandemic.

Strengthening patient participation is considered a crucial element of primary health care (PHC) nurses' practice when working with chronically ill patients. The COVID-19 pandemic had extraordinary effects on PHC nursing routines and how chronically ill patients' could be involved in their own care. This study investigates the adaptation of Spanish PHC nurses' approaches to supporting the participation of patients living with chronic illness during the COVID-19 pandemic. To reach this goal, we interviewed 13 PHC nurses who practiced in PHC centers in Spain. The interviews were analyzed using thematic coding. Three themes emerged from the descriptions of the nurses: (1) High COVID-19-related workload, decreasing health promotion, and chronic care, (2) Emphasis on patients' and families' self-responsibility, (3) Expanded digital and telephone communication with fewer in-person consultations. Nurses felt especially challenged to uphold the support for vulnerable groups, such as older people or patients without family support. Future research should focus on how the participation of the most vulnerable chronic patients can be supported in the context of the growing relevance of remote care.

Social workers' perspectives on barriers and facilitators in responding to intimate partner violence in primary health care in Spain.

To identify the barriers and facilitators of managing intimate partner violence (IPV) cases, from the perspective of primary health care (PHC) social workers. Qualitative study through interviews with 14 social workers working in PHC centres in Spain. A thematic analysis approach was applied to identify barriers and facilitators according to the Tanahashi model. The barriers identified by social workers in providing effective coverage to women suffering from IPV included insufficient practical training, a lack of knowledge from women on social workers' roles, a lack of teamwork, and excess IPV case referrals from other professionals to social workers. The identified facilitators were the existence of electronic protocols and good practices including therapeutic support groups and holistic intervention approaches. An excess of referrals to social workers of identified IPV cases following consultation by other members of the PHC team, alongside the lack of interdisciplinary teamwork, does not enable a comprehensive and holistic approach to this problem. Compulsory, practical, and interdisciplinary training in IPV for all PHC professionals and students must be a priority for health agencies and universities in order to facilitate a comprehensive and quality approach for all women suffering from IPV.

A New Instrument for Measuring Dietary Knowledge in Patients With Diabetes: Psychometric Testing of the CoNOCidiet-Diabetes.

To determine the psychometric properties of the CoNOCidiet-Diabetes, a new instrument based on nursing outcome "Knowledge: prescribed diet." Methodological design. The participant were 359 patients diagnosed with diabetes visiting 27 primary healthcare centers in Spain. Reliability (internal consistency and test-retest), validity (convergent criterion validity, concurrent content validity and known-groups validity), and sensitivity to change was tested. CoNOCidiet-Diabetes has shown evidence of acceptable psychometric properties as instrument but some items should be revised. This research provides a new instrument developed to specifically measure dietary knowledge in individuals with diabetes. For nursing practice: The literalness of the CoNOCidiet-Diabetes with the nursing outcome "Knowledge: prescribed diet" facilitate its measurement using the patient's statements.

PMU55 - CONSEQUENCES ON ECONOMIC OUTCOMES OF GENERIC VERSUS BRAND-NAME DRUGS USED IN ROUTINE CLINICAL PRACTICE: THE CASE OF TREATING PERIPHERAL NEUROPATHIC PAIN OR GENERALIZED ANXIETY DISORDER WITH PREGABALIN

To provide real-world evidence on treatment persistence and economic and clinical consequences of generic versus brand-name pregabalin routinely used to treat peripheral neuropathic pain (pNP) or generalized anxiety disorder (GAD). Real-world secondary data analysis of electronic-medical-records (EMR) abstracted from a database including primary healthcare centers in Spain. Brand-name (Lyrica®) and generic pregabalin data from subjects’ first starting treatment for pNP or GAD between January-2015 and June-2016 were used. Main outcomes included treatment persistence (time-to-discontinuation), medication possession ratio (MPR), healthcare and non-healthcare resource utilization, and corresponding costs. Remitter and responder rates were also assessed. A total of 4,860 EMRs of patients >18 years-old with pNP (79.1% brand-name, 20.9% generic) and 990 with GAD (68.1% brand-name, 31.9% generic) were analyzed. Discontinuation was lower with brand-name than with generic pregabalin in pNP (adjusted hazard ratio [HR]: 0.70 [95% CI: 0.58–0.85], p<0.001) and GAD patients (HR: 0.63 [0.45–0.84], p<0.001). MPR was higher for brand-name: 83.6% vs. 78.4% in pNP and 81.8% vs. 76.5% in GAD (both p<0.001). Per-patient adjusted mean total costs were lower with brand-name: €1,500 [1,428–1,573] vs. €2,003 [1,864–2,143] in pNP and €1,528 [1,322–1,734] vs. €2,150 [1,845–2,454] in GAD (both p<0.001). More patients were remitters or responders with brand-name versus generic in pNP (55.0% [53.4%–56.6%] vs. 46.7% [43.6%–49.7%] and 59.2% [57.7%–60.8%] vs. 48.4% [45.4%–51.5%], respectively; p<0.001) and GAD (58.6% [54.9%–62.3%] vs. 48.7% [43.2%–53.3%] and 64.6% [60.9%–68.1%] vs. 47.2% [41.7%–52.7%], respectively; p<0.001). Meaningful and significantly higher treatment adherence was found in patients with pNP or GAD who first started therapy with brand-name versus generic pregabalin in routine practice in Spain. Consequently, patients receiving brand-name pregabalin showed better outcomes in terms of pain or anxiety at a lower cost to payers.

Complex multiple risk intervention to promote healthy behaviours in people between 45 to 75\xa0years attended in primary health care (EIRA study): study protocol for a hybrid trial

BackgroundHealth promotion is a key process of current health systems. Primary Health Care (PHC) is the ideal setting for health promotion but multifaceted barriers make its integration difficult in the usual care. The majority of the adult population engages two or more risk behaviours, that is why a multiple intervention might be more effective and efficient. The primary objectives are to evaluate the effectiveness, the cost-effectiveness and an implementation strategy of a complex multiple risk intervention to promote healthy behaviours in people between 45 to 75 years attended in PHC.MethodsThis study is a cluster randomised controlled hybrid type 2 trial with two parallel groups comparing a complex multiple risk behaviour intervention with usual care. It will be carried out in 26 PHC centres in Spain. The study focuses on people between 45 and 75 years who carry out two or more of the following unhealthy behaviours: tobacco use, low adherence to the Mediterranean dietary pattern or insufficient physical activity level. The intervention is based on the Transtheoretical Model and it will be made by physicians and nurses in the routine care of PHC practices according to the conceptual framework of the “5A’s”. It will have a maximum duration of 12 months and it will be carried out to three different levels (individual, group and community). Incremental cost per quality-adjusted life year gained measured by the tariffs of the EuroQol-5D questionnaire will be estimated. The implementation strategy is based on the “Consolidated Framework for Implementation Research”, a set of discrete implementation strategies and an evaluation framework.DiscussionEIRA study will determine the effectiveness and cost-effectiveness of a complex multiple risk intervention and will provide a better understanding of implementation processes of health promotion interventions in PHC setting. It may contribute to increase knowledge about the individual and structural barriers that affect implementation of these interventions and to quantify the contextual factors that moderate the effectiveness of implementation.Trial registrationClinicalTrials.gov, NCT03136211.Retrospectively registered on May 2, 2017.

Primary health care attributes and responses to intimate partner violence in Spain

ObjectiveThis study provides an overview of the perceptions of primary care professionals on how the current primary health care (PHC) attributes in Spain could influence health-related responses to intimate partner violence (IPV). MethodsA qualitative study was conducted using semi-structured interviews with 160 health professionals working in 16 PHC centres in Spain. Data were analysed using a qualitative content analysis. ResultsFour categories emerged from the interview analysis: those committed to the PHC approach, but with difficulties implementing it; community work relying on voluntarism; multidisciplinary team work or professionals who work together?; and continuity of care hindered by heavy work load. Participants felt that person-centred care as well as other attributes of the PHC approach facilitated detecting IPV and a better response to the problem. However, they also pointed out that the current management of the health system (workload, weak supervision and little feedback, misdistribution of human and material resources, etc.) does not facilitate the sustainability of such an approach. ConclusionThere is a gap between the theoretical attributes of PHC and the “reality” of how these attributes are managed in everyday work, and how this influences IPV care.

Diagnostic inertia in obesity and the impact on cardiovascular risk in primary care: a cross-sectional study.

Prevalence of diagnostic inertia (DI), defined as a failure to diagnose disease, has not been analysed in patients with obesity. To quantify DI for cardiovascular risk factors (CVRF) in patients with obesity, and determine its association with the cardiovascular risk score. Cross-sectional study of people ≥40 years attending a preventive programme in primary healthcare centres in Spain in 2003-2004. All patients with obesity attending during the first 6 months of the preventive programme were analysed. Participants had to be free of CVD (myocardial ischaemia or stroke) and aged 40-65 years; the criteria used to measure SCORE (Systematic COronary Risk Evaluation). Three subgroups of patients with obesity with no personal history of CVRF but with poor control of risk factors were established. Outcome variable was DI, defined as poor control of risk factors and no action taken by the physician. Secondary variables were diabetes, fasting blood glucose (FBG), body mass index (BMI), and SCORE. Adjusted odds ratios (OR) was determined using multivariate logistic regression models. Of 8687 patients with obesity in the programme, 6230 fulfilled SCORE criteria. Prevalence of DI in the three subgroups was: hypertension, 1275/1816 (70.2%) patients affected (95% CI = 68.1 to 72.3%); diabetes, 335/359 (93.3%) patients affected (95% CI = 90.7 to 95.9%); dyslipidaemia subgroup, 1796/3341 (53.8%) patients affected (95% CI = 52.1 to 55.4%. Factors associated with DI for each subgroup were: for hypertension, absence of diabetes, higher BMI, and greater cardiovascular risk; for dyslipidaemia, diabetes, higher BMI, and greater cardiovascular risk (SCORE); and for diabetes, lower FBG levels, lower BMI, and greater cardiovascular risk. This study quantified DI in patients with obesity and determined that it was associated with a greater cardiovascular risk.

Efficacy of high doses of oral penicillin versus amoxicillin in the treatment of adults with non-severe pneumonia attended in the community: study protocol for a randomised controlled trial

BackgroundStreptococcus pneumoniae is the bacterial agent which most frequently causes pneumonia. In some Scandinavian countries, this infection is treated with penicillin V since the resistances of pneumococci to this antibiotic are low. Four reasons justify the undertaking of this study; firstly, the cut-off points which determine whether a pneumococcus is susceptible or resistant to penicillin have changed in 2008 and according to some studies published recently the pneumococcal resistances to penicillin in Spain have fallen drastically, with only 0.9% of the strains being resistant to oral penicillin (minimum inhibitory concentration>2 μg/ml); secondly, there is no correlation between pneumococcal infection by a strain resistant to penicillin and therapeutic failure in pneumonia; thirdly, the use of narrow-spectrum antibiotics is urgently needed because of the dearth of new antimicrobials and the link observed between consumption of broad-spectrum antibiotics and emergence and spread of antibacterial resistance; and fourthly, no clinical study comparing amoxicillin and penicillin V in pneumonia in adults has been published. Our aim is to determine whether high-dose penicillin V is as effective as high-dose amoxicillin for the treatment of uncomplicated community-acquired pneumonia.MethodsWe will perform a parallel group, randomised, double-blind, trial in primary healthcare centres in Spain. Patients aged 18 to 65 without significant associated comorbidity attending the physician with signs and symptoms of lower respiratory tract infection and radiological confirmation of the diagnosis of pneumonia will be randomly assigned to either penicillin V 1.6 million units thrice-daily during 10 days or amoxicillin 1,000 mg thrice-daily during 10 days. The main outcome will be clinical cure at 14 days, defined as absence of fever, resolution or improvement of cough, improvement of general wellbeing and resolution or reduction of crackles indicating that no other antimicrobial treatment will be necessary. Any clinical result other than the anterior will be considered as treatment failure. A total of 210 patients will be recruited to detect a non-inferiority margin of 15% between the two treatments with a minimum power of 80% considering an alpha error of 2.5% for a unilateral hypothesis and maximum possible losses of 15%.DiscussionThis pragmatic trial addresses the long-standing hypothesis that the administration of high doses of a narrow-spectrum antibiotic (penicillin V) in patients with non-severe pneumonia attended in the community is not less effective than high doses of amoxicillin (treatment currently recommended) in patients under the age of 65 years.Trial registrationEudraCT number 2012-003511-63.

Social Determinants and Health Effects of Low and High Severity Intimate Partner Violence

We sought to analyze whether the sociodemographic profile of battered women varies according to the level of severity of intimate partner violence (IPV), and to identify possible associations between IPV and different health problems taking into account the severity of these acts. A cross-sectional study of 8,974 women (18-70 years) attending primary healthcare centers in Spain (2006-2007) was performed. A compound index was calculated based on frequency, types (physical, psychological, or both), and duration of IPV. Descriptive and multivariate procedures using logistic regression models were fitted. Women affected by low severity IPV and those affected by high severity IPV were found to have a similar sociodemographic profile. However, divorced women (odds ratio [OR], 8.1; 95% confidence interval [CI], 3.2-20.3), those without tangible support (OR, 6.6; 95% CI, 3.3-13.2), and retired women (OR, 2.7; 95% CI, 1.2-6.0) were more likely to report high severity IPV. Women experiencing high severity IPV were also more likely to suffer from poor health than were those who experienced low severity IPV. The distribution of low and high severity IPV seems to be influenced by the social characteristics of the women involved and may be an important indicator for estimating health effects. This evidence may contribute to the design of more effective interventions.

Partner Violence and Psychological Well-Being: Buffer or Indirect Effect of Social Support

To determine the effect of two kinds of intimate partner violence (IPV) (physical and psychological) in the previous 12 months (current) and before the previous 12 months (past) on psychological well-being among women aged 18 to 70 years who attend primary healthcare centers in Spain; and to analyze the effect of the duration of lifetime IPV and social support on psychological well-being. A cross-sectional survey was carried out among 10,322 women randomly recruited in primary healthcare centers in Spain. Outcome variables were three indicators of psychological well-being (psychological distress, psychotropic drug use, and self-perceived health). Predictor variables were the different types of IPV, IPV timing (current and past), duration of lifetime IPV, and social support. Logistic regression models were fitted. Both types of IPV increased the probability of worse psychological well-being in both IPV timings (current and past). Longer duration of lifetime IPV, friends network size, and tangible support were independently associated with worse psychological well-being. However, an interaction between current IPV and family network size was found. The probability of poor self-perceived health status was reduced by 29% among women exposed to current IPV who had a large family network (odds ratio, 0.71; 95% confidence interval, 0.54-0.94). Psychological well-being was independently affected by IPV (types and duration) and social support (friends network size, tangible support). Only family network size mitigates the negative consequences of IPV on self-perceived health status.