Acute respiratory infection rates in primary care anticipate ICU bed occupancy during COVID-19 waves.

BACKGROUND: Bed occupancy in the ICU is a major constraint to in-patient care during COVID-19 pandemic. Diagnoses of acute respiratory infection (ARI) by general practitioners have not previously been investigated as an early warning indicator of ICU occupancy. METHODS: A population-based central health care system registry in the autonomous community of Catalonia, Spain, was used to analyze all diagnoses of ARI related to COVID-19 established by general practitioners and the number of occupied ICU beds in all hospitals from Catalonia between March 26, 2020 and January 20, 2021. The primary outcome was the cross-correlation between the series of COVID-19-related ARI cases and ICU bed occupancy taking into account the effect of bank holidays and weekends. Recalculations were later implemented until March 27, 2022. FINDINGS: Weekly average incidence of ARI diagnoses increased from 252.7 per 100,000 in August, 2020 to 496.5 in October, 2020 (294.2 in November, 2020), while the average number of ICU beds occupied by COVID-19-infected patients rose from 1.7 per 100,000 to 3.5 in the same period (6.9 in November, 2020). The incidence of ARI detected in the primary care setting anticipated hospital occupancy of ICUs, with a maximum correlation of 17.3 days in advance (95% confidence interval 15.9 to 18.9). INTERPRETATION: COVID-19-related ARI cases may be a novel warning sign of ICU occupancy with a delay of over two weeks, a latency window period for establishing restrictions on social contacts and mobility to mitigate the propagation of COVID-19. Monitoring ARI cases would enable immediate adoption of measures to prevent ICU saturation in future waves.

Direct and indirect costs and resource use in dementia care: A cross-sectional study in patients living at home.

BACKGROUND: Due to the high prevalence of dementia, health care needs are increasing beyond existing formal resources. In Spain, it is the family that takes care of this disease. AIMS: To analyze the direct (health and non-health) and indirect economic costs related to care of people with dementia living with their informal caregiver in the home care/community environment, from the perspective of illness severity, associated comorbidity and social impact. DESIGN: Multicentric, descriptive study. SETTING: Three primary care public health centers associated with Hospital Clínic, Barcelona (Spain). PARTICIPANTS: Patients over 65 years old with a diagnosis of dementia, and included in a home care program. INCLUSION CRITERIA: People with a diagnosis of dementia made by a specialist neurologist; aged 65 years or older; a score ≤ 24 on the Mini-Mental State Examination, and identification of an informal caregiver. EXCLUSION CRITERIA: Patients unable to identify an informal caregiver, and those with primary psychiatric pathology or Korsakoff's syndrome. MEASUREMENTS: Use of Resources in Dementia to assess costs; Mini-Mental State Examination to evaluate cognitive capacity; Katz-Index to measure functional capacity; Neuropsychiatric Index for neuropsychiatric symptoms, and the Charlson-Index for comorbidity. Data collection took place between November, 2010 and April, 2012. RESULTS: The average estimated monthly care costs for people with dementia in the home setting are 1956.2€ (SD 1463.9). Informal care was the major contributor to this with a mean estimated cost of 1214.86 (SD 902.68)€/month. Greater illness severity, dependency in activities of daily living, comorbidity and behavioral disturbance are associated with higher costs. Behavioral disturbance appeared as the only factor independently associated with cost in dementia care. The group of people with dementia with severe behavioral disturbance requires the most care resources with an average cost of 2545.2 (SD 1753.2)€/month. CONCLUSIONS: There is a direct association between dementia severity and increased costs. In addition, informal caregivers looking after people with dementia in Spain represent an important social cost. The independent factor associated with an increase in the total costs of patient care was neuropsychiatric symptoms.

Professional care providers in dementia care in eight European countries; their training and involvement in early dementia stage and in home care.

Knowledge concerning professionals involved in dementia care throughout its trajectory is sparse; the focus has mainly been on nursing-home care and less on home care, diagnosis and treatment of the disease and its complications despite the fact that home care is the most prominent type of care. The aim of this study was to explore and describe professional care providers involved in dementia care and their educational level applying the International Standard Classification of Education (ISCED) and further to investigate practice in the RightTimePlaceCare-countries with regard to screening, diagnostic procedures and treatment of dementia and home care. The findings demonstrate more similarities than differences in terms of type of professionals involved among the countries although untrained staff were more common in some countries. Findings also show that many types of professionals are involved, who to turn to may not be clear, for instance in terms of medical specialities and it may be unclear who bears the ultimate responsibility. The professionals involved in diagnosis, treatment and care are educated to bachelor's level or above whilst everyday care is provided by people trained at a lower ISCED level or with no formal training. Registered nurses as well as occupational therapists have bachelor's degrees in most countries, but not in Germany or Estonia. Professionals specifically trained in dementia care are not so common. Further research is needed to reveal not only who provides the diagnostics and treatment, but also how home care is organised and quality assured. Many different types of professionals serve as providers along the trajectory of the disease which may be difficult for the patient and the informal caregiver to cope with.