A Cost-Benefit Analysis of the COVID-19 Asymptomatic Mass Testing Strategy in the North Metropolitan Area of Barcelona.

BACKGROUND: The epidemiological situation generated by COVID-19 has highlighted the importance of applying non-pharmacological measures in the management of the epidemic. Mass screening of the asymptomatic general population has been established as a priority strategy by carrying out diagnostic tests to detect possible cases, isolate contacts, cut transmission chains and thus limit the spread of the virus. OBJECTIVE: To evaluate the economic impact of mass COVID-19 screenings of an asymptomatic population during the first and second wave of the epidemic in Catalonia, Spain. METHODOLOGY: Cost-Benefit Analysis based on the estimated total costs of mass screening versus health gains and associated health costs avoided. RESULTS: Excluding the value of monetized health, the Benefit-Cost ratio was estimated at 0.45, a low value that would seem to advise against mass screening policies. However, if monetized health is included, the ratio is close to 1.20, reversing the interpretation. In other words, the monetization of health is the critical element that tips the scales in favour of the desirability of screening. Results show that the interventions with the highest return are those that maximize the percentage of positives detected. CONCLUSION: Efficient management of resources for the policy of mass screening in asymptomatic populations can generate high social returns. The positivity rate critically determines its desirability. Likewise, precocity in the detection of cases will cut more transmissions in the chain of contagion and increase the economic return of these interventions. Maximizing the value of resources depends on screening strategies being accompanied by contact-tracing and specific in their focus, targeting, for example, high-risk subpopulations with the highest rate of expected positives.

[Intermediate hospital care for subacute elderly patients as an alternative to prolonged acute hospitalization]. / Derivación de pacientes geriátricos subagudos a un hospital de atención intermedia como alternativa a la permanencia en un hospital general.

OBJECTIVE: We evaluated the rapid discharge of older patients with reactivated chronic diseases from an acute general hospital to an intermediate care hospital. METHODS: A cohort study was carried out. Compliance with predefined quality standards and patient selection were evaluated. RESULTS: Sixty-eight patients (mean age 82.6 years, 48.5% men) were discharged from the emergency department (69.1%) or medical wards (mean [SD] global length of stay 2.6 [2.9] days in acute wards and 1.5 [1.6] days in the emergency department). Mean post-acute length of stay (SD) was 11.4 (4.2) days. Fifty-six patients (82.4%) were discharged to their previous living situation (home or nursing home), two back to the emergency department, seven to long-term care, and three died. All quality standards were met. In a multivariate analysis, male gender and a higher risk of malnutrition were associated with an increased risk of not returning to the previous living situation (p <0.05). CONCLUSIONS: Intermediate care for selected patients with reactivated chronic diseases might represent an alternative to prolonged acute hospitalization.

[Satisfaction survey of CatSalut-PLAENSA(©). Strategies to incorporate citizens' perception of the quality of the service in health policies]. / Plan de encuestas de satisfacción del CatSalut-PLAENSA(©). Estrategias para incorporar la percepción de la calidad de servicio de los ciudadanos en las políticas de salud.

The aim of this work is to present the strategies, activities and results of satisfaction surveys Plan CatSalut- PLAENSA(©) 2003-2010 that are making progress in improving the quality of health services. Since 2003, CatSalut has at its disposal the plan known as PLAENSA(©) Satisfaction Surveys, a tool for assessment and improvement proposals addressed to the insurance services provided by contracted public entities. The plan follows 3 key strategies: systematic and objective policyholders' satisfaction measurement, related to the services received; release of improvement proposals according to a standardized model, including standardized monitoring, and promotion of equity through propagation among health centres and territories. Current assessment provided by the insured about most health services has been already collected, leading to more tan 2,500 projects of improvement which are being developed by the providers of the 7 health regions of Catalonia.

[Initial treatment of patients with subjective memory complaints and/or cognitive impairment in primary care: ISSEA Study]. / Tratamiento inicial de los pacientes con quejas subjetivas de memoria y/o deterioro cognitivo en atención primaria: estudio ISSEA.

OBJECTIVE: To describe the initial treatment of patients >60 years who had subjective memory complaints and/or cognitive impairment for at least 6 months. DESIGN: Observational, longitudinal, multicentre, and naturalistic study, with a follow-up period of 12 months. SETTING: A total of 105 primary care centres. PARTICIPANTS: The study included 921 patients who attended a clinic. MAIN MEASUREMENTS: In the baseline visit, the social demographic characteristics, diagnosis, treatment, and the health care referrals were recorded, and in the next 2 (6 and 12 months) the diagnostic change, treatment, and referrals. RESULTS: The majority of subjects were female (66.9%) and the mean age was 74.3+/-6.8 years. In the initial visit, 50.5% (95% confidence interval [CI], 47.3-53.7) of the diagnoses were classed as syndromic and 33.3% (95% CI, 30.3-36.3), aetiological. The primary care doctor modified an unconfirmed initial diagnosis in 22% (95% CI, 19.3-24.7) of the patients during the 12 months follow-up study. A diagnosis was made in 63.8% (95% CI, 60.7-66.9) of patients by anamnesis, physical examination, the screening test, and laboratory data. In the initial visit, el 52.6% (95% CI, 49.4-55.8) received treatment of mainly nootropics and neuroprotectors, and later, the percentage of patients on cholinesterase inhibitors increased. The primary care doctor referred 54.9% (95% CI, 51.7-58.1) of the patients during the 12 months of the study. CONCLUSIONS: The primary care doctor diagnoses the majority of patients with the means available, mainly based on anamnesis, examination, the screening test, and laboratory data. They prescribe drugs that lack efficacy for this disease and few of those that have been shown to be effective.