Primary and Community Care Transformation in Post-COVID Era: Nationwide General Practitioner Survey.

Introduction: The health emergency caused by COVID-19 has led to substantial changes in the usual working system of primary healthcare centers and in relations with users. The Catalan Society of Family and Community Medicine designed a survey that aimed to collect the opinions and facilitate the participation of its partners on what the future work model of general practitioners (GPs) should look like post-COVID-19. Methodology: Online survey of Family and Community Medicine members consisting of filiation data, 22 Likert-type multiple-choice questions grouped in five thematic axes, and a free text question. Results: The number of respondents to the questionnaire was 1051 (22.6% of all members): 83.2% said they spent excessive time on bureaucratic tasks; 91.8% were against call center systems; 66% believed that home care is the responsibility of every family doctor; 77.5% supported continuity of care as a fundamental value of patient-centered care; and >90% defended the contracting of complementary tests and first hospital visits from primary healthcare (PHC). Conclusions: The survey responses describe a strong consensus on the identity and competencies of the GP and on the needs of and the threats to the PHC system. The demand for an increase in health resources, greater professional leadership, elimination of bureaucracy, an increase in the number of health professionals, and greater management autonomy, are the axes towards which a new era in PHC should be directed.

[Spirometry as method of screening and intervention in high- risk smokers in primary care]. / Espirometría como método de cribado y de intervención antitabaco en fumadores de alto riesgo en atención primaria.

OBJECTIVE: To show the effectiveness of screening in the detection of new cases of COPD in smokers of high-risk, and to describe the characteristics associated with COPD, as well as determine the predisposition to quit. DESIGN: A cross-sectional and multicentre study. LOCATION: Basic Primary Care Centres representing different rural and urban areas of Lleida. PARTICIPANTS: A total of 497 active smokers without COPD from 40 to 70 years selected from the database Primary Care Database (e-CAP). INTERVENTION: Spirometry was performed on all patients. The spirometry results were reported and brief counselling was given on quitting smoking and the readiness to stop smoking was determined. VARIABLES: Age, gender, height, weight, smoking, respiratory symptoms and physical activity. RESULTS: The majority of patients (65.4%) were men, age 51± 7.6 years. They smoked an average of 32 packs/year; 40.4% performed moderate activity and 27.4% referred to some respiratory symptoms. Of the 25% who had an obstructive or mixed pattern, 75.8% of the cases had a moderate level of severity. A decision to quit was made by 38.8%. In the multivariate analysis, gender, age 50 to 59 years and a smoking index>40 were associated with COPD. Moderate or intense physical activity decreased the risk of COPD. CONCLUSIONS: To perform spirometry in high-risk smokers, to show the spirometry results and give brief anti-smoking counselling, enables not previously diagnosed cases of COPD to be detected. It also helps to determine the readiness to stop smoking and to establish individualised treatment and follow-up plans.

A comparison of emotional wellbeing and burnout of primary care professionals in 2014 and 2021.

Background: Due to the pandemic that started in February-March 2020 and after many years of economic restrictions suffered by our health system, the levels of stress, exhaustion and suffering among health workers has increased. Objective: Our study aims to perform a comparative analysis of the degree of burnout and emotional wellbeing among health professionals between 2014 and 2021. Methods: This is a comparative descriptive study of two cohorts of primary care professionals of the Lleida health region (SPAIN). We have one cohort from 2014 and another from 2021 with the same selection criteria. Burnout was assessed using the Maslach Burnout Inventory (MBI-HSS) test. Gender, age, professional category and work environment were also evaluated. Results: We obtained a response rate in 2014 of 52.7% (n = 267) and of 41.4% (n = 217) in 2021 with similar sociodemographic characteristics. There are significant differences (p < 0.001) in the three categories of burnout. The high scores for emotional exhaustion and depersonalization have increased, rising between 2014 and 2021 from 23.2 to 60.8% and from 12.4 to 42.4%, respectively. However, there is also a significant increase in high personal accomplishment, rising from 9.0% in 2014 to 26.7%. We have also detected differences depending on age and professional role. Conclusion: This study shows worsening burnout levels of primary care professionals in our region, specifically emotional exhaustion and depersonalization. However, it also shows that during the pandemic, personal accomplishment was reinforced.

Knowledge management through two virtual communities of practice (Endobloc and Pneumobloc).

We developed two virtual communities of practice (Endobloc and Pneumobloc) to increase the interaction between general practitioners and nurses in primary care and hospital endocrinologists and pulmonologists. They were designed and developed using an existing web 2.0-based virtual network belonging to the local National Health System, and we quantitatively assessed the usefulness through the participation and use during the first 24 months after the launch in 2010. A total of 26,372 visits (47% Endobloc's visits) and 2351 contributions (Endobloc's contribution 38.9%) to both virtual communities of practice were registered during the first 24 months. The most popular sections were the e-Blog and the e-Consultations section in both virtual communities of practice, but some differences in the pattern of use in other sections were observed. Activity on the virtual communities of practice occurred throughout the day including weekends and holiday periods. We showed that virtual communities of practice are feasible under real-life clinical practice.