Risk Factors for COVID-19 Morbidity and Mortality in Institutionalised Elderly People.

BACKGROUND: SARS-CoV-2 has caused a high mortality in institutionalised individuals. There are very few studies on the involvement and the real impact of COVID-19 in nursing homes. This study analysed factors related to morbidity and mortality of COVID-19 in institutionalised elderly people. METHODS: This cohort study included 842 individuals from 12 nursing homes in Sant Cugat del Vallès (Spain) from 15 March to 15 May 2020. We evaluated individual factors (demographic, dependence, clinical, and therapeutic) and those related to the nursing homes (size and staff) associated with infection and mortality by SARS-CoV-2. Infection was diagnosed by molecular biology test. RESULTS: Of the 842 residents included in the analysis, 784 underwent a Polymerase Chain Reaction (PCR) test; 74.2% were women, the mean age was 87.1 years, and 11.1% died. The PCR test was positive in 44%. A total of 33.4% of the residents presented symptoms compatible with COVID-19 and of these, 80.9% were PCR-positive for SARS-CoV-2. Infection by SARS-CoV-2 among residents was associated with the rate of staff infected in the homes. Mortality by SARS-CoV-2 was related to male sex and a greater grade of dependence measured with the Barthel index. CONCLUSIONS: SARS-Cov-2 infection in institutionalised people is associated with the infection rate in nursing home workers and mortality by SARS-Cov-2 with sex and greater dependency according to the Barthel index. Adequate management of nursing home staff and special attention to measures of infection control, especially of individuals with greater dependence, are keys for successful management of future pandemic situations.

[Healthy heart: Results of a community education program on cardiovascular health]. / «Salut al cor/salud en el corazón¼: resultados del programa de educación sanitaria en salud cardiovascular de Mútua Terrassa.

OBJECTIVE: To improve the knowledge of the population about heart-healthy habits through a training program supplemented by a web site and community activities. DESIGN: A controlled clinical trial with intervention done through participation in the Cardiovascular Health Training Classroom (CHTC) LOCATION: A town of 80,000 inhabitants. PATIENTS: both sexes, aged 55 to 70 years, with at least one cardiovascular risk factor (CVRF). INTERVENTION: The intervention group (IG) consisted of patients who participated in the CHTC. Intervention was carried out through a 20-hour presential group course in which a support web site was offered and complementary activities were organized. Classes were taught by three Primary Care nurses. MAIN MEASUREMENTS: The primary endpoint was knowledge of CVRF. The secondary variables were age, sex, CVRF, lifestyle, visits to health centers, pharmaceutical use adherence, and satisfaction with the program. RESULTS: Data from patients in the first 10 courses (n=150) were evaluated. A statistically significant improvement was observed in overall knowledge of CVRF in the IG (87.3% to 100%) compared with control group (GC) (84.5% to 92.7%), p<.001, as well as an improvement in physical activity is (IG: 71.2% to 83.1% versus CG: 72.6% to 78.2%), p=.05. The total number of Primary Care visits (medical and nursing) decreased in the IG more than in the CG. The satisfaction rate of the course was very high. CONCLUSIONS: This experience is effective in improving cardiovascular health knowledge and promoting some healthy habits.

[Elaboration, implementation and follow-up of a postmenopausal osteoporosis protocol: Collaboration between the Primary care and Rheumatology departments]. / Elaboración, implantación y seguimiento de un protocolo de osteoporosis posmenopáusica: colaboración entre Atención Primaria y el Servicio de Reumatología.

OBJECTIVE: To improve the clinical management of postmenopausal osteroporosis, an intervention based on the implementation of a guideline agreed to between the Primary Care and Specialized departments of all centers at "Mutua of Terrassa" was carried out. METHODS: Descriptive and interventional study. The intervention consisted of the elaboration of a consensus guideline that was presented in all centers. Results were assessed from bone densitometry studies requested by family physicians over 1 year. RESULTS: 1.165 densitometric studies were requested, of which 689 were for the diagnosis of new patients. For the evaluation of the guidelines, details were obtained from 560. 502 studies (89,6% IC95% 87,1-92,2) complied with indication criteria established in the guideline. Of the total of patients who received bisphosphonates and other drugs affecting bone metabolism (43 osteopenic and 167 osteoporotic), 83,7% (IC95% 69,3-93,2) and 89,8% (IC95% 85,2-94,4) respectively complied with drug recommendations. Drug consumption during the year 2007 was reduced by 152.745 euros (-6,3%) although the number of patients increased in 565 (+4,9%) with respect to the previous year. 442 (78,9% IC95% 75,6-82,3) densitometries presented a result in the osteopenia or osteroporosis category. There were statistically significant differences of the results according to the patients' age and the motive for the bone densitometry request. CONCLUSIONS: Implementation of the guideline allowed for the effective management of the clinical process of osteroporosis in our field.

[Repeat prescription management systems: strategy for optimising their use]. / Sistemas de gestión para la renovación de recetas médicas: estrategia para optimizar su utilización.

OBJECTIVE: To improve patient compliance with a repeat prescription system. To evaluate the reasons for not being punctual in collecting prescriptions and the non-compliance declared by the patients themselves. DESIGN: Quasi-experimental study before and after intervention including a control group. SETTING: Primary health care centre which serves a population of 62,981 inhabitants. PARTICIPANTS: Patients with chronic diseases included in the repeat prescription management system (100 in the control group and 100 in the intervention group) who were unpunctual in collecting their prescriptions. INTERVENTIONS: An informative-educational session consisting of a short interview with the pharmacist from Primary Health Care Centre, in which the patient was educated on compliance of the repeat prescription system and treatment. The reasons for the unpunctuality were identified and the Moriskey-Green test was performed. MAIN MEASUREMENTS: Punctuality of the patients in collecting their prescriptions after the intervention. Reasons for unpunctuality recorded at recruitment. Therapeutic compliance according to the Moriskey-Green test. RESULTS: There was an overall absolute improvement of 17% in punctuality in the intervention group (60% of the patients in the intervention group and 43% in the control group were punctual in the first as well as in the second follow up. Women were more punctual in the intervention group. There were no differences seen due to age, number of medications or reason for unpunctuality. CONCLUSIONS: It is possible to improve patient compliance with the prescription renewal system using a simple informative-educational intervention.

[Management systems for the renewal of medical prescriptions: the vision of users and health professionals]. / Sistemas de gestión para la renovación de recetas médicas: la visión del usuario y del profesional sanitario.

OBJECTIVE: To find the degree of satisfaction of users and doctors who use the repeat medical prescription system. DESIGN: Multi-centre, cross-sectional study. SETTING: Four primary care centres covering 160 000 inhabitants. PARTICIPANTS: Users included in the repeat medical prescription system and doctors who use it. MAIN MEASUREMENTS: Questionnaire on satisfaction. MAIN RESULTS: Users (52.4% women) filled in 429 questionnaires (mean age, 64.2; SD, 13.98). Average medicines taken were 4.4 (SD, 3.04). The period established for picking up prescriptions was usually 60 days (77.4%). 83.9% (95% CI, 80.4-87.4) of those questioned stated they had no problems, with a mean degree of satisfaction at 8.4 (SD, 1.52). There were no significant differences for gender (P=.53). There was a very weak but significant positive correlation between the score and the age of those questioned (r(2)=1%; P=.03). Mean score of satisfaction had statistically significant differences, depending on the PCC. 86.9% (95% CI, 83.8-90.1) of users collected the prescriptions within the term set. The factors associated with greater adherence were age and a greater number of medicines per person. Doctors filled in 47 questionnaires. Mean score was 7.42 (SD, 1.09) and all except one (98%; 95% CI, 89.1-99.9) thought that the system meant an improvement in clinical management. CONCLUSION: Users are very satisfied, although they believe certain organisational points should be improved in order to improve accessibility.

Effectiveness of the combination of feedback and educational recommendations for improving drug prescription in general practice.

BACKGROUND: Although there is a great concern regarding rational use of drugs, the available evidence for the most appropriate strategies to improve prescribing is scarce. GOAL: The goal of this study was to evaluate the effectiveness of the combination of feedback of individualized prescribing data and educational recommendations for improving the quality of prescribing in general practice. METHOD: A quasiexperimental intervention study was conducted in which prescribing rates of 282 family physicians before and after the intervention were compared. Physicians assigned to the individualized feedback group (n = 195) received individual instruction with specific recommendations for improvement according to their baseline prescribing quality levels, whereas physicians in the minimal intervention group (n = 87) only received standard nonindividualized prescribing data for the practice group as a whole. RESULTS: A trend toward increasing high pharmacologic intrinsic value in both groups was observed. Overprescription of antibiotics showed a decrease in the individualized feedback group (P = 0.006) and it did not change in the minimal intervention group. A different trend in the values in each group was observed with nonsteroidal antiinflammatory drugs, although it was not statistically significant. Overprescription of antiulcerative agents decreased among physicians in the individualized feedback group (P = 0.003); however, there were not statistically significant differences as compared with the minimal intervention group. Changes in indicators of drug selection were more favorable for the group with individualized feedback, although no statistically significant differences were observed. Pharmaceutical expenditure increased significantly in the minimal intervention group as compared with the individualized feedback group, with an approximate difference of dollars 7.87 per inhabitant and trimester (P = 0.003). CONCLUSION: The intervention showed that improving the quality of prescribing was feasible, particularly in overprescribing, and was associated with considerable savings in pharmaceutical costs.